Parent weight change as a predictor of child weight change in family-based behavioral obesity treatment

BACKGROUND: Family-based behavioral weight control treatment involves the parent in the modification of child and parent eating and activity change. OBJECTIVE: To assess if parent standardized body mass index (z-BMI) change predicts child z-BMI change. DESIGN: Secondary data analysis based on parent and child z-BMI changes from 3 family-based, randomized, controlled weight control studies. Hierarchical regression models tested whether parent z-BMI change increased prediction of child z-BMI change through treatment and 24-month follow-up beyond other factors that influence child weight change, such as child age, sex, socioeconomic status, and baseline child and parent z-BMI. Differences in child z-BMI change as a function of quartiles of parental z-BMI change were tested using an analysis of covariance. SETTING: Pediatric obesity research clinic. PARTICIPANTS: Obese 8- to 12-year-old children and their parents from 142 families who participated in family-based weight control programs. MAIN OUTCOME MEASURES: Child and parent z-BMI changes over time. RESULTS: Parent z-BMI change significantly predicted child z-BMI change for the 0- to 6-month (P<.001) and 0- to 24-month (P <.009) time points. In hierarchical regression models, parent z-BMI change was a significant incremental predictor of child z-BMI change at 6 and 24 months, with the additional r(2) ranging from 11.6% at 6 months (P <.001) to 3.8% at 24 months (P =.02). Parents in the highest quartile of z-BMI change had children with significantly greater z-BMI change than that of children with parents in the other quartiles (P =.01). CONCLUSION: Parent z-BMI change is an independent predictor of obese child z-BMI change in family-based behavioral treatment, and youth benefit the most from parents who lose the most weight in family-based behavioral treatments.     

Recognition and management of overweight and obese children: a questionnaire survey of general practitioners and parents in England

Aims: To (i) compare the views of general practitioners (GPs) and parents about the causes, consequences and management of childhood overweight/obesity; and (ii) explore the extent to which they can identify overweight/obesity in children. Methods: A questionnaire was mailed to all GPs in one Primary Care Trust and all parents in one primary school in southern England, 2008. Information was gathered on socio‐demographic background, views about causes, consequences and management of childhood overweight/obesity; judgements about the weight status of 14 images of children (seven boys, seven girls) in the Children's Body Image Scale (CBIS). Comparisons were made between GP and parents' responses using unpaired bivariate tests. Results: The response rate was 33%. Differences exist between the views of GPs and parents about childhood weight management: 86.4% of parents felt GPs should be involved, compared to 73.3% of GPs (P < 0.001). Parents thought GPs should be more proactive than the GPs stated they would be. GPs were significantly more likely than parents to see a role for school nurses and dieticians. One third of respondents thought GPs lacked expertise in child weight management. Most GPs and parents correctly identified obese children from the images, but inaccuracies occurred at category margins. Conclusions: Childhood overweight/obesity is a serious public health concern, and primary care has a role to play in tackling it. GPs in England need more training in childhood overweight/obesity management. Their role needs to be clarified in the context of multiagency approaches.     

Exercise,diet, and childhood obesity: the GH-IGF-I connection

The recent "obesity epidemic" among children and adolescents is a major public health concern. The mechanisms responsible for the increased incidence of childhood obesity are not yet well understood. The absence of a clear mechanism makes treating the obese child or adolescent a difficult task, and standardized therapeutic approaches simply do not yet exist. Metabolic derangements associated with obesity may contribute to the difficulty in treatment. Observed abnormalities in the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis in obese adults and the impact of exercise on the GH-IGF-I system are of particular relevance to the growing obese child. In this review, we focus on the interacting mechanisms of diet and exercise through specific hormonal mediators and their contribution to the current obesity epidemic. An improved understanding of these mechanisms may be helpful in creating effective treatment programs for children with obesity.     

Exercise Testing of the Child with Obesity

As the prevalence of childhood obesity increases, exercise testing of obese children is likely to increase as well. This article discusses the implications of pediatric obesity for exercise testing and provides some recommendations for conducting tests and evaluating results. Studies comparing obese and nonobese children during exercise testing indicate that obese children are capable of meeting the challenges of exercise testing to nearly the same extent as their nonobese peers. Their physiologic responses, at least for the levels of obesity reported in the literature, are not sufficiently different from their nonobese counterparts to necessitate major changes in test protocols. Laboratory staff should pay special attention to fostering confidence in the obese child during the pretest routine.     

The neuroendocrinology of childhood obesity

The regulation of energy balance is enormously complex, with numerous genetic, hormonal, neural and behavioral, and societal influences. Although the current epidemic of obesity clearly has its underpinnings in the changes in culture during the past half-century (see other articles in this issue), the role of the neuroendocrine system in the genesis of obesity, as described in this article, is physiologically and therapeutically unavoidable. An understanding of this system has suggested organic causes (and therapies) for some rare and not-so-rare forms of obesity. With so many inputs, it is not far-fetched to assume that dysfunction of other parts of this feedback system will be found to explain other forms of obesity in the future. What does this mean for obese children entering the pediatrician's office? Fortunately or unfortunately, diet and exercise are the mainstays of obesity therapy for children and adults. Most diet-exercise programs result in an acute 11-kg weight loss in adults; the question is whether it can be sustained without significant long-term behavioral modification. For instance, the European Sibutramine Trial of Obesity Reduction and Maintenance trial showed that 42% of treated subjects drop out; of those remaining, 77% of subjects lost more than 5% of initial body weight, but only 43% of those maintained more than 80% of this over 2 years. Could there be an organic component in those who do not respond? Of course, obesity pharmacotherapies sometimes have beneficial acute effects, but these drugs work for only as long as they are consumed; discontinuation tends to result in a "rebound" weight gain, suggesting that the cause of the obesity is still present. Furthermore, in 2001, there are no obesity drugs approved for children. A useful guiding principle is that children deserve at the minimum an initial medical evaluation, including birth weight, medical history, family history, dietary evaluation, and exercise assessment. Perhaps the most important feature that can distinguish "organic" from "behavioral" weight gain in childhood is the age of the "adiposity rebound." The Centers for Disease Control and Prevention now supplies BMI charts for boys and girls at www.cdc.gov/growthcharts. Plotting of the BMI versus age allows pediatricians to determine the age at which the BMI starts to increase (mean, 5.5 years). The earlier the adiposity rebound, the more likely the child will be obese as an adult, and the more likely that an organic cause can be determined. In such patients, thyroid levels and fasting insulin and leptin levels should be measured. An initial attempt at diet and exercise is essential; patients who do not respond with BMI stabilization should be investigated for a more ominous cause of their obesity. As the nosology of obesity improves, pediatricians will be able to increase the diagnostic efficiency and therapeutic success of this unfortunate, debilitating, and expensive epidemic.     

Randomised controlled trial: A parent-based group education programme for overweight children

AIM: Childhood overweight and obesity is a significant community health problem with severe long-term complications. This paper aims to evaluate a four-by-two-hour weekly group parent education programme targeting children who are overweight. METHODS: A randomised time series design with wait-list controls was conducted for overweight and obese children aged 3-10 years. RESULTS: A statistically significant reduction in child body mass index and energy intake was found post treatment; no differences were reported for child sedentary electronic media time, physical activity and waist circumference. Children's baseline activity levels were found to be at or slightly above national recommended standards. No change occurred in primary parent body mass index or waist circumference after treatment. CONCLUSIONS: A brief group education programme for parents was effective in reducing childhood overweight at 3 months follow-up.     

Associations Between Obesity and Comorbid Mental Health,Developmental, and Physical Health Conditions in a Nationally Representative Sample of US Children Aged 10 to 17

ObjectiveThis large population-based study of US children considered the association of obesity with a broad range of comorbidities. This study examined relationships between weight status and health for US children.MethodsWe performed cross-sectional analysis of data on 43,297 children aged 10 to 17 from the 2007 National Survey of Children’s Health. Weight status was calculated from parent report of child height and weight. Logistic regression models assessed associations between weight status and 21 indicators of general health, psychosocial functioning, and specific health disorders, adjusting for sociodemographic factors.ResultsUsing body mass index (BMI) percentiles for age and sex, 15% of US children were considered overweight (BMI 85th to <95th percentile), and 16% were obese (BMI ≥95th percentile). Compared with children classified as not overweight, obese children were more likely to have reported good/fair/poor health (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI] 1.76–2.69), activity restrictions (AOR 1.39, 95% CI 1.10–1.75), internalizing problems (AOR 1.59, 95% CI 1.04–2.45), externalizing problems (AOR 1.33, 95% CI 1.07–1.65), grade repetition (AOR 1.57, 95% CI 1.24–1.99), school problems, and missed school days. Attention deficit/hyperactivity disorder, conduct disorder, depression, learning disability, developmental delay, bone/joint/muscle problems, asthma, allergies, headaches, and ear infections were all more common in obese children.ConclusionsObese children have increased odds of worse reported general health, psychosocial functioning, and specific health disorders. Physicians, parents, and teachers should be informed of the specific comorbidities associated with childhood obesity to target interventions that could enhance well-being. Future research should examine additional comorbidities and seek to confirm associations using longitudinal data and clinical measures of height and weight.     

Exercise therapy and hypocaloric diet in the treatment of obese children and adolescents

Fourteen obese children and adolescents were treated with a combined therapy of low calorie diet and exercise and their progress compared to that of 11 obese children treated with diet only. Children treated with combination therapy were encouraged to perform aerobic exercises daily, for a period of time which was calculated to consume approximately 250 kcal per exercise session. After 4 months of therapy, a significantly (P less than 0.05) larger decrease of % overweight was observed in the group of children treated with diet and exercise (-25 +/- 13.5%) than in those treated with diet only (-15.8 +/- 10.5%). Treatment compliance was better in the group treated with diet and exercise than in the group which followed a low calorie diet only. We think that unsupervised exercise therapy can be successfully combined with a low calorie diet in the treatment of childhood obesity.     

Adults' values and attitudes about genetic testing for obesity risk in children.

OBJECTIVE: We explored personal attitudes about genetic testing of children for obesity risk among parents of overweight children. We also gathered telephone opinions from the parents and from obese adults about policy related to such genetic testing. METHODS: We conducted three parents' focus groups, during which they produced numerical ratings on whether they would want their children to be tested according to scenarios in which 1) genetically-targeted drug treatment would be available, 2) a positive test would be associated with a prognosis for developing diabetes, or 3) neither of these. Quantitative data were also gathered during follow-up calls. RESULTS: Parents were more likely to want testing for their children under the first two scenarios, although there was interest in the third scenario, particularly among separated/divorced parents, and those whose children were not dieting. Even if treatment were not available, more than three-quarters believed testing should be available, more than one-third of them at birth. The youngest child age to divulge a positive result, on average, was 10 years. A primary reason was the perceived helpfulness of the result in framing behavior of both parent and child in preventing development of obesity. Respondents generally failed to perceive the possible negative consequences of a positive test result, insufficiently to consider implications of a negative result. CONCLUSIONS: Additional research is required in order to understand the best ways to educate parents about genetic testing for obesity risk, given the strong interest shown in having such testing available and divulging results to minor children.     

A randomized,triple masked,placebo-controlled clinical trial for controlling childhood obesity

Background  

The efficacy of pharmacological treatment in controlling childhood obesity is controversial. We aimed to compare the effects of three types of drug regimens and placebo on generalized and abdominal obesity among obese children and adolescents who did not succeed to lose weight 3 months after lifestyle modification (diet and exercise).     

Childhood Obesity in Secondary Care: National Prospective Audit of Australian Pediatric Practice

ObjectiveIn many countries, pediatricians offer skilled secondary care for children with conditions more challenging than can readily be managed in the primary care sector, but the extent to which this sector engages with the detection and management of obesity remains largely unexplored. This study aimed to audit the prevalence, diagnosis, patient, and consultation characteristics of obesity in Australian pediatric practices.MethodsThis was a national prospective patient audit in Australia. During the course of 2 weeks, members of the Australian Paediatric Research Network prospectively recorded consecutive outpatient consultations by using a brief standardized data collection form. Measures included height, weight, demographics, child and parent health ratings, diagnoses, referrals, investigations, and consultation characteristics. We compared the prevalence of pediatrician-diagnosed and measured obesity (body mass index ≥95th percentile) and top-ranked diagnoses, patient, and consultation characteristics in (a) obese and nonobese children, and (b) obese children with and without a diagnosis.ResultsA total of 198 pediatricians recorded 5466 consultations with 2–17 year olds, with body mass index z-scores calculated for 3436 (62.9%). Of the 12.6% obese children, only one-third received an “overweight/obese” diagnosis. Obese children diagnosed as overweight/obese were heavier, older, and in poorer health than those not diagnosed and incurred more Medicare (government-funded health system) cost and referrals.ConclusionsObesity is infrequently clinically diagnosed by Australian pediatricians and measurement practices vary widely. Further research could focus on supporting and normalizing clinical obesity activities from which pediatricians and parents could see clear benefits.     

Significance of gender of obese children and body weight of parents and siblings for the results of the treatment of obesity in childhood

We studied the influence of family size, family history of obesity, and the obese children's sex on the short and medium term outcome of an obesity therapy in children aged 10.7 +/- 3 years with mean percentage overweight of 41.4 +/- 16.9%. Family parameters such as obesity on other family members, single child families, and sex of the obese children did not influence the decision to stop or to complete therapy. Boys were more successful in weight reduction than girls both after 3-6 months and after 3-5 years; the difference being not significant, however. Children without family history initially were significantly less overweight than those with familial obesity, and they exhibited the best short and medium term results. Children of obese families initially were the fattest ones. They reduced their weight more than average, but they tended to regain weight during the following 3-5 years, reaching the highest levels of overweight after that time. Children without family history of obesity did not regain weight, however. Thus even after good short term results obese children of obese parents should be regarded at risk for relapse and should be checked for years after therapy to prevent weight regain.     

Dietitians and exercise professionals in a childhood obesity treatment team

There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given.
Conclusion: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.     

Dietitians and exercise professionals in a childhood obesity treatment team

There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given. Conclusion: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.     

Treatment of childhood obesity in obese families

BACKGROUND: Parental obesity reduces the likelihood of a multidisciplinary childhood obesity program to succeed, suggesting that special family-based interventions should be constructed for obese children from obese families. AIM: To examine the effects of an intense combined 3-month familial dietary-behavioral-physical activity intervention for a subgroup of obese children (BMI >95th percentile) from obese families (parental BMI >27 kg/m2) compared to a control group of obese children and obese parents who did not participate in the combined intervention. CHILDREN: Twenty-two obese children were randomly assigned to the intervention (n = 11) or control (n = 11) group. Anthropometric measurements, body composition, dietary and activity habits and fitness levels were measured before and at the end of a 3-month intervention. RESULTS: The intervention led to a significant difference in change in body weight (-0.2 +/- 0.3 vs 1.7 +/- 0.6 kg; p <0.05), BMI percentiles (-1.4 +/- 0.5 vs -0.1 +/- 0.2%; p <0.05), and to a decrease in screen (television and computer) time (-2.2 +/- 0.6 vs 0.1 +/- 0.3 h/day; p <0.05) in the intervention group compared to the controls. In addition, the intervention led to a significant improvement in fitness level determined by endurance time (181 +/- 30 vs 26 +/- 63 seconds in the intervention vs control group, respectively; p <0.05). CONCLUSION: Obese children from obese families pose a therapeutic challenge to health care providers. Intense family-oriented multidisciplinary weight management intervention should be designed for treatment in this unique population.     

Psychological Aspects of Obesity in Children and Adolescents

Childhood obesity is multi factorial health condition, so the simple evaluation of body fat will not be sufficed to manage the global epidemic of childhood obesity. Literature consistently provides evidence for physical health risks associated with childhood obesity; however in recent times, mental health of the obese children has also gained attention of the researchers as well as clinicians. Obese children experience number of psycho-social problems that significantly affect their quality of life and wellbeing. Co-morbid psychosocial and emotional problems of obesity generally act as causal or maintaining factors of obesity and thus significantly affect the treatment outcome. Therefore it becomes imperative for the clinicians/pediatricians to broaden their clinical assessment and include screening of important psycho-social factors within the clinical examination of childhood obesity. This article provides an evidence based comprehensive overview about the psychological factors and psychiatric factors (depression, anxiety, eating disorder, stress, body shape concerns, low self esteem) associated with childhood obesity that can further be utilized in the evaluation and management of this epidemic. The article also elaborates the role of current evidence based psychological approaches such as Cognitive Behavior Therapy (CBT) for management of obesity in children and adolescents. CBT techniques combined with lifestyle intervention and involving parents have been recommended by literature repetitively. However, there are a number of environmental, familial and personal barriers that hinder the whole process of weight loss in children. The article also discusses potential strategies to overcome those barriers.