Search

Both schools and caregivers play an important role in supporting children's mental health, but there are few mechanisms for caregivers and school-based mental health providers to work collaboratively to address children's needs. Closures of schools during the first wave of the COVID-19 pandemic left gaps in mental health support services to children and increased the burden on caregivers to ensure their children's well-being. In this study, investigators explored the feasibility and acceptability of a motivational interviewing-based program in which school-based mental health providers were trained to connect directly to caregivers to assist them in supporting key aspects of their children's well-being, including sleep, coping, and academic behavior. Results indicated a high degree of satisfaction with the program and a perception that it was helpful to caregivers and children. However, major challenges in recruitment of providers, as well as qualitative interviews with those providers who participated, indicated that the feasibility of implementing such a program is limited without significant additional implementation infrastructure. Findings suggest that structured support of caregivers, accessed through their children's schools, has high potential for improving child outcomes and family well-being. Future research should explore what implementation infrastructure is needed for schools to effectively offer these types of supports.

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

Background: Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the "black box" of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. Aim: To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques used in sessions, and intervention activities implemented by parents between sessions) with study outcomes. Methods: A random selection of 100 parent-child dyads in the intervention arm of a phone-based obesity prevention trial was included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, number of behavior change techniques used during the sessions, and number of intervention-recommended activities implemented by the parents between sessions (e.g., parent-reported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child body mass index (BMI) percentile, was measured at baseline and 12 months. Results: Overall session length was associated with decreases in child BMI percentile (b = -0.02, p = 0.01). There was no association between the number of behavior change techniques used in the sessions and decreases in child BMI percentile (b = -0.29, p = 0.27). The number of activities the parents reported implementing between sessions was associated with decreases in child BMI percentile (b = -1.25, p = 0.02). Discussion: To improve future interventions, greater attention should be paid to the intended and delivered session length, and efforts should be made to facilitate parents' implementation of intervention-recommended activities between sessions (ClinicalTrials.gov, No. NCT01084590).

Summary: Objective: To prospectively evaluate the relationship between cumulative environmental stress and cardiometabolic risk in middle childhood, and to examine whether hair cortisol, a measure of hypothalamic pituitary adrenal‐axis activity, mediates this relationship. Methods: In a cohort of children from low‐income households (n = 320; 59% Hispanic, 23% Black, body mass index (BMI) percentile >50th at enrollment), environmental stressors including family and neighbourhood factors representing disadvantage/deprivation, and cortisol concentrations from hair samples, were measured over five timepoints beginning when children were 2–4 years old. Cardiometabolic risk factors (i.e., BMI, blood pressure, lipids, blood sugar, C‐reactive protein) were measured at the final timepoint when children were 7–11 years of age. Results: In adjusted logistic regression models, greater cumulative environmental stress was associated with a higher likelihood of elevated cardiometabolic risk in middle childhood (p = 0.01). Children from minoritized racial/ethnic groups had a higher prevalence of both stressors and cardiometabolic risk factors. Cumulative environmental stress was associated with higher hair cortisol concentrations (p < 0.01). However, hair cortisol was not directly associated with cardiometabolic risk factors and did not explain the association between environmental stress and cardiometabolic risk in causal mediation analysis. Conclusions: The influence of cumulative stress on cardiometabolic health can be observed in middle childhood and may contribute to cardiometabolic health disparities, highlighting the importance of public health interventions to mitigate disadvantage. [ABSTRACT FROM AUTHOR]

To examine associations between decreased emotional eating and weight loss success; and whether participation in a behavioral weight loss intervention was associated with a greater reduction in emotional eating over time compared to usual care. Secondary data analysis of a randomized controlled trial conducted at two university medical centers with 227 overweight adults with diabetes. Logistic and standard regression analyses examined associations between emotional eating change and weight loss success (i.e., weight loss of ≥7 % of body weight and decrease in BMI). After 6 months of intervention, decreased emotional eating was associated with greater odds of weight loss success (p = .05). The odds of weight loss success for subjects with decreased emotional eating at 12 months were 1.70 times higher than for subjects with increased emotional eating. No differences in change in emotional eating were found between subjects in the behavioral weight loss intervention and usual care. Strategies to reduce emotional eating may be useful to promote greater weight loss among overweight adults with diabetes.

Men are underrepresented in weight loss programs and little is currently known about the weight loss strategies men prefer. This study describes the weight loss strategies used by men during a men-only weight loss program. At baseline, 3 months, and 6 months, participants reported how frequently they used 45 weight loss strategies including strategies frequently recommended by the program (i.e., mentioned during every intervention contact; e.g., daily self-weighing), strategies occasionally recommended by the program (i.e., mentioned at least once during the program; e.g., reduce calories from beverages), and strategies not included in the program (e.g., increase daily steps). At baseline participants (N = 107, 44.2 years, body mass index = 31.4 kg/m[superscript 2], 76.6% White) reported regularly using 7.3 ± 6.6 (M ± SD) strategies. The intervention group increased the number of strategies used to 19.1 ± 8.3 at 3 months and 17.1 ± 8.4 at 6 months with no changes in the waitlist group. The intervention group reported increased use of most of the strategies frequently recommended by the program (4 of 5), nearly half of the strategies occasionally recommended by the program (10 of 24), and one strategy not included in the program (of 16) at 6 months. The intervention effect at 6 months was significantly mediated by the number of strategies used at 3 months. This study adds to what is known about men's use of weight loss strategies prior to and during a formal weight loss program and will help future program developers create programs that are tailored to men.

ObjectiveTo test whether a weight loss program promotes greater weight loss, glycemic control, and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake.Research design and methodsThis randomized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling, with prepackaged foods in a planned menu during the initial phase, or to usual care (UC; two weight loss counseling sessions and monthly contacts).ResultsRelative weight loss was 7.4% (95% CI 5.7-9.2%), 9.0% (7.1-10.9%), and 2.5% (1.3-3.8%) for the lower fat, lower carbohydrate, and UC groups (P < 0.001 intervention effect). Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year (fasting glucose 141 [95% CI 133-149] vs. 159 [144-174] mg/dL, P = 0.023; hemoglobin A1c 6.9% [6.6-7.1%] vs. 7.5% [7.1-7.9%] or 52 [49-54] vs. 58 [54-63] mmol/mol, P = 0.001; triglycerides 148 [134-163] vs. 204 [173-234] mg/dL, P < 0.001). The lower versus higher carbohydrate groups maintained lower hemoglobin A1c (6.6% [95% CI 6.3-6.8%] vs. 7.2% [6.8-7.5%] or 49 [45-51] vs. 55 [51-58] mmol/mol) at 1 year (P = 0.008).ConclusionsThe weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes.

This cross-sectional analysis of the Minnesota Now Everybody Together for Amazing Healthful Kids (NET-Works) study evaluated whether SNAP participation was associated with specific parental feeding styles and child eating behaviors. Associations between parent-reported feeding styles and child eating behaviors and SNAP participation were examined using multiple linear regression analyses and responses from 534 parent/child dyads (49.1% female children, 91.7% female parents). SNAP participation was not associated with specific feeding styles or child eating behaviors when adjusting for food insecurity, timing in SNAP cycle, and other covariates in this large, ethnically and racially diverse sample of predominantly mothers and preschool-aged children. Other factors, such as food insecurity, not SNAP participation, may influence parental feeding and child eating behaviors, and screening by health care providers is recommended. [ABSTRACT FROM AUTHOR]

Summary: Background and Objectives: The NET‐Works trial (2012–2018) randomized 534 children ages 2–4 years at baseline and their caregivers to either a 3‐year multicomponent obesity prevention intervention or a control group. This research examined treatment effects on body mass index and other outcomes at 66 months. Methods: Parent–child dyads (n = 338) who agreed to participate in a 66 month measurement visit were measured for child BMI, physical activity, diet, and cardiometabolic risk factor variables. Results: At 66 months, no significant treatment effects were observed on BMI (Effect = −0.38; 95% CI = −1.13, 0.37). Subgroup results were consistent with the NET‐Works 36 month results. Children with overweight at baseline in the intervention group gained significantly less BMI versus children with overweight in the control group (Effect = −1.28; 95% CI = −2.48, −0.07). Among Hispanic children, those in the intervention gained significantly less BMI than those in the control group (Effect = −1.04; 95% CI = −1.97, −0.11). Conclusions: Evidence suggests that early intervention with children at highest risk for obesity, using community‐based, multicomponent, multisetting interventions, may be effective in reducing excess weight gain and obesity among certain subgroups of children. The intervention appeared to be effective in slowing BMI gain 66 months after randomization among children who were already overweight at ages 2–4 years and among children of Hispanic ethnicity. [ABSTRACT FROM AUTHOR]

Economic hardship during childhood has been linked to poor physical and mental health. This study examines cross‐sectional and longitudinal associations of a summed economic hardship score of poverty, food insecurity, and financial hardship with hair cortisol in young children. Data from 24‐month (Time 1, mean age 5 years) and 36‐month (Time 2, mean age 6 years) follow‐up from the NET‐Works obesity prevention trial (NET‐Works, NCT0166891) were used. Hair cortisol measures obtained at each time point were log‐transformed and regressed on economic hardship at Time 1 and a cumulative economic hardship from Time 1 to Time 2, using generalized linear regressions. All models were adjusted for child age, sex, race/ethnicity, and intervention (prevention vs. control) arm. The final analytic sample sizes ranged from 248 to 287. Longitudinal analyses indicated that for every 1‐unit higher economic hardship score at Time 1, hair cortisol at Time 2 follow‐up was on average 0.07 log‐picograms per milligram (pg/mg) higher (95% confidence interval [CI]: 0.01, 0.13). For every 1‐unit increase in the cumulative economic hardship score between Time 1 and 2, there was a 0.04 log‐pg/mg (95% CI: 0.00, 0.07) average higher level of hair cortisol at Time 2 follow‐up. Results show suggestive but limited evidence for an association between economic hardship and cortisol in young children. [ABSTRACT FROM AUTHOR]

Objectives: To assess the correlates of parental classification of adolescent weight status. Methods: Measured adolescent weight status was compared to parent self-report perception data (n 374 dyads) using multivariate analyses with interactions to identify characteristics associated with inaccurate parent classification of adolescent weight status. Results: Adolescent weight status was underestimated by 31 of parents. College-educated parents were more likely to underestimate the weight of their male adolescents (OR1.95) and overweight adolescents (OR4.0). Non-college-educated parents were 8.92 times as likely to misclassify overweight adolescents, regardless of the sex of the child. Conclusions: Parental perception may play a role in supporting adolescent's healthy weight-related behaviors.

Objective: To examine the effect of self-weighing frequency on weight change and body satisfaction. Design: Observational study based on findings from a 6-month randomized controlled telephone-based weight loss trial. Data collected at baseline and 6 months. Setting: Metropolitan community-based sample. Participants: Sixty-three obese adults. Mean age 49.5 years, 82% percent white, and 79% female. Mean body mass index at baseline was 34.2 kg/m[superscript 2]. Main Outcome Measures: Change in weight and body satisfaction. Analysis: General linear model regression was used to assess the effect of self-weighing on outcomes of interest. Statistical significance was set at alpha level 0.05. Treatment group and baseline values of dependent variables included as covariates in all analyses. Results: Participants who increased their frequency of self-weighing over the 6-month period demonstrated significantly better weight loss outcomes than those who maintained or decreased their frequency of self-weighing (-6.8 kg vs -3.1 kg, F = 8.59, P = 0.006). There were no significant associations between self-weighing frequency and body satisfaction at 6 months (F = 0.55, P = 0.58). Conclusions and Implications: These findings support frequent self-weighing for weight control. There appears to be little or no effect of self-weighing on body satisfaction. Future research should replicate these findings across a larger, more diverse population of overweight adults. (Contains 2 tables.)

Examined the relationship between weight-related sport involvement, disordered eating, health behavior, and psycho-social factors in female adolescents. Survey data indicated that girls in weight-related sports were at increased risk for disordered eating, though the majority did not report disordered eating. This group was also at decreased risk for other problems, such as marijuana use and depressive symptoms. (SM)

Surveyed adolescent girls regarding body dissatisfaction, dieting, and internalization of sociocultural values, media-influenced knowledge, acceptance of varied body shapes, and media exposure. Girls understood media influence on self-image and behavior and accepted varied body shapes. Significant numbers reported dissatisfaction with weight and body parts. Correlates of dieting included perceptions of overweight, body dissatisfaction, and internalization of sociocultural ideals. (SM)