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Journal For Healthcare Quality :... 2014Pediatric obesity treatment programs report high attrition rates, but it is unknown if family experience and satisfaction contributes. This review surveys the literature... (Review)
Review
Pediatric obesity treatment programs report high attrition rates, but it is unknown if family experience and satisfaction contributes. This review surveys the literature regarding satisfaction in pediatric obesity and questions used in measurement. A systematic review of the literature was conducted using Medline, PsychINFO, and CINAHL. Studies of satisfaction in pediatric weight management were reviewed, and related studies of obesity were included. Satisfaction survey questions were obtained from the articles or from the authors. Eighteen studies were included; 14 quantitative and 4 qualitative. Only one study linked satisfaction to attrition, and none investigated the association of satisfaction and weight outcomes. Most investigations included satisfaction as a secondary aim or used single-item questions of overall satisfaction; only one assessed satisfaction in noncompleters. Overall, participants expressed high levels of satisfaction with obesity treatment or prevention programs. Surveys focused predominantly on overall satisfaction or specific components of the program. Few in-depth studies of satisfaction with pediatric obesity treatment have been conducted. Increased focus on family satisfaction with obesity treatment may provide an avenue to lower attrition rates and improve outcomes. Enhancing measurement of satisfaction to yield actionable responses could positively influence outcomes, and a framework, via patient-centered care principles, is provided.
Topics: Adolescent; Child; Child, Preschool; Family; Humans; Patient Dropouts; Pediatric Obesity; Personal Satisfaction
PubMed: 23414547
DOI: 10.1111/jhq.12003 -
The Cochrane Database of Systematic... Jun 2017Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages.
OBJECTIVES
To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases.
SELECTION CRITERIA
We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN RESULTS
We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials.
AUTHORS' CONCLUSIONS
Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
Topics: Behavior Therapy; Body Mass Index; Child; Combined Modality Therapy; Exercise; Humans; Overweight; Pediatric Obesity; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 28639319
DOI: 10.1002/14651858.CD012651 -
Pediatric Obesity Dec 2015Mobile health (mHealth) is a relatively nascent field, with a variety of technologies being explored and developed. Because of the explosive growth in this field, it is... (Review)
Review
Mobile health (mHealth) is a relatively nascent field, with a variety of technologies being explored and developed. Because of the explosive growth in this field, it is of interest to examine the design, development and efficacy of various interventions as research becomes available. This systematic review examines current use of mHealth technologies in the prevention or treatment of pediatric obesity to catalogue the types of technologies utilized and the impact of mHealth to improve obesity-related outcomes in youth. Of the 4021 articles that were identified, 41 articles met inclusion criteria. Seventeen intervention studies incorporated mHealth as the primary or supplementary treatment. The remaining articles were in the beginning stages of research development and most often described moderate-to-high usability, feasibility and acceptability. Although few effects were observed on outcomes such as body mass index, increases in physical activity, self-reported breakfast and fruit and vegetable consumption, adherence to treatment, and self-monitoring were observed. Findings from this review suggest that mHealth approaches are feasible and acceptable tools in the prevention and treatment of pediatric obesity. The large heterogeneity in research designs highlights the need for more agile scientific processes that can keep up with the speed of technology development.
Topics: Body Mass Index; Cell Phone; Child; Humans; Pediatric Obesity; Telemedicine; Wireless Technology
PubMed: 25641770
DOI: 10.1111/ijpo.12002 -
International Journal of Obesity (2005) Feb 2024Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are potentially obesogenic for children. We undertook a systematic review to synthesize this literature and explore... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are potentially obesogenic for children. We undertook a systematic review to synthesize this literature and explore sources of heterogeneity in previously published epidemiological studies.
METHODS
Studies that collected individual-level PFAS and anthropometric data from children up to 12 years of age were identified by searching six databases. We excluded studies that only evaluated obesity measures at the time of birth. A full-text review and quality assessment of the studies was performed using the Office of Health Assessment and Translation (OHAT) criteria. Forest plots were created to summarize measures of association and assess heterogeneity across studies by chemical type and exposure timing. Funnel plots were used to assess small-study effects.
RESULTS
We identified 24 studies, of which 19 used a cohort design. There were 13 studies included in the meta-analysis examining various chemicals and outcomes. Overall prenatal exposures to four different types of PFAS were not statistically associated with changes in body mass index (BMI) or waist circumference. In contrast, for three chemicals, postnatal exposures were inversely related to changes in BMI (i.e., per log10 increase in PFOS: BMI z-score of -0.16 (95% CI: -0.22, -0.10)). There was no substantial heterogeneity in the reported measures of association within prenatal and postnatal subgroups. We observed modest small-study effects, but correction for these effects using the Trim and Fill method did not change our summary estimate(s).
CONCLUSION
Our review found no evidence of a positive association between prenatal PFAS exposure and pediatric obesity, whereas an inverse association was found for postnatal exposure. These findings should be interpreted cautiously due to the small number of studies. Future research that can inform on the effects of exposure mixtures, the timing of the exposure, outcome measures, and the shape of the exposure-response curve is needed.
Topics: Pregnancy; Child; Female; Humans; Pediatric Obesity; Body Mass Index; Fluorocarbons; Environmental Pollutants
PubMed: 37907715
DOI: 10.1038/s41366-023-01401-6 -
The Cochrane Database of Systematic... Mar 2014The prevalence of overweight and obesity in childhood and adolescence is high. Excessive body fat at a young age is likely to persist into adulthood and is associated... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The prevalence of overweight and obesity in childhood and adolescence is high. Excessive body fat at a young age is likely to persist into adulthood and is associated with physical and psychosocial co-morbidities, as well as lower cognitive, school and later life achievement. Lifestyle changes, including reduced caloric intake, decreased sedentary behaviour and increased physical activity, are recommended for prevention and treatment of child and adolescent obesity. Evidence suggests that lifestyle interventions can benefit cognitive function and school achievement in children of normal weight. Similar beneficial effects may be seen in overweight or obese children and adolescents.
OBJECTIVES
To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function and future success in overweight or obese children and adolescents compared with standard care, waiting list control, no treatment or attention control.
SEARCH METHODS
We searched the following databases in May 2013: CENTRAL, MEDLINE, EMBASE, CINAHL Plus, PsycINFO, ERIC, IBSS, Cochrane Database of Systematic Reviews, DARE, ISI Conference Proceedings Citation Index, SPORTDiscus, Database on Obesity and Sedentary Behaviour Studies, Database of Promoting Health Effectiveness Reviews (DoPHER) and Database of Health Promotion Research. In addition, we searched the Network Digital Library of Theses and Dissertations (NDLTD), three trials registries and reference lists. We also contacted researchers in the field.
SELECTION CRITERIA
We included (cluster) randomised and controlled clinical trials of lifestyle interventions for weight management in overweight or obese children three to 18 years of age. Studies in children with medical conditions known to affect weight status, school achievement and cognitive function were excluded.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, extracted data, assessed quality and risk of bias and cross-checked extracts to resolve discrepancies when required. Authors were contacted to obtain further study details and were asked to provide data on the overweight and obese study population when they were not reported separately.
MAIN RESULTS
Of 529 screened full-text articles, we included in the review six studies (14 articles) of 674 overweight and obese children and adolescents, comprising four studies with multicomponent lifestyle interventions and two studies with physical activity only interventions. We conducted a meta-analysis when possible and a sensitivity analysis to consider the impact of cluster-randomised controlled trials and/or studies at 'high risk' of attrition bias on the intervention effect. We prioritised reporting of the sensitivity analysis when risk of bias and differences in intervention type and duration were suspected to have influenced the findings substantially. Analysis of a single study indicated that school-based healthy lifestyle education combined with nutrition interventions can produce small improvements in overall school achievement (mean difference (MD) 1.78 points on a scale of zero to 100, 95% confidence interval (CI) 0.8 to 2.76; P < 0.001; N = 321; moderate-quality evidence). Single component physical activity interventions produced small improvements in mathematics achievement (MD 3.00 points on a scale of zero to 200, 95% CI 0.78 to 5.22; P value = 0.008; one RCT; N = 96; high-quality evidence), executive function (MD 3.00, scale mean 100, standard deviation (SD) 15, 95% CI 0.09 to 5.91; P value = 0.04; one RCT; N = 116) and working memory (MD 3.00, scale mean 100, SD 15, 95% CI 0.51 to 5.49; P value = 0.02; one RCT; N = 116). No evidence suggested an effect of any lifestyle intervention on reading, vocabulary and language achievements, attention, inhibitory control and simultaneous processing. Pooling of data in meta-analyses was restricted by variations in study design. Heterogeneity was present within some meta-analyses and may have been explained by differences in types of interventions. Risk of bias was low for most assessed items; however in half of the studies, risk of bias was detected for attrition, participant selection and blinding. No study provided evidence of the effect of lifestyle interventions on future success. Whether changes in academic and cognitive abilities were connected to changes in body weight status was unclear because of conflicting findings and variations in study design.
AUTHORS' CONCLUSIONS
Despite the large number of childhood obesity treatment trials, evidence regarding their impact on school achievement and cognitive abilities is lacking. Existing studies have a range of methodological issues affecting the quality of evidence. Multicomponent interventions targeting physical activity and healthy diet could benefit general school achievement, whereas a physical activity intervention delivered for childhood weight management could benefit mathematics achievement, executive function and working memory. Although the effects are small, a very large number of children and adolescents could benefit from these interventions. Therefore health policy makers may wish to consider these potential additional benefits when promoting physical activity and healthy eating in schools. Future obesity treatment trials are needed to examine overweight or obese children and adolescents and to report academic and cognitive as well as physical outcomes.
Topics: Achievement; Adolescent; Child; Educational Status; Executive Function; Exercise; Humans; Life Style; Mathematics; Overweight; Pediatric Obesity; Randomized Controlled Trials as Topic; Sensitivity and Specificity
PubMed: 24627300
DOI: 10.1002/14651858.CD009728.pub2 -
PLoS Neglected Tropical Diseases Feb 2018Severe dengue infection often has unpredictable clinical progressions and outcomes. Obesity may play a role in the deterioration of dengue infection due to stronger body... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Severe dengue infection often has unpredictable clinical progressions and outcomes. Obesity may play a role in the deterioration of dengue infection due to stronger body immune responses. Several studies found that obese dengue patients have a more severe presentation with a poorer prognosis. However, the association was inconclusive due to the variation in the results of earlier studies. Therefore, we conducted a systematic review and meta-analysis to explore the relationship between obesity and dengue severity.
METHODS
We performed a systematic search of relevant studies on Ovid (MEDLINE), EMBASE, the Cochrane Library, Web of Science, Scopus and grey literature databases. At least two authors independently conducted the literature search, selecting eligible studies, and extracting data. Meta-analysis using random-effects model was conducted to compute the pooled odds ratio with 95% confidence intervals (CI).
FINDINGS
We obtained a total of 13,333 articles from the searches. For the final analysis, we included a total of fifteen studies among pediatric patients. Three cohort studies, two case-control studies, and one cross-sectional study found an association between obesity and dengue severity. In contrast, six cohort studies and three case-control studies found no significant relationship between obesity and dengue severity. Our meta-analysis revealed that there was 38 percent higher odds (Odds Ratio = 1.38; 95% CI:1.10, 1.73) of developing severe dengue infection among obese children compared to non-obese children. We found no heterogeneity found between studies. The differences in obesity classification, study quality, and study design do not modify the association between obesity and dengue severity.
CONCLUSION
This review found that obesity is a risk factor for dengue severity among children. The result highlights and improves our understanding that obesity might influence the severity of dengue infection.
Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Male; Obesity; Odds Ratio; Prognosis; Risk Factors; Severe Dengue; Severity of Illness Index
PubMed: 29415036
DOI: 10.1371/journal.pntd.0006263 -
Pediatrics Feb 2017Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention... (Review)
Review
CONTEXT
Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research.
OBJECTIVE
This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years).
DATA SOURCES
A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*).
STUDY SELECTION
Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study.
DATA EXTRACTION
Two authors independently extracted data using a predefined template.
RESULTS
The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement.
LIMITATIONS
The review was limited to RCTs published in English peer-reviewed journals over a 10-year period.
CONCLUSIONS
Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers.
Topics: Adolescent; Behavior Therapy; Child; Child, Preschool; Father-Child Relations; Female; Humans; Infant; Male; Mother-Child Relations; Parenting; Pediatric Obesity; Randomized Controlled Trials as Topic; Risk Factors; Single-Parent Family
PubMed: 28130430
DOI: 10.1542/peds.2016-2635 -
Genes Jun 2021Obesity is a chronic disease, which needs to be early detected early and treated in order prevent its complications. Changes in telomere length (TL) have been associated...
Obesity is a chronic disease, which needs to be early detected early and treated in order prevent its complications. Changes in telomere length (TL) have been associated with obesity and its complications, such as diabetes mellitus and metabolic syndrome. Therefore, we conducted a systematic review to summarize results of studies that have measured TL in children and adolescents with obesity. Fourteen studies aiming to assess TL in pediatric patients with either obesity or who were overweight were included in this review. In conclusion, obesity and adiposity parameters are negatively associated with TL. Shorter telomeres are observed in children with obesity compared with their lean counterparts. Factors involved in obesity etiology, such as diet and physical activity, may contribute to maintenance of TL integrity. In the long term, TL change could be used as a biomarker to predict response to obesity treatment.
Topics: Adolescent; Child; Humans; Pediatric Obesity; Telomere Homeostasis
PubMed: 34205609
DOI: 10.3390/genes12060946 -
Obesity Facts 2016The increasing prevalence of paediatric obesity and related metabolic complications has been mainly associated with lower aerobic fitness while less is known regarding... (Review)
Review
The increasing prevalence of paediatric obesity and related metabolic complications has been mainly associated with lower aerobic fitness while less is known regarding potential musculoskeletal impairments. The purpose of the present systematic review was to report the evidence regarding muscular fitness in children and adolescents with obesity. A systematic article search was conducted between November 2014 and June 2015 using MEDLINE, EMBASE, CINAHL psycINFO, SPORTDiscus and SocINDEX. Articles published in English and reporting results on muscle strength and muscular fitness in children and adolescents aged 6 to 18 years were eligible. Of 548 identified titles, 36 studies were included for analyses. While laboratory-based studies described higher absolute muscular fitness in youth with obesity compared with their lean peers, these differences are negated when corrected for body weight and lean mass, then supporting field-based investigations. All interventional studies reviewed led to improved muscular fitness in youth with obesity. Children and adolescents with obesity display impaired muscular fitness compared to healthy-weight peers, which seems mainly due to factors such as excessive body weight and increased inertia of the body. Our analysis also points out the lack of information regarding the role of age, maturation or sex in the current literature and reveals that routinely used field tests analysing overall daily muscular fitness in children with obesity provide satisfactory results when compared to laboratory-based data.
Topics: Body Weight; Europe; Female; Humans; Male; Muscle Strength; Pediatric Obesity; Physical Fitness; Weight Gain
PubMed: 26901423
DOI: 10.1159/000443687 -
BMJ Clinical Evidence Apr 2011Obesity is the result of long-term energy imbalances, where daily energy intake exceeds daily energy expenditure. Along with long-term health problems, obesity in... (Review)
Review
INTRODUCTION
Obesity is the result of long-term energy imbalances, where daily energy intake exceeds daily energy expenditure. Along with long-term health problems, obesity in children may also be associated with psychosocial problems, including social marginalisation, low self-esteem, and impaired quality of life. Most obese adolescents stay obese as adults. Obesity is increasing among children and adolescents, with 16.8% of boys and 15.2% of girls in the UK aged 2 to 15 years obese in 2008.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of lifestyle interventions for the treatment of childhood obesity? What are the effects of surgical interventions for the treatment of childhood obesity? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 14 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following lifestyle interventions: behavioural, diet, and multifactorial interventions; physical activity; and bariatric surgery.
Topics: Bariatric Surgery; Child; Energy Metabolism; Humans; Life Style; Obesity; Pediatric Obesity; Quality of Life
PubMed: 21463538
DOI: No ID Found