Stephanie M. Walsh

Youth Understanding of Healthy Eating and Obesity: A Focus Group Study

Introduction. Given the high prevalence of childhood obesity in the United States, we aimed to investigate youths understanding of obesity and to investigate gaps between their nutritional knowledge, dietary habits, and perceived susceptibility to obesity and its co-morbidities. Methods. A marketing firm contracted by Childrens Healthcare of Atlanta facilitated a series of focus group discussions (FGD) to test potential concepts and sample ads for the development of an obesity awareness campaign. Data were collected in August and September of 2010 with both overweight and healthy weight 4th-5th grade and 7th-8th grade students. We conducted a secondary analysis of the qualitative FGD transcripts using inductive thematic coding to identify key themes related to youth reports of family eating habits (including food preparation, meal frequency, and eating environment), perceived facilitators and barriers of healthy diet, and knowledge about obesity and its complications. Results. Across focus group discussions, mixed attitudes about healthy eating, low perceived risk of being or becoming obese, and limited knowledge about the health consequences of obesity may contribute to the rising prevalence of obesity among youth in Georgia. Most youth were aware that obesity was a problem; yet most overweight youth felt that their weight was healthy and attributed overweight to genetics or slow metabolism. Conclusions. Our analysis suggests that urban youth in Georgia commonly recognize obesity as a problem, but there is less understanding of the link to lifestyle choices or the connection to future morbidities, suggesting a need for education to connect lifestyle behaviors to development of obesity.

Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

BACKGROUND Childhood obesity in Georgia exceeds the national rate. The states pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role. PURPOSE The aim of this study was to assess and compare weight-management-related counseling perceptions and practices among Georgias PCPs. METHODS In 2012-2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management-related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value <0.05. RESULTS The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82-87%; p≤0.002) and screen time (86% vs. 74-75%; p≤0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p<0.001) and to track progress (50% vs. 35-39%; p<0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%). CONCLUSIONS Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known high-risk behaviors remain.

The multi-disciplinary approach to adolescent bariatric surgery

The multi-disciplinary team is essential for the success of an adolescent bariatric surgical program. This article will describe the components of the team and their roles. Essential members include a pediatrician or pediatric subspecialist with an interest and expertise in adolescent obesity, a pediatric surgeon with bariatric expertise, or an adult bariatric surgeon with adolescent experience, adolescent/child psychologist, pediatric nutritionist, exercise physiologist or physical therapist, nursing support, and a patient coordinator. Some programs have found a social worker to be helpful as well. The function of the team members is more important than the title. A physical therapist may develop an activity program or a social worker may function as the coordinator. The whole team, led by the pediatric bariatrician, makes decisions concerning the selection of candidates for bariatric surgery. During team rounds, each patient is discussed and treatment decisions are made.

Brief Training in Patient-Centered Counseling for Healthy Weight Management Increases Counseling Self-efficacy and Goal Setting Among Pediatric Primary Care Providers Results of a Pilot Program

Background. We hypothesized that training in patient-centered counseling would improve self-efficacy and quality of weight management–related counseling provided by pediatric primary care physicians (PCPs). Methods. A total of 36 PCPs attended a brief (2-hour) training and consented to participate in an evaluation. Training impact was assessed using self-administered, pretraining and posttraining surveys and a review of patient charts from prior to and from 6 and 12 months after training for a random subsample of 19 PCPs (10 charts/timepoint per PCP). Results. Self-reported effectiveness at obesity prevention and treatment increased from 16.7% to 44.4% (P = .01) and from 19.4% to 55.6% (P < .001), respectively. Self-efficacy in counseling and motivating patients increased from 44.4% to 80.6% (P < .001) and 27.8% to 63.9% (P < .001), respectively. Goal documentation increased from 3.9% to 16.4% and 57.9% at 6 months and 12 months posttraining, respectively. Conclusions. Brief training in patient-centered counseling appears to increase self-efficacy and the frequency and quality of weight-related counseling provided by PCPs.

Challenges and Successes of a Multidisciplinary Pediatric Obesity Treatment Program

BACKGROUND Despite the well-documented need for multidisciplinary pediatric obesity treatment programs, few programs exist and best practices are not clearly defined. We describe the design and initial quality-related outcomes of the Strong4Life multidisciplinary pediatric obesity treatment program along with some challenges and solutions implemented over the first 2 years. The purpose of this report is to inform others interested in designing similar programs. PROGRAM DESCRIPTION The Strong4Life Clinic obesity program was designed to provide children with the medical care, as well as the behavior change guidance and support needed to reverse their obesity and/or minimize the related health risks. This low-intensity program is designed to provide approximately 6 hours of care over 12 months from a medical provider, psychologist, registered dietitian nutritionist, exercise physiologist, and nurse. RESULTS Between August 2011 and February 2014, the Strong4Life clinic served 781 high-risk (mean sex- and age-adjusted body mass index [BMI] percentile 98.8) and racially/ethnically diverse (45% non-Hispanic black and 24% Hispanic) patients. Of the 781 patients seen, 66% returned for at least 1 visit. Nearly all returning Strong4Life patients stabilized or improved their BMI (90% of those who participated <6 months, 97% of those who participated 6 to <12 months, and 92% of those who participated ≥12 months). CONCLUSIONS This report describes a low-intensity multidisciplinary weight management program that is feasible. Initial assessment of the program suggests benefit in most patients who participate >6 months, but longer follow-up and assessment of comorbidities are needed.

Increasing Children’s Voluntary Physical Activity Outside of School Hours Through Targeting Social Cognitive Theory Variables

Introduction: Volume of moderate-to-vigorous physical activity completed during the elementary school day is insufficient, and associated with health risks. Improvements in theory-based psychosocial factors might facilitate increased out-of-school physical activity. Methods: A behaviorally based after-school care protocol, Youth Fit 4 Life, was tested for its association with increased voluntary, out-of-school physical activity and improvements in its theory-based psychosocial predictors in 9- to 12-year-olds. Results: Increases over 12 weeks in out-of-school physical activity, and improvements in self-regulation for physical activity, exercise self-efficacy, and mood, were significantly greater in the Youth Fit 4 Life group (n = 88) when contrasted with a typical care control group (n = 57). Changes in the 3 psychosocial variables significantly mediated the group–physical activity change relationship (R2 = .31, P < .001). Change in self-regulation was a significant independent mediator, and had a reciprocal relationship with change in out-of-school physical activity. In the Youth Fit 4 Life group, occurrence of 300 min/wk of overall physical activity increased from 41% to 71%. Conclusions: Targeting theory-based psychosocial changes within a structured after-school care physical activity program was associated with increases in children’s overall time being physically active. After replication, large scale application will be warranted.

Effects of the Youth Fit 4 Life physical activity/nutrition protocol on body mass index, fitness and targeted social cognitive theory variables in 9‐ to 12‐year‐olds during after‐school care

Childhood overweight and obesity is unacceptably high in industrialised nations. School‐based interventions have largely been atheoretical and ineffective. This study aimed to test a new theory‐based protocol for its effects on measures of fitness and body mass index (BMI), and its proposed psychosocial mediators, during elementary after‐school (out‐of‐school hours) care.

Association of a Behaviorally Based High School Health Education Curriculum with Increased Exercise.

Increasing exercise in children and adolescents through academic classes is an understudied area. Potential benefits include associated improvements in health, psychosocial, and quality-of-life factors. A sample of 98 students (M age = 14.3) from high school health education classes received six, 40-min lessons incorporating cognitive–behavioral methods to increase exercise over 6 weeks. Significant within-group improvements in exercise, mood, and body satisfaction were found, with slightly larger effect sizes identified for the boys. Increase in exercise was significantly associated with reduced mood distress (β = −.17, p < .001). For the girls only, change in body satisfaction significantly mediated that relationship, and a reciprocal relationship between changes in mood and body satisfaction was also identified. Incorporation of lessons emphasizing goal setting and self-regulation within high school health education classes may foster increased exercise and associated improvements in mood and body satisfaction. For girls, the positive effects may reinforce one another.