A Pilot Study On Cognitive-behavioral Approach For Combatting Childhood Obesity In Qatar

Levels of overweight and obesity have reached alarming proportions in Qatar and other Gulf nations. In Qatar, the need to establish national strategies for the prevention and treatment of obesity was recognized in the National Health Strategy 2011-2016, which stresses the need for prevention. The treatment and prevention of childhood obesity is largely through lifestyle changes- encouraging health eating and physical activity. However, changing such behaviors is complex and requires integrated approaches to tackle such a multifaceted problem. In this study, we sought to implement and evaluate a novel weight management program for Qatari school children at the vulnerable age of 9-12 years. The program uses a cognitive-behavioral approach that involves developing social and emotional competences, promotion healthy dietary habits, and development of physical literacy, while enlisting family involvement in an attempt to maintain long term weight loss. This study also sought to take things further by integrating cutting edge insights from behavioral economics. The pilot study was conducted by an interdisciplinary team of collaborators from Qatar (Qatar University, Supreme Education Council, Aspire, Hamad Medical Corporation) and external partners (Imperial College and Leeds Metropolitan University/MoreLife, UK). The study was branded Agdar/???? and involved development of intervention materials, questionnaires, neuropsychological measures, and other study components such as training manuals and virtual world program. A sample of 100 overweight or obese Qatari children (age 9-12) from 5 independent schools participated in the intervention along with a control group. The intervention was conducted in Arabic and consisted of three phases (1) intensive weight loss camps, (2) after-school clubs as consolidation phase, and (3) a maintenance phase using virtual world program. Variables measured included anthropometric (BMI, Fat composition, and Waist circumference, and Blood pressure), Lifestyle (Physical Activity and Dietary questionnaires), and Psychometric assessments (Self-esteem, Subjective well-being, and Impulsivity, including heart monitoring). Overall, 100% of children who participated in the camp lost weight with a significant reduction BMI-SDS (p<0.001). The camp led to a significant improvement in subjective wellbeing in all five dimensions (p<0.01). The afterschool clubs showed a synergistic effect on children who lost weight at camp where further weight loss was achieved in the after school club phase. The overall percentage BMI-SDS reduction (-8.7%) was significantly higher than the required reduction for health benefits in both adolescents (-3%) and adults (-5%). Girls continued to outperform boys in terms of weight loss reduction and maintenance (-11.9 vs. -5.6%, respectively). This success occurred despite pre-camp surveys showing nearly two thirds of children not meeting their daily requirements of fruits and vegetables while consuming calorie-dense fast foods and over half of the participants not engaging in physical activity. Physiological parameters such as standard deviation of the heart beat-to-beat intervals, used as proxy for impulsivity, correlated significantly with BMI-SDS (p<0.035). Children with a higher BMI were less able to withhold their choices (proxy for impulsivity) and the physiological control of their heart rate correlated with this. These findings could help in segmentation of intervention participants into groups to which tailored programs could enhance impact on behavior change.qscienc

Diversity, distribution and conservation of the terrestrial reptiles of Oman (Sauropsida, Squamata)

All authors: Salvador Carranza , Meritxell Xipell, Pedro Tarroso, Andrew Gardner, Edwin Nicholas Arnold, Michael D. Robinson, Marc Simó-Riudalbas, Raquel Vasconcelos, Philip de Pous, Fèlix Amat, Jiří Šmíd, Roberto Sindaco, Margarita Metallinou †, Johannes Els, Juan Manuel Pleguezuelos, Luis Machado, David Donaire, Gabriel Martínez, Joan Garcia-Porta, Tomáš Mazuch, Thomas Wilms, Jürgen Gebhart, Javier Aznar, Javier Gallego, Bernd-Michael Zwanzig, Daniel Fernández-Guiberteau, Theodore Papenfuss, Saleh Al Saadi, Ali Alghafri, Sultan Khalifa, Hamed Al Farqani, Salim Bait Bilal, Iman Sulaiman Alazri, Aziza Saud Al Adhoobi, Zeyana Salim Al Omairi, Mohammed Al Shariani, Ali Al Kiyumi, Thuraya Al Sariri, Ahmed Said Al Shukaili, Suleiman Nasser Al Akhzami.In the present work, we use an exceptional database including 5,359 records of 101 species of Oman’s terrestrial reptiles together with spatial tools to infer the spatial patterns of species richness and endemicity, to infer the habitat preference of each species and to better define conservation priorities, with especial focus on the effectiveness of the protected areas in preserving this unique arid fauna. Our results indicate that the sampling effort is not only remarkable from a taxonomic point of view, with multiple observations for most species, but also for the spatial coverage achieved. The observations are distributed almost continuously across the two-dimensional climatic space of Oman defined by the mean annual temperature and the total annual precipitation and across the Principal Component Analysis (PCA) of the multivariate climatic space and are well represented within 17 out of the 20 climatic clusters grouping 10% of the explained climatic variance defined by PC1 and PC2. Species richness is highest in the Hajar and Dhofar Mountains, two of the most biodiverse areas of the Arabian Peninsula, and endemic species richness is greatest in the Jebel Akhdar, the highest part of the Hajar Mountains. Oman’s 22 protected areas cover only 3.91% of the country, including within their limits 63.37% of terrestrial reptiles and 50% of all endemics. Our analyses show that large areas of the climatic space of Oman lie outside protected areas and that seven of the 20 climatic clusters are not protected at all. The results of the gap analysis indicate that most of the species are below the conservation target of 17% or even the less restrictive 12% of their total area within a protected area in order to be considered adequately protected. Therefore, an evaluation of the coverage of the current network of protected areas and the identification of priority protected areas for reptiles using reserve design algorithms are urgently needed. Our study also shows that more than half of the species are still pending of a definitive evaluation by the International Union for Conservation of Nature (IUCN).This work was funded by grants CGL2012-36970, CGL2015-70390-P from the Ministerio de Economía y Competitividad, Spain (cofunded by FEDER) to SC, the project Field study for the conservation of reptiles in Oman, Ministry of Environment and Climate Affairs, Oman (Ref: 22412027) to SC and grant 2014-SGR-1532 from the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement de la Generalitat de Catalunya to SC. MSR is funded by a FPI grant from the Ministerio de Economía y Competitividad, Spain (BES-2013-064248); RV, PT and LM were funded by Fundação para a Ciência e Tecnologia (FCT) through post-doc grants (SFRH/BPD/79913/2011) to RV, (SFRH/BPD/93473/2013) to PT and PhD grant (SFRH/BD/89820/2012) to LM, financed by Programa Operacional Potencial Humano (POPH) – Quadro de Referência Estrategico Nacional (QREN) from the European Social Fund and Portuguese Ministerio da Educação e Ciência

Effect of Intensive Weight Loss Camp and Maintenance Clubs on Overweight School Children in Qatar

Obesity and overweight continue to raise in Qatar due to a confluence of factors such as genetics, overeating, inactivity, tradition of food-centered social events, convenience, and advertising of energy-dense fast foods, and hot climate making outdoor activities impractical most of the year. Estimates by experts within and outside Qatar point to an extremely high rate of obesity and overweight in Qatar, with the World Health Organization placing the rate at 78%. This places Qatar among the top of countries worldwide in the overall prevalence of obesity and overweight. Childhood obesity in particular has also been rapidly increasing with the combined rate of obesity and overweight hovering around 40%, up from below 30% less than ten years ago. This trend is alarming due to the increased risks for obesity-related conditions such as diabetes, coronary heart diseases, and lower quality of living. Hence, comprehensive obesity prevention interventions are needed to stem the rise of obesity among Qatari children. This study was conducted to evaluate the effectiveness of an integrated weight loss intervention incorporating lifestyle education, physical activity, and behavioral psychology nudges among Qatari school children. The intervention was designed to integrate family and school support and fit within Qatari school system calendar and schedule. The study was branded Agdar/&#x623;&#x642;&#x62F;&#x631; and conducted by an interdisciplinary team of collaborators from Qatar (Qatar University, Supreme Education Council, Aspire, Hamad Medical Corporation) and external partners (Imperial College, Leeds Metropolitan University/MoreLife, UK). In the first year of a three-year intervention study, four randomly chosen schools in Qatar participated in the intervention with a total of 941 Qatari children (316 girls and 625 boys) between 9 to 12 years of age of whom 430 children were qualified to participate in the study. A group of four other randomly chosen schools served as control. Out of 430 qualified children, one hundred children (50 boys and 50 girls) with BMI in the 95th percentile from the intervention schools were enrolled in a two phase weight loss intervention. Phase 1 consisted of an intensive weight loss camp with a highly structured set of activity which combined a range of physical activity, lifestyle learning, dietary control, behavioral nudge techniques, and social activity. The second phase consisted of a ten week after school sessions on lifestyle education and weight management for those children who successfully completed camp. These after school/community clubs were run on school premises to facilitate integration in school schedule. The two phases were designed to be complementary: the camp helps children lose weight and introduces them healthy lifestyle behavior, whereas the after school phase embeds/consolidates the knowledge already learnt and helps in long term weight management. During the camp, children participated in a range of structured interactive and skill based activities including a mixture of water based activity, contact games and electives, where the children were able to choose from a range of physical activities. At camp, participants were subjected to a series of assessments including anthropometric (Weight, Height, BMI, Waist Circumference, Blood pressure), Lifestyle and Physical Activity Questionnaires (diet and physical activity), and Psychometric assessment (self-esteem and subjective well-being). During the clubs, only anthropometric measurements took place to ensure the children get the most out of the sessions focusing on reward and recognition and celebrating success regardless of the magnitude of the health improvement. This phase was designed to provide children and parents with the tools, know-how, and the confidence to carry on with the new healthy lifestyle at home as means to ensure durable weight management. Data show that out of the 941 children in intervention schools, 430 children or 45.7% were either overweight or obese, having BMI in the top 95th centile by age. This rate is higher than the 42% we observed in a pilot study conducted by our team in 2014 and the 40% prevalence of overweight and obesity among children reported by other studies. A total of 100 children aged 9-12 completed the camp with a significant reduction in percent BMI SDS of 12.5% (p < .001). The average percent BMI SDS reduction was higher for girls than that of boys (11 vs. 14%). This percent BMI SDS reduction is four times the minimum BMI SDS reduction (3%) required for health benefits in adolescents. The camp also resulted in a significant improvement in self-esteem (p < .001) with females edging males in terms of improvement in self-esteem. A slight but not significant improvement in subject wellbeing was also observed between the start and end of camp (p = 0.128). These improvements in percent BMI SDS reduction (weight loss) and self-esteem occurred in a group that reported an unhealthy lifestyle profile with respect to physical activity and diet. In fact, participant responses painted a profile characterized by little or no physical activity (1 to 2 times/week) with two thirds of participants reporting fewer than 3 occasions of physical activity in their previous week. Participants' diet was characterized by low intake of fruits and vegetables and high intake of calorie-dense foods including sweets, soft drinks, and fast foods. Girls reported eating more fruits than boys but they seem to indulge more frequently in sweets. As the camp phase resulted in a significant weight loss among all participants (100% of participant lost weight at variable levels), particularly girls who were more serious in participation, the clubs were found to help participants in weight management. After an initial weight gain during a 3 week period between camp and club phases (percent BMI SDS reduction down to 10%), participants were able to recover and maintain their post camp levels of BMI SDS reduction. Correlations on data suggest that the more clubs participants (particularly boys) attended, the more likely they were to lose weight during the club phase (p = .028). In summary, the intervention camp was effective in significantly reducing the weight of all participants, despite its short duration of 11 days. After school clubs showed effectiveness in maintaining or further enhancing weight loss achieved in the camp and in engaging parents. The synergistic effect of the camp and after school/community clubs suggests promising potential for successful incorporation of this integrated intervention into the school curriculum, especially since the camp occurs during mid-year school break and the after school clubs during school days. The succeeding cohorts will provide further data for validation of this potential. The one year follow up data are being collected to assess the durability of weight changes and the stickiness of behavioral changes induced by the different phases of this intervention.qscienc

Physical map of Oman.

<p>Map of Oman showing topographical relief and names of the most relevant toponyms mentioned in this study.</p

Maps of species richness.

<p>(A) Species richness by governorate; (B) species richness by grids of 10 arc-minutes of latitude and longitude.</p

Number of species displayed in a cumulative way.

<p>Dots represent the years with species descriptions. Dashed lines divide the graph into intervals of 20 years. The last dot includes the species in the process of being described.</p

Principal Component Analysis (PCA) of the climatic space of Oman (grey dots) using 12 BIOCLIM variables.

<p>Dashed lines delimit the climatic clusters that group 10% of the explained variance by PC1 and PC2. Green dots represent the climatic space of protected areas.</p

Map of Oman indicating the sampling effort.

<p>Grids of 10 arc-minutes (~18km) with observations (red dot). Empty grid cells are either due to no observation or no sampling.</p

Climate variability of Oman.

<p>(A) Map showing the distribution and extension of the 20 climatic clusters of Oman identified in this study that group 10% of the explained variance by PC1 and PC2; (B) Principal Component Analysis (PCA) of the climatic space of Oman using 12 BIOCLIM variables and with the 20 climatic clusters that group 10% of the explained variance by PC1 and PC2 with the same colors as in the map. Clusters have been numbered from 1 to 20 with the following order: from left to right and from bottom to top.</p

Map of protected areas of Oman.

<p>Topographical map of Oman showing the distribution, limits and names of the 22 protected areas. Information provided by the Ministry of Environment and Climate Affairs of Oman.</p