Childhood obesity interventions
Berge, phd, lmft, department of family medicine and community health, university of minnesota, phillips wangensteen building, 516 delaware street se, minneapolis, mn 55455, email:email: @9000lhomauthor information ► copyright and license information ►copyright 2011, mary ann liebert, article has been cited by other articles in ctbackground: with the rising prevalence of childhood obesity over the last several decades, and the call for more family-based intervention research to combat childhood obesity, it is important to examine the extant research on family-based interventions in order to make recommendations and improve future ive: to conduct a meta-analysis of family-based interventions targeting childhood obesity in the last decade in order to inform the research in the next s: a literature review was conducted between december 2009-april 2010. Studies published between the years 2000–2009 that used family-based interventions to treat childhood obesity were included. Change in secondary variables (dietary intake, sugar-sweetened beverage intake, physical activity) were substantially different between studies and are reported as sion: to date, there is preliminary evidence suggesting that family-based interventions targeting childhood obesity are successful in producing weight loss in the short and long-term. Limitations with the research, recommendations for future research, and implications for practitioners working with overweight/obese children are uctionover the last two decades obesity prevalence in children has more than doubled,1–3 childhood overweight and obesity are associated with increased risk for adverse health problems, including hypertension, cardiovascular disease, metabolic syndrome, and type ii diabetes. These expert panels and committees, along with other researchers, have identified family involvement in the treatment of childhood obesity as a neglected area of research and have called for more family-based interventions. 10 thus, the purpose of this meta-analysis is to assess the state of the science on family-based interventions targeting childhood obesity in the last decade, in order to determine the success of these interventions and inform research in the next systems theoryfamily systems theory indicates that families live in complex systems in which multiple interactions occur simultaneously. These mutually influencing patterns within the family are important to consider when designing childhood obesity interventions because targeting child health behaviors may be contingent on family interactions and modeling. Thus, this meta-analysis uses family systems theory to guide the understanding of findings from family-based interventions used in treating childhood obesity in the last of the researchprior to the year 2000there have been very few family-based interventions to treat childhood obesity prior to the year 2000. 14,15 family-based interventions include the target children and one or more family member(s) directly involved in the treatment intervention. The most successful family-based obesity treatment interventions have been conducted by epstein and his colleagues in a clinical setting using the stoplight diet. Thus, this meta-analysis focuses on studies conducted in the last decade in order to identify the state of the research on family-based interventions during the time when calls for family-based interventions were sstudy abstractionwe followed the recommendations of lipsey and wilson for study abstraction. Searches were performed on pubmed, medline, psycinfo, cochrane library, cinahl and social science abstracts search engines using various combinations of the following key terms: child, childhood, obesity, overweight, family, family-based, parent, treatment, weight-loss, interventions. Second, the tables of content for journals that commonly publish in childhood obesity studies were reviewed (e. Journal of pediatrics, preventive medicine, journal of pediatric psychology, journal of family psychology, american journal of public health, journal of the american dietetic association, obesity). Fourth, established researchers in the field of childhood obesity treatment were contacted and asked for copies of unpublished articles (under review or in press). Based intervention studies to reduce childhood overweight/obesity included in the meta-analysisinclusion/exclusion criteriastudies were selected for inclusion in the meta-analysis if they met the following criteria: 1) published in peer-reviewed journals between 2000 and 2009; 2) written in english; 3) studies were childhood obesity interventions (treatment not prevention). Studies were not required to be randomized control trials (rct's) because this is a relatively new area of research and there were few rct's that included family members directly in interventions; 4) included a member or members of the target child's family in the intervention; the parent or family member component was defined as an intervention strategy that directly engaged parent or family member support or assistance in child health behavior change; 5) recruited children between the ages 5–18; and 6) included pre- and post- measurements of body mass index (bmi) (e. Due to the relatively small amount of studies using family-based interventions, we included all available studies in the meta-analysis as a first step in understanding the existing literature on family-based treatment extractiondata from the studies were extracted using standardized forms developed by the authors. Variablesa number of studies examined links between family-based interventions for child obesity and secondary health outcomes for the target child(ren), such as fruit/vegetable intake, consumption of water and sugar-sweetened beverages, physical activity and sedentary behaviors.
None of the reviewed articles compared changes in secondary health variables between two treatment sionthe main aim of this meta-analysis was to identify the state of the research on family-based interventions targeting childhood obesity in the last decade, in order to inform research in the next decade. Thus, the scientific evidence suggests the usefulness of using family-based interventions in childhood obesity treatment. Overall, there has been movement to respond to the calls by expert panels and committees to include the family in childhood obesity interventions. There are still unanswered questions regarding whether it is important if the involved parent is the same-sex or opposite-sex of the target child, or whether the intervention should target only the parent in treating childhood obesity. Long term follow-up studies are important for establishing the success of family-based interventions in producing sustainable weight loss over time in children. With the issue of childhood obesity especially, it is important to be able to show continued weight loss or maintenance in order to counteract the devastating outcomes of adult obesity such as: hypertension, cardiovascular disease, metabolic syndrome, and type ii diabetes. The curriculum used in the family-based interventions included three main components: (1) nutritional and physical activity education, (2) psychoeducational parenting groups, and (3) behavioral control/monitoring of diet and exercise. The interventions that targeted both parenting skills and nutrition/physical activity education showed more statistically significant results with larger effect sizes compared to interventions that used education only or education plus behavioral control/monitoring. This implies the importance of teaching parents both structure/setting limits skills and empathic/caring skills in treating childhood n and colleagues' stoplight diet was used in 40% (8 of 20) of the studies. This is a limitation of the current research on family-based interventions that needs to be addressed. It is well known that ethnic/racial minorities are at highest risk for overweight/obesity. 3 thus, it is crucial to identify family-based interventions that are suitable for children from diverse ethnic/racial and low socioeconomic backgrounds. 48 based on the results of this meta-analysis, and the importance of “family” to many ethnic/racial groups, family-based interventions targeting minority children need to be developed and ement of bmi. Although a few (n=4) studies examined links between family-based childhood obesity interventions and secondary health outcomes (e. These significant findings suggest that it would be important to measure secondary outcomes in childhood obesity intervention research. This is important because it is likely that there are multiple pathways to child weight change, rather than a magic variable or program that will solve the childhood obesity problem. Dietary intake, physical activity) as primary study outcomes, rather than secondary, in childhood obesity treatment studies. As family-based intervention research continues to show significant results for treating childhood obesity, it will be important to use theory in conceptualizing study designs that will allow for sustainability of weight loss in children. Although the last decade has shown an increase in family-based interventions for childhood obesity, more is needed.
More studies, conducted by more researchers, are necessary in order to firmly establish the evidence in favor of family-based interventions. This would help confirm the evidence supporting family-based interventions to target childhood ations for clinical practiceresults from the current meta-analysis provide implications for practitioners who treat children with overweight and obesity issues. First, results suggest that referring children with overweight or obesity concerns to family-based interventions is a good option for practitioners. The current meta-analysis showed moderate to large effect sizes for effectiveness of family-based interventions in reducing child weight. Interventions that include one parent visit, or only send home materials for parents, are not considered family-based interventions. The current meta-analysis showed that including at least one parent in the childhood obesity intervention was important and that the sex of the parent may also be important. In addition, family-based interventions that showed child weight loss in the short and long term were more likely to target weight change/management in the child, as well as, the parent/family. Thus, identifying family-based interventions that include both individual level change and system level change (e. Epstein's stop light diet) would be important in order for practitioners to have resources to provide referrals to families with children who are overweight/gh findings from the met-analysis show positive results for using family-based interventions to combat childhood obesity, family-based interventions or treatment centers are not always readily available to providers. Many pediatric specialty clinics, or clinics located at research universities have family-based obesity treatment programs. In addition, many community mental health clinics are beginning to include obesity treatment options, but it is important to identify whether they are individually-based treatments or family-based treatments. Further, there is likely to be more childhood obesity intervention options available in the near future as the topic has become one of national and international importance. Is preliminary evidence suggesting that family-based interventions treating childhood obesity are successful in producing weight loss in the short and long term. Ogden cl, carroll md, curtin lr, mcdowell ma, tabak cj, flegal ence of overweight and obesity in the united states, 1999–2004. Review of familial correlates of child and adolescent obesity: what has the 21st century taught us so far? Kitzmann km, beech -based interventions for pediatric obesity: methodological and conceptual challenges from family psychology. Epstein lh, paluch ra, roemmich jn, beecher -based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Epstein lh, valoski a, wing rr, mccurley -year outcomes of behavioral family-based treatment for childhood obesity. Germann jn, kischenbaum d, rich and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children.
Levine md, ringham rm, kalarchian ma, wisniewski l, marcus family-based behavioral weight control appropriate for severe pediatric obesity? Goldfield gs, epstein lh, kilanowski ck, paluch ra, kogut-bossler -effectiveness of group and mixed family-based treatment for childhood obesity. Epstein lh, paluch ra, saelens be, ernst mm, wilfley s in eating disorder symptoms with pediatric obesity treatment. Beech bm, klesges r, kumanyika sk, murray dm, klesges l, mcclanahan b, slawson d, nunnally c, rochon j, mclain-allen b, pree-cary - and parent-targeted interventions: the memphis gems pilot study. Epstein lh, paluch ra, raynor differences in obese children and siblings in family-based obesity treatment. Kalavainen mp, korppi mo, nuutinen al efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. Janicke dm, sallinen bj, perri mg, lutes ld, huerta m, silverstein jh, brumback ison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project story. Epstein lh, gordy cc, raynor ha, beddome m, kilanowski ck, paluch sing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Temple jl, wrotniak bh, paluch ra, roemmich jn, epstein onship between sex of parent and child on weight loss and maintenance in a family-based obesity treatment program. Mcgarvey e, keller a, forrester m, williams e, seward d, suttle ility and benefits of a parent-focused preschool child obesity intervention. Danielzik s, pust s, muller -based interventions to prevent overweight and obesity in prepubertal children: process and 4-years outcome evaluation of the kiel obesity prevention study (kops). Barlow committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Katz -based interventions for health promotion and weight control: not just waiting on the world to change. In press [pmc free article] [pubmed]articles from childhood obesity are provided here courtesy of mary ann liebert, s:article | pubreader | epub (beta) | pdf (1. Findings may be used for research purposes, but should not be considered ood obesity is a serious health problem in the united states and worldwide. We assessed the effectiveness of childhood obesity prevention programs by reviewing all interventional studies that aimed to improve diet, physical activity, or both and that were conducted in schools, homes, primary care clinics, childcare settings, the community, or combinations of these settings in high-income countries. Body mass index [bmi], waist circumference, percent body fat, skinfold thickness, prevalence of obesity and overweight); intermediate outcomes (e. Together, the reviewers graded the strength of the evidence (soe) supporting interventions--diet, physical activity, or both--in each setting for the outcomes of interest. The majority of the interventions (104 studies) were school based, although many of them included components delivered in other settings.
Other studies tested interventions delivered at home (n=6), in primary care (n=1), in childcare (n=4), and in the community (n=9). For obesity prevention, the following settings and interventions showed benefit: school-based--diet or physical activity interventions (soe moderate); school-based with a home component--physical activity interventions (soe high) and both diet and physical activity (soe moderate); school-based with home and community components--diet and physical activity interventions (soe high); school-based with a community component--diet and physical activity interventions (soe moderate); community with a school component--diet and physical activity interventions (soe moderate). The strength of the evidence is either low or insufficient for the remainder of the interventions and evidence is moderate about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity interventions in a school-based setting with a family component or diet and physical activity interventions in a school-based setting with home and community components have the most evidence for effectiveness. More research is needed to test interventions in other settings, such as those testing policy, environmental, and consumer health informatics l, wu y, wilson rf, et al. Pmid: ch protocol december 20, ood obesity prevention programs: a comparative effectiveness review and y: three interventions that reduce childhood obesity are projected to save more than they cost to implement. Choices paper identifying cost-effective nutrition interventions with broad population reach highlights the importance of primary prevention for policy makers aiming to reduce childhood interventions that reduce childhood obesity are projected to save more than they cost to ker sl, claire wang y, long mw, giles cm, ward zj, barrett jl, kenney el, sonneville kr, afzal as, resch sc, cradock affairs, 34, no. 11 (2015): united states will not be able to treat its way out of the obesity epidemic with current clinical practice. Instead, reversing the tide of obesity will require expanded investment in primary prevention, focusing on a combination of interventions with broad population reach, proven individual effectiveness, and low cost of study is the first of its kind to estimate the cost effectiveness of a wide variety of nutrition interventions high on the obesity policy agenda—documenting their potential reach, comparative effectiveness, implementation cost, and cost-effectiveness. Researchers identified three interventions that would more than pay for themselves by reducing healthcare costs related to obesity: an excise tax on sugar-sweetened beverages; elimination of the tax subsidy for advertising unhealthy food to children; and nutrition standards for food and drinks sold in schools outside of school meals. The projected net savings to society in obesity-related health care costs for each dollar spent would be $30. Onal interventions modeled include restaurant menu calorie labeling, increased access to adolescent bariatric surgery, improved early care and education, and nutrition standards for school meals. The study points out that the improvements in nutrition standards for both school meals and foods and beverages sold outside of meals through current smart snacks in school regulation make the healthy, hunger-free kids act of 2010 one of the most important national obesity prevention policy achievements in recent researchers analyzed interventions separately, no strategy on its own would be sufficient to reverse the obesity epidemic. The study also emphasizes the importance of obesity prevention that spans across multiple settings throughout the life course. While childhood interventions are necessary to reduce obesity during the early years of life and ensure that children enter into adulthood at a healthy weight, it is critical that environments spanning the life course continue to support healthy eating and drinking behaviors. Policy makers looking to reverse the childhood obesity epidemic and reduce long-term obesity prevalence need to focus on implementing cost-effective preventive interventions that reach a large percentage of our nation’s children,” says lead investigator of the choices project, dr. Chan school of public study notes that interventions affecting both children and adults are particularly attractive, since near-term health care cost savings can be achieved by reducing adult obesity, while laying the ground work for long-term cost savings by reducing childhood obesity. Billion in net costs over the course of the decade, primarily due to reductions in adult health care entions that can achieve near-term health cost savings among adults and reduce childhood obesity offer policy makers an opportunity to make long-term investments in children’s health while generating short-term y: three interventions that reduce childhood obesity are projected to save more than they cost to implement. Billion in net costs over the course of the decade, primarily due to reductions in adult health care entions that can achieve near-term health cost savings among adults and reduce childhood obesity offer policy makers an opportunity to make long-term investments in children’s health while generating short-term returns.
Article was corrected | view al ative effectiveness of clinical-community childhood obesity interventionsa randomized clinical m. Ial comment d articles interview error and incorrect is the effectiveness of 2 clinical-community interventions in improving child body mass index z score and parent-report of their child’s health-related quality of life? However, no statistically significant differences were found between the 2 intervention interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child body mass approaches to care delivery that leverage clinical and community resources could improve body mass index (bmi) and family-centered examine the extent to which 2 clinical-community interventions improved child bmi z score and health-related quality of life, as well as parental resource empowerment in the connect for health , setting, and 2-arm, blinded, randomized clinical trial was conducted from june 2014 through march 2016, with measures at baseline and 1 year after randomization. And interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child identifier: y in to access your in to your personal utional sign in: openathens | a free personal account to download free article pdfs,Sign up for alerts, and ibe to the in to access your in to your personal a free personal account to access your subscriptions, sign up for alerts, and ibe to learning for one in to download free article in to access your in to your personal utional sign in: openathens | a free personal account to download free article pdfs,Sign up for alerts, and more.