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Twelve-Month Outcomes of the First 1000 Days Program on Infant Weight Status.
Taveras, EM, Perkins, ME, Boudreau, AA, Blake-Lamb, T, Matathia, S, Kotelchuck, M, Luo, M, Price, SN, Roche, B, Cheng, ER
Pediatrics. 2021;(2)
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OBJECTIVES To examine the effects of the First 1000 Days intervention on the prevalence of infant overweight and maternal postpartum weight retention and care. METHODS Using a quasi-experimental design, we evaluated the effects of the First 1000 Days program among 995 term, low-income infants and their mothers receiving care in 2 intervention community health centers and 650 dyads in 2 comparison health centers. The program includes staff training, growth tracking, health and behavioral screening, patient navigation, text messaging, educational materials, and health coaching. Comparison centers implemented usual care. Infant outcomes were assessed at 6 and 12 months, including weight-for-length z score and overweight (weight for length ≥97.7th percentile). We also examined maternal weight retention and receipt of care 6 weeks' post partum. RESULTS The mean birth weight was 3.34 kg (SD 0.45); 57% of infants were Hispanic; 66% were publicly insured. At 6 months, infants had lower weight-for-length z scores (β: -.27; 95% confidence interval [CI]: -.39 to -.15) and lower odds of overweight (adjusted odds ratio [OR]: 0.46; 95% CI: 0.28 to 0.76) than infants in comparison sites; differences persisted at 12 months (z score β: -.18; 95% CI: -.30 to -.07; adjusted OR for overweight: 0.60; 95% CI: 0.39 to 0.92). Mothers in the intervention sites had modestly lower, but nonsignificant, weight retention at 6 weeks' post partum (β: -.51 kg; 95% CI: -1.15 to .13) and had higher odds (adjusted OR: 1.50; 95% CI: 1.16 to 1.94) of completing their postpartum visit compared with mothers in the comparison sites. CONCLUSIONS An early-life systems-change intervention combined with coaching was associated with improved infant weight status and maternal postpartum care.
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Outcomes of Bariatric Surgery in Older Versus Younger Adolescents.
Ogle, SB, Dewberry, LC, Jenkins, TM, Inge, TH, Kelsey, M, Bruzoni, M, Pratt, JSA
Pediatrics. 2021;(3)
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OBJECTIVES In this report, we compare weight loss, comorbidity resolution, nutritional abnormalities, and quality of life between younger and older adolescents after metabolic and bariatric surgery. METHODS From March 2007 to December 2011, 242 adolescents (≤19 years of age) who underwent bariatric surgery at 5 clinical centers in the United States were enrolled in the prospective, multicenter, long-term outcome study Teen-Longitudinal Assessment of Bariatric Surgery. Outcome data from younger (13-15 years; n = 66) and older (16-19 years; n = 162) study participants were compared. Outcomes included percent BMI change, comorbidity outcomes (hypertension, dyslipidemia, and type 2 diabetes mellitus), nutritional abnormalities, and quality of life over 5 years post surgery. RESULTS Baseline characteristics, except for age, between the 2 cohorts were similar. No significant differences in frequency of remission of hypertension (P = .84) or dyslipidemia (P = .74) were observed between age groups. Remission of type 2 diabetes mellitus was high in both groups, although statistically higher in older adolescents (relative risk 0.86; P = .046). Weight loss and quality of life were similar in the 2 age groups. Younger adolescents were less likely to develop elevated transferrin (prevalence ratio 0.52; P = .048) and low vitamin D levels (prevalence ratio 0.8; P = .034). CONCLUSIONS The differences in outcome of metabolic and bariatric surgery between younger and older adolescents were few. These data suggest that younger adolescents with severe obesity should not be denied consideration for surgical therapy on the basis of age alone and that providers should consider adolescents of all ages for surgical therapy for obesity when clinically indicated.
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Assessing the acceptability of an adapted preschool obesity prevention programme: ToyBox-Scotland.
Malden, S, Reilly, JJ, Hughes, A, Bardid, F, Summerbell, C, De Craemer, M, Cardon, G, Androutsos, O, Manios, Y, Gibson, AM
Child: care, health and development. 2020;(2):213-222
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BACKGROUND Childhood obesity is a global public health issue. Interventions to prevent the onset of obesity in the early years are often implemented in preschool settings. The ToyBox intervention was delivered across Europe and targeted energy balance-related behaviours in preschools and children's homes through teacher-led activities and parental education materials and was adapted for use in Scotland. This study assessed the acceptability of the 18-week adapted intervention to both parents and teachers. METHODS Mixed methods were employed to collect both qualitative and quantitative data. Preschool staff and children's parents/caregivers completed post-intervention feedback surveys, from which acceptability scores were calculated and presented as proportions. Focus groups were conducted with preschool staff, whereas parents/caregivers participated in semi-structured interviews. A thematic analysis was applied to qualitative data following the development of a coding framework. Quantitative and qualitative data were analysed using SPSS and NVivo 10, respectively. RESULTS Preschool staff rated the intervention as highly acceptable based on post-intervention feedback surveys (80%; mean score 8.8/11). Lower acceptability scores were observed for parents/caregivers (49%; 3.9/8). Nine preschool practitioners participated in focus groups (n = 3). User-friendliness of the intervention materials, integration of the intervention with the curriculum, and flexibility of the intervention were identified as facilitators to delivery. Barriers to delivery were time, insufficient space, and conflicting policies within preschools with regard to changing classroom layouts. Parental interviews (n = 4) revealed a lack of time to be a major barrier, which prevented parents from participating in home-based activities. Parents perceived the materials to be simple to understand and visually appealing. CONCLUSIONS This study identified a number of barriers and facilitators to the delivery and evaluation of the ToyBox Scotland preschool obesity prevention programme, which should be considered before any further scale-up of the intervention.
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Promoting physical activity through walking to treat childhood obesity, mainly for mild to moderate obesity.
Yoshinaga, M, Miyazaki, A, Aoki, M, Ogata, H, Ito, Y, Hamajima, T, Tokuda, M, Lin, L, Horigome, H, Takahashi, H, et al
Pediatrics international : official journal of the Japan Pediatric Society. 2020;(8):976-984
Abstract
BACKGROUND There are no randomized controlled trials examining the effect of walking on childhood obesity. METHODS A randomized controlled trial was conducted between August 2014 and April 2015 in Japan. Elementary school children aged 6 to 12 years with a percentage overweight (%OW) of ≥20% were recruited. One hundred and ninety children wanted to participate in the program, and all were accepted. After viewing a video that promoted physical activity through walking, participants were randomly assigned to three groups: walking (≥10 000 steps on school holidays), limiting screen time (<90 min on weekdays and <150 min on school holidays), and a control group (no intervention). The primary outcome was a decrease in %OW after 3 months' intervention. Per protocol analysis was performed using 156 participants who fulfilled the inclusion criteria of a %OW ≥20%. RESULTS The mean %OW was 35 ± 7% before intervention. The mean reduction in %OW after intervention in the walking (n = 59), limiting ST (n = 46), and control (n = 51) groups were -4.06 ± 4.84, -1.97 ± 4.62, and -1.81 ± 3.64 percentage points, respectively. Reduction in %OW was significantly larger in the walking group than in the control group: adjusted mean difference, -2.18 percentage points (95% confidence interval, -3.85 to -0.52), P = 0.002. The intervention in children also had favorable effects on the lifestyles of their parents. The intention-to-treat analysis of all 190 participants showed comparable results. CONCLUSION Promoting physical activity through walking on school holidays may be an additional strategy for treating elementary school children with obesity.
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Common genetic variation in obesity, lipid transfer genes and risk of Metabolic Syndrome: Results from IDEFICS/I.Family study and meta-analysis.
Nagrani, R, Foraita, R, Gianfagna, F, Iacoviello, L, Marild, S, Michels, N, Molnár, D, Moreno, L, Russo, P, Veidebaum, T, et al
Scientific reports. 2020;(1):7189
Abstract
As the prevalence of metabolic syndrome (MetS) in children and young adults is increasing, a better understanding of genetics that underlie MetS will provide critical insights into the origin of the disease. We examined associations of common genetic variants and repeated MetS score from early childhood to adolescence in a pan-European, prospective IDEFICS/I.Family cohort study with baseline survey and follow-up examinations after two and six years. We tested associations in 3067 children using a linear mixed model and confirmed the results with meta-analysis of identified SNPs. With a stringent Bonferroni adjustment for multiple comparisons we obtained significant associations(p < 1.4 × 10-4) for 5 SNPs, which were in high LD (r2 > 0.85) in the 16q12.2 non-coding intronic chromosomal region of FTO gene with strongest association observed for rs8050136 (effect size(β) = 0.31, pWald = 1.52 × 10-5). We also observed a strong association of rs708272 in CETP with increased HDL (p = 5.63 × 10-40) and decreased TRG (p = 9.60 × 10-5) levels. These findings along with meta-analysis advance etiologic understanding of childhood MetS, highlighting that genetic predisposition to MetS is largely driven by genes of obesity and lipid metabolism. Inclusion of the associated genetic variants in polygenic scores for MetS may prove to be fundamental for identifying children and subsequently adults of the high-risk group to allow earlier targeted interventions.
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Association of Multisetting Community Programs and Policies With Child Body Mass Index: The Healthy Communities Study.
Collie-Akers, VL, Fawcett, SB, Schultz, JA, Fleming, KK, Swinburne Romine, RE, Ritchie, LD, Frongillo, EA, Arteaga, SS
Preventing chronic disease. 2020;:E34
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INTRODUCTION Expert opinion suggests that efforts to address childhood obesity should seek to transform the environments in which children operate. The objective of this study was to describe the extent to which multisetting programs and policies interact with community and child predictors and are associated with child body mass index (BMI) in the 130 US communities participating in the Healthy Communities Study. METHODS For 2 years beginning in fall 2013, we collected data through key informant interviews on community programs and policies related to healthy weight among children that occurred in the 10 years before the interview. We characterized community programs and policies by intensity of efforts and the number of settings in which a program or policy was implemented. Child height and weight were measured during household data collection. We used multilevel modeling to examine associations of community programs and policies in multiple settings and child and community predictors with BMI z scores of children. RESULTS The mean number of settings in which community policies and programs were implemented was 7.3 per community. Of 130 communities, 31 (23.8%) implemented community programs and policies in multiple settings. Higher-intensity community programs and policies were associated with lower BMI in communities that used multiple settings but not in communities that implemented programs and policies in few settings. CONCLUSION Efforts to prevent childhood obesity may be more effective when community programs and policies are both intensive and are implemented in multiple settings in which children live, learn, and play.
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Association between the time spent watching television and the sociodemographic characteristics with the presence of overweight and obesity in Colombian adolescents (secondary analysis of the ENSIN 2010).
Rincón-Pabón, D, Urazán-Hernández, Y, González-Santamaría, J
PloS one. 2019;(5):e0216455
Abstract
OBJECTIVE To determine the association between the time spent watching television and the sociodemographic characteristics with the presence of overweight and obesity in Colombian adolescents. MATERIALS AND METHODS Secondary analysis of the information obtained in the National Survey of the Nutritional Situation 2010 of Colombia, in a probabilistic sample of 18177 adolescents with an age range between 13 and 17 years. The time spent watching television and / or videogames and sociodemographic factors was determined. Anthropometric markers and body composition were recorded. Associations were established through logistic regression models. RESULTS The prevalence of overweight was 13.0% (95% CI 12.4-13.8) and obesity was 3.0% (95% CI 2.8-3.3). The prevalences of overweight and obesity were higher in adolescent women [16.6% (95% CI 15.8-17.5) and 3.4% (95% CI 3.1-3.7), respectively]. Overweight and obesity were associated with being female [OR 1.94 (95%CI 1.77-2.12) and OR 1.29 (95%CI 1.09-1.53), respectively], high socioeconomic level [OR 1.22 (95%CI 1.10-1.36) and OR 1.47 (95%CI 1.19-1.81), respectively], reside in urban area [OR 1.13 (95%CI 1.03-1.24) and OR 1.47 (95%CI 1.21-1.79), respectively]. Being indigenous was associated with being overweight [OR 1.25 (95%CI 1.10-1.42)], while being Afro-Colombian was associated with obesity [OR 1.33 (95%CI 1.05-1.69)]. Watching television and / or video games for two or more hours a day [OR1.17 (95%CI 1.06-1.30)] was associated with being overweight; whereas watching television every day of the week was associated with obesity [OR 1.66 (95%CI 1.13-2.43)]. CONCLUSIONS The population studied has a significant prevalence of overweight and obesity, being overweight is associated with being a woman, a high socioeconomic status, residing in an urban area, having an indigenous ethnicity, watching television for three days during the week and looking at more than two hours of television in a day; Obesity is associated with being a woman, a medium-high and high socioeconomic status, residing in an urban area, Afro-Colombian ethnicity, watching television at least once in the last week and watching television every day during the last week.
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CHAMP: A cluster randomized-control trial to prevent obesity in child care centers.
Armstrong, B, Trude, ACB, Johnson, C, Castelo, RJ, Zemanick, A, Haber-Sage, S, Arbaiza, R, Black, MM
Contemporary clinical trials. 2019;:105849
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Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.
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A randomised controlled trial of performance review and facilitated feedback to increase implementation of healthy eating and physical activity-promoting policies and practices in centre-based childcare.
Finch, M, Stacey, F, Jones, J, Yoong, SL, Grady, A, Wolfenden, L
Implementation science : IS. 2019;(1):17
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BACKGROUND While it is recommended that childcare services implement policies and practices to support obesity prevention, there remains limited evidence to inform policy and practice. The aim of this study is to examine the effectiveness of performance review and facilitated feedback in increasing the implementation of healthy eating and physical activity-promoting policies and practices in childcare services. METHODS The study was conducted with childcare services in the Hunter New England region of New South Wales, Australia. Eligible services were randomised to a wait-list control group or to receive the implementation strategy. The strategy targeted the implementation of written nutrition, physical activity, and small screen recreation policies; providing information to families regarding healthy eating, physical activity, and small screen time; providing twice weekly healthy eating learning experiences to children; providing water and plain milk only to children; providing fundamental movement skills activities for children every day; and limiting the use of electronic screen time for educational purposes and learning experiences. Intervention services received a performance review and facilitated feedback process five times over the 10 months that included an assessment of current practices, goal setting, identification of barriers to implementation, problem-solving, and resource provision. The primary outcome was the proportion of services implementing all six policies and practices, assessed by nominated supervisor completion of a computer-assisted telephone interview at baseline and 12-month follow-up. RESULTS One hundred and eight services took part. There were no significant differences in the proportion of services implementing all six practices at 12 months (mean difference 0.51; 95% CI 0.16 to 1.58; p = 0.24). There were also no differences between groups in the mean number of policies and practices implemented (mean difference 0.1; 95% CI - 0.4 to 0.6; p = 0.71), or the proportion implementing each of the six individual policies and practices at 12 months (OR range 0.57 to 1.85; p > 0.05). CONCLUSIONS Further support may be required to assist childcare services to make recommended changes to their policies and practices. TRIAL REGISTRATION The trial was registered retrospectively on 10 September 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614000972628 .
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Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial.
Ickovics, JR, Duffany, KO, Shebl, FM, Peters, SM, Read, MA, Gilstad-Hayden, KR, Schwartz, MB
American journal of preventive medicine. 2019;(1):e1-e11
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INTRODUCTION Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories. STUDY DESIGN Cluster randomized trial using 2 × 2 factorial design. SETTING/PARTICIPANTS Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention). INTERVENTION Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school). MAIN OUTCOME MEASURES Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols. RESULTS Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (β=-2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI percentile increased 3%-4%. There was no difference in student BMI between those in schools with and without physical activity policy implementation. Examining behavioral correlates in eighth grade, students at schools randomized to the nutrition condition consumed fewer unhealthy foods and sugar-sweetened beverages, and ate less frequently at fast-food restaurants (all p<0.03). CONCLUSIONS This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02043626.