Examining the effect of three low-intensity pediatric obesity interventions: a pilot randomized controlled trial.

BACKGROUND: Primary care is an ideal setting to treat pediatric obesity. Effective, low-intensity (≤25 contact hours over 6 months) interventions that reduce standardized body mass index (z-BMI) and can be delivered by primary care providers are needed. OBJECTIVE: This pilot randomized controlled trial investigated the effect of 3 low-intensity (≤25 contact hours over 6 months) pediatric obesity treatments on z-BMI. METHODS: Twenty-two families (children 8.0 ± 1.8 years, z-BMI of 2.34 ± 0.48) were randomized into 1 of 3, 6-month, low-intensity conditions: newsletter (N), newsletter and growth monitoring (N + GM), or newsletter and growth monitoring plus family-based behavioral counseling (N + GM + BC). Anthropometrics and child eating and leisure-time behaviors were measured. RESULTS: Mixed-factor analyses of variance found a significant (P < .05) main effect of time for z-BMI and servings per day of sugar sweetened beverages, with both decreasing over time. CONCLUSION: Low-intensity obesity treatments can reduce z-BMI and may be more feasible in primary care.

Incorporating the life course model into MCH nutrition leadership education and training programs.

Life course perspective, social determinants of health, and health equity have been combined into one comprehensive model, the life course model (LCM), for strategic planning by US Health Resources and Services Administration's Maternal and Child Health Bureau. The purpose of this project was to describe a faculty development process; identify strategies for incorporation of the LCM into nutrition leadership education and training at the graduate and professional levels; and suggest broader implications for training, research, and practice. Nineteen representatives from 6 MCHB-funded nutrition leadership education and training programs and 10 federal partners participated in a one-day session that began with an overview of the models and concluded with guided small group discussions on how to incorporate them into maternal and child health (MCH) leadership training using obesity as an example. Written notes from group discussions were compiled and coded emergently. Content analysis determined the most salient themes about incorporating the models into training. Four major LCM-related themes emerged, three of which were about training: (1) incorporation by training grants through LCM-framed coursework and experiences for trainees, and similarly framed continuing education and skills development for professionals; (2) incorporation through collaboration with other training programs and state and community partners, and through advocacy; and (3) incorporation by others at the federal and local levels through policy, political, and prevention efforts. The fourth theme focused on anticipated challenges of incorporating the model in training. Multiple methods for incorporating the LCM into MCH training and practice are warranted. Challenges to incorporating include the need for research and related policy development.

Behavioral lifestyle intervention in the treatment of obesity.

This article provides an overview of research regarding adult behavioral lifestyle intervention for obesity treatment. We first describe two trials using a behavioral lifestyle intervention to induce weight loss in adults, the Diabetes Prevention Program (DPP) and the Look AHEAD (Action for Health in Diabetes) trial. We then review the three main components of a behavioral lifestyle intervention program: behavior therapy, an energy- and fat-restricted diet, and a moderate- to vigorous-intensity physical activity prescription. Research regarding the influence of dietary prescriptions focusing on macronutrient composition, meal replacements, and more novel dietary approaches (such as reducing dietary variety and energy density) on weight loss is examined. Methods to assist with meeting physical activity goals, such as shortening exercise bouts, using a pedometer, and having access to exercise equipment within the home, are reviewed. To assist with improving weight loss outcomes, broadening activity goals to include resistance training and a reduction in sedentary behavior are considered. To increase the accessibility of behavioral lifestyle interventions to treat obesity in the broader population, translation of efficacious interventions such as the DPP, must be undertaken. Translational studies have successfully altered the DPP to reduce treatment intensity and/or used alternative modalities to implement the DPP in primary care, worksite, and church settings; several examples are provided. The use of new methodologies or technologies that provide individualized treatment and real-time feedback, and which may further enhance weight loss in behavioral lifestyle interventions, is also discussed.

Are changes in consumption of "healthy" foods related to changes in consumption of "unhealthy" foods during pediatric obesity treatment?

Increasing fruits and vegetables (FVs), a dietary recommendation for pediatric weight management, is theorized to reduce energy intake by reducing intake of more energy-dense foods, such as snack foods (SFs). This study examined the relationship between changes in FV, SF, and energy intake in children enrolled in a 6-month, family-based behavioral pediatric weight management trial. Secondary data analyses examined dietary intake in 80 overweight (≥ 85th to <95th percentile for body mass index [BMI]) and obese (≥ 95th percentile for BMI) children (7.2 ± 1.7 years) with complete dietary records at 0 and 6 months. Participants were randomized to one of three treatment conditions: (1) increased growth monitoring with feedback; (2) decrease SFs and sugar sweetened beverages; or (3) increase FVs and low-fat dairy. With treatment condition controlled in all analyses, FV intake significantly increased, while SF and energy intake decreased, but not significantly, from 0 to 6 months. Change in FV intake was not significantly associated with change in SF consumption. Additionally, change in FV intake was not significantly related to change in energy intake. However, reduction in SF intake was significantly related to reduction in energy intake. Changing only FVs, as compared to changing other dietary behaviors, during a pediatric obesity intervention may not assist with reducing energy intake.

The effects of an energy density prescription on diet quality and weight loss: a pilot randomized controlled trial.

Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.1±7.6 years, body mass index [BMI; calculated as kg/m(2)] 34.8±4.8, 81.8% women, and 93.2% white) were recruited between December 2009 and March 2010 and randomly assigned to: Low ED (consume ≥10 foods ≤1.0 kcal/g dietary ED and ≤2 foods ≥3.0 kcal/g dietary ED per day (n=15); Low-Energy, Low-Fat (1,200 to 1,500 kcal/day, ≤30% energy from fat (n=15); or Low-ED, Low-Energy, Low-Fat (n=14). Participants received 12 weekly group sessions led by a research interventionist. Dietary intake (measured by 3-day food records), self-reported physical activity, and weight were measured at baseline and 3 months. Intent-to-treat analyses showed all conditions reduced dietary ED and energy intake (P<0.001). Low-ED and Low-ED, Low-Energy, Low-Fat interventions increased fruit consumption (P<0.05). All conditions increased self-reported physical activity (P<0.001), with no difference between conditions. Although participants in all conditions lost weight (P<0.001), those in the Low-ED condition lost more (P<0.05) than those in the Low-ED, Low-Energy, Low-Fat condition (Low-ED -20.5±7.0 lb, Low-Energy, Low-Fat -16.9±10.1 lb, and Low-ED, Low-Energy, Low-Fat -12.5± 6.5 lb). A diet prescription that lowered ED increased fruit intake and enhanced weight loss compared with other weight loss prescriptions.

Dietary energy density and successful weight loss maintenance.

Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI=27-45kg/m(2)), normal weight adults (NW: BMI=19-24.9 kg/m(2)), and weight loss maintainers (WLM: current BMI=19-24.9kg/m(2) [lost≥10% of maximum body weight and maintained loss for ≥5years]) participating in 2 studies, with data collected from July 2006 to March 2007. Three 24-h phone dietary recalls from 287 participants (OW=97, NW=85, WLM=105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food+all beverages except water [F+AB], food+caloric beverages [F+CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM=1.39±0.45kcal/g; NW=1.60±0.43 kcal/g; OW=1.83±0.42 kcal/g). Self-reported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM=4.9±3.1 servings/day; NW=3.9±2.0 servings/day; OW=3.4±1.7 servings/day; whole grains: WLM=2.2±1.8 servings/day; NW=1.4±1.2 servings/day; OW=1.3±1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials.

Impact of portion size and energy density on snack intake in preschool-aged children.

The influence of dietary environmental factors on child weight status may be important in the battle against childhood obesity. Portion size and energy density are factors shown to impact entrée energy intake in children. However, the influence of these factors on child snack energy intake has not been studied. Thus, the aim of this study was to investigate the impact of portion size on intake of a lower energy-dense and higher energy-dense snack in preschool-aged children. A 2×2 crossover design (within-subject factors of portion size and energy density) was conducted on Wednesdays in a preschool setting on the University of Tennessee campus from October 2008 to November 2008. Seventeen children had complete data (age 3.8±0.6 years; 10 of 17 were female; 14 of 17 were white). Foods were applesauce (lower energy dense=0.43 kcal/g) and chocolate pudding (higher energy dense=1.19 kcal/g), and portion sizes were 150 g (small) and 300 g (large). Measures included anthropometrics, hunger, liking of foods, and caretakers' child-feeding practices using validated instruments. Mixed factorial analyses of covariance, with order controlled, analyzed gram and energy snack intake across conditions. There was no significant main effect of energy density on snack intake, but the main effect of portion size on snack intake (small portion size 84.2±30.8 kcal, large portion size 99.0±52.5 kcal; P<0.05) was significant. Results indicate increased energy intake when snacks are offered in larger portion size, regardless of energy density. Snack portion size may be an environmental strategy that can reduce excessive energy intake in children.