Martina R. Gallagher

Smaller Weight Changes in Standardized Body Mass Index in Response to Treatment as Weight Classification Increases

OBJECTIVES To compare the differential efficacy of a weight loss program for Mexican-American children who are overweight, obese, and severely obese. STUDY DESIGN Study participants were enrolled in an intensive weight loss intervention aimed at improving eating and physical activity behaviors with behavior modification strategies. Participants included 212 children (45% female) between the ages of 9 and 14 (mean = 12.0, standard deviation = 0.7). All participants were classified as overweight, obese, or severely obese. RESULTS Repeated measures analyses revealed that children in the overweight, obese, and severely obese weight categories differed significantly in standardized body mass index (zBMI) decreases at baseline, 3, 6, and 12 months (F = 4.57, P < .01, η(p)(2) = .06). Follow-up paired samples t tests showed a significant change in zBMI from baseline to 3 and 6 months for children in the overweight, obese, and severely obese weight categories. However, at 12 months only the overweight and obese students continued to show significant improvement from baseline in zBMI. CONCLUSIONS These findings suggest that an intensive behavioral weight loss intervention that has demonstrated efficacy for decreasing zBMI may have incrementally smaller effects for children as weight classification increases.

Impact of a School-Based Pediatric Obesity Prevention Program Facilitated by Health Professionals

BACKGROUND This study evaluated a school-based obesity intervention for elementary school children (N = 835) where health professionals assisted teachers with the integration of healthy messages into the school curriculum. METHODS Schools were randomized into a professional-facilitated intervention (PFI; N = 4) or a self-help (SH; N = 3) condition. Changes in weight-based outcomes were assessed in students enrolled in the second grade from all 7 schools (overall: N = 835 students; PFI: N = 509 students, SH: N = 326 students). Students were between ages 7 and 9 and from diverse ethnic backgrounds (Asian = 25.3%, Black = 23.3%, Hispanic = 23.1%, White = 28.3%). The sample included 321 overweight/obese (BMI ≥ 85th percentile), 477 normal-weight (BMI ≥ 5th percentile and <85th percentile), and 37 underweight (BMI < 5th percentile) students. RESULTS After 2 years, children who were overweight/obese in the PFI condition significantly reduced their standardized BMI (zBMI) compared to children in the SH condition (Wald χ(2)  = 28.7, p < .001). End-of-year grades decreased for overweight/obese students in both conditions; however, students in the PFI exhibited a smaller decrease in grades compared to the SH condition (Wald χ(2)  = 80.3, p < .001). CONCLUSION The results indicate that an obesity prevention program where health professionals assist teachers by integrating healthy messages into existing curriculum was effective in reducing zBMI compared to the SH condition.

Sleep duration and its association with ambulatory blood pressure in a school-based, diverse sample of adolescents

BACKGROUND Evidence is accumulating that sleep duration is related to blood pressure (BP) and hypertensive status, but the strength of the association varies by age, and findings are inconsistent for adolescents. This cross-sectional study tested the hypothesis that sleep duration, both during the night and during naps, would be negatively associated with ambulatory systolic BP (SBP) and diastolic BP (DBP) measured over 24 hours in adolescents. METHODS In this ethnically diverse (37% non-Hispanic black, 31% Hispanic, 29% non-Hispanic white, 3% other), school-based sample of 366 adolescents aged 11-16 years, ambulatory BP was measured every 30 minutes for 24 hours on a school day; actigraphy was used to measure sleep duration. Covariables included demographic factors, anthropometric indices, physical activity, and position and location at the time of each BP measurement. Mixed models were used to test day and night sleep duration as predictors of 24-hour SBP and DBP, controlling for covariables. RESULTS The mean sleep duration was 6.83 (SD = 1.36) hours at night, and 7.23 (SD = 1.67) hours over 24 hours. Controlling for duration of sleep during the day and covariables, each additional hour of nighttime sleep was associated with lower SBP (-0.57; P < 0.0001); controlling for nighttime sleep duration and covariables, each additional hour of daytime sleep was associated with lower SBP (-0.73; P < 0.001) and lower DBP (-0.50; P < 0.001). CONCLUSIONS Longer sleep duration was significantly associated with lower ambulatory SBP and DBP in adolescents. The findings have potential implications for cardiovascular health in this age group.

Relationship of Sleep Duration and Regularity with Dietary Intake among Preschool-Aged Children with Obesity from Low-Income Families

Objective: Diet is a modifiable factor associated with pediatric obesity outcomes, but few studies have evaluated the relationships of sleep duration and regularity on dietary intake of young preschool-aged children. The goal of this study was to evaluate whether short sleep duration and irregular sleep timing were associated with greater calorie, carbohydrate and fat consumption among young children with obesity from low-income families. Methods: Fifty-one ethnically diverse children aged 2 to 4 years were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics in a southeast Texas county. Sleep behaviors were parent reported using the Child Sleep Assessment tool. Dietary intake data were obtained by 24-hour recall interviews (2 weekdays and 1 weekend day). Results: Short sleep duration (<11 hr) was highly prevalent among this cohort of preschool-aged children. Short sleep duration was associated with greater fat and decreased carbohydrate consumption. Children with greater variability in sleep duration and timing had greater energy intake from fat and protein sources. Conclusion: Allowing for the opportunity to educate parents on the importance of maintaining regular, adequate sleep and relationships between sleep and dietary intake may decrease the risk of childhood obesity in this high-risk pediatric population.

El papel de los síndromes culturales y los remedios tradicionales mexicanos en la promoción de salud de los niños

Purpose: To describe the context in which culture-bound syndromes that mothers of Mexican descent believed affected child wellness and describe how they restored health when these syndromes affected their children. Design: The findings of this come from a larger study that focused on the health promotion and protection practices used by mothers of Mexican descent in urban Texas A naturalistic design, using Spradley’s ethnographic interview techniques and participant observations, was selected to explore and describe the child health promotion and protection practices, including culture-bound syndromes, used by mothers of Mexican origin. Method: Data collection consisted of 21 ethnographic interviews enhanced by focused home observations with nine Spanish speaking mothers. Results: To these group of mothers, the culture-bound syndromes of empacho , fright and evil eye could affect children’s eating and sleep patterns, thereby causing an imbalance in a child’s wellbeing. Therefore the participants believed that they had be mindful of culture-bound syndromes that affected their children’s health and take care of those syndromes by using folk remedies to restore balance in their children’s’ wellbeing. Conclusion: The findings of this study provide an in-depth description of culture-bound syndromes and the folk remedies which mother of Mexican descent used to promote and protect the health of their preschool children. This knowledge provides a framework for healthcare professionals to use when working with mothers of Mexican descent who may be using folk healing to promote and protect the health of their children.

How Did They Grow: An Intervention to Reduce Stunted Growth in Low-Income Mexican-American Children.

Growth stunting is a complex phenomenon related to undernutrition that can contribute to developmental delay, cognitive deficits, and small size and obesity in adulthood. Stunted growth, defined as height for age below the 5th percentile, is primarily caused by chronic malnutrition. In this study, a community-based intervention to reduce undernutrition was tested in a quasi-experimental design with 174 low-income, Mexican-American mothers and children recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in a major southwestern city. The intervention was based on the public health nursing practice of collaborating with mothers of young children on appropriate nutrition and parenting, and was tailored by the author and community informants for mothers of children with stunted growth. Data were collected on child height and weight, dietary intake, maternal acculturation, maternal perceived stress as measured by the Perceived Stress Scale (PSS), home environment as measured by the home screening questionnaire (HSQ), and maternal-child interaction as measured by the Nursing Child Assessment Teaching Scale (NCATS). Intervention children had higher growth velocity than the children in the comparison group. These findings were especially prominent for children of women who were older and less acculturated. Results suggest that a nursing intervention delivered in collaboration with WIC can make a significant improvement in growth of low-income children with growth stunting.

Engaging Latino Fathers in Children’s Eating and Other Obesity-Related Behaviors: a Review

Purpose of ReviewThere is a growing evidence of the important role that fathers play in influencing their children’s eating and other weight-related behaviors. Latino children are at high risk for obesity and associated medical conditions. Engaging Latino fathers is a potentially important and unique way to help promote healthy lifestyles for Latino children, but doing so requires a culturally sensitive understanding both of fathers’ current role and the family perceptions of this role.Recent FindingsHere, we review recent data and argue that there are subtle but important differences between the qualitative and quantitative research conducted regarding the role Latino fathers may play in promoting healthy eating and physical activity for their children. We suggest how to synthesize these findings and also present qualitative results for ways to best engage Latino fathers in research studies with a focus on physical activity.SummaryResults from the review support that Latino fathers are important potential targets for child obesity prevention, but our findings stress the importance of considering cultural values when trying to recruit, engage and retain Latino fathers for such research.

Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population

OBJECTIVES Infants are at risk of overweight. Infant overweight predisposes child, adolescent, and adult to obesity. We hypothesized that parent education, initiated prenatally and provided in the home, would reduce the incidence of infant overweight at age 12 months. METHODS Pregnant obese Latina women were recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and randomized to intervention versus control. Intervention subjects received home visits by trained Spanish-fluent community health workers who provided counseling on infant growth, breastfeeding, nutrition, child development, sleep, physical activity, and safety. Promotoras did not visit the control subjects. A research assistant collected outcome data on all subjects. RESULTS Compared to controls, parent education did not reduce infant overweight. Infant overweight developed rapidly and was present in 46% of infants by age 6 months. Infants overweight at 6 months were likely to be overweight at age 12 months (r = 0.60, P < .0001). Overweight was more common in formula-fed infants at ages 6 months (P < .06) and 12 months (P = .005). Breastfeeding was less common in families with employed mothers (P = .02) and unemployed fathers (P < .01), but the father living with the mother at the time of the prenatal visit predicted successful breastfeeding at infant age 2 months (P < .003). Compared to formula feeding, overweight at age 12 months was 2.7 times less likely for infants breastfed for ≥2 months (P = .01). CONCLUSIONS The lack of success of the intervention may be explained in part by a high cesarean section rate in the intervention group, food and employment insecurity, and confounding by WIC breastfeeding promotion, which was available to all mothers. Breastfeeding was the most important mediator of infant overweight. The study supports efforts by WIC to vigorously promote breastfeeding.