Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going?

Lenders, Carine; Manders, Aaron; Perdomo, Joanna; Ireland, Kathy; Barlow, Sarah E.

doi:10.1007/s13679-016-0210-2

Cited by 10 publications

(5 citation statements)

References 89 publications

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“…However, in this pilot study we sought to conduct an intervention in a real-world primary care setting that would likely have limited resources in terms of incentives for patients participating, as well as limited professional staff available to support a treatment intervention. Previous research has documented similar findings of low enrollment and high attrition in real-world childhood obesity treatment settings and identified a great need for additional research in these settings [22][23][24][25].…”

Section: Discussionmentioning

confidence: 71%

Primary Care Practice-Based Framework for Childhood Obesity Treatment Utilizing Health Coaching and a Behavioral Screening Tool: the My Health, My Way! Randomized Controlled Pilot Trial

2022

Arch Pediatr

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Background: Childhood obesity treatment recommendations promote utilization of screening tools, motivational interviewing, and support staff to facilitate lifestyle behavior change with children and families through a staged approach. While these recommendations are evidence-based and have been in place for over a decade, little research has been done to explore the utilization and effectiveness of the framework in real-world primary care settings. Objective: The purpose of the My Health, My Way! (MHMW) pilot study was to determine the effectiveness of a primary care practice-based framework for childhood obesity treatment on behaviors related to nutrition, physical activity, sleep, and screen time. Methods: Families of pediatric patients at a primary care practice in the Midwest were invited to participate if the child was 5-12 years of age and had a body mass index (BMI) ≥ 85th percentile. Participants were randomized to standard of care (control) or a six-month intervention, which involved monthly health coaching sessions utilizing the Family Nutrition and Physical Activity (FNPA) screening tool. Outcome measures included FNPA score, BMI percentile, and BMI z-score. Results: Thirty-five participants enrolled and 28 completed baseline measures. Participants in the intervention group had greater increases in FNPA scores than the control group for those that completed the study, though not significantly different (4.86 ± 6.28 versus 0.38 ± 4.6; p = 0.135). However, the effect size (d = 0.88) is considered to be large. There was a significantly greater mean change score on the FNPA subscale of family eating practices (intervention 0.57 ± 0.54, control -0.13 ± 0.41; p = 0.041). Conclusions: A primary care practice-based framework for childhood obesity treatment utilizing health coaching and a behavioral screening tool may be effective for facilitating lifestyle behavior change with children and families. Additional study is needed to examine retention strategies in real-world primary care interventions.

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Section: Discussionmentioning

confidence: 71%

Primary Care Practice-Based Framework for Childhood Obesity Treatment Utilizing Health Coaching and a Behavioral Screening Tool: the My Health, My Way! Randomized Controlled Pilot Trial

2022

Arch Pediatr

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“…In our study, 33.9% of children dropped out, which is slightly lower than the median of 37% found in a review on paediatric obesity management by Dhaliwal et al 23 This is noteworthy because children in deprived areas, as compared with nondeprived areas, are usually less likely to complete a weight-loss intervention programme. 5 , 7 , 11 However, there is still substantial room for improvement. Previous research showed that children who have parents who are more involved, adhere better to the intervention and lose significantly more weight.…”

Section: Discussionmentioning

confidence: 99%

“… 2 The limited effectiveness of these intervention programmes is often thought to be the result of low compliance 3–6 and high dropout rates. 7 …”

Section: Introductionmentioning

confidence: 99%

Determinants of dropout and compliance of children participating in a multidisciplinary intervention programme for overweight and obesity in socially deprived areas

Hassan

Henkemans

Teeffelen³

et al. 2022

Family Practice

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Background Children with overweight and obesity in socially deprived areas (SDAs) are less likely to complete and be compliant to a weight-loss programme. Objectives To identify factors associated with dropout and compliance of a multidisciplinary weight-loss programme in SDA. Methods This prospective longitudinal cohort study included children (6–12 years) with overweight and obesity in a 12-week multidisciplinary intervention living in SDA in Rotterdam, the Netherlands. Potential predictive variables for dropout and compliance included were age, sex, the weight of the child and parents, quality of life, and referral status (self-registration or referral). A Cox proportional hazards model was performed to study the association between dropout and its potential predictive variables, whereas logistic regression analyses were used for the potential predictors for compliance. Results A total of 121 children started the intervention programme. Forty-one (33.9%) children dropped out and 68 (56.2%) were compliant with the intervention. The risk of dropping out of the intervention was significantly lower for a child with overweight parents than for those with parents with normal weight (adjusted hazard ratio [HR] 0.22 [95% confidence interval, CI 0.063–0.75]), and for those with parents with obesity (adjusted HR 0.18 [95% CI 0.060–0.52]). No other potential predictive variables were associated with dropout or compliance. Conclusion Children from SDA participating in a weight-loss programme have a relatively high dropout and a low compliance rate. Parental weight seems to be an important predictor for dropout of children from SDA, where children with normal weight or obese parents have the highest risk of dropout compared with children of overweight parents.

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“…It has been reported that medical students feel unfamiliar with obesity prevention and treatment. Self-reporting by pediatricians and primary care physicians demonstrated they also feel unprepared to successfully provide care to children with obesity (9)(10)(11).…”

Section: Study Importancementioning

confidence: 99%

Exploring Pediatric Obesity Training, Perspectives, and Management Patterns Among Pediatric Primary Care Physicians

Reyes

Perez

Czepiel

et al. 2020

Obesity

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Objective: Significant variability exists in the amount of formal obesity training obtained by physicians caring for pediatric patients. The study objective was to assess the relationship between formal obesity training and pediatrics physicians' perceptions, practice patterns, overall knowledge, and confidence during management of pediatric obesity. Methods: An anonymous survey was distributed via email from February 2020 through March 2020 at a large academic system. Internal medicine/pediatrics (46 total) and pediatrics (104 total) primary care providers were selected. Data were collected on the total number of obesity-related training hours by quartiles, demographics, physicians' clinical practice patterns, and physicians' knowledge of pediatric obesity management, along with their perceptions, attitudes, and beliefs. Results: A total of 73 survey participants completed the survey: 69% were female, 77% were older than 40 years, and 74% were White. Physicians with the highest training were most likely to feel confident when managing pediatric obesity. However, only 20% of all physicians felt confident providing pre-and post-bariatric surgery care, and just 6% of physicians self-reported achieving management success. Conclusions: Increased obesity training improves physicians' confidence and leads to familiarity with management guidelines. Formal obesity training should be prioritized during residency and beyond so that physicians who care for pediatric patients are better equipped to offer unbiased and effective care.

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Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going?

Cited by 10 publications

References 89 publications

Primary Care Practice-Based Framework for Childhood Obesity Treatment Utilizing Health Coaching and a Behavioral Screening Tool: the My Health, My Way! Randomized Controlled Pilot Trial

Primary Care Practice-Based Framework for Childhood Obesity Treatment Utilizing Health Coaching and a Behavioral Screening Tool: the My Health, My Way! Randomized Controlled Pilot Trial

Determinants of dropout and compliance of children participating in a multidisciplinary intervention programme for overweight and obesity in socially deprived areas

Exploring Pediatric Obesity Training, Perspectives, and Management Patterns Among Pediatric Primary Care Physicians

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