Mary Beth McCullough

Overlap in Eating Disorders and Obesity in Adolescence.

While eating disorders and obesity have traditionally been conceptualized as separate conditions, recent research suggests important overlap in several areas including etiology, comorbidity, risk factors, and prevention approaches. Examining the commonality among these conditions is particularly important as adolescents who present with both eating disorder symptomology and obesity demonstrate poorer outcomes within weight control treatments and are at greater risk for future development of full threshold eating disorders and additional weight gain. The purpose of this paper is to review the research examining the overlap in prevalence rates for eating disorders and obesity in adolescents, as well as shared etiology, risk factors, and psychiatric and medical comorbidities. Current preventive and treatment approaches also will be discussed, while highlighting the need for more integrated assessment, prevention, and treatment efforts that focus on maladaptive eating and activity patterns shared by both eating disorders and obesity.

Family factors that characterize adolescents with severe obesity and their role in weight loss surgery outcomes

To comprehensively assess family characteristics of adolescents with severe obesity and whether family factors impact weight loss outcomes following weight loss surgery (WLS).

The immigrant paradox and adolescent obesity: examining health behaviors as potential mediators.

Objective: Adolescent obesity is a national public health concern with significant immediate and long-term health consequences. Certain social groups in the United States, such as immigrant adolescents, have been identified as particularly vulnerable to overweight and obesity. A pattern of results coined the “immigrant paradox” that refers to the phenomenon wherein obesity is less prevalent in first-generation immigrant youth when compared with second- and third-generation peers. Seeking to better understand this concerning trend, this study examined the mediating role of several health behaviors on the relation between generation status and body mass index (BMI). Method: Participants were 2292 Latino immigrant adolescents and emerging adults enrolled in the National Longitudinal Study of Adolescent Health. Results: Multiple linear regression models indicated that sedentary behaviors partially mediated the relation between generation status and BMI. Conclusion: The findings indicate the unique role that sedentary behaviors play in explaining weight gain among Latino immigrants.

Learning about Activity and Understanding Nutrition for Child Health (LAUNCH): Rationale, design, and implementation of a randomized clinical trial of a family-based pediatric weight management program for preschoolers

Obesity affects nearly 2 million preschool age children in the United States and is not abating. However, research on interventions for already obese preschoolers is limited. To address this significant gap in the literature, we developed an intervention targeting obesity reduction in 2 to 5year olds, Learning about Activity and Understanding Nutrition for Child Health (LAUNCH). This paper describes the rationale, design, participant enrollment, and implementation of a 3-arm randomized, parallel-group clinical trial comparing LAUNCH to a motivational-interviewing intervention (MI) and standard care (STC), respectively. Whereas LAUNCH was designed as a skills based intervention, MI focused on addressing the guardians motivation to make changes in diet and activity and providing tools to do so at the guardians level of readiness to implement changes. Child body mass index z-score was the primary outcome, assessed at pretreatment, posttreatment (Month 6), and 6 and 12month follow-ups (Months 12 and 18). Mechanisms of weight change (e.g., dietary intake, physical activity) and environmental factors associated with weight (e.g., foods available in the home, caregiver diet) were also assessed. This study is unique because it is one of the few randomized controlled trials to examine a developmentally informed, clinic and home skills based behavioral family intervention for preschoolers who are already obese. Being obese during the preschool years increases the likelihood of remaining obese as an adult and is associated with serious health conditions; if this intervention is successful, it has the potential to change the health trajectories for young children with obesity.

Barriers to Recruitment in Pediatric Obesity Trials: Comparing Opt-in and Opt-out Recruitment Approaches

Objective To compare the efficacy of opt‐in versus opt‐out recruitment methods in pediatric weight management clinical trials. Methods Recruitment of preschoolers and school‐age children across two obesity randomized controlled trials (RCTs) were compared using the same opt‐in recruitment approach (parents contact researchers in response to mailings). Opt‐in and opt‐out strategies (parents send decline postcard in response to mailings if they do not want to participate) were then compared across two preschool obesity RCTs. Results Opt‐in strategies yielded a significantly lower overall recruitment rate among preschoolers compared with school‐age children. Among preschoolers, an opt‐out strategy demonstrated a significantly higher overall recruitment rate compared with an opt‐in strategy with the main advantage in the number of families initially contacted. Conclusions Opt‐out recruitment strategies may be more effective in overcoming the barriers of recruitment in the preschool age‐group because it does not rely on parent recognition of obesity.

A Review of the Structural Characteristics of Family Meals with Children in the United States

Family meals are associated with a range of positive outcomes among children and adolescents. There is inconsistency, however, in the way in which studies have defined and measured family meals. Therefore, a systematic review of the literature was conducted to determine how studies describe family meals with the use of structural characteristics. The current review focused on studies in the United States that included children ages 2-18 y. A total of 33 studies were identified that characterized family meals with the use of ≥1 of the following structural features: frequency or mean number of family meals per week, length of family meal, people present at meal, and where meals occurred. No study characterized family meals by using all 4 family meal features, whereas most studies (81%) characterized family meals by using frequency or mean number of meals per week. Findings not only provide an initial understanding of the structural features used to define family meals but also point to the importance of developing a more comprehensive, sensitive assessment that can accurately capture the complex and multidimensional nature of family meals.

Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps

Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.

Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation

• communities, urban planners, architects, developers, and public health professionals developing and implementing sustainable strategies for improving the physical environment of communities that are as large as several square miles or more or as small as a few blocks in size in ways that encourage and support physical activity; and • communities and organizations developing and maintaining sustainable strategies to create and/ or enhance access to places and programs where people can be physically active in a safe and enjoyable way. Strategy 1-2: Provide and support community programs designed to increase physical activity. Communities and organizations should encourage physical activity by providing and supporting programs designed to increase such activity.

Clinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial

Objective To test the hypotheses that an innovative skills‐based behavioral family clinic and home‐based intervention (LAUNCH) would reduce body mass index z score (BMIz) compared with motivational interviewing and to standard care in preschool‐aged children with obesity. Study design Randomized controlled trial with children between the ages of 2 and 5 years above the 95th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012 and June 8, 2015. Children were randomized to LAUNCH (an 18‐session clinic and home‐based behavioral intervention), motivational interviewing (delivered at the same frequency as LAUNCH), or standard care (no formal intervention). Weight and height were measured by assessors blinded to participant assignment. The primary outcome, BMIz at month 6 after adjusting for baseline BMIz, was tested separately comparing LAUNCH with motivational interviewing and LAUNCH with standard care using regression‐based analysis of covariance models. Results A total of 151 of the 167 children randomized met intent‐to‐treat criteria and 92% completed the study. Children were 76% White and 57% female, with an average age of 55 months and BMI percentile of 98.57, with no demographic differences between the groups. LAUNCH participants demonstrated a significantly greater decrease in BMIz (mean = −0.32, SD = ±0.33) compared with motivational interviewing (mean = −0.05, SD = ±0.27), P < .001, ω2 = 0.74 and compared with standard care (mean = −0.13, SD = ±0.31), P < .004, ω2 = 0.75. Conclusions In preschool‐age children, an intensive 6‐month behavioral skills‐based intervention is necessary to reduce obesity. Trial Registration Clinicaltrials.gov NCT01546727.

Are Preschoolers Meeting the Mark? Comparing the Dietary, Activity, and Sleep Behaviors of Preschoolers With Obesity to National Recommendations

Objective National health organizations and expert committees have issued recommendations for health behaviors related to obesity risk. Behavioral and family-based weight management interventions for preschoolers often target improving adherence to these recommendations, but it is unknown how the health behaviors of preschoolers with obesity enrolled in weight control treatments (WCTs) compare with these guidelines. In this study, the dietary intake, activity, and sleep behaviors of preschoolers with obesity enrolled in a family-based behavioral WCT are described and compared with national health behavior recommendations. Methods Health behaviors of 151 preschoolers with obesity (M age = 4.60, SD = 0.93) enrolled in a clinical trial of a weight management program were measured at baseline through caregiver-report questionnaires, three 24-hr dietary recalls, and accelerometers. Results In total, 70% of the sample exceeded daily caloric recommendations, only 10 and 5% met recommendations for fruit and vegetable intake, respectively, and only 30% met the recommendation of consuming no sugar-sweetened beverages. The majority of the sample met the daily recommendations for 60 min of moderate-to-vigorous activity (80%), < 2 hr of screen time (68%), and sleep duration (70%). Conclusions Behavioral weight management interventions for preschoolers with obesity should target the health behaviors where children are not meeting recommendations.