William J. Heerman

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.

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

Interaction between Maternal Prepregnancy Body Mass Index and Gestational Weight Gain Shapes Infant Growth

5,340 to

Food insecurity is associated with diabetes self-care behaviours and glycaemic control.

29,460, increasing proportionally with rising weight. If the model’s assumptions hold true, Millennial American women will earn an average of

Adverse family experiences during childhood and adolescent obesity

956 billion less while men will earn an average of

Reporting of treatment fidelity in behavioural paediatric obesity intervention trials: a systematic review

43 billion less due to obesity.ImplicationsAs Millennials enter the workforce, the growing prevalence of obesity among their generation may negatively impact their productivity and resulting economic prosperity. Given that most of one’s adult life is spent on the job, employers have a unique opportunity to contribute to the solution by creating an environmental culture of health.Originality/ValueThis is the first assessment, which we know of, that examines the potential economic impact of obesity on the Millennial generation. We propose a unique approach applying a common health framework, the Chronic Care Model, to business strategies to contain costs and maximize Millennial workers’ health and productivity.

Health Literacy and Injury Prevention Behaviors Among Caregivers of Infants

OBJECTIVE To quantify the combined effect of maternal prepregnancy obesity and maternal gestational weight gain (GWG) on the shape of infant growth throughout the first year of life. METHODS A retrospective cohort of mother-child dyads with children born between January 2007 and May 2012 was identified in a linked electronic medical record. Data were abstracted to define the primary exposures of maternal prepregnancy body mass index (BMI) and GWG, and the primary outcome of infant growth trajectory. RESULTS We included 499 mother-child dyads. The average maternal age was 28.2 years; 55% of mothers were overweight or obese before pregnancy, and 42% of mothers had excess GWG, as defined by the Institute of Medicine. Maternal prepregnancy BMI (P < .001) and the interaction between prepregnancy BMI and maternal GWG (P = .02) showed significant association with infant growth trajectory through the first year of life after controlling for breast-feeding and other covariates, while GWG alone did not reach statistical significance (P = .38). Among infants of mothers with excess GWG, a prepregnancy BMI of 40 kg/m(2) versus 25 kg/m(2) resulted in a 13.6% (95% confidence interval 5.8, 21.5; P < .001) increase in 3-month infant weight/length percentile that persisted at 12 months (8.4%, 95% confidence interval 0.2, 16.5; P = .04). CONCLUSIONS The combined effect of excess maternal GWG and prepregnancy obesity resulted in higher infant birth weight, rapid weight gain in the first 3 months of life, with a sustained weight elevation throughout the first year of life. These findings highlight the importance of the preconception and prenatal periods for pediatric obesity prevention.

A health literate approach to the prevention of childhood overweight and obesity

Food insecurity is the ‘limited or uncertain availability of nutritionally adequate and safe foods’. Our objective was to examine the association between food insecurity, diabetes self‐care and glycaemic control.

Clusters of Healthy and Unhealthy Eating Behaviors Are Associated With Body Mass Index Among Adults

To evaluate the association between adverse family experiences (AFEs) during childhood and adolescent obesity and to determine populations at highest risk for AFEs.

Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index: A Randomized Clinical Trial

Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double‐coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter‐coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p < 0.01) as was the number of articles published for a given study (p < 0.01). The frequency of reporting treatment fidelity components has not improved over time (p = 0.26). Specific recommendations are made to support paediatric obesity researchers in leading health behaviour disciplines towards more rigorous measurement and reporting of treatment fidelity.