Marilyn Dumont-Driscoll

Factors associated with parental use of restrictive feeding practices to control their children's food intake §

There is a critical need to identify risk factors that make parents more likely to restrict their childs food intake. Child weight and ethnicity, parent weight, parent body dissatisfaction, and parent concern of child weight were examined as correlates of parent use of restrictive feeding practices in a diverse sample of 191 youth (ages 7-17). Participants attending a pediatric outpatient visit completed the Child Feeding Questionnaire (parent feeding practices and beliefs), the Figure Rating Scale (body dissatisfaction) and a demographic form. Parent BMI and child degree of overweight were calculated. Parent use of restrictive feeding practices was positively associated with parent BMI and was moderated by parent body dissatisfaction. Parent concern of child weight mediated the relationship between increasing child degree of overweight and parent use of restrictive feeding practices. There were no differences by child gender or ethnicity in parent use of restrictive feeding practices. These preliminary findings highlight the importance of assessing for underlying parent motivations for utilizing restrictive feeding practices and may help to identify and intervene with families at-risk for engaging in counterproductive weight control strategies. Continued identification of correlates of parent use of restrictive feeding practices is needed across child development and among individuals from diverse backgrounds.

The Extension Family Lifestyle Intervention Project (E-FLIP for Kids): Design and methods

The Extension Family Lifestyle Intervention Project (E-FLIP for Kids) is a three-arm, randomized controlled trial assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight and obese children and their parents in rural counties. Participants will include 240 parent-child dyads from nine rural counties in north central Florida. Dyads will be randomized to one of three conditions: (a) a Family-Based Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention, and (c) an Education Control Condition. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 12) and follow-up (month 24). Assessment and intervention sessions will be held at Cooperative Extension Service offices within each participating county. The primary outcome measure is change in child BMI z-score. Additional key outcome measures include child body fat, waist circumference, dietary intake, physical activity, blood lipids, blood glucose, blood pressure, physical fitness, quality of life, and program and participants costs. Parent BMI, dietary intake, and physical activity also will be assessed. Randomized controlled trials testing the effectiveness of childhood obesity interventions in real-world community-based settings are extremely valuable, but much too rare. The E-FLIP for Kids trial will evaluate the impact of a community-based intervention delivered to families in rural settings utilizing the existing Cooperative Extension Service network on long-term child behavior, weight status and biological markers of diabetes and early cardiovascular disease. If successful, a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities.

Moderators of Weight-Based Stigmatization Among Youth Who Are Overweight and Non-overweight: The Role of Gender, Race, and Body Dissatisfaction

Objective: To identify demographic correlates and moderators of weight-based stigmatization in a diverse sample of children and adolescents. Method: A total of 157 children/adolescents aged 7 to 17 years and their parents participated in this study, and the following measurements were used: demographic questionnaire, child weight and height, figure ranking weight-based stigmatization, and body dissatisfaction. Results: Weight-based stigmatization was greater among younger children and females. Gender moderated the relationship between age and weight-based stigmatization, with significant differences in endorsement of weight bias between child and adolescent females. Gender also moderated the relationship between race and weight-based stigmatization, with African-American females endorsing significantly lower levels of weight-based stigmatization than white females. Body dissatisfaction moderated the relationship between degree of overweight and weight-based stigmatization and served as a protective buffer from endorsement of weight-based stigmatization among children with greater degree of overweight but low body dissatisfaction. Conclusion: Weight-based stigmatization is prevalent, with certain age groups and populations at particular risk for its endorsement. Identification of correlates and moderators of weight-based stigmatization can inform the design of effective interventions to reduce its profound negative impact on children who are overweight or obese.

The Relationship Among Child Weight Status, Psychosocial Functioning, and Pediatric Health Care Expenditures in a Medicaid Population

OBJECTIVES To examine the association between weight status and health service use, while considering the influence of psychosocial functioning and demographic variables. METHODS Two hundred child-parent dyads were recruited from pediatric primary care clinics and completed measures of height, weight, and questionnaires assessing psychosocial functioning. Claims and expenditure data over a 12-month retrospective period were extracted from the Medicaid claims database. RESULTS Children who were obese incurred greater health service use and expenditures than children who were of a healthy weight, even after controlling for psychosocial functioning and other demographic variables. Children who were overweight (but not obese) did not have differing levels of claims or expenditures than their healthy weight peers. CONCLUSIONS Understanding the impact of pediatric obesity on long-term expenditures is critical. These results provide some indication of the financial savings that might be achieved if obese children were supported to achieve a healthier weight status.

Increased T lymphocytes bearing the gamma-delta T cell receptor in subjects at high risk for insulin dependent diabetes

The effector mechanisms responsible for autoimmune beta cell destruction in insulin dependent (type 1) diabetes (IDD) remain elusive. In order to investigate whether T lymphocytes bearing the gamma-delta T cell receptor (gamma delta+ T cells) could be involved in this process, we measured percentages of peripheral blood gamma delta+ T cells in IDD patients, relatives of IDD probands and controls. High levels of gamma delta+ T cells strongly differentiated 23 relatives at high risk for IDD on the basis of positive islet cell autoantibodies (ICA positive relatives) from 59 controls (P = 0.0013), whereas 26 ICA negative relatives, 14 recent-onset and nine long term IDD patients could not be distinguished from controls on the basis of percentages of gamma delta+ T cells. These data suggest that increased levels of circulating gamma delta+ T cells correlate with the ongoing autoimmune process in pancreatic islets of subjects at high risk for IDD and may thus represent an additional marker for the development of the disease.

Associations between Actual and Perceived Weight and Psychosocial Functioning in Children: The Importance of Child Perceptions

BACKGROUND Inconsistent relationships between weight and psychosocial functioning may be due to discrepancies between objective measures of weight and childrens perceptions of weight. The current study compared the predictive validity of actual versus perceived weight in children to determine which is the strongest predictor of psychosocial functioning. METHODS Ninety-eight youth (ages 8-17) completed measures of perceived weight and psychosocial functioning (i.e., depressive symptoms, peer victimization, and self-esteem) while attending a well-child visit. Height and weight were obtained from the medical record and used to classify children as healthy weight, overweight, or obese. Actual and perceived weight percentiles were entered simultaneously in regression analyses predicting psychosocial functioning. RESULTS A disproportionate number of overweight (70%) and obese (40.6%) youth reported a perceived weight in the healthy range (below 85(th) BMI percentile). Perceived weight was predictive of depressive symptoms whereas actual weight was not. No relationship between weight (perceived or actual) was found for peer victimization or self-esteem. CONCLUSIONS Weight underestimation is common in children, particularly among youth who are overweight and obese. Perceived, but not actual, weight was predictive of depressive symptoms, highlighting the importance of weight perceptions among youth across the weight spectrum.

A Pilot Study Examining a Group-Based Behavioral Family Intervention for Obese Children Enrolled in Medicaid: Differential Outcomes by Race

This pilot study examined the efficacy of a behavioral family intervention (BFI) to address weight management in obese children from economically disadvantaged backgrounds. Forty children, ages 6 to 12, and their parents enrolled in Medicaid were assigned to a BFI or an individual standard of care condition. Assessments were completed at baseline, posttreatment, and 9-month follow up. There were no differences in weight outcomes across treatment conditions. However, there were trends to suggest differences in weight change by child race. Specifically, children identified as African American benefited less from the BFI than Caucasian children. Implications for practice and research are discussed.

Executive Function and Dysregulated Eating Behaviors in Pediatric Obesity

Objective To examine the association between caregiver proxy report of executive function (EF) and dysregulated eating behavior in children with obesity. Methods Participants were 195 youth with obesity aged 8-17 years, and their legal guardians. Youth height, weight, demographics, depressive symptoms, eating behaviors, and EF were assessed cross-sectionally during a medical visit. Analyses of covariance, adjusted for child age, gender, race/ethnicity, standardized BMI, depressive symptoms, and family income were used to examine differences in youth EF across caregiver and youth self-report of eating behaviors. Results Youth EF differed significantly by caregiver report of eating behavior but not youth self-report. Post hoc analyses showed that youth with overeating or binge eating had poorer EF than youth without these eating behaviors. Conclusions Executive dysfunction, as reported by caregivers, in youth with obesity may be associated with dysregulated eating behaviors predictive of poor long-term psychosocial and weight outcomes. Further consideration of EF-specific targets for assessment and intervention in youth with obesity may be warranted.

Youth internalizing symptoms, sleep-related problems, and disordered eating attitudes and behaviors: A moderated mediation analysis.

PURPOSE Internalizing symptoms increase the risk for disordered eating; however, the mechanism through which this relationship occurs remains unclear. Sleep-related problems may be a potential link as they are associated with both emotional functioning and disordered eating. The present study aims to evaluate the mediating roles of two sleep-related problems (sleep disturbance and daytime sleepiness) in the relationship between youth internalizing symptoms and disordered eating, and to explore if age moderates these relations. METHODS Participants were 225 youth (8-17years) attending a primary care appointment. Youth and legal guardians completed questionnaires about youth disordered eating attitudes and behaviors, internalizing symptoms, sleep disturbance, and daytime sleepiness. Mediation and moderated mediation analyses were utilized. RESULTS The mediation model revealed both youth sleep disturbance and daytime sleepiness independently mediated the association between internalizing symptoms and disordered eating attitudes and behaviors, and explained 18% of the variance in disordered eating. The moderated mediation model including youth age accounted for 21% of the variance in disordered eating; youth age significantly interacted with sleep disturbance, but not with daytime sleepiness, to predict disordered eating. Sleep disturbance only mediated the relationship between internalizing symptoms and disordered eating in youth 12years old and younger, while daytime sleepiness was a significant mediator regardless of age. CONCLUSION As sleep-related problems are frequently improved with the adoption of health behaviors conducive to good sleep, these results may suggest a relatively modifiable and cost-effective target to reduce youth risk for disordered eating.

Variability of the Institutional Review Board Process Within a National Research Network

Objective. To determine the variability of the institutional review board (IRB) process for a minimal risk multicenter study. Methods. Participants included 24 Continuity Research Network (CORNET) sites of the Academic Pediatric Association that participated in a cross-sectional study. Each site obtained individual institutional IRB approval. An anonymous questionnaire went to site investigators about the IRB process at their institution. Results Twenty-two of 24 sites (92%) responded. Preparation time ranged from 1 to 20 hours, mean of 7.1 hours. Individuals submitting ≤3 IRB applications/year required more time for completion than those submitting >3/year (P < .05). Thirteen of 22 (59%) study sites received approval with “exempt” status, and 6 (27%) approved as “expedited” studies. Conclusions. IRB experiences were highly variable across study sites. These findings indicate that multicenter research projects should anticipate barriers to timely study implementation. Improved IRB standardization or centralization for multicenter clinical studies would facilitate this type of practice-based clinical research.