Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities.

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions.

The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.

Development and Implementation of a Hybrid Online and In-Person Food Sovereignty and Nutrition Education Curriculum for Native American Parents: The FRESH Study.

The Food Resource Equity and Sustainability for Health ("FRESH") study is an Indigenous-led intervention to increase vegetable and fruit intake among Native American children. As part of this study, we developed a hybrid (online and in-person) food sovereignty and nutrition education curriculum for the parents of these children. This 16-week curriculum was developed to promote household- and community-level healthy eating and food sovereignty practices to parents of preschool-aged children residing in Osage Nation, Oklahoma. A total of 81 parent/caregivers participated in the curriculum component of the FRESH study, with a median age of 34 years (range: 23-54 years). Most study participants were female (88.9%) and less than half (45.7%) had an annual household income of more than US$50,000. Most were married or had a significant other (76.5%) and worked full-time (65.4%). The median total number of children in the home <18 years of age was three (range: 1-8). Participation among the 94 parents was 56% during the first week and was 12% in the final week. Having some college or technical training (vs. having a college degree) and having an annual household income of US$20,000-US$50,000 (vs. more than US$50,000) were associated with fewer sessions attended (p = 0.004 and 0.02, respectively) Being married (vs. not) was associated with higher attendance (p < .0001). Participation in a hybrid food sovereignty and nutrition education curriculum for parents was generally low, but income, education, and marital status were associated with curriculum participation. Our research adds to the literature by describing the development and implementation of this curriculum and recommendations for future research incorporating Indigenous approaches to health.

Health Care Provider's Role in Obesity Prevention and Healthy Development of Young American Indian Children.

INTRODUCTION: Health care providers (HCPs) serving American Indian (AI) populations are critical stakeholders in promoting healthy weight-related behaviors of young AI children. The purpose of this study is to develop an understanding of how HCP perceive their role in the healthy development of young AI children, and how they envision working with early care and education teachers and parents to enhance children's health. METHOD: Twenty HCP that serve young AI children in Oklahoma participated in individual interviews. Thematic analysis was conducted on coded transcripts and three main themes, each with two to four subthemes were identified. RESULTS: HCP had limited contact with teachers, felt family health was equal or more important than child health, and parental empowerment and gradual change was essential for success. CONCLUSION: Creating ways to involve HCP, early care and education teachers, and parents together in multilevel and multisector interventions has the potential to improve the health of young AI children.

Early Care and Education Teacher's Role in Obesity Prevention and Healthy Development of Young American Indian Children.

INTRODUCTION: The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children's health. METHODOLOGY: Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged. RESULTS: Teachers felt that nutrition and physical activity were important to children's health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child's behavior. DISCUSSION: Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.

A Structural Equation Modelling Approach to Understanding Influences of Maternal and Family Characteristics on Feeding Practices in Young Children.

BACKGROUND: The family environment is influential for a child's healthy development through parent and sibling influences on feeding practices. Multiple-child households may protect against unhealthy feeding practices, but additional children contribute to higher maternal stress. Households of married parents may decrease maternal stress by sharing parental demands. OBJECTIVE: We aimed to evaluate the collective influence of maternal stress, marital status, and number of children on feeding practices. METHODS: Mothers of 2- to 5-y-old children (n = 278) were recruited mainly on a university campus and completed an online survey to examine associations between maternal stress (Depression, Anxiety, Stress Scale), number of children, marital status, and feeding practices (restriction and pressure to eat; Child Feeding Questionnaire). Relationships were examined through the use of multivariate regression and structural equation modelling. RESULTS: A mainly married (85%) and Caucasian (73%) sample participated, with most mothers reporting multiple children [2 children (45%) or ≥3 children (24%)]. Marital status was not associated with either feeding practice, i.e., restriction and pressure to eat (P < 0.05). In adjusted models, maternal stress (ß = 0.04, SE = 0.01, P = 0.003) and number of children (ß = 0.24, SE = 0.08, P = 0.003) in the household individually contributed to higher feeding restriction; their interaction resulted in lower feeding restriction (ß = -0.01, SE = 0.05, P = 0.005). In stratified models, maternal stress was associated with restriction in single-child households (ß = -0.03, SE = 0.009, P = 0.002), but not multiple-child households (ß = -0.004, SE = 0.005, P = 0.40). CONCLUSIONS: Number of children had no effect on feeding practices individually, but may contribute to a less restrictive feeding environment. Additional investigation into creating less stressful and more positive feeding environments for all mothers can lead to healthier mothers and families.

Association Between Maternal Stress, Work Status, Concern About Child Weight, and Restrictive Feeding Practices in Preschool Children.

Objectives To examine the relationship between maternal stress, work status, concern about child weight, and the use of restrictive feeding practices among mothers of preschool children. Methods 285 mothers of 2-to-5-year-old children completed an on-line survey. Questions included demographics, items from the Depression Anxiety Stress Scale, and the Child Feeding Questionnaire. Linear regression and ANOVA examined the relationship between maternal stress, work hours, concern about child weight, and the use of restrictive practices for one 2-to-5-year-old child living within the home. Results Mothers were 32.6 ± 5.2 years of age and spent 39.7 ± 12.0 h/week at work. Seventy-one percent worked full time. Children were 3.4 ± 1.0 years of age and 51% male. Stress (3.41 ± 0.77, p ≤ 0.001) and concern about child weight (3.41 ± 0.77, p ≤ 0.00) were associated with the use of restrictive feeding practices. Mothers with severe/extremely severe stress used restriction more than mothers with normal stress, respectively (3.63 ± 0.80, 3.30 ± 0.81, p = 0.03). No difference was found among mothers with mild/moderate stress (3.50 ± 0.63, p = 0.06). There was no association between work hours (p = 0.50) or work status (p = 0.91) and the use of restrictive feeding practices. Conclusions Maternal stress and concern about child weight were associated with the use of restrictive feeding practices. Considering the current rates of childhood obesity in the United States, understanding factors that influence a child's food environment is advantageous and can help improve maternal and child health.

Trends in obesity prevalence and disparities among low-income children in Oklahoma, 2005-2010.

BACKGROUND: National WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) data indicate a decrease in obesity prevalence among most low-income preschool-aged children. Though racial/ethnic disparities exist, studies examining obesity trends among various racial/ethnic groups are lacking. The aims of this study were to identify racial/ethnic disparities in obesity among low-income preschool children in Oklahoma and describe trends in obesity prevalence among four major racial/ethnic groups. METHODS: Subjects included 218,486 children 2-4 years of age who participated in WIC in Oklahoma from 2005 to 2010. Logistic regression was performed to identify disparities and trends in obesity among American Indian, Hispanic, White, and African American children. RESULTS: Racial/ethnic disparities in obesity were evident, with prevalence highest in Hispanics and lowest in African Americans. Obesity increased among girls for all racial/ethnic groups from 2005 to 2010 (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01, 1.03). Among boys, obesity increased in African Americans (OR, 1.04; 95% CI, 1.01, 1.07), but remained stable in other racial/ethnic groups. CONCLUSIONS: In Oklahoma, in contrast to recent national studies, obesity is increasing among certain groups of low-income preschool children. These findings suggest geographic diversity in obesity and that state-specific obesity surveillance is important to help target interventions to those at highest risk.

Maternal reporting of prenatal ultrasounds among women in the National Birth Defects Prevention Study.

BACKGROUND: Increased availability and usage of ultrasound screening have led to improved identification of fetal structural abnormalities prenatally. Few population-based studies have been published on prenatal detection for structural birth defects in the United States. The aim of this study is to determine the frequency of maternal reporting of abnormal prenatal ultrasounds for selected birth defects and to investigate associated maternal characteristics. METHODS: Participants included 4013 mothers enrolled in the National Birth Defects Prevention Study who carried a fetus with at least one of 14 structural birth defects between 1997 and 2004. Frequencies of abnormal prenatal ultrasounds were based on maternal report and computed for isolated and multiple defects. Associations between maternal characteristics and abnormal prenatal ultrasounds were assessed using logistic regression. RESULTS: Overall, 46% of participants reported an abnormal ultrasound. Infants with omphalocele, anencephaly, gastroschisis, and renal agenesis were more likely to have abnormal prenatal ultrasounds than those with cleft and limb abnormalities. Hispanic women were less likely to report abnormal prenatal ultrasounds of birth defects than Caucasians, as were women who had a body mass index ≥ 30 kg/m(2) compared with those with a normal body mass index. CONCLUSION: Of the 14 selected birth defects in this study, less than half were reported by mothers of affected infants to have had an abnormal ultrasound during pregnancy. The frequency of reporting abnormal prenatal ultrasounds varies by type of defect, maternal race/ethnicity, and maternal body mass index status.

Obesity prevalence in low-income preschool children in Oklahoma.

OBJECTIVE: To determine the prevalence of overweight and obesity in low-income preschool children in Oklahoma and to identify potential race/ethnic disparities. METHODS: Subjects included 39,151 children aged 2 to 4 years who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in 2009. Body mass index percentiles were calculated from the child's height, weight, sex, and age. RESULTS: In 2009, 30.7% of Oklahoma's children in WIC were overweight, including 13.7% obese. Disparities by race/ethnicity were greatest for obese children: prevalence was 18.8% for American Indians (odds ratio [OR] = 1.8, confidence interval [CI] = 1.54-2.03) and 17.2% for Hispanics (OR = 1.6, CI = 1.52-1.73) compared with 11.8% for non-Hispanic whites, whereas African Americans were less obese (OR = 0.9, CI = 0.79-0.98). CONCLUSION: Obesity rates in low-income Oklahoma children are highest among American Indians and Hispanic children. Interventions aimed at these high-risk groups need to be explored.

Disparities in peaks, plateaus, and declines in prevalence of high BMI among adolescents.

OBJECTIVES: The objective of this study was to investigate trends in prevalence of high BMI from 2001 to 2008 and examine racial/ethnic disparities. METHODS: Records for a total of 8 283 718 fifth-, seventh-, and ninth-grade students who underwent California's school-based BMI screening between 2001 and 2008 were included. Logistic regression identified trends in prevalence of high BMI (>or=85th, >or=95th, >or=97th, and >or=99th percentiles). RESULTS: For 3 of 4 BMI cut points, prevalence continued to increase for black and American Indian girls through 2008, Hispanic girls plateaued after 2005, non-Hispanic white girls declined to 2001 prevalence levels after peaking in 2005, and Asian girls showed no increases. Non-Hispanic white boys peaked in 2005, then declined to 2001 prevalence levels for all BMI cut points; Hispanic and Asian boys declined after 2005 (for 3 lowest BMI cut points only) but remained above 2001 levels; and American Indian boys peaked later (2007) and declined only for BMI>or=95th. No girls and few boys showed a decline after peaking in prevalence of BMI>or=99th percentile. In 2008, disparities in prevalence were greatest for BMI>or=99th percentile, with prevalence of 4.9% for American Indian girls and 4.6% for black girls versus 1.3% for non-Hispanic white girls. CONCLUSIONS: On the basis of statewide California data, prevalence of high BMI is declining for some groups but has not declined for American Indian and black girls. These trends portend greater disparities over time, particularly in severe obesity. Interventions and policies that are tailored to the highest risk groups should be pursued.