Health-Related Quality of Life across Recent Pediatric Obesity Classification Recommendations.

Extreme body mass index (BMI) values (i.e., above the 97th and below the 3rd percentiles) are inaccurately represented on the Centers for Disease Control and Prevention's growth curves, which may limit the utility of BMI percentile and BMI z-score for capturing changes in clinical outcomes for patients at extreme weights. Modeling child obesity severity based upon the percentage of BMI in excess of the 95th percentile (BMI95pct) has been proposed as an improved metric to better capture variability in weight at extreme ends of growth curves, which may improve our understanding of relationships between weight status and changes in clinical outcomes. However, few studies have evaluated whether the use of BMI95pct would refine our understanding of differences in clinical psychosocial constructs compared to previous methods for categorization. This cross-sectional study evaluated child obesity severity based on BMI95pct to examine potential group differences in a validated, obesity-specific measure of Health-Related Quality of Life (HRQoL). Four hundred and sixty-five children with obesity completed Sizing Me Up, a self-report measure of HRQoL. Children were classified into categories based on BMI95pct (i.e., class I: ≥100% and <120%; class II: ≥120% and <140%; class III: ≥140%). The results indicate that children with class III obesity reported lower HRQoL than children with class I and class II obesity; however, there were no differences between Class II and Class I. In much of the previous literature, children with class II and class III obesity are often combined under the category "Severe Obesity" based upon BMI above the 99th percentile. This study suggests that grouping children from various classes together would neglect to capture critical differences in HRQoL. Future research including children with severe obesity should consider obesity classes to best account for functioning and clinical outcomes.

Latent profile analysis of young adolescents' physical activity across locations on schooldays.

PURPOSE: To investigate whether adolescents cluster into profiles based on where they accumulate moderate-to-vigorous physical activity (MVPA), if overall MVPA differs across profiles, and if walking to school and participant and neighborhood characteristics explain profile membership. METHODS: Adolescents (N=528; mean age=14.12±1.44; 50% girls) wore accelerometers and Global Positioning Systems (GPS) trackers for 3.9±1.5 days to assess MVPA minutes in five locations: at home, at school, in home neighborhood, in school neighborhood, and other. Walking to school and participant characteristics were assessed by questionnaire, and neighborhood environment by Geographic Information Systems (GIS). Latent profile analysis (LPA) was used to identify profiles/groups of participants based on accumulation of physical activity across the five locations. Mixed-effects regression tested differences in overall MVPA, walking to school, and other characteristics across profiles. RESULTS: Four initial profiles emerged: one Insufficiently Active profile and three "Active" profiles (Active Around School, Active Home Neighborhood, and Active Other Locations). The Insufficiently Active profile emerging from the first LPA (90% of participants) was further separated into four profiles in a second LPA: Insufficiently Active, and three additional "Active" profiles (Moderately-Active Around School, Moderately-Active Home Neighborhood, and Active At Home). Those in the six Active profiles had more overall MVPA (41.1-92.7 minutes/day) than those in the two Insufficiently Active profiles (34.5-38.3 minutes/day). Variables that differed across profiles included walking to school, sports/athletic ability, and neighborhood walkability. CONCLUSIONS: Although most participants did not meet the MVPA guideline, the six Active profiles showed the places in which many adolescents were able to achieve the 60-minute/day guideline. The home and school neighborhood (partly through walking to school), "other" locations, and to a lesser extent the home, appeared to be key sources for physical activity that distinguished active from insufficiently active adolescents. Finding the right match between the individual and physical activity source/location may be a promising strategy for increasing active travel and MVPA in adolescents.

Factor Structure of a Spanish Translation of an Obesity-Specific Parent-Report Measure of Health-Related Quality of Life.

Objective: Latino youth are disproportionately affected by pediatric obesity and consequently experience impaired health-related quality of life (HRQOL). Although many caregivers of Latino youth do not speak English fluently, no validated Spanish translations of obesity-specific HRQOL measures exist for this population. Therefore, non-English-speaking Latino parents have typically been excluded from analyses related to HRQOL. This study assesses the factor structure of a Spanish translation of a parent-report measure of obesity-specific HRQOL, Sizing Them Up, in a treatment-seeking sample of children with obesity. Methods: Structural equation modeling was used to assess the factor structure of the 6-subscale, 22-item Sizing Them Up measure in 154 parents of treatment-seeking Latino youth (5-18 years of age). Analyses exploring internal consistency and convergent validity were also conducted. Results: Acceptable measurement fit was achieved for the six-factor solution. However, the higher-order model assessing Total HRQOL did not reach acceptable levels, as results found that the Positive Social Attributes (PSA) subscale was not representative of Total HRQOL; internal consistency and convergent validity results also supported this finding. Conclusions: The current study provides support for the utility of a modified version of Sizing Them Up, excluding the PSA Scale, as a parent-report measure of obesity-specific HRQOL in treatment-seeking Latino youth with obesity.

Confirmatory Factor Analysis of Sizing Me Up: Validation of an Obesity-Specific Health-Related Quality of Life Measure in Latino Youth.

Objectives: This study aims to validate an obesity-specific health-related quality of life (HRQOL) measure, Sizing Me Up (SMU), in treatment-seeking Latino youth. Pediatric obesity has been associated with reduced HRQOL; therefore, valid measures are important for use in diverse populations that may be at increased risk for obesity and related comorbidities. Methods: Structural equation modeling tested the fit of the 5-subscale, 22-item SMU measure in Latino youth, 5-13 years of age, with obesity ( N = 204). Invariance testing was conducted to examine equivalence between Latino and non-Latino groups ( N = 250). Results: SMU achieved acceptable fit in a Latino population [χ 2 = 428.33, df = 199, p < .001, Root Mean Squared Error of Approximation = 0.072 (0.062-0.082), Comparative Fit Index = 0.915, Tucker-Lewis Index = 0.901, Weighted Root Mean Square Residual = 1.2230]. Additionally, factor structure and factor loadings were invariant across Latino and non-Latino groups, but thresholds were not invariant. Conclusions: SMU is a valid measure of obesity-specific HRQOL in treatment-seeking Latino youth with obesity.

Patient Attendance and Outcomes in a Structured Weight Management Program.

OBJECTIVES: To determine service utilization and identify patient characteristics associated with service utilization in youth with obesity presenting for structured weight management, and to explore weight-related outcomes associated with service utilization. STUDY DESIGN: In this retrospective study conducted between January 2008 and December 2013, we examined variables associated with the care of 2089 patients aged 2-18 years presenting for an initial visit to 2 tertiary care-based, multidisciplinary structured weight management clinics. RESULTS: Only 53% of patients returned for a second visit, 29% returned for a third visit, and virtually none (0.5%) completed the recommended 6 visits within 6 months. Patients who were Hispanic, government-insured, and whose parent/s spoke Spanish were more likely to return to clinic. Of those patients who returned for at least a second visit, 70% demonstrated a reduction in or maintenance of body mass index z-score. CONCLUSIONS: Patient retention remains a significant barrier to effective pediatric weight management. Structured weight management programs should increase their efforts to engage patients and families at the initial visit and identify and address barriers to follow up.

Making the Business Case for Coverage of Family-Based Behavioral Group Interventions for Pediatric Obesity.

BACKGROUND: Pediatric obesity presents a significant burden. However, family-based behavioral group (FBBG) obesity interventions are largely uncovered by our health care system. The present study uses Return on Investment (ROI) and Internal Rate of Return (IRR) analyses to analyze the business side of FBBG interventions. METHODS: ROI and IRR were calculated to determine longitudinal cost-effectiveness of a FBBG intervention. Multiple simulations of cost savings are projected using three estimated trajectories of weight change and variations in assumptions. RESULTS: The baseline model of child savings gives an average IRR of 0.2% ± 0.08% and an average ROI of 20.8% ± 0.4%, which represents a break-even IRR and a positive ROI. More pessimistic simulations result in negative IRR values. CONCLUSIONS: Under certain assumptions, FBBGs offer a break-even proposition. Results are limited by lack of data regarding several assumptions, and future research should evaluate changes in cost savings following changes in child and adult weight.

Prevalence and Health Correlates of Overweight and Obesity in Children with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) may be at increased risk for overweight and obesity, but little information is known about correlates of overweight and obesity in this population. This study compared prevalence rates of parent-reported overweight and obesity and specific health behaviors (i.e., parent report of child sleep, family meal patterns, child screen time, and child physical activity) among children with ASD (N = more than 900 [weighted to represent 690,000; age 10-17]) compared with children without ASD using data from a nationally representative sample. Additionally, the relationship between specific health behaviors (i.e., child sleep, family meals, screen time, and physical activity) and weight status was examined in the ASD population. Data were from the National Survey of Children's Health 2011-2012. Results indicate that children with ASD were more likely to be obese but not more likely to be overweight than non-ASD youth. Children with ASD engaged in physical activity less than children without ASD, but no differences were found on sleep, most measures of screen time, and mealtimes. However, parent perceived poorer sleep was associated with increased weight status, and fewer family meals were associated with normal weight status among children with ASD.

Systematic review: mealtime behavior measures used in pediatric chronic illness populations.

OBJECTIVE: This systematic review evaluates the utility and psychometric properties of pediatric mealtime assessments (direct observation and parent-report measures) using evidence-based criteria developed by the Division 54 Evidence-Based Assessment Task Force. METHOD: Measures of mealtime behavior used in at least one chronic illness pediatric population were eligible for inclusion. A total of 23 assessment measures were reviewed (16 parent-/self-report; 7 direct observation). RESULTS: 3 parent-report and 4 direct observation measures were classified as well-established, 3 met criteria for approaching well-established, and 13 were categorized as promising. Measures have been primarily used in children with feeding disorders, cystic fibrosis, and autism spectrum disorders. CONCLUSIONS: Overall, the literature of pediatric mealtime assessment tools shows a strong evidence base for many direct observation methods and subjective parent-report measures. Exploratory and confirmatory factor analyses are available for some measures; recommendations for future validation research and measure development across pediatric populations are discussed.

Weighing physical activity: the impact of a family-based group lifestyle intervention for pediatric obesity on participants' physical activity.

OBJECTIVES: To examine differences in self-reported physical activity (PA) between participants enrolled in the treatment versus active control condition of a pediatric obesity intervention, and to test associations between parent and child PA. METHODS: Participants (N = 93) included children aged 7-17 years and their parent. Analyses tested whether participants in the treatment condition reported greater PA at postintervention and 12-month follow-up compared with the control condition. Further, researchers examined change in PA across time and whether change in parent PA was associated with change in child PA. RESULTS: Children in the treatment condition reported greater PA at 12-month follow-up. Parents in the treatment group reported a significant increase in PA between baseline and postintervention. Change in parent PA was associated with changes in child PA across multiple periods. CONCLUSIONS: Family-based obesity interventions may promote long-term change in self-reported PA among youths, and change in parent PA may be a contributing factor.