Sarah E. Messiah

Effect of a Two-Year Obesity Prevention Intervention on Percentile Changes in Body Mass Index and Academic Performance in Low-Income Elementary School Children

OBJECTIVES We assessed the effects of a school-based obesity prevention intervention that included dietary, curricula, and physical activity components on body mass index (BMI) percentiles and academic performance among low-income elementary school children. METHODS The study had a quasi-experimental design (4 intervention schools and 1 control school; 4588 schoolchildren; 48% Hispanic) and was conducted over a 2-year period. Data are presented for the subset of the cohort who qualified for free or reduced-price school lunches (68% Hispanic; n = 1197). Demographic and anthropometric data were collected in the fall and spring of each year, and academic data were collected at the end of each year. RESULTS Significantly more intervention than control children stayed within normal BMI percentile ranges both years (P = .02). Although not significantly so, more obese children in the intervention (4.4%) than in the control (2.5%) decreased their BMI percentiles. Overall, intervention schoolchildren had significantly higher math scores both years (P < .001). Hispanic and White intervention schoolchildren were significantly more likely to have higher math scores (P < .001). Although not significantly so, intervention schoolchildren had higher reading scores both years. CONCLUSIONS School-based interventions can improve health and academic performance among low-income schoolchildren.

Conservation of residual acoustic hearing after cochlear implantation.

Objective: This study was designed to test the hypothesis that partial hearing conservation is attainable after cochlear implantation with a long perimodiolar electrode. Surgical strategies for hearing conservation during cochlear implantation are described. Study design: Prospective, single-subject, repeated-measures design. Setting: Academic tertiary care center. Patients: Twenty-eight severely to profoundly hearing-impaired adult cochlear implant recipients who had some measurable hearing preoperatively. Intervention: Cochlear implantation using Nucleus Freedom Contour Advance electrode. Main Outcome Measures: Preimplant and postimplant pure-tone thresholds and speech recognition scores were obtained to determine the incidence and degree of conserved hearing at a mean interval of 9 (±3.9) months. Results: Thirty-two percent of subjects experienced complete conservation of hearing (0- to 10-dB loss), and 57% experienced partial conservation of hearing (>11 dB) after implantation. However, open-set speech recognition was partially conserved in only one subject. Cochlear implant performance was not better in patients with conservation of residual hearing. Conclusion: Conservation of pure-tone hearing was possible in 89% of implanted patients; however, residual speech perception was not conserved with this long perimodiolar electrode. A ceiling effect tends to inflate the prevalence of hearing conservation in implantation studies of severely to profoundly hearing-impaired patients.

Effective Multi-level, Multi-sector, School-based Obesity Prevention Programming Improves Weight, Blood Pressure, and Academic Performance, Especially among Low-Income, Minority Children

Introduction. Successfully addressing childhood onset obesity requires multilevel (individual, community, and governmental), multi-agency collaboration. Methods. The Healthier Options for Public Schoolchildren (HOPS)/OrganWise Guys® (OWG) quasi-experimental controlled pilot study (four intervention schools, one control school, total N=3,769; 50.2% Hispanic) was an elementary school-based obesity prevention intervention designed to keep children at a normal, healthy weight, and improve health status and academic achievement. The HOPS/OWG included the following replicable, holistic components: (1) modified dietary offerings, (2) nutrition/lifestyle educational curricula; (3) physical activity component; and (4) wellness projects. Demographic, anthropometric (body mass index [BMI]), blood pressure, and academic data were collected during the two-year study period (2004-6). Results. Statistically significant improvements in BMI, blood pressure, and academic scores, among low-income Hispanic and White children in particular, were seen in the intervention versus controls. Conclusion. Holistic school-based obesity prevention interventions can improve health outcomes and academic performance, in particular among high-risk populations.

Relationship between Body Mass Index and Metabolic Syndrome Risk Factors among US 8- to 14-Year-Olds, 1999 to 2002

OBJECTIVES To determine the prevalence of metabolic syndrome risk factors (MSRF) and examine the relationship between body mass index and the prevalence of >or=3 MSRF in 8- to 11- and 12- to 14-year-old age groups. STUDY DESIGN Combined 1999 to 2002 National Health and Nutrition Examination Survey data were analyzed (N = 1698). Prevalence of normal weight, at-risk for overweight, and overweight were determined. Prevalence of >or=3 MSRF (abnormal waist circumference, glucose, HDL cholesterol, triglyceride, systolic and diastolic blood pressure) were reported using (1) an age, sex, and ethnicity-adjusted and (2) a crude profile (no adjustments). RESULTS Among overweight 8- to 11-year-old children, 6.5% (95% CI, 3.82 to 10.86) had >or=3 MSRF using the crude profile and 9.51% (95% CI 5.59 to 15.71) using the adjusted profile. Among overweight 12- to 14-year-olds, 43.76% (95% CI, 33.27 to 54.85) had >or=3 MSRF using the crude profile and 26.28% (95% CI, 16.71 to 38.78) using the adjusted profile. CONCLUSIONS A substantial number of overweight 8- to 14-year-olds have >or=3 MSRF, indicating that overweight in early adolescence may put children at risk for adult-onset cardiovascular disease and/or type 2 diabetes well before they become teenagers.

Healthier options for public schoolchildren program improves weight and blood pressure in 6- to 13-year-olds.

Childhood obesity and related health consequences continue to be major clinical and public health issues in the United States. Schools provide an opportunity to implement obesity prevention strategies to large and diverse pediatric audiences. Healthier Options for Public Schoolchildren was a quasiexperimental elementary school-based obesity prevention intervention targeting ethnically diverse 6- to 13-year-olds (kindergarten through sixth grade). Over 2 school years (August 2004 to June 2006), five elementary schools (four intervention, one control, N=2,494, 48% Hispanic) in Osceola County, FL, participated in the study. Intervention components included integrated and replicable nutrition, physical activity, and lifestyle educational curricula matched to state curricula standards; modified school meals, including nutrient-dense items, created by registered dietitians; and parent and staff educational components. Demographic, anthropometric, and blood pressure data were collected at baseline and at three time points over 2 years. Repeated measures analysis showed significantly decreased diastolic blood pressure in girls in the intervention group compared to controls (P<0.05). Systolic blood pressure decreased significantly for girls in the intervention group compared to controls during Year 1 (fall 2004 to fall 2005) (P<0.05); while not statistically significant the second year, the trend continued through Year 2. Overall weight z scores and body mass index z scores decreased significantly for girls in the intervention group compared to controls (P<0.05 and P<0.01, respectively). School-based prevention interventions, including nutrition and physical activity components, show promise in improving health, particularly among girls. If healthy weight and blood pressure can be maintained from an early age, cardiovascular disease in early adulthood may be prevented.

BMI, waist circumference, and selected cardiovascular disease risk factors among preschool-age children

In adults, overweight is often associated with other cardiovascular disease (CVD) risk factors. We determined whether these associations were also present in young children. This study examined the relationships between elevated BMI (≥85th and ≥95th percentiles for age and sex) and the highest quintile of waist circumference (WC) with CVD risk factors, including fasting triglyceride (TGL), high‐ and low‐density lipoprotein (HDL and LDL), total cholesterol (TC), non‐HDL cholesterol, and C‐reactive protein (CRP) in 3,644 3‐ to 6‐year‐old children included in the 1999–2008 National Health and Nutrition Examination Surveys (NHANES). Results showed that 20% (highest quintile) of the sample had a TC >170 mg/dl, LDL >109 mg/dl, TGL >103 mg/dl, non‐HDL >128 mg/dl, CRP >0.13 mg/dl, WC >57.2 cm, and HDL <42 mg/dl. Increased BMI and WC were associated with increased CRP levels in non‐Hispanic black boys and girls, Hispanic boys, and non‐Hispanic white girls, whereas elevated TGL and non‐HDL cholesterol and low HDL cholesterol were generally associated with elevated BMI and WC in Hispanic children. TC and LDL cholesterol were not significantly associated with elevated weight in 3‐ to 6‐year‐olds. BMI and WC were similar in predicting the same risk factors. In summary, this analysis shows that in preschool‐age children, greater BMI and WC are associated with biomarkers that are related to CVD risk, but these associations vary by ethnicity. Child health providers should consider using both BMI and WC to identify young children who may be at risk for elevated CVD biomarkers.

Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database.

BACKGROUND Bariatric surgery is 1 of the few effective treatments of morbid obesity. However, the weight loss and other health-related outcomes for this procedure in large, diverse adolescent patient populations have not been well characterized. Our objective was to analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. The BOLD data are collected from 423 surgeons at 360 facilities in the United States. METHODS The main outcome measures included the anthropometric and co-morbidity status at baseline (n = 890) and at 3 (n = 786), 6 (n = 541), and 12 (n = 259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) aged 11 to 19 years were included in the present analyses. RESULTS The overall 1-year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 versus 20 kg, P < .001). Similar results were found for all other anthropometric changes and comparisons within 1 year between surgery types (P < .001). In general, the gastric bypass patients reported more improvement than the adjustable gastric band patients in co-morbidities at 1 year after surgery. A total of 45 readmissions occurred among gastric bypass patients and 10 among adjustable gastric band patients, with 29 and 8 reoperations required, respectively. CONCLUSIONS The weight loss at 3, 6, and 12 months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related co-morbidities in morbidly obese adolescents for ≥1 year.

Bariatric Surgery Significantly Decreases the Prevalence of Type 2 Diabetes Mellitus and Pre-Diabetes among Morbidly Obese Multiethnic Adults: Long-Term Results

BACKGROUND Type 2 diabetes (T2DM) and obesity are codependent epidemics that disproportionately affect ethnic minorities. Recent studies have shown that in non-Hispanic whites, bariatric surgical procedures successfully reverse or improve abnormal glucose metabolism, yet little is known about the results of bariatric surgery in Hispanic and other ethnic minority adults with T2DM. STUDY DESIGN A retrospective analysis of 1,603 adults (77% female, 66% Hispanic, mean age at surgery 45.1 years [SD 11.6 years]) who underwent bariatric surgery from 2002 to 2010 was conducted. A total of 377 subjects had diagnosed T2DM, 107 had fasting plasma glucose (FPG) ≥126 mg/dL but were not on T2DM medication, 276 were pre-diabetic (FPG = 100 to 125 mg/dL), and 843 had normal FPG. Pre-surgery and 6, 12, 24, and 36 months post-surgery comparative-means analyses of weight, body mass index, estimated weight loss, hemoglobin A1c, and FPG were conducted via repeated-measures analysis. RESULTS By 1 year and through 3 years post-surgery, all groups had normal FPG. Patients with undiagnosed diabetes had a 43% FPG decrease followed by diagnosed diabetics (33%). Patients with diagnosed diabetes showed a slightly greater loss in hemoglobin A1c (2.30%) versus undiagnosed diabetics (2.13%). Patients with pre-diabetes saw the most dramatic loss in weight (47.00 kg), followed by patients with undiagnosed diabetes (46.62 kg), normal FPG (43.14 kg), and patients with diagnosed diabetes (41.39 kg) (p < 0.0001 for all up to 24 months). CONCLUSIONS Bariatric surgery results in significant long-term weight loss and improvement in FPG levels among ethnically diverse adults. Bariatric surgery has the potential to be an effective treatment option for weight loss and chronic disease risk improvements in this demographic.

Body Mass Index, Waist Circumference, and Cardiovascular Risk Factors in Adolescents

OBJECTIVE To determine optimal threshold values for body mass index (BMI) and waist circumference (WC) for detecting cardiovascular disease (CVD) risk (as defined with >/=3 CVD risk factors [RFs]) in adolescents. STUDY DESIGN The 1999-2004 National Health and Nutrition Examination Surveys (NHANES) cross-sectional data for 12- to 19-year-old adolescents (n = 2581) was analyzed. Main outcome measures were >/=3 age-adjusted CVD RFs (high- and low-density lipoprotein cholesterol level, triglyceride level, glucose level, insulin level, and systolic and diastolic blood pressure). The presence of >/=3 RFs was predicted from age- and sex-adjusted BMI and WC values with receiver operating characteristics analyses. RESULTS The proportion of adolescents at risk for >/=3 RFs ranged from 17% to 19%. Both BMI and WC had good diagnostic accuracy, ranging from 0.73 to 0.83, and good sensitivity and specificity, ranging from 0.68 to 0.77. The BMI cutoff points ranged from 19.5 to 25.0 kg/m(2) for boys and from 19.4 to 27.0 kg/m(2) for girls, and WC cutoff points ranged from 66.8 to 87.5 cm for boys and from 71.5 to 87.2 cm for girls. CONCLUSIONS Age-, sex-, and ethnicity/race-specific threshold values for BMI and WC may have significant clinical usefulness in identifying adolescents and teenagers at risk for later CVD onset.

Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting.

BackgroundMany unhealthy dietary and physical activity habits that foster the development of obesity are established by the age of five. Presently, approximately 70 percent of children in the United States are currently enrolled in early childcare facilities, making this an ideal setting to implement and evaluate childhood obesity prevention efforts. We describe here the methods for conducting an obesity prevention randomized trial in the child care setting.Methods/designA randomized, controlled obesity prevention trial is currently being conducted over a three year period (2010-present). The sample consists of 28 low-income, ethnically diverse child care centers with 1105 children (sample is 60% Hispanic, 15% Haitian, 12% Black, 2% non-Hispanic White and 71% of caregivers were born outside of the US). The purpose is to test the efficacy of a parent and teacher role-modeling intervention on children’s nutrition and physical activity behaviors. . The Healthy Caregivers-Healthy Children (HC2) intervention arm schools received a combination of (1) implementing a daily curricula for teachers/parents (the nutritional gatekeepers); (2) implementing a daily curricula for children; (3) technical assistance with meal and snack menu modifications such as including more fresh and less canned produce; and (4) creation of a center policy for dietary requirements for meals and snacks, physical activity and screen time. Control arm schools received an attention control safety curriculum. Major outcome measures include pre-post changes in child body mass index percentile and z score, fruit and vegetable and other nutritious food intake, amount of physical activity, and parental nutrition and physical activity knowledge, attitudes, and beliefs, defined by intentions and behaviors. All measures were administered at the beginning and end of the school year for year one and year two of the study for a total of 4 longitudinal time points for assessment.DiscussionAlthough few attempts have been made to prevent obesity during the first years of life, this period may represent the best opportunity for obesity prevention. Findings from this investigation will inform both the fields of childhood obesity prevention and early childhood research about the effects of an obesity prevention program housed in the childcare setting.Trial registrationTrial registration number: NCT01722032