Pub Date : 2024-01-01Epub Date: 2023-02-07DOI: 10.1089/chi.2022.0175
Emily W Gray, Webb A Smith, E Thomaseo Burton, Darla Hale, Adebowale Odulana, Ying Z Weatherall
Background: Metabolic and bariatric surgery (MBS) has been shown to be safe and effective for the treatment of adolescent obesity, yet many providers express hesitance to refer adolescents for surgery due to concerns for insufficient insurance coverage. Methods: The Healthy Lifestyle Clinic, a pediatric weight management clinic, was established in 2014, and an adolescent MBS program was added in 2017. Patients 15 years or older who meet the selection criteria are eligible for the surgery track. A retrospective chart review was conducted to describe our experience obtaining insurance approval for laparoscopic sleeve gastrectomy (LSG) for our adolescent patients. Results: Almost all patients who were interested in and eligible for LSG ultimately received insurance approval. Most patients had public insurance (70%). Sixty-four percent of patients were approved after the initial application, 23% were approved after a peer-to-peer review, and 11% required an appeal for approval. There was no difference in the time from insurance application to insurance approval based on age, race/ethnicity, or type of insurance. Conclusions: Age <18 years and having public health insurance have not been demonstrated as barriers to insurance approval for LSG in our cohort. Providers should not delay referral for MBS for eligible adolescents based on concern for insufficient insurance coverage. Adolescent MBS programs would benefit from a patient advocate to help families navigate the insurance approval process and reduce barriers to surgery.
{"title":"Insurance Approval for Laparoscopic Sleeve Gastrectomy in Adolescents in the Midsouth.","authors":"Emily W Gray, Webb A Smith, E Thomaseo Burton, Darla Hale, Adebowale Odulana, Ying Z Weatherall","doi":"10.1089/chi.2022.0175","DOIUrl":"10.1089/chi.2022.0175","url":null,"abstract":"<p><p><b><i>Background:</i></b> Metabolic and bariatric surgery (MBS) has been shown to be safe and effective for the treatment of adolescent obesity, yet many providers express hesitance to refer adolescents for surgery due to concerns for insufficient insurance coverage. <b><i>Methods:</i></b> The Healthy Lifestyle Clinic, a pediatric weight management clinic, was established in 2014, and an adolescent MBS program was added in 2017. Patients 15 years or older who meet the selection criteria are eligible for the surgery track. A retrospective chart review was conducted to describe our experience obtaining insurance approval for laparoscopic sleeve gastrectomy (LSG) for our adolescent patients. <b><i>Results:</i></b> Almost all patients who were interested in and eligible for LSG ultimately received insurance approval. Most patients had public insurance (70%). Sixty-four percent of patients were approved after the initial application, 23% were approved after a peer-to-peer review, and 11% required an appeal for approval. There was no difference in the time from insurance application to insurance approval based on age, race/ethnicity, or type of insurance. <b><i>Conclusions:</i></b> Age <18 years and having public health insurance have not been demonstrated as barriers to insurance approval for LSG in our cohort. Providers should not delay referral for MBS for eligible adolescents based on concern for insufficient insurance coverage. Adolescent MBS programs would benefit from a patient advocate to help families navigate the insurance approval process and reduce barriers to surgery.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10654607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2022-12-26DOI: 10.1089/chi.2022.0086
Chisom B Okoli, Nicole Arrington, Jori Hall, Trena Paulus, Isa Miles, Josephine Shieh, Kassidy Sharpe, Caree J Cotwright
Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to obesity among young children 0 to 5 years of age. In addition, parental beverage intake influences children's beverage intake. Objective: This study explores Black parents' perceptions about and barriers to limiting SSBs among young children. Methods: Twenty-seven Black parents participated in six focus groups conducted across the state of Georgia. Questions grounded in Social Cognitive Theory (SCT) assessed perceived health impacts of SSBs and water consumption, influences of beverage choices, barriers to limiting SSB intake, and resources needed to overcome barriers. Before the focus group sessions, participants completed a demographic survey. Quantitative data were analyzed using R statistical software. Focus group sessions were analyzed using NVivo. Results: Family and cultural norms, price, taste, flavor, water safety, tantrums, and product placement at grocery stores primarily influenced beverage choice and consumption. Restaurant refills, price, lack of confidence, advertisements, cravings, tantrums, and budget were perceived barriers to drinking more water and fewer SSBs daily. Resources Black parents noted would help in promoting and serving healthy beverages to their young children included education on beverage recommendations, training on how to read nutrition labels, healthy alternatives, and the presence of support systems. Conclusion: Findings from this study will inform interventions to reduce SSB intake among Black families with young children.
{"title":"Black Parents' Perceptions and Barriers to Limiting Sugar-Sweetened Beverages Among Young Children: A Social Cognitive Theory Application.","authors":"Chisom B Okoli, Nicole Arrington, Jori Hall, Trena Paulus, Isa Miles, Josephine Shieh, Kassidy Sharpe, Caree J Cotwright","doi":"10.1089/chi.2022.0086","DOIUrl":"10.1089/chi.2022.0086","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Sugar-sweetened beverages (SSBs) are a major contributor to obesity among young children 0 to 5 years of age. In addition, parental beverage intake influences children's beverage intake. <b><i>Objective:</i></b> This study explores Black parents' perceptions about and barriers to limiting SSBs among young children. <b><i>Methods:</i></b> Twenty-seven Black parents participated in six focus groups conducted across the state of Georgia. Questions grounded in Social Cognitive Theory (SCT) assessed perceived health impacts of SSBs and water consumption, influences of beverage choices, barriers to limiting SSB intake, and resources needed to overcome barriers. Before the focus group sessions, participants completed a demographic survey. Quantitative data were analyzed using R statistical software. Focus group sessions were analyzed using NVivo. <b><i>Results:</i></b> Family and cultural norms, price, taste, flavor, water safety, tantrums, and product placement at grocery stores primarily influenced beverage choice and consumption. Restaurant refills, price, lack of confidence, advertisements, cravings, tantrums, and budget were perceived barriers to drinking more water and fewer SSBs daily. Resources Black parents noted would help in promoting and serving healthy beverages to their young children included education on beverage recommendations, training on how to read nutrition labels, healthy alternatives, and the presence of support systems. <b><i>Conclusion:</i></b> Findings from this study will inform interventions to reduce SSB intake among Black families with young children.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10449680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2022-12-30DOI: 10.1089/chi.2022.0217
Kathryn E Kyler, Amy Houtrow, Matt Hall
Childhood obesity prevalence continues to increase, and may be coupled with a rise in rates of chronic conditions tied to obesity. We compared the prevalence and severity of 14 chronic conditions between adolescents aged 10-17 years with and without obesity using the 2018-2019 National Survey of Children's Health (NSCH). Chi square tests assessed differences in chronic condition prevalence across weight groups, and logistic regression determined the odds of having chronic conditions in adolescents with versus without obesity. We found adolescents with obesity had higher prevalence of >85% of included chronic conditions. Those with obesity had higher odds of moderate/severe depression [adjusted odds ratio (aOR) 1.41, 95% confidence interval (CI) 1.01-1.96], autism spectrum disorder (aOR 2.07, 95% CI 1.2-3.57), and developmental delay (aOR 1.77, 95% CI 1.15-2.73). Awareness of the ties between having a chronic condition among adolescents with obesity may help providers in assessing risk of morbidity among this at-risk group of children.
{"title":"Prevalence and Severity of Chronic Conditions Among Adolescents With Obesity.","authors":"Kathryn E Kyler, Amy Houtrow, Matt Hall","doi":"10.1089/chi.2022.0217","DOIUrl":"10.1089/chi.2022.0217","url":null,"abstract":"<p><p>Childhood obesity prevalence continues to increase, and may be coupled with a rise in rates of chronic conditions tied to obesity. We compared the prevalence and severity of 14 chronic conditions between adolescents aged 10-17 years with and without obesity using the 2018-2019 National Survey of Children's Health (NSCH). Chi square tests assessed differences in chronic condition prevalence across weight groups, and logistic regression determined the odds of having chronic conditions in adolescents with versus without obesity. We found adolescents with obesity had higher prevalence of >85% of included chronic conditions. Those with obesity had higher odds of moderate/severe depression [adjusted odds ratio (aOR) 1.41, 95% confidence interval (CI) 1.01-1.96], autism spectrum disorder (aOR 2.07, 95% CI 1.2-3.57), and developmental delay (aOR 1.77, 95% CI 1.15-2.73). Awareness of the ties between having a chronic condition among adolescents with obesity may help providers in assessing risk of morbidity among this at-risk group of children.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10466961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-08-14DOI: 10.1089/chi.2022.0035
Rachele De Giuseppe, Francesca Bergomas, Federica Loperfido, Francesca Giampieri, Giorgia Preatoni, Valeria Calcaterra, Hellas Cena
Background: Celiac disease (CD) is a multifactorial, immune-mediated enteropathic disorder that may occur at any age with heterogeneous clinical presentation. In the last years, unusual manifestations have become very frequent, and currently, it is not so uncommon to diagnose CD in subjects with overweight or obesity, especially in adults; however, little is known in the pediatric population. This systematic review aims to evaluate the literature regarding the association between CD and overweight/obesity in school-age children. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic database search of articles published in the last 20 years in English was carried out in Web of Sciences, PubMed, and Medline. The quality of the included studies was assessed by using the STrengthening the Reporting of OBservational studies in Epidemiology statement. Results: Of the 1396 articles identified, 9 articles, investigating overweight/obesity in children/adolescents affected by CD or screening CD in children/adolescents with overweight/obesity, met the inclusion criteria. Overall, the results showed that the prevalence of overweight or obesity in school-age children (6-17 years) affected by CD ranged between 3.5% and 20%, highlighting that the coexistence of CD with overweight/obesity in children is not uncommon as previously thought. Conclusion: Although CD has been historically correlated with being underweight due to malabsorption, it should be evaluated also in children with overweight and obesity, especially those who have a familiar predisposition to other autoimmune diseases and/or manifest unusual symptoms of CD.
背景:乳糜泻(CD)是一种多因素、免疫介导的肠病,可发生于任何年龄,临床表现各异。近些年来,不寻常的表现变得非常频繁,目前,在超重或肥胖的患者中诊断出乳糜泻并不罕见,尤其是在成人中;然而,人们对儿童中的乳糜泻知之甚少。本系统综述旨在评估有关学龄儿童 CD 与超重/肥胖之间关系的文献。研究方法:遵循《系统综述和元分析首选报告项目》指南。在 Web of Sciences、PubMed 和 Medline 上对过去 20 年发表的英文文章进行了电子数据库检索。采用《加强流行病学中产科观察研究的报告》(STrengthening the Reporting of OBservational studies in Epidemiology)声明对纳入研究的质量进行了评估。结果:在确定的 1396 篇文章中,有 9 篇文章符合纳入标准,这些文章调查了受 CD 影响的儿童/青少年的超重/肥胖情况,或筛查了超重/肥胖儿童/青少年中的 CD 患者。总体而言,研究结果表明,受 CD 影响的学龄儿童(6-17 岁)中超重或肥胖的发生率介于 3.5% 和 20% 之间,这表明 CD 与超重/肥胖并存的情况并不像之前认为的那样罕见。结论虽然 CD 历来与吸收不良导致的体重不足有关,但对于超重和肥胖的儿童,尤其是那些有其他自身免疫性疾病易感性和/或表现出不寻常 CD 症状的儿童,也应进行评估。
{"title":"Could Celiac Disease and Overweight/Obesity Coexist in School-Aged Children and Adolescents? A Systematic Review.","authors":"Rachele De Giuseppe, Francesca Bergomas, Federica Loperfido, Francesca Giampieri, Giorgia Preatoni, Valeria Calcaterra, Hellas Cena","doi":"10.1089/chi.2022.0035","DOIUrl":"10.1089/chi.2022.0035","url":null,"abstract":"<p><p><b><i>Background:</i></b> Celiac disease (CD) is a multifactorial, immune-mediated enteropathic disorder that may occur at any age with heterogeneous clinical presentation. In the last years, unusual manifestations have become very frequent, and currently, it is not so uncommon to diagnose CD in subjects with overweight or obesity, especially in adults; however, little is known in the pediatric population. This systematic review aims to evaluate the literature regarding the association between CD and overweight/obesity in school-age children. <b><i>Methods:</i></b> The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic database search of articles published in the last 20 years in English was carried out in Web of Sciences, PubMed, and Medline. The quality of the included studies was assessed by using the STrengthening the Reporting of OBservational studies in Epidemiology statement. <b><i>Results:</i></b> Of the 1396 articles identified, 9 articles, investigating overweight/obesity in children/adolescents affected by CD or screening CD in children/adolescents with overweight/obesity, met the inclusion criteria. Overall, the results showed that the prevalence of overweight or obesity in school-age children (6-17 years) affected by CD ranged between 3.5% and 20%, highlighting that the coexistence of CD with overweight/obesity in children is not uncommon as previously thought. <b><i>Conclusion:</i></b> Although CD has been historically correlated with being underweight due to malabsorption, it should be evaluated also in children with overweight and obesity, especially those who have a familiar predisposition to other autoimmune diseases and/or manifest unusual symptoms of CD.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9993690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-11-08DOI: 10.1089/chi.2022.0157
Michael Cosimini, Payal Shah, Christina Jung, Ashely Bennett, Kevin Fang, Olga Solomon, Juan Espinoza
Nonmedical descriptors, adjectives that are not related to a medical condition, such as "cute," are often used in presentations in pediatrics. We hypothesize that patterns of their use may reflect obesity bias. Descriptors used by pediatric residents presenting cases of children <9 years in an outpatient clinic during the 2018-2019 and 2019-2020 academic years were recorded. The primary outcome was the association of the use of positive nonmedical descriptors with children's obesity status using logistic regression. Positive descriptors were used in 14% of 994 presentations. Most addressed the appearance of the child with variations of "cute" and "adorable." There was no variation in use of positive descriptors by obesity status. On multivariate logistic regression, the odds of using positive descriptors were higher among female residents, and positive descriptor use declined with patient age. Negative descriptors were rare and often focused on weight.
{"title":"Cute Kid? Patient Obesity Status and the Use of Nonmedical Descriptors in Presentations by Pediatric Residents.","authors":"Michael Cosimini, Payal Shah, Christina Jung, Ashely Bennett, Kevin Fang, Olga Solomon, Juan Espinoza","doi":"10.1089/chi.2022.0157","DOIUrl":"10.1089/chi.2022.0157","url":null,"abstract":"<p><p>Nonmedical descriptors, adjectives that are not related to a medical condition, such as \"cute,\" are often used in presentations in pediatrics. We hypothesize that patterns of their use may reflect obesity bias. Descriptors used by pediatric residents presenting cases of children <9 years in an outpatient clinic during the 2018-2019 and 2019-2020 academic years were recorded. The primary outcome was the association of the use of positive nonmedical descriptors with children's obesity status using logistic regression. Positive descriptors were used in 14% of 994 presentations. Most addressed the appearance of the child with variations of \"cute\" and \"adorable.\" There was no variation in use of positive descriptors by obesity status. On multivariate logistic regression, the odds of using positive descriptors were higher among female residents, and positive descriptor use declined with patient age. Negative descriptors were rare and often focused on weight.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-10-28DOI: 10.1089/chi.2022.0112
Christopher Fay, Ines Castro, Desiree Sierra Velez, Cara F Ruggiero, Giselle O'Connor, Meghan Perkins, Mandy Luo, Mona Sharifi, Fernanda Neri Mini, Elsie M Taveras, Karen Kuhlthau, Lauren Fiechtner
Background: Despite modest mean body mass index (BMI) improvements in pediatric weight management interventions (PWMIs), some children are more and less successful in achieving a healthier weight. We sought to understand key behavior modifications and strategies used to overcome barriers that led to success or nonresponse. Methods: Using a semistructured guide, we conducted interviews in English and Spanish to explore the perspectives of caregivers whose children responded (BMI z-score change of greater than or equal to -0.2 units over 1 year) or did not respond (≥5% increase in % of the 95th percentile for BMI over 1 year) to a PWMI. Interviews were recorded, transcribed, and then coded using the framework approach. Researchers met regularly to review coding, content, and emerging themes. Results: We reached thematic saturation after interviewing the caregivers of 14 responders and 16 nonresponders and identified 7 themes as key elements of a positive response: (1) positive parenting approach; (2) application and practice of new information; (3) higher agency for change; (4) management of unmet social needs through creative solutions; (5) promoting mindful eating; (6) family alignment on health behaviors; and (7) mitigation of weight stigma. Conclusion: The effectiveness of PWMI may be enhanced by incorporating curricular elements that specifically promote the approaches identified among responders in this study. Similarly, lessons can be learned from nonresponders, so clinicians can identify and help early on when behaviors associated with nonresponse are seen. Clinical Trial Registration number: ClinicalTrials.gov: NCT03012126.
{"title":"Keys to Achieving Clinically Important Weight Loss: Perceptions of Responders and Nonresponders in the Clinic and Community Approaches to Healthy Weight Trial.","authors":"Christopher Fay, Ines Castro, Desiree Sierra Velez, Cara F Ruggiero, Giselle O'Connor, Meghan Perkins, Mandy Luo, Mona Sharifi, Fernanda Neri Mini, Elsie M Taveras, Karen Kuhlthau, Lauren Fiechtner","doi":"10.1089/chi.2022.0112","DOIUrl":"10.1089/chi.2022.0112","url":null,"abstract":"<p><p><b><i>Background:</i></b> Despite modest mean body mass index (BMI) improvements in pediatric weight management interventions (PWMIs), some children are more and less successful in achieving a healthier weight. We sought to understand key behavior modifications and strategies used to overcome barriers that led to success or nonresponse. <b><i>Methods:</i></b> Using a semistructured guide, we conducted interviews in English and Spanish to explore the perspectives of caregivers whose children responded (BMI z-score change of greater than or equal to -0.2 units over 1 year) or did not respond (≥5% increase in % of the 95th percentile for BMI over 1 year) to a PWMI. Interviews were recorded, transcribed, and then coded using the framework approach. Researchers met regularly to review coding, content, and emerging themes. <b><i>Results:</i></b> We reached thematic saturation after interviewing the caregivers of 14 responders and 16 nonresponders and identified 7 themes as key elements of a positive response: (1) positive parenting approach; (2) application and practice of new information; (3) higher agency for change; (4) management of unmet social needs through creative solutions; (5) promoting mindful eating; (6) family alignment on health behaviors; and (7) mitigation of weight stigma. <b><i>Conclusion:</i></b> The effectiveness of PWMI may be enhanced by incorporating curricular elements that specifically promote the approaches identified among responders in this study. Similarly, lessons can be learned from nonresponders, so clinicians can identify and help early on when behaviors associated with nonresponse are seen. Clinical Trial Registration number: ClinicalTrials.gov: NCT03012126.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9594677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-12-02DOI: 10.1089/chi.2022.0165
Kelly Hall, Nora Geary, Amy Lowry Warnock, Carrie Dooyema
Background: Quality Rating and Improvement Systems (QRISs) are used to assess, improve, and communicate quality in early care and education (ECE) programs. One strategy for supporting healthy growth in early childhood is embedding nutrition, physical activity, infant feeding, and screen time content into state QRIS standards, using the Caring for Our Children high-impact obesity prevention standards (HIOPS) and the CDC Spectrum of Opportunities framework (CDC Spectrum). We assessed the number of obesity prevention standards in QRISs in 2020 and compared results to an analysis published in 2015. Methods: We collected state QRIS standards for ECE centers from March to April 2020. Two analysts coded documents for standards related to 47 HIOPS and 6 Spectrum areas. Results: Thirty-nine states and the District of Columbia had statewide QRISs in early 2020. Of these, 21 QRISs (53%) embedded 1 or more HIOPS, and 26 (65%) embedded 1 or more Spectrum components. On average, 6.9% of HIOPS were embedded in QRIS standards in 2020, an increase from 4.6% in 2015. Nine QRISs included more HIOPS in 2020 than in 2015. Five QRISs added 10% or more of the 47 HIOPS between 2015 and 2020. Physical activity and screen time standards continued to be most often included; infant feeding standards were least included. Conclusion: Obesity prevention components were embedded in three-quarters of state QRISs, and more were embedded in 2020 than in 2015, suggesting that QRISs can be levers for supporting healthy weight in ECE settings.
{"title":"Supporting Healthy Weight in Statewide Quality Rating and Improvement Systems: A Review of 2020 Standards and Comparison to 2015 Standards.","authors":"Kelly Hall, Nora Geary, Amy Lowry Warnock, Carrie Dooyema","doi":"10.1089/chi.2022.0165","DOIUrl":"10.1089/chi.2022.0165","url":null,"abstract":"<p><p><b><i>Background:</i></b> Quality Rating and Improvement Systems (QRISs) are used to assess, improve, and communicate quality in early care and education (ECE) programs. One strategy for supporting healthy growth in early childhood is embedding nutrition, physical activity, infant feeding, and screen time content into state QRIS standards, using the Caring for Our Children high-impact obesity prevention standards (HIOPS) and the CDC Spectrum of Opportunities framework (CDC Spectrum). We assessed the number of obesity prevention standards in QRISs in 2020 and compared results to an analysis published in 2015. <b><i>Methods:</i></b> We collected state QRIS standards for ECE centers from March to April 2020. Two analysts coded documents for standards related to 47 HIOPS and 6 Spectrum areas. <b><i>Results:</i></b> Thirty-nine states and the District of Columbia had statewide QRISs in early 2020. Of these, 21 QRISs (53%) embedded 1 or more HIOPS, and 26 (65%) embedded 1 or more Spectrum components. On average, 6.9% of HIOPS were embedded in QRIS standards in 2020, an increase from 4.6% in 2015. Nine QRISs included more HIOPS in 2020 than in 2015. Five QRISs added 10% or more of the 47 HIOPS between 2015 and 2020. Physical activity and screen time standards continued to be most often included; infant feeding standards were least included. <b><i>Conclusion:</i></b> Obesity prevention components were embedded in three-quarters of state QRISs, and more were embedded in 2020 than in 2015, suggesting that QRISs can be levers for supporting healthy weight in ECE settings.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10235206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9573460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-11-11DOI: 10.1089/chi.2022.0137
Jennifer S Savage, Amy M Moore, Samantha M R Kling, Michele Marini, Erika Hernandez, Jennifer Franceschelli Hosterman, Sandra Hassink, Ian M Paul, Lisa Bailey-Davis
Background: Rapid weight gain during infancy is associated with risk for later obesity, yet little research to date has examined the effect of a responsive parenting (RP) intervention with care coordination between pediatric primary care providers and Women, Infants, and Children nutritionists on infant weight. Methods: The Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study is a pragmatic, randomized clinical trial for mothers and infants (n = 288) designed to examine the effect of a patient-centered RP intervention that used advanced health information technology strategies to coordinate care to reduce rapid infant weight gain compared with standard care. General linear models examined intervention effects on infant conditional weight gain scores, weight-for-age z scores, BMI, and overweight status (BMI-for-age ≥85th percentile) from birth to age 6 months, and mothers' use of food to soothe from age 2 to 6 months. Results: There were no intervention effects on infant conditional weight gain scores or overweight status at 6 months. Infants in the RP intervention had lower mean weight-for-age z scores [M = -0.04, standard error (SE) = 0.04 vs. M = 0.05, SE = 0.04; p = 0.008] and lower mean BMI (M = 16.05, SE = 0.09 vs. M = 16.24, SE = 0.09; p = 0.03) compared with standard care. Mothers' use of emotion-based food to soothe was lower in the RP intervention compared with standard care from age 2 to 6 months [M difference = -0.32, standard deviation (SD) = 0.81 vs. 0.00, SD = 0.90; p = 0.01]. Conclusions: This pragmatic, patient-centered RP intervention did not reduce rapid infant weight gain or overweight but was associated with modestly lower infant BMI and reduced mothers' use of emotion-based food to soothe. Trial Registration: clinicaltrials.gov identifier: NCT03482908.
背景:婴儿期体重快速增加与后期肥胖的风险相关,但迄今为止很少有研究调查反应性育儿(RP)干预与儿科初级保健提供者和妇女、婴儿和儿童营养学家之间的护理协调对婴儿体重的影响。方法:妇女、婴儿和儿童对婴儿早期健康生活方式的增强(WEE Baby)护理研究是一项实用的、针对母亲和婴儿的随机临床试验(n = 288),旨在检验以患者为中心的RP干预的效果,该干预使用先进的卫生信息技术策略来协调护理,以减少与标准护理相比婴儿体重的快速增加。一般线性模型检验了干预对婴儿出生至6个月的条件体重增加评分、年龄体重z评分、BMI和超重状态(BMI年龄≥85百分位数)的影响,以及母亲在2至6个月期间使用食物抚慰的影响。结果:干预对婴儿条件体重增加评分或6个月时的超重状况没有影响。RP干预组婴儿的平均年龄体重z得分较低[M = -0.04,标准误差(SE) = 0.04, M = 0.05, SE = 0.04;p = 0.008)和较低的平均BMI (M = 16.05, SE = 0.09和M = 16.24, SE = 0.09;P = 0.03)。2 ~ 6个月时,RP干预中母亲使用基于情绪的食物进行安抚的比例低于标准护理[M差= -0.32,标准差(SD) = 0.81 vs. 0.00, SD = 0.90;p = 0.01]。结论:这种实用的、以患者为中心的RP干预并没有减少婴儿体重的快速增加或超重,但与婴儿体重指数的适度降低和母亲使用基于情绪的食物来安抚有关。试验注册:clinicaltrials.gov标识符:NCT03482908。
{"title":"Coordination Between Primary Care and Women, Infants, and Children to Prevent Obesity for Infants from Low-Income Families: A Pragmatic Randomized Clinical Trial.","authors":"Jennifer S Savage, Amy M Moore, Samantha M R Kling, Michele Marini, Erika Hernandez, Jennifer Franceschelli Hosterman, Sandra Hassink, Ian M Paul, Lisa Bailey-Davis","doi":"10.1089/chi.2022.0137","DOIUrl":"10.1089/chi.2022.0137","url":null,"abstract":"<p><p><b><i>Background:</i></b> Rapid weight gain during infancy is associated with risk for later obesity, yet little research to date has examined the effect of a responsive parenting (RP) intervention with care coordination between pediatric primary care providers and Women, Infants, and Children nutritionists on infant weight. <b><i>Methods:</i></b> The Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study is a pragmatic, randomized clinical trial for mothers and infants (<i>n</i> = 288) designed to examine the effect of a patient-centered RP intervention that used advanced health information technology strategies to coordinate care to reduce rapid infant weight gain compared with standard care. General linear models examined intervention effects on infant conditional weight gain scores, weight-for-age <i>z</i> scores, BMI, and overweight status (BMI-for-age ≥85th percentile) from birth to age 6 months, and mothers' use of food to soothe from age 2 to 6 months. <b><i>Results:</i></b> There were no intervention effects on infant conditional weight gain scores or overweight status at 6 months. Infants in the RP intervention had lower mean weight-for-age <i>z</i> scores [<i>M</i> = -0.04, standard error (SE) = 0.04 vs. <i>M</i> = 0.05, SE = 0.04; <i>p</i> = 0.008] and lower mean BMI (<i>M</i> = 16.05, SE = 0.09 vs. <i>M</i> = 16.24, SE = 0.09; <i>p</i> = 0.03) compared with standard care. Mothers' use of emotion-based food to soothe was lower in the RP intervention compared with standard care from age 2 to 6 months [<i>M</i> difference = -0.32, standard deviation (SD) = 0.81 vs. 0.00, SD = 0.90; <i>p</i> = 0.01]. <b><i>Conclusions:</i></b> This pragmatic, patient-centered RP intervention did not reduce rapid infant weight gain or overweight but was associated with modestly lower infant BMI and reduced mothers' use of emotion-based food to soothe. <b>Trial Registration:</b> clinicaltrials.gov identifier: NCT03482908.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40683460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-11-22DOI: 10.1089/chi.2022.0158
Janani Rajbhandari-Thapa, Sae Rom Chung, Huimin Hu, Daniel B Hall, Biplav Babu Tiwari
The United States has implemented policy efforts for public and private insurance to cover counseling services related to the treatment of obesity. However, no research has yet studied counseling service utilization among pediatric patients with obesity. We used 3 years (2017-2019) of IBM MarketScan Commercial Claims and Encounters Database and IBM MarketScan Multi-State Medicaid Data to examine such utilization patterns. We found the proportion of patients receiving any counseling services to be low among both privately insured (7.06%-7.97%) and Medicaid patients (9.51%-11.61%) within 6 months from diagnosis of obesity. This underutilization is concerning as many pediatric patients go undiagnosed, as evidenced in this research. Among the utilized services, nutrition counseling and face-to-face counseling were utilized the most by privately and Medicaid-insured patients over 6- and 12-month follow-ups. Our study underscores the need for implementing policies and programs to promote the utilization of counseling services among pediatric patients.
{"title":"Utilization of Counseling Services by Pediatric Patients With Obesity Using MarketScan Data (2017-2019).","authors":"Janani Rajbhandari-Thapa, Sae Rom Chung, Huimin Hu, Daniel B Hall, Biplav Babu Tiwari","doi":"10.1089/chi.2022.0158","DOIUrl":"10.1089/chi.2022.0158","url":null,"abstract":"<p><p>The United States has implemented policy efforts for public and private insurance to cover counseling services related to the treatment of obesity. However, no research has yet studied counseling service utilization among pediatric patients with obesity. We used 3 years (2017-2019) of IBM MarketScan Commercial Claims and Encounters Database and IBM MarketScan Multi-State Medicaid Data to examine such utilization patterns. We found the proportion of patients receiving any counseling services to be low among both privately insured (7.06%-7.97%) and Medicaid patients (9.51%-11.61%) within 6 months from diagnosis of obesity. This underutilization is concerning as many pediatric patients go undiagnosed, as evidenced in this research. Among the utilized services, nutrition counseling and face-to-face counseling were utilized the most by privately and Medicaid-insured patients over 6- and 12-month follow-ups. Our study underscores the need for implementing policies and programs to promote the utilization of counseling services among pediatric patients.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-12-07DOI: 10.1089/chi.2022.0173
Ellen V Pudney, Rebecca M Puhl, Linda C Halgunseth, Marlene B Schwartz
Parental weight talk with children can have negative consequences; yet, it is not well understood why parents engage in it and if demographic differences exist. Utilizing the extant qualitative literature, we developed two scales to quantitatively examine parental reasons for engaging in and avoiding weight talk. An Internet sample of 408 US parents (64% mothers; 34% White, 33% Black, and 32% Hispanic/Latinx) completed the scales. Parents cited concern for their child's health as a primary reason for weight talk, whereas avoidance stemmed from not wanting their child to be weight-obsessed. White and Hispanic vs. Black parents, and parents with experienced weight stigma, were more likely to cite personal struggles with body weight as reasons to both engage in and avoid weight talk. Fathers vs. mothers were more likely to cite protecting their child from weight-based bullying as a reason for weight talk. Understanding these parental motivations can inform health interventions.
{"title":"Parental Reasons for Engaging in or Avoiding Weight Talk With Children.","authors":"Ellen V Pudney, Rebecca M Puhl, Linda C Halgunseth, Marlene B Schwartz","doi":"10.1089/chi.2022.0173","DOIUrl":"10.1089/chi.2022.0173","url":null,"abstract":"<p><p>Parental weight talk with children can have negative consequences; yet, it is not well understood why parents engage in it and if demographic differences exist. Utilizing the extant qualitative literature, we developed two scales to quantitatively examine parental reasons for engaging in and avoiding weight talk. An Internet sample of 408 US parents (64% mothers; 34% White, 33% Black, and 32% Hispanic/Latinx) completed the scales. Parents cited concern for their child's health as a primary reason for weight talk, whereas avoidance stemmed from not wanting their child to be weight-obsessed. White and Hispanic vs. Black parents, and parents with experienced weight stigma, were more likely to cite personal struggles with body weight as reasons to both engage in and avoid weight talk. Fathers vs. mothers were more likely to cite protecting their child from weight-based bullying as a reason for weight talk. Understanding these parental motivations can inform health interventions.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10361245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}