Shari L. Barkin

The Relationship between Executive Function and Obesity in Children and Adolescents: A Systematic Literature Review

The objective of this paper is to examine the relationship between the development of executive function (EF) and obesity in children and adolescents. We reviewed 1,065 unique abstracts: 31 from PubMed, 87 from Google Scholar, 16 from Science Direct, and 931 from PsycINFO. Of those abstracts, 28 met inclusion criteria and were reviewed. From the articles reviewed, an additional 3 articles were added from article references (N = 31). Twenty-three studies pertained to EF (2 also studied the prefrontal and orbitofrontal cortices (OFCs); 6 also studied cognitive function), five studied the relationship between obesity and prefrontal and orbitofrontal cortices, and three evaluated cognitive function and obesity. Inhibitory control was most often studied in both childhood (76.9%) and adolescent (72.7%) studies, and obese children performed significantly worse (P < 0.05) than healthy weight controls on various tasks measuring this EF domain. Although 27.3% of adolescent studies measured mental flexibility, no childhood studies examined this EF domain. Adolescents with higher BMI had a strong association with neurostructural deficits evident in the OFC. Future research should be longitudinal and use a uniform method of EF measurement to better establish causality between EF and obesity and consequently direct future intervention strategies.

Interventions Aimed at Decreasing Obesity in Children Younger Than 2 Years: A Systematic Review

OBJECTIVE To assess the evidence for interventions designed to prevent or reduce overweight and obesity in children younger than 2 years. DATA SOURCES MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and references from relevant articles. STUDY SELECTION Included were published studies that evaluated an intervention designed to prevent or reduce overweight or obesity in children younger than 2 years. DATA EXTRACTION Extracted from eligible studies were measured outcomes, including changes in child weight status, dietary intake, and physical activity and parental attitudes and knowledge about nutrition. Studies were assessed for scientific quality using standard criteria, with an assigned quality score ranging from 0.00 to 2.00 (0.00-0.99 is poor, 1.00-1.49 is fair, and 1.50-2.00 is good). DATA SYNTHESIS We retrieved 1557 citations; 38 articles were reviewed, and 12 articles representing 10 studies met study inclusion criteria. Eight studies used educational interventions to promote dietary behaviors, and 2 studies used a combination of nutrition education and physical activity. Study settings included home (n = 2), clinic (n = 3), classroom (n = 4), or a combination (n = 1). Intervention durations were generally less than 6 months and had modest success in affecting measures, such as dietary intake and parental attitudes and knowledge about nutrition. No intervention improved child weight status. Studies were of poor or fair quality (median quality score, 0.86; range, 0.28-1.43). CONCLUSIONS Few published studies attempted to intervene among children younger than 2 years to prevent or reduce obesity. Limited evidence suggests that interventions may improve dietary intake and parental attitudes and knowledge about nutrition for children in this age group. For clinically important and sustainable effect, future research should focus on designing rigorous interventions that target young children and their families.

Culturally tailored, family-centered, behavioral obesity intervention for Latino-American preschool-aged children.

OBJECTIVE: To test the effect of a culturally tailored, family-centered, short-term behavioral intervention on BMI in Latino-American preschool-aged children. METHODS: In a randomized controlled trial, 54 parent–child dyads were allocated to the intervention and 52 dyads were allocated to an alternative school-readiness program as the control condition. Parent–child dyads were eligible if the parent self-defined Latino, was at least 18 years old, had a 2- to 6-year-old child not currently enrolled in another healthy lifestyle program, had a valid telephone number, and planned on remaining in the city for the next 6 months. The Salud Con La Familia (Health with the Family) program consisted of 12 weekly 90-minute skills-building sessions designed to improve family nutritional habits and increase physical activity. Both programs were conducted in a community recreation center serving an urban neighborhood of mostly Spanish-speaking residents. RESULTS: Forty-two percent of participating preschool-aged children were overweight or obese. Controlling for child age, gender, and baseline BMI, the effect of the treatment condition on postintervention absolute BMI was B = –0.59 (P < .001). The intervention effect seemed to be strongest for obese children. CONCLUSIONS: A skills-building, culturally tailored intervention involving parent–child dyads changed short-term early growth patterns in these Latino-American preschool-aged children. Examining long-term effects would be a prudent next step.

Report of the national heart, lung, and blood institute's working group on obesity and other cardiovascular risk factors in congenital heart disease

Obesity among North American youth has risen to epidemic levels and is expected to result in costly and burdensome health problems, most notably type 2 diabetes mellitus and premature coronary artery disease. In the 2001–2002 National Health and Nutrition Examination Survey survey, 31% of children aged 6 to 19 years were overweight, defined as body mass index (BMI) at the 85th to 95th percentile, or obese (BMI ≥95th percentile).1 Recent research indicates that a significant portion of children with congenital heart disease (CHD) are also obese or overweight.2 Although much has been written on obesity prevention and management of children with normal hearts,3 little is known about how children with CHD will be affected. The National Heart, Lung, and Blood Institute convened a Working Group (WG) on obesity and other cardiovascular risk factors in congenital heart disease in May 2009 to address knowledge gaps, challenges, and opportunities related to research, policies, and the clinical care of children born with CHD who also have or are at risk for obesity and other cardiovascular risk factors.4 The WG was composed of individuals with expertise in pediatric obesity and pediatric cardiology with the goals of summarizing the existing evidence on obesity and cardiovascular risk prevention and treatment in the CHD population, raising awareness of missing data, and presenting data from “healthy” children with potential applicability to children with CHD. In this report, we discuss the prevalence of obesity, potential etiological factors, possible sequelae, and obesity and cardiovascular risk management and treatment in patients with CHD. The recommendations of the WG are presented. There are no longitudinal data on weight trends in children with CHD, and only recently have concerns been raised about obesity. In 2005, Stefan et al5 demonstrated that children with CHD whose activities are restricted are …

The Relationship Between Hispanic Parents and Their Preschool-Aged Children's Physical Activity

OBJECTIVE: The goal of this study was to examine activity pattern associations between Hispanic parents and their preschool-aged children. METHODS: We examined baseline data collected as part of a randomized controlled trial. Self-defined Hispanic parents with children aged 3 to 5 years were randomly assigned to either a weekly healthy lifestyle group (intervention) or a monthly school-readiness group (control) for 3 months. There were no weight eligibility criteria. All participants were instructed to wear an accelerometer for up to 7 consecutive days to measure physical activity. RESULTS: Of the 106 dyads enrolled in the study, 80 children and 85 parents provided useable actigraphy data. Mean percentage of time spent in sedentary behaviors was 82.0% (SD: 10.4) for parents and 69.8% (SD: 18.5) for preschool-aged children. Percentage of awake time per day spent in sedentary behavior was strongly correlated for parents and children (r = 0.597; P < .001). Correlations between activity level were large (r = 0.895 and 0.739 for low and moderate activity levels, respectively), except for vigorous activity level, for which the parent-child correlation was nonsignificant (P = .64) because of a near-0 level of vigorous parental activity. Childs age (P = .81) and gender (P = .43) were nonsignificant predictors of child activity levels. CONCLUSIONS: These results suggest that parental activity levels are a powerful explanation of preschool-aged child activity levels, except for vigorous activity, which children do on their own without parental participation. Hispanic parents play a critical role in setting physical activity patterns in their children.

Anticipatory Guidance Topics: Are More Better?

OBJECTIVE Anticipatory guidance is a cornerstone of primary care pediatrics. Despite the fact that retention of information is essential for later action, data are lacking on what parents recall immediately after the visit and 1 month later and how the total number of topics discussed affects this outcome. METHODS Parents and practitioners completed postvisit surveys of anticipatory guidance topics discussed during health-maintenance visits for children ages 2-11. Postvisit and 1 month later, parental recall was compared with provider report of topics discussed. We examined the relationship between parental recall and the total number of topics discussed. RESULTS Families with children ages 2-11 years from across the United States participated in this study (N = 861). Providers reported discussing the topics of nutrition, car restraints, dental care, and reading aloud most often (72%- 93%). Concordance between parent and provider was high for all topics (72%-90%). Immediately postvisit, parents reported 6.33 (SD 2.9) as the mean number of topics discussed while providers reported 6.9 (SD 2.7) as the mean number of topics discussed. However, parental recall decreased significantly with more topics (> or =9) discussed. The same trend existed 1 month later. CONCLUSIONS Providers and parents have good agreement about topics discussed or not discussed during a well-child visit; however, parental recall dwindles with increasing numbers of topics discussed. Rethinking well-child care to limit the total number of topics discussed is warranted.

Social network diagnostics: a tool for monitoring group interventions

BackgroundMany behavioral interventions designed to improve health outcomes are delivered in group settings. To date, however, group interventions have not been evaluated to determine if the groups generate interaction among members and how changes in group interaction may affect program outcomes at the individual or group level.MethodsThis article presents a model and practical tool for monitoring how social ties and social structure are changing within the group during program implementation. The approach is based on social network analysis and has two phases: collecting network measurements at strategic intervention points to determine if group dynamics are evolving in ways anticipated by the intervention, and providing the results back to the group leader to guide implementation next steps. This process aims to initially increase network connectivity and ultimately accelerate the diffusion of desirable behaviors through the new network. This article presents the Social Network Diagnostic Tool and, as proof of concept, pilot data collected during the formative phase of a childhood obesity intervention.ResultsThe number of reported advice partners and discussion partners increased during program implementation. Density, the number of ties among people in the network expressed as a percentage of all possible ties, increased from 0.082 to 0.182 (p < 0.05) in the advice network, and from 0.027 to 0.055 (p > 0.05) in the discussion network.ConclusionsThe observed two-fold increase in network density represents a significant shift in advice partners over the intervention period. Using the Social Network Tool to empirically guide program activities of an obesity intervention was feasible.

Growing Right Onto Wellness (GROW): A Family-Centered, Community-Based Obesity Prevention Randomized Controlled Trial for Preschool Child-Parent Pairs

Growing Right Onto Wellness (GROW) is a randomized controlled trial that tests the efficacy of a family-centered, community-based, behavioral intervention to prevent childhood obesity among preschool-aged children. Focusing on parent-child pairs, GROW utilizes a multi-level framework, which accounts for macro (i.e., built-environment) and micro (i.e., genetics) level systems that contribute to the childhood obesity epidemic. Six hundred parent-child pairs will be randomized to a 3-year healthy lifestyle intervention or a 3-year school readiness program. Eligible children are enrolled between ages 3 and 5, are from minority communities, and are not obese. The principal site for the GROW intervention is local community recreation centers and libraries. The primary outcome is childhood body mass index (BMI) trajectory at the end of the three-year study period. In addition to other anthropometric measurements, mediators and moderators of growth are considered, including genetics, accelerometry, and diet recall. GROW is a staged intensity intervention, consisting of intensive, maintenance, and sustainability phases. Throughout the study, parents build skills in nutrition, physical activity, and parenting, concurrently forming new social networks. Participants are taught goal-setting, self-monitoring, and problem solving techniques to facilitate sustainable behavior change. The GROW curriculum uses low health literacy communication and social media to communicate key health messages. The control arm is administered to both control and intervention participants. By conducting this trial in public community centers, and by implementing a family-centered approach to sustainable healthy childhood growth, we aim to develop an exportable community-based intervention to address the expanding public health crisis of pediatric obesity.

Social Influences on Self-Reported Physical Activity in Overweight Latino Children

Psychosocial variables influence physical activity for different age groups, sex, and ethnic groups. However, little is known about their influence on physical activity in preadolescent Latino children. The authors examined how a) confidence in ones ability to be physically active (self-efficacy); b) ideas about the consequences of being physically active (beliefs), and c) the influences of family and friends on physical activity (social influences) effect physical activity levels in overweight (body mass index ≥85%) Latino preadolescent children. One hundred and fourteen preadolescents participated in a larger intervention designed to improve healthy lifestyles for Latino families. The authors report baseline data collected at a community-based primary care clinic. Multivariate regression analyses showed that only social influences significantly predicted (P < .01) the metabolic equivalent adjusted self-reported baseline physical activity. Prevention and intervention strategies that augment social influences on physical activity are likely to result in more physical activity and improved health in these children.

Millennials and the World of Work: The Impact of Obesity on Health and Productivity

PurposeThirty states now report one in three children between 10–17 years of age are either overweight or obese. This disturbing trend will have lasting implications for our children, specifically those known as the Millennial generation born between 1982 and 1993.ApproachUtilizing evidence in the existing literature, we created an economic model to predict the impact of obesity on the aggregate lifetime earnings for the Millennial generation and the consequences for employers and employees. We provide case reports on successful business strategies that speak to the classic characteristics of the Millennials.FindingsThe lifetime medical expenditure that is attributable to obesity for an obese 20-year-old varies from