Pediatric%20Overweight%20and%20Obesity - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Pediatric%20Overweight%20and%20Obesity

Description:

– PowerPoint PPT presentation

Number of Views:107
Avg rating:3.0/5.0
Slides: 110
Provided by: phhp3
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Pediatric%20Overweight%20and%20Obesity


1
Pediatric Overweight and Obesity
  • Wendy Novoa, M.S.
  • November 14, 2006

2
Overview
  • Obesity Trends and Prevalence
  • Definition of Overweight and Obesity
  • Causes of Overweight and Obesity
  • Medical and Psychosocial Complications
  • Empirically Supported Treatments
  • Project STORY

3
Trends and Prevalence
4
Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
5
Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
6
Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
7
Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
8
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
9
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
10
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
11
Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
12
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
13
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
14
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
15
Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
16
Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
17
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
18
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
19
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
20
Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
21
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
22
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
23
Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
24
Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
25
Obesity Trends Among U.S. AdultsBRFSS, 1990,
1995, 2005
(BMI ?30, or about 30 lbs overweight for 54
person)
1995
1990
2005
No Data lt10 1014
1519 2024 2529
30
26
Obesity and Overweight in Children and Adolescents
  • Prevalence
  • 33 overweight (85th-95th percentile)
  • 16 obese (at or above 95th percentile)
  • Children in rural areas have a 54.7 increased
    risk of obesity

27
Prevalence
  • Doubled among children 6-11 and tripled among
    adolescents 12-17 from 1976-1980 to 1999-2000
    (Dietz, 2004)
  • 1999-2000 data indicate that 31 of children and
    adolescents are overweight and 16 are obese
    (Hedley, et al., 2004)
  • Black and Mexican American children
    disproportionately affected (Dietz,
    2004)

28
Higher Prevalence in Rural Areas
  • Research suggests that children in rural areas
    have a 54.7 increased risk of obesity compared
    to urban children
  • Despite increased risk, many individuals living
    in rural areas are medically underserved due to
  • Limited health promotion programs
  • Higher rates of poverty
  • Higher percentages of patients without health
    insurance
  • Lower numbers of health care providers

29
In Florida
  • 60 of Florida adults are overweight or obese
  • (CDC BRFSS, 2004)
  • 26 of Florida high-school students are
    overweight or at risk of becoming overweight
  • (CDC YRBSS, 2003)
  • 21 of non-Hispanic white adults, 33 of
    non-Hispanic black adults, and 26 of Hispanic
    adults in Florida are obese (CDC BRFSS, 2004)
  • 28 of low-income children between 2 and 5 years
    of age in Florida are overweight or at risk of
    becoming overweight (CDC PedNSS, 2003)

30
Costs
  • State specific obesity attributable medical
    expenditures 87 million 7.7 billion
  • (Ogden et al., 2006)
  • Between 1979-1980, the number of obesity and
    obesity-related hospital discharges tripled
  • (Goran, Ball, Cruz, 2003)

31
Definition of Overweight and Obesity
32
Definition for Adults
  • Definition of Obesity and Overweight in Adults
  • BMI under 18.5 Underweight
  • BMI 18.6-24.9 Healthy weight
  • BMI 25-29.9 Overweight
  • BMI 30 or higher Obese
  • Although BMI correlates with the amount of body
    fat, BMI does not directly measure body fat. Some
    people, such as athletes, may have a BMI that
    identifies them as overweight even though they do
    not have excess body fat

33
What is BMI?
  • Body Mass Index (BMI)
  • weight (kg)/height (m)2
  • BMI is a screening tool, not a diagnostic tool
  • In children, BMI is gender and age specific, so
    BMI-for-age is used
  • No gender or age distinctions are made for adult
    BMI calculations (CDC, 2005)

34
Advantages of BMI-for-age
  • Correlates with clinical risk factors for
    cardiovascular disease
  • Compares well with measures of body fat
  • Recommended by expert committees to evaluate
    overweight status in children and adults
  • Tracks well into adulthood (CDC, 2005)

35
Link to Adult Obesity
  • Overweight in children associated with more
    severe obesity among adults
  • Some studies suggest up to 80 of overweight
    adolescents become obese adults
  • An increased risk exists for girls
    (Dietz, 2004)

36
Tracking BMI-for-Age from Birth to 18 Years with
Percent of Overweight Children
who Are Obese at Age 251
Whitaker et al. NEJM 1997337869-873
37
Definition for Children and Adolescents
  • Definition of Obesity and Overweight in Children
    and Adolescents
  • Sex and Age-specific BMI
  • Obese is at or above 95th percentile, based on
    revised CDC growth charts
  • Overweight is at or above 85th percentile
  • (U.S. Department of Health and
    Human Services, 2001)

38
CDC Growth Charts
  • Percentile curves that illustrate the
    distribution of selected body measurements in
    U.S. children
  • The 1977 growth charts were developed by the
    National Center for Health Statistics as a
    clinical tool for health professionals to
    determine if the growth of a child is adequate
  • The 1977 charts were adopted by the World Health
    Organization for international use (CDC,
    2005)

39
CDC Growth Charts
  • The 2000 CDC growth charts represent the revised
    version of the 1977 NCHS growth charts
  • The revised growth charts consist of 16 charts, 8
    for boys and 8 for girls
  • (CDC, 2005)

40
For Children, BMI Changes with Age
BMI
BMI
Example 95th Percentile Tracking Age
BMI 2 yrs 19.3 4 yrs 17.8 9 yrs
21.0 13 yrs 25.1
Boys 2 to 20 years
BMI
BMI
41
(No Transcript)
42
Can you see risk?
  • This boy is 3 years, 3 weeks old
  • Is his BMI-for-age in the gt85th to lt95th
    percentile?
  • Is he at risk for overweight?

Photo from UC Berkeley Longitudinal Study, 1973
43
Plotted BMI-for-Age
Measurements Age3 y, 3 wks Height100.8 cm
(39.7 in) Weight18.6 kg (41
lb) BMI18.3 BMI-for-age gt95th
percentile Overweight
44
Can you see risk?
  • This girl is 4 years, 4 weeks old
  • Is her BMI-for-age in the gt85th to lt95th
    percentile?
  • Is she at risk for overweight?

Photo from UC Berkeley Longitudinal Study, 1974
45
Plotted BMI-for-Age
Measurements
BMI
BMI
Girls 2 to 20 years
Age 4 y, 4 wks Height106.4 cm (41.9
in) Weight15.7 kg (34.5
lb) BMI13.9 BMI-for-age 10th
percentile Normal
BMI
BMI
46
Causes
47
Causes for Overweight
  • Overweight and obesity result from an energy
    imbalance. This involves eating too many calories
    and not getting enough physical activity 
  • Body weight is the result of genes, metabolism,
    behavior, environment and culture
  • Behavior and environment are the greatest areas
    for prevention and treatment actions
  • (CDC, 2005)

48
Causes for Overweight
  • "Despite obesity having strong genetic
    determinants, the genetic composition of the
    population does not change rapidly. Therefore,
    the large increase in . . . obesity must
    reflect major changes in non-genetic factors."
  • from Hill, J. O., Trowbridge, F. L. (1998)
    Childhood obesity future directions and research
    priorities. Pediatrics. Supplement 571

49
Toxic Environment
  • "We take Joe Camel off the billboard because it
    is marketing bad products to our children, but
    Ronald McDonald is considered cute. How different
    are they in their impact, in what they're trying
    to get kids to do?"
  • -Kelly Brownell, Yale University

50
Toxic Environment
  • Encourages overeating and inactivity while at the
    same time discriminates against overweight or
    obese individuals
  • Greater access to pre-packaged, calorie dense
    foods anytime, anywhere
  • Portion sizes have increased over last 20 yrs.

51
COFFEE
20 Years Ago Coffee(with whole milk and sugar)
Today Mocha Coffee(with steamed whole milk and
mocha syrup)
45 calories 8 ounces
How many calories are in today's coffee?
52
COFFEE
20 Years Ago Coffee(with whole milk and sugar)
Today Mocha Coffee(with steamed whole milk and
mocha syrup)
45 calories 8 ounces
350 calories 16 ounces
Calorie Difference 305 calories
53
BAGEL
20 Years Ago
Today
140 calories 3-inch diameter
How many calories are in this bagel?
54
BAGEL
20 Years Ago
Today
140 calories 3-inch diameter
350 calories 6-inch diameter
Calorie Difference 210 calories
55
CHEESEBURGER
Today
20 Years Ago
333 calories
How many calories are in todays cheeseburger?
56
CHEESEBURGER
Today
20 Years Ago
590 calories
333 calories
Calorie Difference 257 calories
57
SODA
20 Years Ago
Today
85 Calories 6.5 ounces
How many calories are in todays portion?
58
SODA
20 Years Ago
Today
250 Calories 20 ounces
85 Calories 6.5 ounces
Calorie Difference 165 Calories
59
CHEESECAKE
20 Years Ago
Today
How many calories are in todays large portion of
cheesecake?
260 calories 3 ounces
60
CHEESECAKE
20 Years Ago
Today
260 calories 3 ounces
640 calories 7 ounces
Calorie Difference 380 calories
61
CHICKEN CAESAR SALAD
20 Years Ago
Today
How many calories are in todays chicken Caesar
salad?
390 calories 1 ½ cups
62
CHICKEN CAESAR SALAD
20 Years Ago
Today
390 calories 1 ½ cups
790 calories 3 ½ cups
Calorie Difference 400 calories
63
Child and Adolescent Nutrition
  • Less than 40 of children and adolescents in the
    United States meet the U.S. dietary guidelines
    for saturated fat (US Dpt. of Agriculture,
    1998)
  • Almost 80 of young people do not eat the
    recommended number of servings of fruits and
    vegetables (Grunbaum et al., 2003)
  • Only 39 of children ages 217 meet the USDAs
    dietary recommendation for fiber (found primarily
    in dried beans and peas, fruits, vegetables, and
    whole grains) (Lin et al., 2001)

64
Child and Adolescent Nutrition
  • 85 of adolescent females do not consume enough
    calcium (NIH, 1997)
  • During the last 25 years consumption of milk has
    decreased 36 among adolescent females
    (Cavadini et al., 2000)
  • From 1978 to 1998, average daily soft drink
    consumption almost doubled among adolescent
    girls, increasing from 6 oz to 11 oz, and almost
    tripled among adolescent boys, from 7 oz to 19
    oz. (US Dpt. of Agriculture, 1998)

65
Physical Activity
  • Overweight children average 3,000 less steps per
    day than normal weight children
    (Tudor-Locke et al., 2004)
  • 71 of 9th graders but only 40 of 12th graders
    enrolled in a physical education class in 2003 
    (Grunbaum et al., 2004)

66
Physical Activity
  • The percentage of high school students who
    attended physical education classes daily
    decreased from 42 in 1991 to 25 in 1995
  • In 2003, 38 of 9th graders but only 18 of 12th
    graders attended a daily physical education
    class 
  • Among the 56 of students who are enrolled in a
    physical education class, 80 exercised or played
    sports for 20 minutes or more during an average
    class (Grunbaum et al., 2004)

67
Secondary Complications
68
Risks of Obesity and Overweight
  • 60 of overweight children have at least one risk
    factor for cardiovascular disease, 25 have at
    least two risk factors
  • ? BP
  • Hyperlipidemia
  • Hyperinsulinemia
  • Increased risk of endocrine and pulmonary
    problems, orthopedic, gastroenterological, and
    neurological difficulties
  • (Strauss, 1999)

69
Risks of Obesity and Overweight
  • Type 2 Diabetes account for 8-45 of all new
    cases of diabetes
    (Dietz, 2004)
  • Risk factors of Type 2 Diabetes include
  • increased body fat and abdominal fat
  • insulin resistance
  • ethnicity (greater risk in African-American,
    Hispanic, and Native American children)
  • onset of puberty (Goran, Ball, Cruz, 2003)
  • Prevalence of metabolic syndrome increased with
    the severity of obesity
  • Reached 50 in severely obese youngsters
  • Each half-unit increase in BMI was associated
    with 1.55 odds ratio increased risk of metabolic
    syndrome (Weiss, et al., 2004)

70
Obesity and Overweight in Children and Adolescents
  • Medical Complications
  • Endocrine
  • Pulmonary
  • Orthopedic
  • Gastroenterological
  • Neurological
  • Cardiovascular
  • Metabolic Syndrome
  • Psychosocial Complications
  • Social Stigmatization
  • Teasing
  • Depression
  • Psychosocial Maladjustment
  • Body Image
  • Body Dissatisfaction
  • Self-Esteem

71
Self-Esteem
  • Women who were overweight as older adolescents
    were less likely to be married, had less
    education, and lower household income than women
    who had not been overweight at 7-year-follow-up
  • (Gortmaker, Must, Perrin, Sobol, Deitz,
    1993)
  • Body dissatisfaction reported in girls as young
    as 9 years old, and internalization of thin
    ideal predicted to be a critical influence on
    development of body dissatisfaction
  • (Sands Wardle, 2003)

72
Social Stigmatization
  • Replicated a 1961 study
  • Found rates of stigmatization is getting worse
  • 458, 5th and 6th grade children ranked drawings
    of students about how much they liked the student
    in the picture
  • Students were overweight, disabled, and normal
    (normal weight or no disability)
  • Students ranked the overweight child lowest
  • Girls ranked the overweight student lower than
    boys (Latner Stunkard, 2003)

73
Body Image
  • Consistently replicated finding that obese
    children have a more negative body image than
    their peers (French et al., 1995
    Manus Killeeen, 1995)
  • 13601, 9-12 graders compared self-reported
    suicidal ideation and attempts to perceived
    weight and BMI (calculated from self-reported ht
    and wt)
  • Negative body image was a risk factor for
    suicidal ideation even when BMI was controlled
    for
  • In other words, perceptions of weight were more
    important than actual weight with regard to mood
    and suicide risk (Eaton et al., 2005)

74
Self-Esteem
  • Mixed results in previous literature including
  • Lower self-esteem than non-obese peers
  • No differences
  • Those that find lower self-esteem is not
    significantly lower in obese populations when
    body image is controlled for
  • (Gortmaker, 1993 French et al., 1995 Manus
    Killeeen, 1995 Strauss, 2000)

75
Self-Esteem
  • Higher body weight related to lower Physical
    Appearance subscale scores and mean self-concept
    (ODea Abraham,
    1999)
  • Decreases in physical and social functioning for
    overweight vs. non-overweight children
    (Williams, Wake, Hesketh, 2005)

76
Self-Esteem
  • Emphasis of slimness was most strongly linked to
  • Body dissatisfaction
  • Disordered eating
  • Global self-esteem
  • An emphasis on popularity and hours spent
    watching television related to body
    dissatisfaction
  • Sport participation seemed to serve as a
    protective function
  • (Tiggemann, 2001)

77
Self-Esteem
  • Current research indicates lower than normal
    weight peers
  • Higher body weight students had lower ratings of
    global self-concept
  • Overweight 9-10 year old students experienced
    significant declines in self-esteem over 4 years
  • Why is this important?
  • Positive self-esteem associated with positive
    adjustment and functioning while negative
    self-esteem associated with behavior disorders
    and negative or depressed mood

78
Why lower Self-Esteem?
  • Developmental Changes
  • Self-esteem gets lower with increasing age
    (Strauss, 2000)
  • Ethnic differences
  • White females report lower self-esteem than
    African American females (Strauss, 2000)
  • Parental concern
  • Obese 10 to 16 year olds more significantly
    correlated with self-esteem problems than did
    BMI (Stradmeijer et al., 2000)
  • Lower body esteem in 5 yr old girls associated
    with higer parental concern about weight,
    independent of actual weight (Davison
    Birch, 2001)

79
Why lower Self-Esteem?
  • Teasing
  • Predictive of lower self-esteem and poorer body
    image for females and males (Gleason
    et al., 2000)
  • Body image
  • Females at greater risk for self-esteem problems
    due to importance of for self-esteem, but risks
    increasing for males (Manus Killeeen, 1995)
  • Locus of Control
  • 9-11 yr old children reported lower self-esteem
    if they believed they were responsible for their
    overweight compared to those who didnt believe
    they were responsible (Pierce Wardle, 1997)

80
Why lower Self-Esteem?
  • Increased discrepancy between media images and
    average individual in the U.S.
  • 20 yrs. ago the average model was only 8 thinner
    than the average American, today is 23 thinner
  • If life size, Barbie would be 56 tall, 110 lbs.
    and measure 39, 18, 33
  • Back too weak to hold up chest, waist too narrow
    to hold more than ½ a liver and few centimeters
    of bowels
  • Diet industry alone worth estimated 100 billion
    a year
  • Overwhelmed with messages about weight loss,
    negative images of fat and fat people

81
Unsafe (and ineffective) Potential Consequences
  • A large number of high school students use unsafe
    methods to lose or maintain weight
  • A nationwide survey found that during the 30 days
    preceding the survey
  • 13 of students went without eating for one or
    more days
  • 6 had vomited or taken laxatives
  • 9 had taken diet pills, powders, or liquids
    without the advice of their physicians
  • (Grunbaum et al., 2003)

82
Pediatric Weight Management Programs
83
Pediatric Obesity and Weight Management Programs
  • Essential components include
  • Behavioral goals (dietary and physical activity)
  • Medical goals to reduce secondary complications
  • Gradual, permanent weight loss
  • Parent involvement
  • Empirically Supported Treatments exist
  • Epsteins Stop Light program
  • Golans program

84
Effects of Weight Management Programs
  • Adolescents in weight loss camps showed
    significant
  • Decrease in body dissatisfaction
  • Increase in global self-worth, athletic
    competence, and physical appearance
    (Walker, Gately, Bewick, Hill, 2003)
  • Children 10-15 yo in weight management program
    with no significant change in average weight or
    BMI showed a significant
  • Decrease in self-concept
  • Greatest changes in self-concept score
    (Cameron, 1999)

85
Program Recommendations
  • Surgeon General Recommendations
  • Recommend Public Health Response settings
  • Families and Communities
  • Schools
  • Health Care
  • Media and Communication (U.S.
    Department of Health and Human Services, 2001)

86
Program Recommendations
  • Expert Committee Recommendations
  • Children w/BMI ?85th percentile should undergo tx
  • Tx should include assessment of readiness to
    engage in program, assessment of diet and
    physical activity habits, primary goal should be
    healthy eating and activity
  • Tx should begin early, involve families, and
    institute permanent changes
  • Parenting skills are foundation for successful
    intervention w/gradual targeted increases in
    activity and targeted reductions in high-fat,
    high-calorie foods
  • Ongoing support for families after initial
    weight-management programs (Barlow Dietz,
    1998)

87
Empirically Supported Treatments
  • Chambless Criteria for Well Established Txs
  • Minimum of 2 well-designed between group studies
    demonstrating efficacy of a particular treatment
    when compared to psychological placebo or
    alternative treatment
  • Equivalent to an already established treatment
  • Inclusion of treatment manuals
  • Clear definition of sample characteristics
  • Treatment effects must be demonstrated by at
    least two investigators (Jelalian
    Saelens, 1999)

88
Empirically Supported Treatments
  • Criteria for inclusion
  • Studies with children and adolescents that
    targeted weight loss as a primary objective or
    reported information through quantitative or
    illustrative presentation of weight loss if other
    outcomes were primary interest
  • Criteria for exclusion
  • Conducted primarily in school setting
  • Conducted with special populations
  • Used medication trials
  • Included participants older than 18 years
    old (Jelalian Saelens, 1999)

89
Studies for Children
  • 26 studies
  • Comprehensive behavioral treatment targeting
    eating and physical activity is superior to
    wait-list control or nutrition education alone
  • 4 studies by Epstein and colleagues document
    long-term maintenance of loss up to 10 years
  • Components include
  • Targeted diet combined with lifestyle or aerobic
    activity
  • Parental inclusion
  • Behavior modification
  • Self-monitoring of diet and activity
  • Stimulus control
  • Contingency management
  • Parent training
  • (Jelalian Saelens, 1999)

90
Studies for Adolescents
  • 7 studies
  • Promising interventions exist
  • 1) At least one well-controlled study and another
    less rigorously controlled study by a separate
    investigator,
  • 2) 2 or more well-controlled studies w/small
    numbers, or
  • 3) 2 or more well-controlled studies by the same
    investigator
  • (Jelalian Saelens, 1999)

91
Studies for Adolescents
  • Overlap in inclusion of behavioral modification
    of diet, but
  • Not as well developed
  • No rigorously conducted study documenting that
    outpatient obesity treatment is superior to
    wait-list control or instruction only
  • Mixed Group (Children and Adolescents or
    non-stated)
  • 9 studies
  • (Jelalian Saelens, 1999)

92
Traffic Light Diet
  • 13 of 26 Childhood studies were by Epstein
  • Empirically supported with multiple studies
    demonstrating significant weight loss that is
    maintained up to 10 years post treatment
  • Tx implementation that includes teaching children
    and parents how to label foods as green, yellow,
    and red foods based on calorie and nutrient
    density
  • Tx also includes developing healthy eating and
    activity environment for children, behavior
    change techniques, and maintenance of behavior
    change
  • (Epstein et al., 2000 Epstein
    et al., 2001)

93
More Epstein
  • Evaluated problem solving in obesity treatment
    and found that additional problem solving did not
    add to effectiveness beyond standard family-based
    treatments (Epstein et al., 2000)
  • Compared emphasizing ? fruit and vegetable intake
    vs. ? fat and sugar intake and found
    significantly greater decreases in overweight
    in ? fruit and vegetable intake group
    (Epstein et al., 2001)
  • Compared stimulus control to reinforcement to
    target sedentary behavior, found to be equivalent
    methods
  • (Epstein et al., 2004)

94
Golans Alternative Approach
  • Health-centered Approach
  • 60 children 7-12 years old in a family-based
    health-centered approach targeting only parents
    vs. children-only control group
  • Demonstrated 29 reduction in childrens
    overweight vs. 20.2 reduction in children-only
    group 7 yr follow-up
  • At 7 yr follow-up, 2 children from child-only
    condition exhibited eating disordered symptoms,
    no children from parent-only condition exhibited
    eating disordered symptoms (Golan Crow, 2004)

95
Primary Care Program
  • 4-month behavioral weight control program
    initiated in a primary care setting and extended
    through telephone and mail contact
  • Treatment group had better change in BMI and
    higher use of behavioral skills than in control
    group
  • No significant difference between groups for
    energy intake, percentage calories from fat,
    physical activity, sedentary behavior, and
    problematic weight-related or eating behaviors
    (Saelens, et al., 2002)

96
Planet Health
  • School-based multidisciplinary intervention for 2
    years with session focused on
  • Decreasing television viewing
  • Decreasing consumption of high-fat foods
  • Increasing fruit and vegetable intake
  • Increasing moderate and vigorous physical
    activity
  • Female obesity reduced compared to controls, no
    difference among boys (Gortmaker et al., 1999)
  • Also had reduced risk of using self-induced
    vomiting/laxatives or diet pills to control
    weight in past 30 days (Austin et al.,
    2005)

97
PACE for Adolescents
  • Patient-Centered Assessment and Counseling for
    Exercise
  • 117 adolescents 11-18 years recruited from
    pediatric and adolescent clinics
  • Receive interactive computer counseling, provider
    counseling, and extended follow-up
  • Intervention targets
  • Moderate physical activity
  • Vigorous physical activity
  • Fat intake
  • Fruit and vegetable intake
  • All outcomes except physical activity improved
    over time, extended interventions (mail or
    telephone) showed no greater outcomes
    (Patrick et al., 2001)

98
Cost Effectiveness of Programs
  • 24 families randomized to group individualized
    tx or group tx only
  • All groups included
  • Traffic Light Diet
  • Physical Activity
  • Self-monitoring
  • Stimulus Control
  • Reinforcement
  • Group treatment alone is more cost effective than
    mixed group plus individual format
    (Goldfield, et al., 2001)

99
Weight Management Programs and Self-Esteem
  • Epstein and Golan
  • No data on self-esteem rates or changes for
    participants
  • Negative Changes
  • Cameron, 1999
  • No significant weight loss
  • Positive Changes
  • Savoye et al., 2005
  • Increased at post, but back to baseline at
    follow-up
  • Walker et al., 2003 Gately et al., 2005
  • Increased during a camp setting
  • Significant weight loss
  • No follow-up data

100
Why the Change in Self-Esteem?
  • Weight loss
  • Large focus during programs on losing weight
  • Behavioral goals
  • Decreasing consumption of high fat and high
    calorie foods
  • Increasing physical activity levels
  • Locus of Control
  • Locus of Control An individuals belief
    regarding their control over personal outcomes
  • Limited data on pediatric obesity and locus of
    control
  • All hypotheses, none yet examined in a pediatric
    weight management program

101
Obesity and Locus of Control in Children
  • Pierce and Wardle (1997) Findings
  • Examined the belief systems of 9-11 year old
    overweight children
  • Children who indicated they felt their overweight
    was due to internal causal beliefs (I eat too
    much or I dont exercise enough) were strongly
    and negatively correlated to self-esteem
  • Children who indicated that they felt their
    overweight was due to external causes (It runs
    in my family or A medical cause) were strongly
    and positively correlated to self-esteem

102
Project STORY
103
Project STORY
  • Project Sensible Treatment of Obesity Rural Youth
    (STORY)
  • 4 month pediatric weight management program
  • Delivered in 3 waves in rural counties in north
    central Florida
  • Interventions delivered in Cooperative Extension
    Office

104
Participants
  • Data from larger study
  • Participants
  • 90 overweight children and their parent(s)
  • 8-13 years old from 4 rural counties
  • Inclusion/Exclusion Criteria
  • Child at or above 85th percentile
  • Participating parent living in home primarily or
    equally responsible for food purchasing and meal
    preparation
  • No condition contraindicating participation in a
    weight management program such as dietary and
    exercise restrictions
  • See proposal for additional criteria

105
Intervention Groups
  • Basic Program
  • Modified Stop-Light Program
  • Use of red, yellow, green classification
  • Physical activity targets and goals
  • Self-esteem and body image addressed
  • Behavioral modification techniques to help
    parents and children reach these goals

106
Intervention Groups
  • Behavioral Family Intervention (BFI)
  • Simultaneous but separate child and parent
    treatment groups
  • Behavioral Parent Intervention (BPI)
  • Parent only treatment group where parents
    encouraged to serve as childs interventionist at
    home
  • Weight List Control Group (WLC)
  • Will receive BFI condition after the 6-month
    follow-up

107
Project STORY Goals
  1. Decrease consumption of high fat and high calorie
    foods with modified version of Stop Light
    Program
  2. Increase physical activity with pedometers and
    daily physical activity logs
  3. Address Self-Esteem and Body Image with specific
    interactive lessons

108
Summary
  • Pediatric Obesity is a major Public Health
    Concern
  • Prevalence will only rise in toxic environment
  • Early intervention and prevention is critical to
    prevent medical, psychosocial, and
    disease-related costs
  • Empirically supported treatments for children are
    available with long term maintenance
  • Self-Esteem should be monitored and targeted in
    overweight and obese individuals
  • More research is needed with adolescents
  • Effective program components, cost effectiveness,
    and media messages are among the next directions
    for the field of research

109
  • Questions?
About PowerShow.com