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BackgroundClinical approaches to treating childhood obesity can be expensive and poorly reimbursed, and often produce suboptimal results. It has been theorized that overeating may have addictive qualities, and a sizable number of adolescents with obesity endorse addictive habits. Interestingly, few weight management interventions have tested techniques founded in addiction medicine principles. We therefore performed a pilot study of an addiction model based mHealth weight loss intervention in adolescents.MethodsAdolescents with obesity were recruited from an multidisciplinary weight management clinic (EMPOWER). Adolescents without significant obesity comorbidities, who exhibited signs of addictive eating, based on the Yale Food Addiction Scale, were enrolled in a pilot study of an interactive, addiction-based, weight loss smartphone app with coaching (http://clinicaltrials.gov: NCT02689154). The app was designed to help subjects omit problem foods, avoid snacking and reduce meal size. A contemporary cohort of adolescents who completed the EMPOWER program were evaluated. Feasibility of recruitment, adherence, retention rates, BMI change and cost of intervention were examined.ResultsEighteen participants were recruited to app intervention. App participants had higher retention (100% vs. 37%) and lower total cost per patient ($855.15 vs. $1428.00) than the EMPOWER clinic participants. App participants exhibited a significant decrease in zBMI and %BMIp95 over the 6 months (p

IntroductionInternet health care applications appear to be centering on three areas: 1) disease monitoring and management, 2) patient education, and 3) patient support groups. This presentation demonstrates how Internet technology can be advantageous in managing certain childhood disorders, as an example, nocturnal enuresis. Treatment options for nocturnal enuresis currently include behavioral modification, medications, wetness alarms, and bladder volume alarms. Regardless of which treatment modality is chosen, considerable time is required on the part of the health care provider to educate, manage, and support the child and parent. Moreover, the impact of enuresis on a child's self-esteem can be profound. Enuresis tends to be a "closet" malady, often leaving the child feeling isolated and "different." To date, support groups for enuresis are rare. A need therefore exists to combat this social isolation and self-esteem impact. MethodsInternet technology offers potential solutions to all of the above issues. The author has designed a pilot Web site specifically for childhood enuresis. The site contains separate areas for children and for teenagers, tailored to the age of the patient, and an area for parents. Each area has the same basic functions of: 1) interactive enuresis management with the patient's health care provider, 2) patient education, and 3) interactive message boards and chat rooms for social support. Interactive management with the health care provider is accomplished via auto-uploaded "secure" patient data and via password-protected patient "rooms" to which provider reports and instructions are downloaded. Educational content includes case histories, anatomy and physiology lessons, explanations of current treatments, and explanations of the latest enuresis research. The "threaded" message board and chat room functions allow anonymous interaction with other enuretic children of the same age, as well as parental interaction with other parents. ResultsThe enuresis Web site has been well received by a pilot group of 10 enuretic children and their parents. Variables such as treatment response, parental satisfaction, and patient self-esteem appear significantly improved, in this uncontrolled study. DiscussionThe management of nocturnal enuresis can be facilitated using Internet technology. Other chronic pediatric disorders such as diabetes, asthma, allergies, behavioral problems such as attention deficit disorder, learning disabilities, growth disorders, and congenital defects appear to be candidates for similar interactive Internet management. Additionally, well-child care could be facilitated, especially in remote areas.

Objective: This randomized clinical trial tested the effectiveness of an addiction-based digital weight-loss intervention, focusing on withdrawal/abstinence from self-identified problem foods, snacking and excessive amounts at meals, and discomfort displacement, with and without coaching, compared to an in-person, multi-disciplinary, care model among adolescents with obesity. We hypothesized that the digital intervention with coaching would yield greater weight loss and lower delivery burden than the standard clinical arm, and greater participant engagement than the digital arm without coaching., Methods: Adolescents were randomized to app intervention, with or without coaching, or in-person multidisciplinary obesity intervention for 6 months. The primary outcome was change in %BMI p95 at weeks 12 and 24. A mixed-effects linear regression model was used to assess the association between change in %BMI p95 and intervention arm. We were also interested in assessing delivery burden, participant engagement and evaluating the relationships between weight change and demographic characteristics, mood, executive function and eating behaviours., Results: All adolescents (n = 161; BMI ≥95th%, age 16 ± 2.5 year; 47% Hispanic, 65% female, 59% publicly insured) lost weight over 24-weeks (-1.29%, [-1.82, -0.76], p < 0.0001), with no significant weight loss difference between groups (p = 0.3). Girls lost more weight than boys, whereas binge eating behaviour at baseline was associated with increase in %BMI p95 when controlling for other covariates. There was no association between ethnicity, mood, timing of intervention in relation to the pandemic, or executive function and change in %BMI p95 ., Conclusions: Contrary with our hypothesis, our results showed no difference in the change in BMI status between treatment arms. Since efficacy of this digital intervention was not inferior to in-person, multi-disciplinary care, this could offer a reasonable weight management option for clinicians, based on youth and family specific characteristics, such as accessibility, resources, and communication styles., Clinical Trial Registration: ClinicalTrials.gov identifier: NCT035008353., (© 2022 World Obesity Federation.)

Purpose: Displacement behavior is a biobehavioral mechanism that allows an animal to deal with situations that cannot readily be faced nor avoided, or that are thwarting. It may explain compulsive overeating (eating addiction). Resembling addiction, displacement behavior is irrepressible behavior that is contextually inappropriate, e.g., sleeping or feeding when threatened by a predator, or binge eating in response to a work altercation. It is thought to be due to rechanneling of overflow brain energy to another drive (e.g., feeding drive) when two drives, e.g., fight or flight, equally oppose each other. Moving the opposing drives out of equilibrium, by resolving the person's underlying problems/stressful situations, theoretically should mitigate the displacement mechanism and addictive overeating., Methods: We developed a mobile phone intervention targeting addictive overeating, including a displacement mechanism component. A displacement use subgroup (N = 37) ages 14-18 with obesity (mean BMI = 38.1) identified life situations they could neither face nor avoid, or that were thwarting them, and developed action plans to address each situation. Feasibility and acceptability were evaluated., Results: Participants found the displacement component to be understandable and user-friendly. The majority (26/37-70%) used the core "Dread List" feature to input 90 individual dreaded/problem situations fueling displacement-based overeating, coupled with action plans to address each problem. Dread items related to school accounted for nearly one-half (46%: 41/90) of all dread situations reported by participants., Conclusion: The displacement mechanism may be a useful basis for treatment of eating addiction and obesity and may provide individuals with hope that they can curb their addiction without relying on willpower to not overeat. A randomized trial evaluating the displacement intervention is planned., Level of Evidence: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees., Registration: The study was reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement and was registered with ClinicalTrials.gov (NCT03500835) April 18, 2018., (© 2022. The Author(s).)

Background: The notion of obesity as an addictive process is controversial. However, studies show that between 5.9 and 30.7% of adolescents with obesity report food or eating addiction. Few weight management interventions have tested techniques based on addiction medicine principles., Methods: This multi-center randomized control trial (RCT) is designed to test the effectiveness of a mobile health (mHealth) weight-loss intervention based on addiction principles, such as withdrawal and tolerance, in a sample of 180 adolescents (ages 14-18) recruited from four pediatric weight management clinics in Southern California. Akin to a Multiphase Optimization Strategy (MOST) design evaluating multicomponent behavioral interventions, we will compare the combination of an app + phone coaching (App+Coach) to app alone (App) and in-clinic multi-disciplinary (Clinic) intervention arms. The primary outcome is mean change in zBMI and %BMI p95 over 18 months. We hypothesize that youth who receive App+Coach will have a greater reduction in body weight over the 18-month study period at a lower cost than standard of care models. Secondary outcomes include adherence to treatment regimen, intervention satisfaction, effect of the intervention on metabolic factors and activity level. We will also explore potential moderators of intervention effectiveness such as addictive eating habits, self-regulation and executive functioning., Conclusions: New and creative approaches are needed to address pediatric obesity. If successful, this RCT may provide an innovative and cost-effective mHealth approach, based on addiction methods, for weight loss among adolescents with overweight and obesity., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: Current treatment regimens for nocturnal enuresis are suboptimal. Medications such as desmopressin are efficacious for preventing the enuretic event but they offer little potential for a permanent cure and have side effects. Although the moisture alarm has good potential for a permanent cure, the child is mostly wet during treatment. Furthermore, the moisture alarm requires that the child make the somewhat remote association between the alarm event and a full bladder after the bladder has emptied. In this exploratory study bladder volume alarming, a new approach to treating nocturnal enuresis, was investigated., Materials and Methods: A total of 40 sequential children 6 to 16 years old with nonorganic nocturnal enuresis who had had at least 1 wetting episode weekly for greater than a year were divided into 2 groups. Each child wore a modified PCI 5000 miniature bladder volume measurement instrument during sleep. An alarm sounded when bladder volume reached 80% of the typical daytime voided volume in group 1 and at 80% of the typical enuretic volume in group 2. Group 2 patients also performed daytime bladder retention exercises in regard to instrument measured bladder volume versus a progressing target volume., Results: In groups 1 and 2 the mean dryness rate before study initiation versus during the study was 32.9 and 9.3 versus 88.7 and 82.1%, respectively. Nighttime bladder capacity increased 69% in group 1 and 78% in group 2, while the cure rate was 55% (mean treatment period 10.5 months) and 60% (mean treatment period 7.2 months), respectively., Conclusions: Bladder volume tracking seems to approach the goals of ideal treatment for nocturnal enuresis in that it prevents the enuretic event, appears to facilitate a permanent cure and is noninvasive.

The ultrasound time intensity curve parameters obtained from an intracoronary injection of either sonicated albumin or Albunex are used to quantify coronary flow changes. How much the volume changes that accompany the flow changes affect various time intensity curve parameters is unknown. Accordingly, we designed a variable-volume in vitro chamber connected to a flow pump operating at four predetermined flow settings (44 to 184 ml/minute). Injections of either sonicated albumin or Albunex were given proximal to a mixing chamber, which then passed through the scanning chamber at three different volume settings. The parameters studied were area under the curve, corrected peak contrast intensity, ascending and descending slopes of the curve, time to peak radiofrequency signal, the time required to reach half peak intensity (half time up), the time required to decay to half peak intensity (half time down), and total transit time (the time from appearance to disappearance of 10% of peak intensity). Although area, half time up, half time down, and transit time all correlated with flow when volume was held constant, only transit time (and the natural logarithm of the transit time) correlated strongly with flow changes when simultaneous changes in volume occurred. Transit time also correlated with volume changes when flow was held constant, but was more sensitive to flow changes. These data may explain why transit time variables may still be able to detect flow changes in the coronary circulation despite a simultaneous change in myocardial blood volume.