Megan B. Irby

Etiologies of obesity in children: nature and nurture.

Childhood obesity is a profoundly complex problem and serves as an example of a biospsychosocial issue. Scientific inquiry has provided incredible insight into the complex etiology of weight gain but must be viewed as an interaction between a humans propensity to conserve calories for survival in a world with an abundance of it. This article provides a brief overview divided between biological (nature) and psychosocial and behavioral (nurture) factors.

Motivational interviewing in a family-based pediatric obesity program: a case study.

Motivational Interviewing (MI) is an effective method for clinicians to guide and support individuals who wish to make complex health behavior changes; however, little research is available to support its use in the treatment of obesity, particularly in family based therapy and multidisciplinary team settings. The objective of this case report is to demonstrate the application of MI within a family based, multidisciplinary treatment program, and provide examples of MI in obesity treatment. We report a case study on the use of MI with behavioral therapy in a pediatric, family based, multidisciplinary weight management program (Brenner FIT Program). Tina, a 14-year-old White female, and her mother participated in the Brenner FIT Program where we successfully integrated MI into her obesity treatment. Further work is needed in the application of MI to diverse care teams to determine frequency of training required for effective use of MI in obesity treatment, its limitations, and its feasibility in community-based programs.

Well-Established and Empirically Supported Behavioral Treatments for Migraine

This paper provides an overview of the well-established and empirically supported behavioral interventions for the treatment of migraine. The considerable evidence base addressing behavioral interventions amassed since 1969 has conclusively established the efficacy of therapies featuring combinations of relaxation, biofeedback, and stress management training, and demonstrated they are capable of yielding benefits on par with pharmacological therapies for migraine. Behavioral interventions also are well suited for delivery across a variety of different contexts (e.g., group vs. individual, standard clinic vs. limited therapist contact, face-to-face vs. technology-assisted). Despite the amply established efficacy and effectiveness of these self-management interventions for the treatment of migraine, the availability and implementation of these approaches remain limited for many headache sufferers. We anticipate the technological advances in delivery platforms will provide better access to behavioral self-management strategies for migraine.

A systematic review of satisfaction and pediatric obesity treatment: new avenues for addressing attrition.

&NA; Pediatric obesity treatment programs report high attrition rates, but it is unknown if family experience and satisfaction contributes. This review surveys the literature regarding satisfaction in pediatric obesity and questions used in measurement. A systematic review of the literature was conducted using Medline, PsychINFO, and CINAHL. Studies of satisfaction in pediatric weight management were reviewed, and related studies of obesity were included. Satisfaction survey questions were obtained from the articles or from the authors. Eighteen studies were included; 14 quantitative and 4 qualitative. Only one study linked satisfaction to attrition, and none investigated the association of satisfaction and weight outcomes. Most investigations included satisfaction as a secondary aim or used single‐item questions of overall satisfaction; only one assessed satisfaction in noncompleters. Overall, participants expressed high levels of satisfaction with obesity treatment or prevention programs. Surveys focused predominantly on overall satisfaction or specific components of the program. Few in‐depth studies of satisfaction with pediatric obesity treatment have been conducted. Increased focus on family satisfaction with obesity treatment may provide an avenue to lower attrition rates and improve outcomes. Enhancing measurement of satisfaction to yield actionable responses could positively influence outcomes, and a framework, via patient‐centered care principles, is provided.

TeleFIT: Adapting a Multidisciplinary, Tertiary-Care Pediatric Obesity Clinic to Rural Populations

Pediatric obesity occurs most frequently in underserved communities where families have difficulty accessing healthcare. Disproportionate obesity rates in rural children denote significant disparities warranting innovative solutions. However, intensive, tertiary-care treatment options outlined in recent expert recommendations may not be available to families living in rural areas. Telemedicine may be useful for providing pediatric obesity treatment to rural families. The aim of this study was to assess the impact of a new outreach program (TeleFIT), which placed telemonitors in four rural satellite clinics to increase access to a pediatric obesity clinic (Brenner Families In Training [FIT]). Before TeleFIT began, of five patients from rural counties enrolled in treatment over a 1-year period, all dropped out by their third visit. Within the first year of TeleFIT, the number of rural patients increased nearly threefold (to 14) and increased again in the second year by an additional 16 new patients (n=35). Preliminary outcomes indicate comparable attrition rates and improvement in weight status compared with patients in conventional treatment. Telemedicine allows rural families to access intensive obesity treatment from local pediatric offices, eliminating geographic barriers. Systems delivering state-of-the-art care in rural areas have tremendous potential for reducing health disparities in rural populations. Further research is needed to test the efficacy of such interventions.

Telemedicine and Pediatric Obesity Treatment: Review of the literature and lessons learned.

Paediatric obesity is more prevalent in rural areas, yet rural families may not have access to paediatric obesity treatment programmes. The use of new technologies, particularly telemedicine, has proven effective in other behavioural fields, such as psychiatry. This paper reviews the literature on the use of telemedicine in paediatric obesity treatment and describes one tertiary‐care paediatric obesity telemedicine programme. We performed a systematic review of the literature from 1990 to 2011 using the following criteria: paediatric age group, overweight or obesity care or treatment, and use of telemedicine technology. Of 2873 abstracts identified, four studies met all inclusion criteria; all were published after 2008. The limited evidence suggests telemedicine to be a promising approach to paediatric weight management, particularly for rural families with limited access to treatments. We also provide important lessons learnt from one paediatric obesity treatment clinic offering services to rural families via telemedicine. Few studies have examined the use of telemedicine for paediatric obesity treatment, but the available data favour this method for treating rural patients. There are several unique key factors influencing successful delivery of a paediatric obesity telemedicine treatment programme. This review identifies a potential avenue for expanded treatment and highlights the need for further investigation.

Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes

Engagement in regular exercise routinely is recommended as an intervention for managing and preventing migraine, and yet empirical support is far from definitive. We possess at best a weak understanding of how aerobic exercise and resulting change in aerobic capacity influence migraine, let alone the optimal parameters for exercise regimens as migraine therapy (eg, who will benefit, when to prescribe, optimal types, and doses/intensities of exercise, level of anticipated benefit). These fundamental knowledge gaps critically limit our capacity to deploy exercise as an intervention for migraine.

Pediatric Obesity Treatment in Children With Neurodevelopmental Disabilities: A Case Series and Review of the Literature.

Obesity can affect any child, but it occurs disproportionately in children with developmental disabilities. Treatment efforts, however, have focused primarily on nondisabled children, and more research is needed to determine how current approaches can be modified for youth with neurodevelopmental disabilities. This article briefly reviews what is currently known about obesity treatment in these children and presents a case series describing methods employed by a family-based, multidisciplinary weight management program in the treatment of obesity. Lessons learned from clinical experience are also discussed, with implications for collaborating with families of children with disabilities in treatment, establishing healthy routines and schedules, setting the pace of treatment progression, and minimizing disruptions in the behavior change process. Though there are no expert recommendations specifically tailored to obesity treatment in children with neurodevelopmental disabilities, existing clinical programs such as the one described here can be adapted to better meet the needs of this underserved population. Further research is warranted to determine the most effective methods for addressing obesity in these children, as has been specified as a national health priority.

Satisfaction and attrition in paediatric weight management.

Paediatric obesity treatment experiences unacceptably high rates of attrition. Few studies have explored parent and child perspectives on dropout. This study sought to capture child and parent experience in treatment and expressed contributors to attrition. Children and parents enrolled in a single family‐based weight management programme participated in semi‐structured interviews, conducted either upon completion of the first intensive phase of treatment or program dropout. Interviews were recorded, transcribed and coded using a multistage inductive approach. Interviews were obtained from 57 parents and 30 children, nearly equal between ‘completers’ or ‘dropouts’. Five themes emerged: overall positive experience with programme; logistical challenges of participation; improved health; discrepancies between child and parent experience and perception, and importance of structure and expectations of weight loss. Primary reasons given for dropout were time commitment; distance from clinic; missed school and work; lack of dedicated adolescent programme; clinic hours; and stress. Few parents or children expressed dissatisfaction. Children reportedly enjoyed ‘having someone to talk to’ about weight, and spending increased time with family. Children and parents overall reported positive experiences in this weight management programme. Attrition appears more related to logistical issues than low satisfaction. Innovative approaches to help overcome logistical challenges and preserve positive aspects may help in decreasing programme attrition.

Family-based obesity treatment in children with disabilities.

OBJECTIVE To assess the relative effectiveness of an interdisciplinary, family-centered, tertiary-care pediatric weight management program for the treatment of patients with and without cognitive disabilities (CD). METHODS Retrospective analysis of the clinical database of a tertiary-care pediatric weight management clinic (n = 453), extracting data from electronic health records including longitudinal change in weight status (body mass index [BMI] z-score) and frequency of attrition from treatment. Upon review of medical records, children enrolled in the treatment program were classified as having no CD (n = 342) or CD (n = 111). RESULTS At baseline, there were no between-group differences in BMI or BMI z-score. After 4 months of treatment, 66% (299) of patients remained enrolled, and complete case data were available for 219 children in final analyses. There were no statistically significant differences in attrition between the 2 groups (no CD vs CD). Mean change in BMI z-score across all groups was -0.03 ± 0.13 (P < .001). Change in BMI z-score was significantly greater among patients with CD (-0.07 ± 0.15) compared to those without CD (-0.03 ± 0.12) (difference 0.04, 95% confidence interval 0.005-0.08, P = .029). These change estimates were observed after adjusting for processes potentially associated with attrition. CONCLUSIONS Children with CD treated in an interdisciplinary, family-centered obesity clinic had similar or better outcomes compared to peers without CD. This success may be attributable to the patient-centered nature of this behavioral weight management program, which focused on leveraging the unique strengths and capabilities of each individual patient and family.