Stacey L. Simon

Moderators of Weight-Based Stigmatization Among Youth Who Are Overweight and Non-overweight: The Role of Gender, Race, and Body Dissatisfaction

Objective: To identify demographic correlates and moderators of weight-based stigmatization in a diverse sample of children and adolescents. Method: A total of 157 children/adolescents aged 7 to 17 years and their parents participated in this study, and the following measurements were used: demographic questionnaire, child weight and height, figure ranking weight-based stigmatization, and body dissatisfaction. Results: Weight-based stigmatization was greater among younger children and females. Gender moderated the relationship between age and weight-based stigmatization, with significant differences in endorsement of weight bias between child and adolescent females. Gender also moderated the relationship between race and weight-based stigmatization, with African-American females endorsing significantly lower levels of weight-based stigmatization than white females. Body dissatisfaction moderated the relationship between degree of overweight and weight-based stigmatization and served as a protective buffer from endorsement of weight-based stigmatization among children with greater degree of overweight but low body dissatisfaction. Conclusion: Weight-based stigmatization is prevalent, with certain age groups and populations at particular risk for its endorsement. Identification of correlates and moderators of weight-based stigmatization can inform the design of effective interventions to reduce its profound negative impact on children who are overweight or obese.

Barriers to treatment of paediatric obstructive sleep apnoea: Development of the adherence barriers to continuous positive airway pressure (CPAP) questionnaire

BACKGROUND Continuous positive airway pressure (CPAP) treatment is often prescribed for youth as a treatment for obstructive sleep apnoea (OSA). Efficacy research in youth is limited, though some evidence suggests that it may relieve symptoms of OSA and possibly prevent future physical, emotional, and behavioural complications. However, the device must be used consistently for benefits to be realised. Non-adherence to medical treatment is prevalent among youth with chronic illness, yet little is known regarding adherence to CPAP in paediatric OSA. METHODS Using a sample of 51 youth (age 8-17 years) recruited from a paediatric sleep specialty clinic, the aims of the current study were to: (1) present descriptive data regarding CPAP adherence in youth with OSA, and (2) develop a psychometrically sound measure of barriers for adherence to CPAP use for youth with OSA. RESULTS Results indicated that adherence to CPAP is poor: youth in the current sample used their CPAP on average 3.35 h per night. The adherence barriers measure demonstrated excellent psychometric properties. CONCLUSIONS The adherence barriers to CPAP questionnaire has the potential to be a useful clinic-based tool for identifying patient-specific issues with CPAP adherence in youth with OSA.

The Relationship Among Child Weight Status, Psychosocial Functioning, and Pediatric Health Care Expenditures in a Medicaid Population

OBJECTIVES To examine the association between weight status and health service use, while considering the influence of psychosocial functioning and demographic variables. METHODS Two hundred child-parent dyads were recruited from pediatric primary care clinics and completed measures of height, weight, and questionnaires assessing psychosocial functioning. Claims and expenditure data over a 12-month retrospective period were extracted from the Medicaid claims database. RESULTS Children who were obese incurred greater health service use and expenditures than children who were of a healthy weight, even after controlling for psychosocial functioning and other demographic variables. Children who were overweight (but not obese) did not have differing levels of claims or expenditures than their healthy weight peers. CONCLUSIONS Understanding the impact of pediatric obesity on long-term expenditures is critical. These results provide some indication of the financial savings that might be achieved if obese children were supported to achieve a healthier weight status.

Body Satisfaction, Nutritional Adherence, and Quality of Life in Youth With Cystic Fibrosis

Children with cystic fibrosis (CF) typically have similar nutritional intake as healthy peers, despite recommendations to consume more calories and fat. Body satisfaction may play a role in nutritional intake: females may be content with their smaller size despite recommendations for weight gain, while males may desire to be larger and more muscular, which is more congruent with medical advice. Females are especially at risk, given their propensity to desire a smaller body size, tendency for lower HRQOL, steeper trajectory of health decline and shorter life expectancy than males. This study evaluated body satisfaction in relation to nutritional adherence and HRQOL in youth with CF. Fifty‐four individuals with CF (age 9–17) completed the Cystic Fibrosis Questionnaire‐Revised (CFQ‐R), the Figure Rating Scale, and a 24‐hr diet recall interview with their caregiver. Twenty‐four percent of youth were non‐adherent with caloric goals, and 40.7% did not obtain the minimum recommendation for fat intake. Youth were classified as inconsistent with treatment goals (TI) if they desired a smaller body size or were content with their current size despite a BMI less than the 50th percentile; 44.8% of females were classified as TI, compared to only 8% of males. Statistical analyses were performed to evaluate the impact of gender and body satisfaction on HRQOL in youth with CF. Linear multiple regression models were fit; TI females had Emotional HRQOL scores 23 points lower than males. Results suggest that improving body satisfaction, especially for females, may help to improve overall quality of life and potentially impact nutritional adherence. Pediatr. Pulmonol. 2011; 46:1085–1092.

A Pilot Study Examining a Group-Based Behavioral Family Intervention for Obese Children Enrolled in Medicaid: Differential Outcomes by Race

This pilot study examined the efficacy of a behavioral family intervention (BFI) to address weight management in obese children from economically disadvantaged backgrounds. Forty children, ages 6 to 12, and their parents enrolled in Medicaid were assigned to a BFI or an individual standard of care condition. Assessments were completed at baseline, posttreatment, and 9-month follow up. There were no differences in weight outcomes across treatment conditions. However, there were trends to suggest differences in weight change by child race. Specifically, children identified as African American benefited less from the BFI than Caucasian children. Implications for practice and research are discussed.

The association between sleep duration and weight in treatment-seeking preschoolers with obesity.

OBJECTIVE To examine the association between nocturnal sleep duration and weight and caloric intake outcomes among preschool-aged children who are obese and enrolled in a family-based weight management program. METHODS Forty-one preschool-aged children who were obese (BMI ≥ 95th percentile) and enrolled in a weight management program completed pre- and posttreatment assessments of body mass, caloric intake, and sleep. Separate linear regression analyses examined the relationship between nocturnal sleep duration and posttreatment body mass index relative to age- and sex-linked norms (BMIz) and caloric intake. RESULTS After controlling for pretreatment BMIz, longer posttreatment nocturnal sleep was significantly associated with lower posttreatment BMIz (β=-0.21, p=0.02) and explained a significant proportion of unique variance in posttreatment BMIz (ΔR(2)=0.04). Similarly, after controlling for pretreatment caloric intake, longer nocturnal sleep duration at posttreatment was significantly associated with lower caloric intake at posttreatment (β=-0.45, p=0.003) and explained a significant proportion of unique variance in posttreatment caloric intake (ΔR(2)=0.19). CONCLUSIONS These findings extend the literature on the sleep and weight relationship and suggest that adequate sleep may be an important element in interventions for preschoolers with obesity.

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.

Web-Based Intervention for Nutritional Management in Cystic Fibrosis: Development, Usability, and Pilot Trial

OBJECTIVES Usability and pilot testing of a web intervention (BeInCharge.org [BIC]) of behavior plus nutrition intervention for children with cystic fibrosis (CF) ages 4-9 years. METHODS Think Aloud methodology was used with five mothers to assess usability and refine the intervention. A pilot trial was then conducted with 10 mothers of children with CF ages 4-9 years randomized to the web-based BIC or a Standard Care Control (STC). Change in weight gain for each group was compared in a pre-to-post design. RESULTS Mothers rated the usability and clarity of BIC highly. The pilot trial showed children of mothers who received BIC had a significant change in weight pre-to-post-treatment (0.67 kg, p = .04). Change for the STC was not significant (0.41 kg, p = .10). CONCLUSIONS A web-based behavior plus nutrition intervention appears promising in increasing weight gain in children with CF.

A Review of Psychosocial Risk Factors for Pediatric Atopy

Pediatric atopy is increasing in prevalence and creates a significant financial and quality of life burden for children and families (e.g., frequent clinic visits, academic, and social challenges). Thus, it is important to understand modifiable risk factors related to disease onset or exacerbation in young children. The existing research base suggests that while a genetic link has been identified, specific family psychological factors (e.g., parent stress) also appear to play a significant role in the development of pediatric atopy. The function of psychological stress in the clinical expression and exacerbation of allergic diseases in young children is hypothesized to be due to neuroendocrine and immunologic systems. Specifically, stress-related activation of the sympathetic and adrenomedullary (SAM) system as well as the hypothalamic-pituitary-adrenocortical (HPA) axis from both the intrauterine environment and early childhood experiences may increase risk of childhood atopy above and beyond genetic risk. Consequently, prevention and intervention strategies aimed at reducing childrens early exposure to stress and psychological difficulties in parents may prove beneficial in preventing or reducing the likelihood that their children will develop atopy.

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.