Hot Papers in the Literature

Mobile technology for obesity prevention: A randomized pilot study in racial- and ethnic-minority girls

Am J Prev Med. 2014 Apr;46(4):404–408.

Nollen NL, Mayo MS, Carlson SE, Rapoff MA, Goggin KJ, Ellerbeck EF.

Background: Mobile technologies have wide-scale reach and disseminability, but no known studies have examined mobile technologies as a stand-alone tool to improve obesity-related behaviors of at-risk youth.

Purpose: To test a 12-week mobile technology intervention for use and estimate effect sizes for a fully powered trial.

Methods: Fifty-one low-income, racial/ethnic-minority girls aged 9–14 years were randomized to a mobile technology (n=26) or control (n=25) condition. Both conditions lasted 12 weeks and targeted fruits/vegetables (FVs; Weeks 1–4); sugar-sweetened beverages (SSBs; Weeks 5–8), and screen time (Weeks 9–12). The mobile intervention prompted real-time goal setting and self-monitoring and provided tips, feedback, and positive reinforcement related to the target behaviors. Controls received the same content in a written manual but no prompting. Outcomes included device utilization and effect size estimates of FVs, SSBs, screen time, and BMI. Data were collected and analyzed in 2011–2012.

Results: Mobile technology girls used the program on 63% of days and exhibited trends toward increased FVs (+0.88, p=0.08) and decreased SSBs (–0.33, p=0.09). The adjusted difference between groups of 1.0 servings of FVs ( p=0.13) and 0.35 servings of SSBs ( p=0.25) indicated small to moderate effects of the intervention (Cohen's d=0.44 and −0.34, respectively). No differences were observed for screen time or BMI.

Conclusions: A stand-alone mobile app may produce small to moderate effects for FVs and SSBs. Given the extensive reach of mobile devices, this pilot study demonstrates the need for larger-scale testing of similar programs to address obesity-related behaviors in high-risk youth.

PMID: 24650843 [PubMed - in process]

PMCID: PMC3962588 [Available on 2015/4/1]

The empowerment of low-income parents engaged in a childhood obesity intervention

Fam Community Health. 2014 Apr-Jun;37(2):104–118.

Jurkowski JM, Lawson HA, Green Mills LL, Wilner PG 3rd, Davison KK.

Parents influence children's obesity risk factors but are infrequently targeted for interventions. This study targeting low-income parents integrated a community-based participatory research approach with the Family Ecological Model and Empowerment Theory to develop a childhood obesity intervention. This article (1) examines pre- to postintervention changes in parents' empowerment; (2) determines the effects of intervention dose on empowerment, and (3) determines whether changes in parent empowerment mediate previous changes identified in food-, physical activity-, and screen-related parenting. The pre-post quasi-experimental design evaluation demonstrated positive changes in parent empowerment and empowerment predicted improvement in parenting practices. The integrated model applied in this study provides a means to enhance intervention relevance and guide translation to other childhood obesity and health disparities studies.

PMID: 24569157 [PubMed - indexed for MEDLINE]

Severe obesity in children: Prevalence, persistence and relation to hypertension

Int J Pediatr Endocrinol. 2014 Mar 3;2014(1):3.

Lo JC, Chandra M, Sinaiko A, Daniels SR, Prineas RJ, Maring B, Parker ED, Sherwood NE, Daley MF, Kharbanda EO, Adams KF, Magid DJ, O'Connor PJ, Greenspan LC.

Background: Newer approaches for classifying gradations of pediatric obesity by level of body mass index (BMI) percentage above the 95th percentile have recently been recommended in the management and tracking of obese children. Examining the prevalence and persistence of severe obesity using such methods along with the associations with other cardiovascular risk factors such as hypertension is important for characterizing the clinical significance of severe obesity classification methods.

Methods: This retrospective study was conducted in an integrated healthcare delivery system to characterize obesity and obesity severity in children and adolescents by level of body mass index (BMI) percentage above the 95th BMI percentile, to examine tracking of obesity status over 2–3 years, and to examine associations with blood pressure. Moderate obesity was defined by BMI 100–119% of the 95th percentile and severe obesity by BMI ≥120 %×95th percentile. Hypertension was defined by 3 consecutive blood pressures ≥95th percentile (for age, sex and height) on separate days and was examined in association with obesity severity.

Results: Among 117,618 children aged 6–17 years with measured blood pressure and BMI at a well-child visit during 2007–2010, the prevalence of obesity was 17.9% overall and was highest among Hispanics (28.9%) and blacks (20.5%) for boys, and blacks (23.2%) and Hispanics (21.5%) for girls. Severe obesity prevalence was 5.6% overall and was highest in 12–17 year old Hispanic boys (10.6%) and black girls (9.5%). Subsequent BMI obtained 2–3 years later also demonstrated strong tracking of severe obesity. Stratification of BMI by percentage above the 95th BMI percentile was associated with a graded increase in the risk of hypertension, with severe obesity contributing to a 2.8-fold greater odds of hypertension compared to moderate obesity.

Conclusion: Severe obesity was found in 5.6% of this community-based pediatric population, varied by gender and race/ethnicity (highest among Hispanics and blacks) and showed strong evidence for persistence over several years. Increasing gradation of obesity was associated with higher risk for hypertension, with a nearly three-fold increased risk when comparing severe to moderate obesity, underscoring the heightened health risk associated with severe obesity in children and adolescents.

PMID: 24580759 [PubMed]

PMCID: PMC3976673

Predictors of Head Start and child-care providers' healthful and controlling feeding practices with children aged 2 to 5 years

J Acad Nutr Diet. 2014 Mar 4. pii: S2212–2672(14)00096-3. doi: 10.1016/j.jand.2014.01.006. [Epub ahead of print]

Dev DA, McBride BA, Speirs KE, Donovan SM, Cho HK.

Few child-care providers meet the national recommendations for healthful feeding practices. Effective strategies are needed to address this disparity, but research examining influences on child-care providers' feeding practices is limited. The purpose of this study was to identify determinants of child-care providers' healthful and controlling feeding practices for children aged 2 to 5 years. In this cross-sectional study, child-care providers (n=118) from 24 center-based programs (six Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, and seven non-CACFP) completed self-administered surveys during 2011–2012. Multilevel multivariate linear regression models were used to predict seven feeding practices. Working in an HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards that require HS providers to practice healthful feeding. Providers who reported being concerned about children's weight, being responsible for feeding children, and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children's weight. Providers with nonwhite race, who were trying to lose weight, who perceived nutrition as important in their own diet, and who had a greater number of nutrition training opportunities were more likely to use restrictive feeding practices. These findings suggest that individual- and child-care-level factors, particularly provider race, education, training, feeding attitudes and styles, and the child-care context may influence providers' feeding practices with young children. Considering these factors when developing interventions for providers to meet feeding practice recommendations may add to the efficacy of childhood obesity prevention programs.

PMID: 24618036 [PubMed - as supplied by publisher]

Associations between sugar-sweetened beverage consumption and fast-food restaurant frequency among adolescents and their friends

J Nutr Educ Behav. 2014 Apr 12. pii: S1499–4046(14)00083-9. doi: 10.1016/j.jneb.2014.02.009. [Epub ahead of print]

Bruening M, Maclehose R, Eisenberg ME, Nanney MS, Story M, Neumark-Sztainer D.

Objective: To assess associations between adolescents and their friends with regard to sugar-sweetened beverage (SSB)/diet soda intake and fast-food (FF) restaurant visits.

Design: Population-based, cross-sectional survey study with direct measures from friends.

Setting: Twenty Minneapolis/St Paul schools during 2009–2010.

Participants: Adolescents (n=2,043; mean age, 14.2±1.9 years; 46.2% female; 80% non-white).

Main outcome measures: Adolescent SSB/diet soda intake and FF visits.

Analysis: Generalized estimating equation logistic models were used to examine associations between adolescents' SSB/diet soda intake and FF visits and similar behaviors in nominated friends (friend groups and best friends). School-level (middle vs high school) interactions were assessed.

Results: Significant associations were found between adolescents and friends behaviors for each of the beverages assessed (P<.05), but they varied by friendship type and school level. Five of 6 models of FF visits (including all FF visits) were significantly associated (P<.05) among adolescents and their friends. Significant interactions by school level were present among adolescents' and friends' FF visits, with associations generally for high school participants compared with middle school participants (P<.05).

Conclusions and implications: Findings suggest that for many beverages and FF restaurant types, friends' behaviors are associated, especially FF visits for older adolescents. Nutrition education efforts may benefit by integrating knowledge of the impact of adolescents' friends on FF visits.

PMID: 24735768 [PubMed - as supplied by publisher]

School-wide programs aimed at obesity among Latino youth in the United States: A review of the evidence

J Sch Health. 2014 Apr;84(4):239–246.

Holub CK, Lobelo F, Mehta SM, Sánchez Romero LM, Arredondo EM, Elder JP.

Background: In the past 30 years, childhood obesity rates have tripled, disproportionately affecting Latino children. From 2003 to 2006, 43.0% of Mexican-American children were classified as overweight compared with 36.9% of non-Hispanic Whites. Obesity interventions targeting children can have a significant impact in the school setting.

Methods: We conducted a systematic review of evidence-based, obesity-related interventions in the school setting. Inclusion criteria included: having 50% or more Latino children in the study, and usage of obesity-related outcomes (eg, body mass index [BMI] z-score, weight, and waist circumference, and body fat).

Results: The majority of identified studies included interventions that targeted both nutrition and physical activity. The most successful interventions were randomized, controlled trials or quasi-experimental controlled studies and had few limitations in execution in the study; however, overall results were mixed. There are promising results for interventions targeting Latino children who are already overweight or obese, but evidence of effectiveness is sparse.

Conclusions: This review is the first to gather evidence-based research systematically aimed at obesity-related interventions in the school setting that are specifically focused on Latino children. Results of the review are promising and timely, given the exigency of the needed evidence, and the current state of childhood obesity in the United States.

PMID: 24617907 [PubMed - in process]

The researchers have left the building: What contributes to sustaining school-based interventions following the conclusion of formal research support?

J Sch Health. 2014 May;84(5):326–333.

Friend S, Flattum CF, Simpson D, Nederhoff DM, Neumark-Sztainer D.

Background: This study examined the sustainability of New Moves, a school-based program aimed at decreasing weight-related problems in adolescent girls. The National Cancer Institute recognizes New Moves as a research-tested intervention program that produced positive behavioral and psychosocial outcomes.

Methods: Ten schools participated in the sustainability study. Teachers completed a survey and interview, and research staff observed 1 physical education (PE) class within 2 years of the study's completion. Qualitative data were grouped by themes. Frequencies were calculated using quantitative data.

Results: All schools continued all-girls PE classes using New Moves components following the study period. Fewer schools continued the nutrition and social support classroom modules and individual coaching sessions while no schools continued lunch get-togethers. Program components were sustained in both New Moves intervention schools and control schools.

Conclusions: Programs are most likely to be sustained if they (1) fit into the current school structure, (2) receive buy-in by teachers, and (3) require minimal additional funds or staff time. Providing control schools with minimal training and intervention resources was sufficient to continue program components if staff perceived the program was important for students' health and compatible within the school's existing infrastructure.

PMID: 24707927 [PubMed - in process]

PMCID: PMC3982199 [Available on 2015/5/1]

Association of a television in the bedroom with increased adiposity gain in a nationally representative sample of children and adolescents

JAMA Pediatr. 2014 Mar 3. doi: 10.1001/jamapediatrics.2013.3921. [Epub ahead of print]

Gilbert-Diamond D, Li Z, Adachi-Mejia AM, McClure AC, Sargent JD.

Importance: Obesity affects health in children and adolescents. Television viewing is an established risk factor for obesity in youth. No prospective study has assessed whether a bedroom television confers an additional risk for obesity in youth.

Objective: To assess the prospective association between the presence of a bedroom television and change in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), independent of television viewing, in a nationally representative sample of US children and adolescents.

Design, setting, and participants: We conducted a random-digit prospective telephone survey that captured children and adolescents from across the United States. Participants included 6522 boys and girls aged 10 to 14 years at baseline who were surveyed via telephone about media risk factors for obesity. Weighted regressions assessed adiposity at 2- and 4-year follow-up, controlling for television and movie viewing, video-game playing, parenting, age, sex, race or ethnicity, household income, and parental educational level.

Exposure: Report of having a television in the bedroom at baseline.

Main outcomes and measures: Age-and sex-adjusted BMI based on self-report and parent report of weight and height at 2- and 4-year follow-up.

Results: Distributions for age, sex, race or ethnicity, and socioeconomic status were similar to census estimates for the US population. Sample weighting methods accounted for higher dropout rates among ethnic minorities and those with lower socioeconomic status. Bedroom televisions were reported by 59.1% of participants at baseline, with boys, ethnic minorities, and those of lower socioeconomic status having significantly higher rates. In multivariate analyses, having a bedroom television was associated with an excess BMI of 0.57 (95% CI, 0.31–0.82) and 0.75 (0.38–1.12) at years 2 and 4, respectively, and a BMI gain of 0.24 (0.02–0.45) from years 2 to 4.

Conclusions and relevance: Having a bedroom television is associated with weight gain beyond the effect of television viewing time. This association could be the result of uncaptured effects of television viewing or of disrupted sleep patterns. With the high prevalence of bedroom televisions, the effect attributable to this risk factor among US children and adolescents is excess weight of 8.7 million kg/y.

PMID: 24589630 [PubMed - as supplied by publisher]

Effects of a pediatric weight management program with and without active video games: A randomized trial

JAMA Pediatr. 2014 Mar 3. doi: 10.1001/jamapediatrics.2013.3436. [Epub ahead of print]

Trost SG, Sundal D, Foster GD, Lent MR, Vojta D.

Importance: Active video games may offer an effective strategy to increase physical activity in overweight and obese children. However, the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown.

Objective: To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence-based weight management program delivered in the community.

Design, setting, and participants: Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts, Rhode Island, and Texas. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%).

Interventions: All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program.

Main outcomes and measures: Objectively measured daily moderate-to-vigorous and vigorous physical activity, percentage overweight, and BMI z score.

Results: Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P<.05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P=.04) and vigorous (3.1 [1.3] min/d; P=.02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], −10.9% [1.6%] vs −5.5% [1.5%]; P=.02) and BMI z score (−0.25 [0.03] vs −0.11 [0.03]; P<.001).

Conclusions and relevance: Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight.

Trial registration: clinicaltrials.gov Identifier: NCT01-757925.

PMID: 24589566 [PubMed - as supplied by publisher]

Racial and ethnic differences associated with feeding- and activity-related behaviors in infants

Pediatrics. 2014 Apr;133(4):e857–e867.

Perrin EM, Rothman RL, Sanders LM, Skinner AC, Eden SK, Shintani A, Throop EM, Yin HS.

Objective: To examine parental reports of feeding and activity behaviors in a cohort of parents of 2-month-olds and how they differ by race/ethnicity.

Methods: Parents participating in Greenlight, a cluster, randomized trial of obesity prevention at 4 health centers, were queried at enrollment about feeding and activity behaviors thought to increase obesity risk. Unadjusted associations between race/ethnicity and the outcomes of interest were performed by using Pearson χ(2) and Kruskal-Wallis tests. Adjusted analyses were performed by using proportional odds logistic regressions.

Results: Eight hundred sixty-three parents (50% Hispanic, 27% black, 18% white; 86% Medicaid) were enrolled. Exclusive formula feeding was more than twice as common (45%) as exclusive breastfeeding (19%); 12% had already introduced solid food; 43% put infants to bed with bottles; 23% propped bottles; 20% always fed when the infant cried; 38% always tried to get children to finish milk; 90% were exposed to television (mean, 346 minutes/day); 50% reported active television watching (mean, 25 minutes/day); and 66% did not meet “tummy time” recommendations. Compared with white parents, black parents were more likely to put children to bed with a bottle (adjusted odds ratio [aOR]=1.97, P<.004; bottle propping, aOR=3.1, P<.001), and report more television watching (aOR=1.6, P=.034). Hispanic parents were more likely than white parents to encourage children to finish feeding (aOR=1.9, P=.007), bottle propping (aOR=2.5, P=.009), and report less tummy time (aOR=0.6, P=.037).

Conclusions: Behaviors thought to relate to later obesity were highly prevalent in this large, diverse sample and varied by race/ethnicity, suggesting the importance of early and culturally-adapted interventions.

PMID: 24639273 [PubMed - in process]

PMCID: PMC3966498 [Available on 2015/4/1]

Impact of the FITKids physical activity intervention on adiposity in prepubertal children

Pediatrics. 2014 Apr;133(4):e875–e883.

Khan NA, Raine LB, Drollette ES, Scudder MR, Pontifex MB, Castelli DM, Donovan SM, Evans EM, Hillman CH.

Objective: To investigate the effect of a 9-month physical activity intervention on cardiorespiratory fitness and adiposity among prepubertal children.

Methods: Prepubertal children (8- to 9-year-olds, N=220, 103 girls) were randomly assigned to a 9-month physical activity intervention or a control group. The intervention provided 70 minutes (5 days/week) of moderate to vigorous physical activity. Maximum oxygen consumption (Vo2max percentile) and dual-energy radiograph absorptiometry measured cardiorespiratory fitness and adiposity, respectively. Intention-to-treat analysis was performed to assess baseline and follow-up cardiorespiratory fitness, percentage fat mass (%FM), percentage central fat mass (%CFM), and estimated visceral adipose tissue (VAT) area.

Results: The intervention group increased in cardiorespiratory fitness (5.4th percentile; 95% confidence interval [CI], 1.8 to 8.9) and decreased in %FM (–0.7%; 95% CI, −1.1 to −0.4) and %CFM (–1.3%; 95% CI, −1.9 to −0.7). Reductions in %FM were evident for both nonoverweight (−0.62%; 95% CI, −1.07 to −0.17) and overweight or obese (−0.86%; 95% CI, −1.46 to −0.25) intervention participants. Conversely, the control group displayed no change in cardiorespiratory fitness while exhibiting increases in %FM (0.4%; 95% CI, 0.1 to 0.7), %CFM (0.6; 95% CI, 0.1 to 1.1), and VAT area (3.0 cm²; 95% CI, 1.6 to 4.4). Nonoverweight control participants increased in %FM (0.52%; 95% CI, 0.13 to 0.91), and their overweight and obese counterparts increased in VAT (4.76 cm²; 95% CI, 1.90 to 7.63).

Conclusions: The physical activity intervention improved cardiorespiratory fitness, reduced %FM, and prevented accumulation of %CFM among prepubertal children with varying adiposity levels. These findings provide support for daily physical activity recommendations to prevent excess fat mass accumulation in childhood.

PMID: 24685956 [PubMed - in process]

PMCID: PMC3966501 [Available on 2015/4/1]

Testing the effectiveness of an abbreviated version of the nutrition detectives program

Prev Chronic Dis. 2014 Apr 10;11:E57.

Katz DL, Treu JA, Ayettey RG, Kavak Y, Katz CS, Njike V.

Introduction: Obese or overweight children have an increased risk for chronic diseases. Targeting diet and exercise in schools could help prevent childhood obesity. We have previously shown the effectiveness of a 90-minute nutrition program in improving elementary school students' food-label literacy. The objective of this study was to investigate the effectiveness of a 45-minute version of the program.

Methods: We conducted a pre-post study in a public school district, with no control group. We provided teacher training and program materials. Participants were 5th-grade students in 5 schools who had parental consent and were willing to take part. We condensed the program to a 45-minute lesson with a presentation and hands-on activity. The lesson showed students why and how to make healthful food choices based on Nutrition Facts panels and ingredient lists. The district's physical education teachers taught the lesson. The primary outcome measure was food-label literacy (ie, the ability to distinguish between more and less healthful foods using a validated test instrument with Nutrition Facts panels and ingredient lists).

Results: A total of 212 students completed pre-post measures. Following program delivery, we observed a significant gain of 16.2 percentage points in scores overall, ranging from 4.3 percentage points to 23.6 percentage points among schools. Results were similar to those achieved with the 90-minute program.

Discussion: The condensed nutrition program improved students' food-label literacy while requiring a minimal allocation of time. Further studies in other school districts would be useful.

PMID: 24721217 [PubMed - in process]

PMCID: PMC3984941

Changes in food and beverage environments after an urban corner store intervention

Prev Med. 2014 Apr 11. pii: S0091–7435(14)00132-7. doi: 10.1016/j.ypmed.2014.04.009. [Epub ahead of print]

Cavanaugh E, Green S, Mallya G, Tierney A, Brensinger C, Glanz K.

Objective: In response to the obesity epidemic, interventions to improve the food environment in corner stores have gained attention. This study evaluated the availability, quality, and price of foods in Philadelphia corner stores before and after a healthy corner store intervention with two levels of intervention intensity (“basic” and “conversion”).

Methods: Observational measures of the food environment were completed in 2011 and again in 2012 in corner stores participating in the intervention, using the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS). Main analyses included the 211 stores evaluated at both time-points. A time-by-treatment interaction analysis was used to evaluate the changes in NEMS-CS scores by intervention level over time.

Results: Availability of fresh fruit increased significantly in conversion stores over time. Specifically, there were significant increases in the availability of apples, oranges, grapes, and broccoli in conversion stores over time. Conversion stores showed a trend toward a significantly larger increase in the availability score compared to basic stores over time.

Conclusion: Interventions aimed at increasing healthy food availability are associated with improvements in the availability of low-fat milk, fruits, and some vegetables, especially when infrastructure changes, such as refrigeration and shelving enhancements, are offered.

PMID: 24732720 [PubMed - as supplied by publisher]