An evaluation to review the effectiveness of an established residential weight management intervention on short-term health outcomes in overweight and obese children and adolescents

Background Overweight and obesity are rapidly escalating to epidemic proportions in the paediatric population. Obesity has profound health and social consequences in both the short- and long-term. Multi-component interventions have been highlighted as the treatment of choice but the current evidence base is limited and many interventions have not been properly evaluated. Objective To review the effectiveness of the Carnegie International Camp (CIC) programme, an established, residential, multi-component weight management intervention, previously demonstrated to be effective across a range of health outcomes for overweight and obese youth (Gately et al., 2005). Methods Replication of the previous evaluative study (Gately et al., 2005); 290 children and adolescents (mean age 13.7 years) participated in one of three successive residential weight management programmes during the school summer holidays of 2006-2008. Design: A prospective cohort study investigation incorporating a quasi-experimental, repeated measures design across a range of physiological and psychological variables associated with overweight and obesity. Measurements were taken before, during and after the intervention period. Comparisons were made with the data from the earlier evaluative study (Gately et al., 2005). Results Significant (p<0.05) improvements were achieved in all outcome variables from baseline (pre) to post intervention. Mean reductions: body mass = 5.56kg (6.0%), total percentage body fat = 4.0%, BMI = 2.19 kgm-2, BMI SDS = 0.27 units, waist circumference = 5.47cm (5.7%), systolic pressure = 3.23mmHg (2.7%), diastolic pressure = 7.92mmHg (10.5%), and a significant increase in self-esteem scores was achieved (+0.22 units, 9.4%). Significant improvements across all outcome variables were also reported by Gately et al. (2005). Similar changes were attained in both studies; significant between-group differences were only identified in three of the outcomes measures; percentage body fat, diastolic blood pressure and self-esteem, and the magnitude of these between-group differences were only small to moderate (eta squared = 0.017; 0.024; 0.038, respectively). Conclusions The CIC programme, an established multi-component, residential weight management intervention, specifically designed to meet the needs of overweight and obese young people, has been re-evaluated and the results from the current study demonstrate its continued acute effectiveness in producing positive outcomes across a range of physiological and psychological variables associated with overweight and obesity

Eating behaviours of preadolescent children over time:stability, continuity and the moderating role of perceived parental feeding practices

The links between childhood eating behaviours and parental feeding practices are well-established in younger children, but there is a lack of research examining these variables in a preadolescent age group, particularly from the child's perspective, and longitudinally. This study firstly aimed to examine the continuity and stability of preadolescent perceptions of their parents' controlling feeding practices (pressure to eat and restriction) over a 12 month period. The second aim was to explore if perceptions of parental feeding practices moderated the relationship between preadolescents' eating behaviours longitudinally. Two hundred and twenty nine preadolescents (mean age at recruitment 8.73 years) completed questionnaires assessing their eating behaviours and their perceptions of parental feeding practices at two time points, 12 months apart (T1 and T2). Preadolescents' perceptions of their parental feeding practices remained stable. Perceptions of restriction and pressure to eat were continuous. Perceptions of parental pressure to eat and restriction significantly moderated the relationships between eating behaviours at T1 and T2. The findings from this study suggest that in a preadolescent population, perceptions of parental pressure to eat and restriction of food may exacerbate the development of problematic eating behaviours

What change in body mass index is needed to improve metabolic health status in childhood obesity:protocol for a systematic review

PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol*. PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. (DOC 80.5 kb

Girls’ Dairy Intake, Energy Intake, and Weight Status

We explored the relationships among girls’ weight status, dairy servings, and total energy intake. The hypothesis that consuming dairy could reduce risk for overweight was evaluated by comparing energy intake and weight status of girls who met or consumed less than the recommended three servings of dairy per day. Participants included 172 11-year-old non-Hispanic white girls, assessed cross-sectionally. Intakes of dairy, calcium, and energy were measured using three 24-hour recalls. Body mass index and body fat measures from dual-energy x-ray absorptiometry were obtained. Because preliminary analyses suggested systematic underreporting of energy intake, the relationships among dairy servings and measures of weight status were examined for the total sample and for subsamples of under-, plausible, and overreporters. Data for the total sample provided support for the hypothesized relationship among weight status, dairy servings, and energy intake. Thirty-nine percent of girls reported consuming the recommended ≥3 servings of dairy per day; these girls also reported higher energy intake but had lower body mass index z scores and body fat than the girls who consumed fewer than three dairy servings each day. Among plausible reporters, no relationship between dairy intake and weight status was noted. This discrepancy may be attributable to a high percentage (45%) of overweight underreporters in the total sample. Our findings reveal that reporting bias, resulting from the presence of a substantial proportion of underreporters of higher weight status, can contribute to obtaining spurious associations between dairy intake and weight status. These findings underscore the need for randomly controlled trials to assess the role of dairy in weight management. The prevalence of pediatric obesity has been rising for more than 20 years (1). There is evidence that increased intake of dairy foods and calcium may play a significant role in maintaining a healthful weight and moderating body fat (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 and 15). However, results across studies have been inconsistent (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 and 28), and this may be attributable to major challenges in using self-reported dietary intake data. Self-reported intakes tend to be subject to underreporting bias and the underreporting of energy intake tends to be positively related to weight status. Underreporters also tend to weigh more (29 and 30). Doubly labeled water techniques assessing energy expenditure suggest underreporting results in a 10% to 50% underestimation of actual energy intake and is a significant problem in older children (31). Doubly labeled water techniques are expensive and not feasible for large samples; thus, several methods have been developed that use estimated energy requirements to assess reporting bias (29 and 32). Therefore, in this study the method suggested by Huang and colleagues (29) was used to classify children as under-, plausible, or overreporters. The objective of this study was to assess the relationship among girls’ weight status, dairy servings, and total energy intake. The hypothesis that consuming dairy could reduce risk for overweight was evaluated by comparing energy intake and weight status of girls who met or consumed less than the recommended three servings of dairy per day. To explore the effect of reporting bias on this relationship, the hypothesis was evaluated using the total sample, and subgroups of girls identified as plausible, under-, or overreporters

Area-Level Variation in Children’s Unmet Need for Community-Based Mental Health Services: Findings from the 2014 Ontario Child Health Study

There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children’s mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children’s unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children’s mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed

Piloting Eyes on the Baby: A Multiagency Training and Implementation Intervention Linking Sudden Unexpected Infant Death Prevention and Safeguarding

We describe the coproduction, pilot implementation, and user evaluation of an evidence-based training intervention addressing prevention of Sudden Unexpected Deaths in Infancy (SUDI) for the multiagency workforce supporting vulnerable families with babies in a northern English county. We aimed in this pilot study to improve knowledge, skills, and engagement of professionals and support staff providing services for vulnerable families with increased risk of SUDI. The training intervention was co-produced by the academic team and the project Steering Committee which comprised senior leaders from the local authority, health and care sectors, and third-sector organisations, and rolled out to multiagency teams between November 2022 and March 2023. Evaluation data were collected using a post-training questionnaire, followed up by the Normalisation Process Theory (NPT) NoMAD survey issued at two time-points post-training, and interviews with stakeholders. The evaluation, conducted from January to May 2023, aimed to assess how well the multiagency workforce accepted SUDI prevention as part of their remit and incorporated SUDI prevention activities into their everyday work. Most multiagency professionals and support staff were enthusiastic about the training and their role in SUDI prevention. Fewer health professionals completed the training than expected. Forty percent (397/993) of invited staff completed the training. Our results revealed initial lack of knowledge and confidence around SUDI prevention and targeted provision for vulnerable families which improved following the Eyes on the Baby training. The proportion of nonhealth professionals rating their knowledge of SUDI prevention as good or excellent increased significantly from 28% before training to 57% afterwards. Self-rated confidence in discussing SUDI prevention with families increased significantly from 71% to 97%. Health professionals’ ratings increased significantly for knowledge from 62% to 96%, and confidence from 85% to 100%. Use of NPT allowed us to identify that by the time of evaluation, the earliest adopters were cognitively involved with the programme and engaged in collective action, while later adopters had not yet reached this stage. We conclude that effective implementation of multiagency working for SUDI prevention can be accomplished by providing clear training and guidance for all staff who have regular or opportunistic contact with vulnerable families. Our next step is to evaluate the sustainability of MAW SUDI prevention over the medium to long term and assess the responses of recipient families to this approach