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1.
Expert Opin Pharmacother ; 21(2): 207-211, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31893931

RESUMEN

Introduction: Approximately 1% of adolescents have polycystic ovary syndrome (PCOS) and almost 40-70% of these patients are overweight or obese. Obese adolescents with PCOS have more severe insulin resistance and hyperandrogenemia, a more adverse lipid profile and a worse quality of life than normal-weight adolescents with PCOS. Accordingly, weight loss is an important component of the management of these patients.Areas covered: The authors discuss the different options for weight loss in obese adolescents with PCOS. Lifestyle changes appear to be effective but adherence to this intervention is suboptimal. There are also limited data regarding the optimal diet in this population. Few small studies have evaluated the effects of pharmacotherapy in these patients. Conflicting data have been reported regarding the effects of metformin on body weight. Notably, agents that have been approved for weight loss in adults have not been evaluated in adolescents with PCOS.Expert opinion: More studies are needed to identify the most appropriate diet for obese adolescents with PCOS. Well-designed randomized controlled studies are also needed to define the safety and efficacy of pharmacotherapy in this population.


Asunto(s)
Estilo de Vida , Obesidad Pediátrica/terapia , Síndrome del Ovario Poliquístico/terapia , Adolescente , Femenino , Humanos , Hiperandrogenismo/terapia , Resistencia a la Insulina , Metformina/uso terapéutico , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Pérdida de Peso
2.
Scand J Med Sci Sports ; 30(1): 4-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31418915

RESUMEN

OBJECTIVE: To investigate the effectiveness of active video games (AVGs) on obesity-related outcomes and physical activity levels in children and adolescents. DESIGN: Systematic review with meta-analysis. METHODS: Literature search was performed in five electronic databases and the main clinical trials registries. Randomized controlled trials investigating the effect of AVGs compared with no/minimal intervention on obesity-related outcomes (body mass index [BMI], body weight, body fat, and waist circumference) and physical activity levels of children and adolescents were eligible. Two independent reviewers extracted the data of each included study. PEDro scale was used to assess risk of bias and GRADE approach to evaluate overall quality of evidence. Pooled estimates were obtained using random effect models. RESULTS: Twelve studies were considered eligible for this review. Included studies mostly reported outcome data at short-term (less or equal than three months) and intermediate-term follow-up (more than 3 months, but <12 months). AVGs were more effective than no/minimal intervention in reducing BMI/zBMI at short-term (SMD = -0.34; 95% CI: -0.62 to -0.05) and intermediate-term follow-up (SMD = -0.36; 95% CI: -0.01 to -0.71). In addition, AVGs were more effective in reducing body weight compared with no/minimal intervention at intermediate-term follow-up (SMD = -0.25; 95% CI: -0.46 to -0.04). Regarding physical activity levels, AVGs were not more effective compared with minimal intervention at short-term and intermediate-term follow-up. CONCLUSIONS: Our review identified that AVGs were better than minimal intervention in reducing BMI and body weight, but not for increasing physical activity in young people.


Asunto(s)
Ejercicio Físico , Obesidad Pediátrica/terapia , Juegos de Video , Adolescente , Índice de Masa Corporal , Peso Corporal , Niño , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 611-619, dic. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-184788

RESUMEN

Antecedentes: El ejercicio intervalado de alta intensidad (HIIT) ha sido utilizado ampliamente para combatir los factores de riesgo cardiovascular en población adolescente y adulta, existiendo un vacío de su aplicabilidad en población infantil. Objetivos: Determinar los efectos de un HIIT sobre distintos parámetros antropométricos y cardiovasculares de niños con sobrepeso y obesidad de entre 7 y 9 años de edad. Material y métodos: Cuatro grupos fueron formados: 1) grupo control con sobrepeso (GCS, n = 30, IMC = 21,60 ± 3,72 kg/m2); 2) grupo control con obesidad (GCO, n = 34, IMC = 23,92 ± 3,11 kg/m2); 3) grupo intervención con sobrepeso (GIS, n = 69, IMC = 20,01 ± 1,88 kg/m2), y 4) grupo intervención con obesidad (GIO, n = 141, IMC=24,12 ± 2,66 kg/m2). El IMC, grasa corporal (GC), circunferencia de cintura, razón cintura-estatura, presión arterial sistólica y diastólica, y capacidad cardiorrespiratoria (CRF), fueron evaluadas pre- y postintervención. Resultados: Existieron diferencias significativas en las variables IMC (p < 0,001), GC (p < 0,001) y CRF (p < 0,001) en la comparación entre grupos (control vs. intervención) en pre- y postintervención (GCS vs. GIS y GCO vs. GIO). El GIS (IMC; pre = 20,01 ± 1,88 vs. post = 19,00 ± 2,02, p < 0,001) y el GIO (IMC; pre = 24,12 ± 2,66 vs. post = 23,23 ± 3,23, p < 0,001) disminuyeron su IMC. De igual forma, en el GIS (GC; pre = 21,84 ± 4,97 vs. post = 19,55±4,81%, p < 0,001) y en el GIO (GC; pre = 30,26 ± 11,49 vs. post =26,81 ± 6,80%, p < 0,001) la GC disminuyó. Ambos grupos intervenidos mejoraron su CRF (p < 0,001). Existió una disminución significativa de escolares con obesidad (pre = 66,4% vs. post = 49,6%) (p < 0,001). Conclusión: La intervención realizada en el contexto escolar mejora los parámetros antropométricos y cardiovasculares de los escolares, permitiendo además disminuir la proporción de escolares con obesidad


Background: High-intensity interval training (HIIT) has been widely used to fight cardiovascular risk factors in adolescents and adults, but no data are available on its applicability in children. Objectives: To assess the effects of HIIT on different anthropometric and cardiovascular parameters of overweight and obese children aged 7-9 years. Material and methods: Four groups were formed: 1) an overweight control group (OWCG, n = 30, BMI = 21.60 ± 3.72 kg/m2); 2) an obesity control group (OCG, n = 34, BMI = 23.92 ± 3.11 kg/m2); 3) an overweight intervention group (OWIG, n = 69, BMI = 20.01 ± 1.88 kg/m2), and 4) an obesity intervention group (OIG, n = 141, BMI = 24.12 ± 2.66 kg/m2). BMI, body fat (BF), waist circumference, height-waist ratio, systolic and diastolic blood pressure and cardiorespiratory fitness (CRF) were assessed before and after intervention. Results: There were significant differences in BMI (P < .001), BF (P < .001), and CRF (P < .001) between the groups (control vs. intervention) before and after intervention (OWCG vs. OWIG and OCG vs. OIG). BMI decreased in the OWIG (BMI, 20.01 ± 1.88 at baseline vs. 19.00 ± 2.02 after HIIT, P < .001) and OIG (BMI, 24.12 ± 2.66 at baseline vs. 23.23 ± 3.23 after HIIT, P < .001) groups. Similarly, BF decreased in the OWIG (BF, 21.84 ± 4.97 at baseline vs. 19.55 ± 4.81% after HIIT, P < .001) and OIG (BF, 30.26 ± 11.49 at baseline vs. 26.81 ± 6.80% after HIIT, P < .001) groups. CRF improved in both intervention groups (P < .001). There was a significant decrease in the prevalence rate of schoolchildren with obesity (from 66.4% to 49.6%) (P < .001). Conclusion: The intervention conducted in the school setting improved the anthropometric and cardiovascular parameters of schoolchildren, and also allowed for reducing the proportion of schoolchildren with obesity


Asunto(s)
Humanos , Niño , Obesidad Pediátrica/diagnóstico , Obesidad Pediátrica/terapia , Ejercicio Físico/fisiología , Capacidad Cardiovascular/fisiología , Antropometría , Sobrepeso/complicaciones , Índice de Masa Corporal , Análisis de Varianza
4.
Artículo en Inglés | MEDLINE | ID: mdl-31683561

RESUMEN

Overweight and obesity have become a serious health problem globally due to its significant role in increased morbidity and mortality. The treatments for this health issue are various such as lifestyle modifications, pharmacological therapies, and surgery. However, little is known about the productivity, workflow, topics, and landscape research of all the papers mentioning the intervention and treatment for children with obesity. A total of 20,925 publications from the Web of Science database mentioning interventions and treatment in reducing the burden of childhood overweight and obesity on physical health, mental health, and society published in the period from 1991 to 2018 were in the analysis. We used Latent Dirichlet Allocation (LDA) for identifying the topics and a dendrogram for research disciplines. We found that the number of papers related to multilevel interventions such as family-based, school-based, and community-based is increasing. The number of papers mentioning interventions aimed at children and adolescents with overweight or obesity is not high in poor-resource settings or countries compared to the growth in the prevalence of overweight and obesity among youth due to cultural concepts or nutrition transition. Therefore, there is a need for support from developed countries to control the rising rates of overweight and obesity.


Asunto(s)
Obesidad Pediátrica/terapia , Adolescente , Terapia Conductista , Niño , Femenino , Humanos , Estilo de Vida , Obesidad Pediátrica/epidemiología , Prevalencia
6.
Pediatrics ; 144(2)2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31300528

RESUMEN

BACKGROUND AND OBJECTIVES: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST). METHODS: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (-0.5) was assessed with risk ratios. RESULTS: A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: -0.45 to -0.15) compared with ST (0.07; 95% CI: -0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (-0.54; 95% CI: -0.77 to -0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST. CONCLUSION: A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.


Asunto(s)
Relaciones Padres-Hijo , Padres , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/terapia , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Padres/psicología , Obesidad Pediátrica/diagnóstico , Suecia/epidemiología , Resultado del Tratamiento
7.
Cochrane Database Syst Rev ; 7: CD001871, 2019 07 23.
Artículo en Inglés | MEDLINE | ID: mdl-31332776

RESUMEN

BACKGROUND: Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES: To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA: Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS: We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS: Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.


Asunto(s)
Dieta , Ejercicio Físico/fisiología , Obesidad Pediátrica/prevención & control , Adolescente , Terapia Conductista , Índice de Masa Corporal , Niño , Preescolar , Terapia Combinada , Femenino , Humanos , Lactante , Masculino , Sobrepeso/prevención & control , Sobrepeso/terapia , Obesidad Pediátrica/terapia , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
8.
BMC Public Health ; 19(1): 716, 2019 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-31182081

RESUMEN

INTRODUCTION: The Go4Fun program in New South Wales, Australia is a community based weight management program for overweight and obese children aged 7-13 years and their families. This study assessed the impact of the number and type of sessions attended on body mass index (BMI) z-score, fruit and vegetable intake and physical activity and sedentary behaviours to determine the number of sessions required to achieve optimal program outcomes. METHODS: Secondary analysis was conducted on pre and post participant program data collected over 3.5 years. Relationships between session attendance and program outcomes were assessed using Spearman's correlation and multivariate analyses of variance and multivariate regression. Number of sessions required to achieve optimal program outcomes was determined using piecewise linear regression. RESULTS: For 3090 participants (48.5% of registrants) who attended at least five sessions, outcome measures improved significantly at post program compared with pre (p < 0.01). No relationships were seen between number and type of sessions attended and outcome measures. Children of mothers without a post-school qualification (university degree or vocational qualification) were more likely to achieve lower levels of improvements in BMI z-score (p = 0.02) and vegetable intake (P < 0.01) than those children with post-school qualified mothers (F = 3.68, p = 0.03). Children of mothers without post-school education that attended seven sessions or more achieved significantly better BMI z-score outcomes (p < 0.01) than those who attended fewer sessions. CONCLUSIONS: Maternal educational attainment influences program attendance and health and behavioural outcomes in a family based obesity treatment program.


Asunto(s)
/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Obesidad Pediátrica/terapia , Programas de Reducción de Peso/estadística & datos numéricos , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Dieta/estadística & datos numéricos , Escolaridad , Ejercicio Físico , Femenino , Frutas , Humanos , Modelos Lineales , Masculino , Nueva Gales del Sur , Evaluación de Programas y Proyectos de Salud , Conducta Sedentaria , Estadísticas no Paramétricas , Verduras , Programas de Reducción de Peso/métodos
9.
BMC Public Health ; 19(1): 686, 2019 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-31159776

RESUMEN

BACKGROUND: Traditional exercise [supervised exercise (SE)] intervention has been proved to be one of the most effective ways to improve metabolic health. However, most exercise interventions were on a high-cost and small scale, moreover lacking of the long-term effect due to low engagement. On the other hand, it was noteworthy that gamification and social incentives were promising strategies to increase engagement and sustain exercise interventions effects; as well as mobile technologies such as WeChat also can provide an appropriate platform to deploy interventions on a broader, low-cost scale. Thus, we aim to develop a novel exercise intervention ('S&G exercise intervention') that combines SE intervention with gamification and social incentives design through WeChat, with the aim of improving metabolic health and poor behaviors among overweight and obesity children. METHODS: We propose a randomized controlled trial of a 'S&G exercise intervention' among 420 overweight and obese children who have at least one marker of metabolic syndrome. Children will be randomized to control or intervention group in a 1:1 ratio. The exercise intervention package includes intervention designs based on integrated social incentives and gamification theory, involving targeted essential volume and intensity of activity (skipping rope) as well as monitoring daily information and providing health advice by WeChat. Participants will undertake assessments at baseline, at end of intervention period, in the follow-up time at months 3,6,12. The primary outcome is outcome of metabolic health. Secondary outcomes include behavioral (e.g., diary physical activity, diet) and anthropometric measures (e.g., body fat rate and muscle mass). DISCUSSIONS: This will be the first study to design an exercise intervention model that combines traditional supervised exercise (SE) intervention with gamification and social incentives theory through WeChat. We believed that this study could explore a low-cost, easy-to-popularize, and effective exercise intervention model for improving metabolic health and promote healthy among obese children. Furthermore, it will also provide important evidence for guidelines to prevent and improve metabolic health and health behaviors. TRIAL REGISTRATION: 10-04-2019;Registration number: ChiCTR1900022396 .


Asunto(s)
Conducta Infantil , Ejercicio Físico , Promoción de la Salud/métodos , Aplicaciones Móviles , Motivación , Obesidad Pediátrica/terapia , Medios de Comunicación Sociales , Terapia Conductista , Composición Corporal , Niño , Dieta , Terapia por Ejercicio , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Síndrome Metabólico/terapia , Sobrepeso , Obesidad Pediátrica/metabolismo , Proyectos de Investigación
10.
Public Health ; 173: 50-57, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31254678

RESUMEN

OBJECTIVES: The aim of this study was to explore factors which mediated or moderated the effect of the Time2bHealthy online program for parents of preschool-aged children on body mass index (BMI) change. STUDY DESIGN: Mediation and moderation analyses of data from a two-arm parallel randomised controlled trial. METHODS: Randomisation was conducted after baseline measures. The intervention group received an 11-week online program, and the comparison group received emailed links to information from an evidence-based parenting website. Data on the primary outcome (child BMI), potential mediators (energy intake, fruit and vegetable intake, discretionary food intake, physical activity, screen-time, sleep, child feeding, parent self-efficacy or parent role-modelling) and potential moderators (child age, parent age, parent income, parent education or parent living situation) were collected at baseline, 3 months and 6 months. PROCESS macro for SPSS was used to analyse possible mediators and moderators on BMI outcomes. RESULTS: Despite significant food-related outcomes in the main analysis of this trial, no significant mediating or moderating effects were found for any hypothesised mediators or moderators. CONCLUSIONS: This study's null results could be explained by the high proportion of children in the healthy weight range, the study period not being long enough to detect change, the multicomponent nature of the intervention or the relatively small number of outcomes measured. Future childhood obesity interventions should continue to explore the effects of mediators and moderators on BMI and consider collecting data on a wide range of mediating and moderating factors to allow for comparison between studies to develop a better understanding of the factors contributing to successful interventions.


Asunto(s)
Instrucción por Computador/métodos , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Estilo de Vida Saludable , Padres/educación , Obesidad Pediátrica/prevención & control , Obesidad Pediátrica/terapia , Índice de Masa Corporal , Peso Corporal , Preescolar , Dieta , Ejercicio Físico , Conducta Alimentaria , Femenino , Humanos , Masculino , Responsabilidad Parental , Conducta Sedentaria , Autoeficacia , Sueño/fisiología
11.
Diabetes Metab Syndr ; 13(3): 2190-2197, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31235156

RESUMEN

AIM: To assess the effectiveness of a cognitive-behavioral treatment (CBT) program on weight reduction among Iranian adolescents who are overweight. METHODS: Using a randomized controlled trial design, 55 adolescents who were overweight (mean [SD] age = 14.64 [1.69] years; zBMI = 2.18 [0.65]) were recruited in the CBT program and 55 in the treatment as usual (TAU; mean age = 14.88 [1.50]; zBMI = 2.09 [0.57]) group. All the participants completed several questionnaires (Child Dietary Self-Efficacy Scale; Weight Efficacy Lifestyle questionnaire; Physical Exercise Self-Efficacy Scale; Pediatric Quality of Life Inventory; and self-reported physical activity and diet) and had their anthropometrics measured (height, weight, waist and hip circumferences, and body fat). RESULTS: The CBT group consumed significantly more fruits and juice, vegetables, and dairy in the 6-month follow-up as compared with the TAU group (p-values <0.001). The CBT group consumed significantly less sweet snacks, salty snacks, sweet drinks, sausages/processed meat, and oils in the six-month follow-up compared with the TAU group (p-values<0.001). Additionally, the waist circumference, BMI, waist-hip ratio, and fat mass were significantly decreased in the CBT group in the six-month follow-up compared with the TAU group (p-values<0.005). The CBT group significantly improved their psychosocial health, physical activity, and health-related quality of life (p-values<0.001). CONCLUSION: The CBT program showed its effectiveness in reducing weight among Iranian adolescents who were overweight. Healthcare providers may want to adopt this program to treat excess weight problems among adolescents.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Dieta/psicología , Dieta/normas , Sobrepeso/terapia , Obesidad Pediátrica/terapia , Calidad de Vida , Adolescente , Fenómenos Fisiológicos Nutricionales de los Adolescentes , Peso Corporal , Terapia por Ejercicio , Femenino , Estudios de Seguimiento , Humanos , Irán/epidemiología , Estilo de Vida , Masculino , Estado Nutricional , Sobrepeso/epidemiología , Sobrepeso/psicología , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/psicología , Pronóstico , Estudios Prospectivos , Psicología del Adolescente , Pérdida de Peso
12.
Hosp Top ; 97(3): 107-118, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31244391

RESUMEN

Introduction: While for adults in Pennsylvania, obesity rates tripled from less than 10% in 1990 to 30% in 2015, the combined rates of overweight, obese, and severely obese children and adolescents in Pennsylvania are projected to approach 37.11% by the end of 2018. Method: Pediatric obesity rates in rural areas tend to be even higher than those in urban areas. Pediatric obesity needs to be addressed, since it is strongly correlated with several chronic diseases. Given the scarcity of resources to manage this trend, innovative population-based approaches are needed. Web-based telehealth, telemedicine, mobile health (mHealth), and telephone conferences have been proposed as solutions to treat and prevent childhood obesity in rural areas; the most suitable solution is through a family-based telemedicine intervention. The purpose of this study is to explore the feasibility of such a telehealth application especially for rural Pennsylvania. Results: Telehealth use in healthcare organizations in Pennsylvania is scarce; however, 92% of Pennsylvania's school districts meet the minimum internet connectivity standards. Discussions: This article, while acknowledging barriers to the adoption of the internet-based telemedicine resources, discusses solutions for increasing their availability and dissemination in rural Pennsylvania. Current internet connectivity standards in Pennsylvania schools reflect ability to participate in telehealth programs in terms of technological background, but schools are not engaged in such programs. An appraisal of the real-life challenges to implement this modality is critical and will pave the way for advocacy and implementation of useful telehealth services in low-resource areas.


Asunto(s)
Obesidad Pediátrica/prevención & control , Servicios de Salud Rural/tendencias , Telemedicina/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/terapia , Pennsylvania/epidemiología , Población Rural/estadística & datos numéricos , Telemedicina/tendencias
13.
Rev Gastroenterol Mex ; 84(2): 185-194, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31101468

RESUMEN

AIM: To identify and discuss the efficacy of dietary interventions, antioxidant supplementation, physical activity, and nutritional and psychologic counseling in the treatment of children and adolescents with non alcoholic fatty liver disease associated with obesity. MATERIALS AND METHODS: A scoping review of studies on nutritional and educational interventions and physical activity in pediatric patients with non alcoholic fatty liver disease was conducted. A search for randomized clinical trials or quasi-experimental studies published up to December 2017 was carried out, utilizing seven databases (Medline, EBSCO, OVID, Science Direct, JSTOR, Wiley, and Biblioteca Digital UDG). RESULTS: From a total of 751 articles, 729 were excluded due to the criteria of age, design, language, diagnostic method, and outcome variables. The analysis included 22 articles. The most frequently used intervention variables were diet and physical activity. The interventions had different durations, but most were carried out for one year. Some authors employed ascorbic acid, vitamin E, or omega-3 fatty acid supplementation. There were varying degrees of improvement in the variables analyzed in the majority of the studies, such as a decrease in ALT levels, a reduced frequency of steatosis determined through imaging studies, and a decrease in body mass index. CONCLUSIONS: The dietary interventions, omega-3 fatty acid supplementation, physical activity, and nutritional and psychologic counseling were identified as efficacious measures in the treatment of non alcoholic fatty liver disease associated with obesity in children and adolescents, according to biochemical or imaging study indicators, within the time frame of the intervention.


Asunto(s)
Dieta , Ejercicio Físico , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/terapia , Obesidad Pediátrica/complicaciones , Obesidad Pediátrica/terapia , Adolescente , Niño , Femenino , Humanos , Masculino , Enfermedad del Hígado Graso no Alcohólico/dietoterapia , Educación del Paciente como Asunto , Obesidad Pediátrica/dietoterapia , Ensayos Clínicos Controlados Aleatorios como Asunto
14.
Pediatrics ; 143(6)2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31126971

RESUMEN

BACKGROUND: Our primary aim was to evaluate the effects of 2 family-based obesity management interventions compared with a control group on BMI in low-income adolescents with overweight or obesity. METHODS: In this randomized clinical trial, 360 urban-residing youth and a parent were randomly assigned to 1 of 2 behaviorally distinct family interventions or an education-only control group. Eligible children were entering the sixth grade with a BMI ≥85th percentile. Interventions were 3 years in length; data were collected annually for 3 years. Effects of the interventions on BMI slope (primary outcome) over 3 years and a set of secondary outcomes were assessed. RESULTS: Participants were primarily African American (77%), had a family income of <25 000 per year, and obese at enrollment (68%). BMI increased over time in all study groups, with group increases ranging from 0.95 to 1.08. In an intent-to-treat analysis, no significant differences were found in adjusted BMI slopes between either of the family-based interventions and the control group (P = .35). No differences were found between the experimental and control groups on secondary outcomes of diet, physical activity, sleep, perceived stress, or cardiometabolic factors. No evidence of effect modification of the study arms by sex, race and/or ethnicity, household income, baseline levels of child and parent obesity, or exposure to a school fitness program were found. CONCLUSIONS: In this low-income, adolescent population, neither of the family-based interventions improved BMI or health-related secondary outcomes. Future interventions should more fully address poverty and other social issues contributing to childhood obesity.


Asunto(s)
Terapia Conductista/métodos , Índice de Masa Corporal , Terapia Familiar/métodos , Obesidad Pediátrica/economía , Pobreza/economía , Población Urbana , Adolescente , Adulto , Niño , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Femenino , Humanos , Masculino , Obesidad Pediátrica/psicología , Obesidad Pediátrica/terapia , Pobreza/psicología
15.
High Blood Press Cardiovasc Prev ; 26(3): 191-197, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31041682

RESUMEN

The atherosclerotic alterations that are the basis of cardiovascular diseases can start already in childhood. For this reason the prevention of cardiovascular diseases should be undertaken very early both in the general population and, in a targeted manner, in subjects at cardiovascular risk. Preventive strategies should include measures to encourage physical activity and correct eating habits and to reduce exposure to pollutants. The main actors responsible for carrying out these preventive interventions are the local and national political authorities. Moreover, particular attention should be paid to the first thousand days of life starting from conception, to prevent unfavorable epigenetic modifications. In addition to initiatives aimed at the general population, interventions should be planned by the medical community to assess the individual risk profile. The current obesity epidemic has in fact made it relatively frequent even among children and adolescents to find some cardiovascular risk factors known in adults such as arterial hypertension, dyslipidemia, glucose metabolism disorders and increased of uric acid values. The purpose of this review is to indicate lines of intervention for cardiovascular prevention in children and adolescents.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Síndrome Metabólico/terapia , Servicios Preventivos de Salud/métodos , Adolescente , Edad de Inicio , Presión Arterial , Biomarcadores/sangre , Glucemia/metabolismo , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Niño , Comorbilidad , Dislipidemias/sangre , Dislipidemias/epidemiología , Dislipidemias/terapia , Trastornos del Metabolismo de la Glucosa/sangre , Trastornos del Metabolismo de la Glucosa/epidemiología , Trastornos del Metabolismo de la Glucosa/terapia , Estado de Salud , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Hipertensión/terapia , Hiperuricemia/sangre , Hiperuricemia/epidemiología , Hiperuricemia/terapia , Lípidos/sangre , Síndrome Metabólico/sangre , Síndrome Metabólico/epidemiología , Síndrome Metabólico/fisiopatología , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/fisiopatología , Obesidad Pediátrica/terapia , Factores Protectores , Factores de Riesgo , Ácido Úrico/sangre , Aumento de Peso
16.
Trials ; 20(1): 296, 2019 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-31138278

RESUMEN

BACKGROUND: The recruitment of participants into community-based randomized controlled trials studying childhood obesity is often challenging, especially from low-income racial/ethnical minorities and when long-term participant commitments are required. This paper describes strategies used to recruit and enroll predominately low-income racial/ethnic minority parents and children into the Childhood Obesity Prevention and Treatment Research (COPTR) consortium. METHODS: The COPTR consortium has run four independent 3-year, multi-level (individual, family, school, clinic, and community) community-based randomized controlled trials. Two were prevention trials in preschool children and the other two were treatment trials in pre-adolescents and adolescent youth. All trials reported monthly participant recruitment numbers using a standardized method over the projected 18-24 months of recruitment. After randomization of participants was completed, recruitment staff and investigators from each trial retrospectively completed a survey of recruitment strategies and their perceived top three recruitment strategies and barriers. RESULTS: Recruitment was completed in 15-21 months across trials, enrolling a total of 1745 parent-child dyads- out of 6314 screened. The number of children screened per randomized child was 4.6 and 3.5 in the two prevention trials, and 3.1 and 2.5 in the two treatment trials. Recruitment strategies reported included: (1) careful planning, (2) working with trusting community partners, (3) hiring recruitment staff who were culturally sensitive, personality appropriate, and willing to work flexible hours, (4) contacting potential participants actively and repeatedly, (5) recruiting at times and locations convenient for participants, (6) providing incentives to participants to complete baseline measures, (7) using a tracking database, (8) evaluating whether participants understand the activities and expectations of the study, and (9) assessing participants' motivation for participating. Working with community partners, hiring culturally sensitive staff, and contacting potential participants repeatedly were cited by two trials among their top three strategies. The requirement of a 3-year commitment to the trial was cited by two trials to be among the top three recruitment barriers. CONCLUSIONS: Comprehensive strategies that include community partnership support, culturally sensitive recruitment staff, and repeated contacts with potential participants can result in successful recruitment of low-income racial/ethnic minority families into obesity prevention and treatment trials. TRIAL REGISTRATION: NET-Works trial: ClinicalTrials.gov, NCT01606891 . Registered on 28 May 2012. GROW trial: ClinicalTrials.gov, NCT01316653 . Registered on 16 March 2011. GOALS trial: ClinicalTrials.gov, NCT01642836 . Registered on 17 July 2012. IMPACT trial: ClinicalTrials.gov, NCT01514279 . Registered on 23 January 2012.


Asunto(s)
Selección de Paciente , Obesidad Pediátrica/prevención & control , Obesidad Pediátrica/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Grupos Étnicos , Humanos , Padres , Pobreza , Proyectos de Investigación
17.
Artículo en Inglés | MEDLINE | ID: mdl-31137491

RESUMEN

Shared decision-making (SDM) is a best practice for delivering high-quality, patient-centered care when there are multiple options from which to choose. A patient decision aid (PDA) to promote SDM for the treatment of adolescent severe obesity was piloted among 12-17-year-olds (n = 31) from six pediatric weight management programs within the Childhood Obesity Multi Program Analysis and Study System (COMPASS). Medical providers used a brochure that described indications, risks, and benefits of intensive lifestyle management alone versus bariatric surgery plus lifestyle. Immediately after, patients/families completed a survey. Patient/family perceptions of provider effort to promote understanding of health issues, to listen to what mattered most to them, and to include what mattered most to them in choosing next steps averaged 8.6, 8.8, and 8.7, respectively (0 = no effort, 9 = every effort). Nearly all (96%) reported knowing the risks/benefits of each treatment option and feeling clear about which risks/benefits mattered most to them. Most (93%) reported having enough support/advice to make a choice, and 89% felt sure about what the best choice was. Providers largely found the PDA to be feasible and acceptable. This pilot will guide a more rigorous study to determine the PDA's effectiveness to support decision-making for adolescent severe obesity treatment.


Asunto(s)
Técnicas de Apoyo para la Decisión , Obesidad Mórbida/terapia , Obesidad Pediátrica/terapia , Adolescente , Cirugía Bariátrica , Niño , Femenino , Humanos , Estilo de Vida , Obesidad Mórbida/cirugía , Obesidad Pediátrica/cirugía , Proyectos Piloto , Análisis de Sistemas , Estados Unidos , Programas de Reducción de Peso
19.
Curr Obes Rep ; 8(3): 201-209, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31054014

RESUMEN

PURPOSE OF REVIEW: This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. RECENT FINDINGS: Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.


Asunto(s)
Obesidad Mórbida/terapia , Obesidad Pediátrica/terapia , Adolescente , Fármacos Antiobesidad/uso terapéutico , Cirugía Bariátrica/métodos , Terapia Conductista/métodos , Índice de Masa Corporal , Niño , Dieta , Ejercicio Físico , Personal de Salud , Humanos , Estilo de Vida , Evaluación de Necesidades , Obesidad Mórbida/psicología , Obesidad Pediátrica/psicología , Psicología , Pérdida de Peso
20.
Transl Behav Med ; 9(3): 570-572, 2019 05 16.
Artículo en Inglés | MEDLINE | ID: mdl-31094429

RESUMEN

Pediatric obesity remains a prevalent health issue in the United States and around the world. Treatments are challenged by a lack of meaningful improvements in child healthy weight. The current commentary describes an intervention study with a unique approach: engaging fathers. The commentary describes why this approach is unique and promising in terms of future directions for the field to consider.


Asunto(s)
Investigación Biomédica , Relaciones Padre-Hijo , Padre/psicología , Obesidad Pediátrica/terapia , Adulto , Índice de Masa Corporal , Niño , Humanos , Masculino
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