Childhood obesity intervention studies: A narrative review and guide for investigators, authors, editors, reviewers, journalists, and readers to guard against exaggerated effectiveness claims (original) (raw)
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BMC Public Health, 2013
Background: The preschool years are a critical window for obesity prevention efforts; representing a time when children establish healthy eating habits and physical activity patterns. Understanding the context in which these behaviors develop is critical to formulating a model to address childhood obesity. The Colorado LEAP Study, an intervention study designed to prevent early childhood obesity, utilizes a social ecological approach to explore individual, family and environmental factors and their relationship to child weight status over a 3 year timeframe. Methods: The study is located in 5 rural Colorado preschool centers and elementary schools (2 treatment and 3 control). Treatment sites receive The Food Friends® nutrition (12 weeks) and physical activity (18 weeks) interventions during preschool. Observational measures assess 3 layers of the social ecological model including individual, family and organizational inputs. Children's food preferences, food intake, gross motor skills, physical activity (pedometers/accelerometers), cognitive, physical and social self-competence and height/weight are collected. Parents provide information on feeding and activity practices, child's diet, oral sensory characteristics, food neophobia, home food and activity environment, height/weight and physical activity (pedometers). School personnel complete a school environment and policy assessment. Measurements are conducted with 3 cohorts at 4 time pointsbaseline, post-intervention, 1-and 2-year follow-up. Discussion: The design of this study allows for longitudinal exploration of relationships among eating habits, physical activity patterns, and weight status within and across spheres of the social ecological model. These methods advance traditional study designs by allowing not only for interaction among spheres but predictively across time. Further, the recruitment strategy includes both boys and girls from ethnic minority populations in rural areas and will provide insights into obesity prevention effects on these at risk populations. Trial registration: ClinicalTrials.gov: NCT01937481.
American Journal of Preventive Medicine, 2005
Past research has identified social and environmental causes and correlates of behaviors thought to be associated with obesity and weight gain among children and adolescents. Much less research has documented the efficacy of interventions designed to manipulate those presumed causes and correlates. These latter efforts have been inhibited by the predominant biomedical and social science problem-oriented research paradigm, emphasizing reductionist approaches to understanding etiologic mechanisms of diseases and risk factors. The implications of this problem-oriented approach are responsible for leaving many of the most important applied research questions unanswered, and for slowing efforts to prevent obesity and improve individual and population health. An alternative, and complementary, solution-oriented research paradigm is proposed, emphasizing experimental research to identify the causes of improved health. This subtle conceptual shift has significant implications for phrasing research questions, generating hypotheses, designing research studies, and making research results more relevant to policy and practice. The solution-oriented research paradigm encourages research with more immediate relevance to human health and a shortened cycle of discovery from the laboratory to the patient and population. Finally, a "litmus test" for evaluating research studies is proposed, to maximize the efficiency of the research enterprise and contributions to the promotion of health and the prevention and treatment of disease. A research study should only be performed if (1) you know what you will conclude from each possible result (whether positive, negative, or null); and (2) the result may change how you would intervene to address a clinical, policy, or public health problem. (Am J Prev Med 2005;28(2S2):194 -201) Generally considered more difficult and more expensive studies, but greater potential to improve health. Am J Prev Med 2005;28(2S2) 195
Childhood overweight and obesity are increasingly prevalent
Chi ldhood overweight and obesity are increasingly prevalent. In Australia, 25% of school-age children are overweight or obese,1 as are 20% of preschoolers.Childhood obesity is one of the strongest predictors of adult obesity3 and is associated with multiple morbidities, including type 2 diabetes, increased peer victimization, poor-self esteem, and depression. Although genetics plays a role,many risk factors forchildhood overweight and obesity have roots in the home environment through parenting style and parental (especially maternal) eating styles,8,9 behaviors, and child feeding practices. Accordingly, the role of maternal feeding practices in the etiology of child BMI has been researched, with particular attention directed to the role of controlling feeding practices. Controlling feeding practices, such as pressuring to eat and restricting and monitoring access to foods, are believed to impede development of children's self-regulation by promoting reliance on external cues of hunger and satiety and to alter the appeal of target foodsleading to ingestion in the absence of hunger and excessive weight gain. Conversely, pressure to eat reduces preference and intake of healthy target foods. Various studies support this connection. The occurrence of various parental feeding practices is also known to vary across cultural and socioeconomic groupings and may be biased to some extent by child gender. However, the relationship between controlling feeding practices and child BMI has not proved robust. Although maternal restriction has shown positive, negative, and null associations with child BMI, the bulk of studies show a positive relationship. On the other hand, evidence on the relationship between maternal pressure and later child BMI is somewhat inconsistent. Interestingly, parental feeding practices characterized by high monitoring uniformly show no association with child BMI. A relatively small number of published studies suggest that maternal mood is associated with controlling feeding styles. For example, among mothers of 5-yearold daughters, maternal depression was associated with greater restriction and pressure to eat. Furthermore, others have shown this to be mediated by parenting quality. Other researchers have reported similar findings regarding parental symptoms of depression, anxiety, and stress. One longitudinal study of global maternal psychological distress from pregnancy to 12 months postpartum found no association between mental health (either in pregnancy, or the first year postpartum) and pressure to eat at 1 year postpartum.However, maternal use of restriction at 1 year was predicted by anxiety in pregnancy and the postpartum period. Subsequent research revealed that monitoring, restriction, and pressure to eat at 1 and 2 years postpartum were partially predicted by maternal mood at 6 and 12 months postpartum.In short, research on the relationship between maternal mood and controlling feeding practices, while scarce, suggests that an association exists. Given the relative scarcity of evidence, the aim of the current study was two fold. The first was to examine whether controlling maternal feeding practices predict child BMI and the second was to investigate whether maternal depressive and anxious symptoms were predictive of controlling child feeding practices. We chose the most widely employed psychometrically sound measure of maternal feeding practices and followed a moderately large sample of Australian families longitudinally.
Childhood Obesity in the United States of America
European Scientific Journal, ESJ, 2014
Obesity in the U.S. is a problem that is beginning to grow large in our children‘s lives. The solution to this problem is centered in three areas; the help of the community, health education, and consumer education. The two main factors casing childhood obesity is eating high fat, high protein foods along with a serious sedentary lifestyle. Childhood obesity in the United State is a rising epidemic, a serious health crisis, and is steadily increasing because it seems that people refuse to change for the good of the nation. Since the last decade the percentage of children being obese has increased steadily. The cause of this is a poor nutrition and physical activity and the plan is to get back to how it used to be, if not better. Children in the U.S. are eating more processed foods at home and there is less physical activity and sports at school. While children are developing bad habits when they are young, they are likely to turn into an adult who is obese and has bad habits. This i...