Search

Objectives: This study aimed to understand barriers to engagement in healthy lifestyle behaviors among adolescents with comorbid Type 1 diabetes (T1D) and overweight/obesity (n = 12), their caregivers (n = 12), and pediatric endocrinologists (n = 9)., Methods: Participants (n = 33) completed individual, semi-structured interviews. Interviews were transcribed verbatim, and applied thematic analysis was used to analyze the interview data., Results: Results from adolescents, caregivers, and pediatric endocrinologists revealed three thematic barriers to healthy lifestyle behaviors for adolescents with T1D and overweight/obesity: (1) discomfort with aspects of T1D that draw attention to the self; (2) T1D as a barrier to engagement in healthy lifestyle behaviors; and (3) physiological dysregulation due to T1D impacting health behaviors., Conclusions: Results identify perceived limitations to engaging in recommended healthy lifestyle behaviors and diabetes management concurrently. Results may assist research and clinical care in identifying supports and guidance needed to support adolescents in meeting behavioral recommendations for their health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Childhood obesity is a significant health problem associated with negative physical and mental health outcomes. Although evidence-based family healthy weight programs (FHWPs), such as JOIN for ME, have been developed, there is a significant lag before these are disseminated more broadly. This study outlines the process of participating in the Speeding Research-tested Interventions (SPRINT) program, highlighting lessons learned, to increase the reach of a previously tested and efficacious FHWP, JOIN for ME. Qualitative interviews were conducted with policymakers, benefits providers, employers, philanthropists, community stakeholders, and medical providers to iteratively test the developed JOIN for ME business model and identify themes regarding effective scaling and sustainability of an evidence-based FHWP. Rapid qualitative analysis of 45 interviews identified four key themes regarding scaling of an FHWP. These were (i) virtual program delivery, (ii) focus on equity, (iii) return on investment, and (iv) tie-in to local community. The process of engaging stakeholders from multiple backgrounds is critical to refining an efficacious program to ensure scalability and sustainment. The SPRINT process allows researchers to understand the marketplace for evidence-based interventions and develop adaptations for sustaining and scaling research tested programs., (© Society of Behavioral Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Childhood obesity is associated with negative physical and psychosocial outcomes, especially for children from low-income backgrounds. It is critical to adapt evidence-based family healthy weight programs to meet the needs of this population. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions was used to describe the process of using qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to guide adaptations to the JOIN for ME pediatric weight management intervention. Qualitative interviews were conducted with key community and intervention stakeholders (e.g., nurse care managers, prior JOIN for ME coaches; N = 21). Focus groups were conducted in both Spanish and English with children with overweight or obesity from low-income backgrounds (N = 35) and caregivers of children with overweight or obesity from low-income backgrounds (N = 71). Qualitative data analysis informed modifications including content adaptations to simplify and tailor materials, contextual adaptations to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to increase connections with community partners. The process of engaging multiple stakeholder perspectives to tailor an existing intervention can provide a model for future researchers to improve the potential disseminability of an intervention., (© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME , for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.

Advances have been made in the development of effective interventions to address pediatric obesity; however, research findings often do not translate into clinical practice and a limited number of programs have been designed toward wide-spread dissemination and implementation. The Rhode Island (RI)-Childhood Obesity Research Demonstration (CORD) 3.0 Project involves adapting and testing an evidence-based pediatric weight management intervention (PWMI), JOIN for ME , for wide-scale dissemination and implementation in communities with a high proportion of families from low-income backgrounds. In this article, we describe the robust developmental formative evaluation (FE) process employed by RI-CORD as a model for the use of FE to drive dissemination of evidence-based PWMIs. The current project was guided by the Consolidated Framework for Implementation Research and Proctor Implementation Outcomes. This article also showcases examples of how the use of key informant interviews from engaged stakeholders in the community during a developmental FE process can drive selection of implementation strategies. The use of FE, driven by evidence-based theory, can help provide a roadmap to successful implementation of a pediatric weight management program, such as JOIN for ME .

The U.S. Preventive Services Task Force (USPSTF) has set forth recommendations for clinicians to screen youth (6-18 years) for obesity. Those identified should be referred to comprehensive weight management programs consisting of at least 26 contact hours and focus on multiple targets of behaviour (ie, diet, physical activity, behaviour change). However, these recommendations are primarily based upon outcomes from randomized controlled trials and the feasibility of meeting these guidelines for adolescents in a clinical setting is unknown. The present study employed a multi-informant qualitative approach with adolescents, parents, and physicians, to identify and understand multiple perspectives on the feasibility and acceptability of implementing the USPSTF guidelines. In-depth interviews with seven adolescents, seven parents, and four physicians were analysed. Generally, participants viewed the guidelines positively but identified changes that may be necessary to increase the feasibility of adolescents engaging in programs that meet these guidelines. Participants also noted the importance of flexibility within programs, indicating that it would be difficult for many adolescents to participate in a program that was not tailored to their needs and resources. Future research should focus on adapting clinical weight management programs to meet both USPSTF guidelines and the needs of adolescents and their families., (© 2021 World Obesity Federation.)

Introduction: Although families face many barriers to obtaining and maintaining a healthy weight status for children, there remains a lack of psychometrically sound tools to assess perceived barriers. The Barriers to Child Weight Management (BCWM) scale quantitatively assesses parents' perceptions of barriers to engaging in positive weight-related behaviors but has not been validated within a clinical sample. The present study sought to validate the BCWM scale among parents of children presenting to a tertiary pediatric weight management clinic., Method: Participants included 258 parents of children aged 6-18 years presenting to a tertiary care behavioral weight management program. Parents completed the BCWM prior to the initial clinic visit. Confirmatory factor analysis was conducted to test the previously identified 4-factor structure within a clinical sample., Results: Overall model fit was good with the addition of 2 theoretically appropriate model respecifications, χ2(144) = 278.60, p < .001, comparative fit index = .90, root mean square error of approximation = .05, standardized root mean square residual = .06., Discussion: The BCWM is a promising tool to assess parental perceptions of barriers to healthy weight-related behaviors among youth presenting for clinical weight management intervention. Incorporation of this measure into pediatric weight-management appointments may aid in quickly identifying points of intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Introduction: Stress has been consistently related to obesity-promoting eating patterns (i.e., emotional, external, and restrained eating) throughout the life span, including during adolescence. One particularly salient source of stress within adolescence is parent-adolescent conflict. The current study sought to examine whether parent-adolescent conflict is a significant predictor of adolescent obesity-promoting eating patterns, beyond general adolescent stress., Methods: A sample of adolescents (N = 51; 39.2% overweight or obese) completed a study examining stress and eating behaviors. As part of the larger study, adolescents completed measures related to parent-adolescent conflict, general adolescent stress, and obesity-promoting eating patterns. Adolescent height and weight were measured objectively and used to calculate adolescent body mass index (BMI) percentile for age and gender., Results: General adolescent stress predicted all three obesity-promoting eating patterns, emotional, external, and restrained eating, controlling for adolescent BMI percentile. Higher levels of parent-adolescent conflict significantly predicted greater restrained eating, controlling for adolescent BMI percentile and general adolescent stress. Conflict did not predict emotional or external eating patterns., Discussion: Adolescents' perceptions of parent-adolescent conflict appear to present a unique source of stress, above and beyond general perceived stress, that is, particularly relevant to the experience of restrained eating patterns. These findings provide support for the potential integration of assessment and intervention for parent-adolescent conflict within previously established behavioral weight control interventions to decrease restrained eating behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: Families face many barriers related to creating or maintaining a healthy lifestyle, which likely contributes to the prevalence of childhood obesity in the United States; however, no measure currently exists to examine these barriers. This study developed a quantitative measure of parents' perceptions of barriers to family healthy lifestyle., Methods: Parents of children between the ages of 7-17 were recruited using Amazon Mturk (n = 812). Exploratory and confirmatory factor analyses and preliminary convergent validity analyses were conducted., Results: Four factors emerged in the final measure: Parent Disengagement, Cost and Built Environment, Lack of Family Support, and Family Time Constraints, with the final 19-item measure having good initial psychometric properties, including reliability and validity., Conclusions: Future research is needed to examine whether this measure may be used in clinical practice to identify barriers to a healthy family lifestyle, to tailor interventions for families.

Background: Pediatric obesity is a public health concern related to multiple negative physical and psychosocial problems. While behavioral weight control (BWC) interventions are generally effective in decreasing pediatric weight status, these interventions are not able to reach the third of U.S. children currently classified as overweight or obese., Method: This review and meta-analysis examined the overall effectiveness of mobile health (mHealth) technologies employing self-monitoring, a central component of change within BWC, to decrease pediatric weight status., Results: Overall, a small, but significant overall effect size (d = 0.42) was found with the inclusion of nine eligible studies examining the effect on weight status. However, the quality of studies included within this weight status meta-analysis was weak, therefore limiting the interpretability of results. Analyses were also conducted examining the effect of mHealth technologies employing self-monitoring on secondary behavioral outcomes of physical activity and diet. Results indicated a small to medium, but nonsignificant effect (d = 0.41; four samples) on physical activity and a small, but significant effect on diet (d = 0.10; eight samples)., Conclusions: Overall, the articles included in behavioral outcomes were of generally moderate quality. More work is needed to better identify the utility of mHealth and specific treatment components (such as self-monitoring), for pediatric weight management.