Parents' willingness to pay for the prevention of childhood overweight and obesity

Objective: To determine parental willingness-to-pay (WTP) for childhood obesity prevention. Methods: Cross-sectional data from the follow-up measurements (2011) of a health promotion programme in German primary schools. Data collection included anthropometric measurements of children and self-administered questionnaires for parents, including WTP assessment. Mann-Whitney U-Test was used for differences between groups, and regression analysis to identify factors associated with general WTP and amount of WTP. Results: From 1 534 parents, 97.8% considered overweight/obesity to be serious public health problems. A general WTP to reduce the incidence of childhood overweight/obesity by half, was declared by 48.8%. Parents of overweight/obese children showed with 61.4%, significantly more frequently, their general WTP than the others with 47.2% (p = 0.001). Mean WTP was €23.04 (99% confidence interval (CI) [22.45; 23.75]) per month. Parents of centrally obese children showed significantly higher WTP than parents of the other children (p = 0.001). General WTP and the amount of WTP were associated with the central obesity of the child, migration status and household income. Additionally, general WTP was associated with maternal obesity. Conclusions: Nearly half of the parents were willing to invest in prevention of obesity. The general WTP significantly occurs more often and with higher amount in affected parents

Early Life Cognitive Abilities and Body Weight: Cross-Sectional Study of the Association of Inhibitory Control, Cognitive Flexibility, and Sustained Attention with BMI Percentiles in Primary School Children

The objective of this study was to investigate the association of different cognitive abilities with children’s body weight adjusted for further weight influencing sociodemographic, family, and lifestyle factors. Cross-sectional data of 498 primary school children (7.0 ± 0.6 years; 49.8% boys) participating in a health promotion programme in southwest Germany were used. Children performed a computer-based test battery (KiTAP) including an inhibitory control task (Go-Nogo paradigm), a cognitive flexibility task, and a sustained attention task. Height and weight were measured in a standardized manner and converted to BMI percentiles based on national standards. Sociodemographic features (migration background and parental education), family characteristics (parental body weight), and children’s lifestyle (TV consumption, physical activity, consumption of sugar-sweetened beverages and breakfast habits) were assessed via parental questionnaire. A hierarchical regression analysis revealed inhibitory control and cognitive flexibility to be significant cognitive predictors for children’s body weight. There was no association concerning sustained attention. The findings suggest that especially cognitive abilities known as executive functions (inhibitory control and cognitive flexibility) are associated with children’s body weight. Future longitudinal and intervention studies are necessary to investigate the directionality of the association and the potential of integrating cognitive training in obesity prevention strategies. This trial is registered with ClinicalTrials.gov DRKS00000494

Evaluation of a health promotion program in children: Study protocol and design of the cluster-randomized Baden-Württemberg primary school study [DRKS-ID: DRKS00000494]

<p>Abstract</p> <p>Background</p> <p>Increasing prevalences of overweight and obesity in children are known problems in industrialized countries. Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood. "Komm mit in das gesunde Boot - Grundschule" is a school-based program to promote a healthier lifestyle. Main goals of the intervention are to increase physical activity, decrease the consumption of sugar-sweetened beverages, and to decrease time spent sedentary by promoting active choices for healthy lifestyle. The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools. The efficacy of this large scale intervention is examined via the Baden-Württemberg Study.</p> <p>Methods/Design</p> <p>The Baden-Württemberg Study is a prospective, stratified, cluster-randomized, and longitudinal study with two groups (intervention group and control group). Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012. Efficacy of the intervention is being assessed using three main outcomes: changes in waist circumference, skinfold thickness and 6 minutes run. Stratified cluster-randomization (according to class grade level) was performed for primary schools; pupils, teachers/principals, and parents were investigated. An approximately balanced number of classes in intervention group and control group could be reached by stratified randomization and was maintained at follow-up.</p> <p>Discussion</p> <p>At present, "Komm mit in das Gesunde Boot - Grundschule" is the largest school-based health promotion program in Germany. Comparative objective main outcomes are used for the evaluation of efficacy. Simulations showed sufficient power with the existing sample size. Therefore, the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children, teachers and parents. The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program.</p> <p>Trial registration</p> <p>German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494</p

Übergewicht und Adipositas im Grundschulalter - gesundheitsökonomische Aspekte der Prävention und Untersuchung der Erkrankungshäufigkeit und gesundheitsbezogenen Lebensqualität

Aim: Firstly the cost-effectiveness analysis of the URMEL-ICE intervention. Secondly, associations of central obesity and physical activity with health in primary school children in the Baden-Württemberg Study. Methods: URMEL-ICE intervention with data from 719 children analysed, effectiveness measured as prevented gain of waist circumference (WC) and waist to height ratio (WHtR). First cross-sectional data collection of the Baden-Württemberg Study including 1948 children. Parental information on children’s health related quality of life (HRQoL; KINDLR, EQ5D-Y VAS), number of sick days and visits to a physician during the last year, physical activity patterns. Central obesity defined as WHtR equal to or greater 0.5. Results: WC gain was 1.61 cm and WHtR 0.014 less in the URMEL-ICE intervention vs. control. Intervention costs € 24.09 per child. Incremental cost-effectiveness ratio (ICER) was € 11.11 (95 % confidence interval (CI) [8.78; 15.02]) per cm WC and € 18.55 (95 % CI [14.04; 26.86]) per unit (0.01) WHtR gain prevented. In the Baden-Württemberg Study children with central obesity differed from the others in the number of sick days (9.05 vs. 6.84, p < 0.001) and visits to a physician (3.58 vs. 2.91, p < 0.05). HRQoL of centrally obese children was lower in EQ5D-Y VAS (88.1 vs. 91.6, p < 0.001) and in KINDLR subscales ‘school’ (79.9 vs. 82.5, p < 0.05) and ‘friends’ (75.4 vs. 78.3, p < 0.05). Children who were physically active for 60 min/day on at least four days a week, were less frequently sick for more than five days (OR 0.70) and had a higher HRQoL measured with KINDLR (OR 1.73) and EQ5D-Y VAS (OR 1.41). Conclusion: The URMEL-ICE study provides new information about cost-effectiveness of structured health promotion in primary school. Cross-sectional results from the Baden-Württemberg Study show higher rates of sick days, visits to a physician and lower HRQoL in children with central obesity. This emphasizes the meaning of an early onset of health promotion and prevention

The Weight Problem: Overview of the Most Common Concepts for Body Mass and Fat Distribution and Critical Consideration of Their Usefulness for Risk Assessment and Practice

The prevalence of obesity already reached epidemic proportions many years ago and more people may die from this pandemic than from COVID-19. However, the figures depend on which measure of fat mass is used. The determination of the associated health risk also depends on the applied measure. Therefore, we will examine the most common measures for their significance, their contribution to risk assessment and their applicability. The following categories are reported: indices of increased accumulation of body fat; weight indices and mortality; weight indices and risk of disease; normal weight obesity and normal weight abdominal obesity; metabolically healthy obesity; the obesity paradox. It appears that BMI is still the most common measure for determining weight categories, followed by measures of abdominal fat distribution. Newer measures, unlike BMI, take fat distribution into account but often lack validated cut-off values or have limited applicability. Given the high prevalence of obesity and the associated risk of disease and mortality, it is important for a targeted approach to identify risk groups and determine individual risk. Therefore, in addition to BMI, a measure of fat distribution should always be used to ensure that less obvious but risky manifestations such as normal weight obesity are identified

Intermittent Use of Anti-Hormonal Agents for the Endocrine Therapy of Sex-Hormone-Dependent Breast and Prostate Cancer: A Protocol for a Systematic Review

Therapies with the continuous administration of anti-hormonal agents in sex-hormone-dependent malignancies such as prostate and breast carcinomas often lead to the development of resistant tumor cells. A systematic evaluation of the use and effects of the intermittent application of endocrine therapy could provide information on the state of knowledge in this research area. PubMed, Cochrane Library, Embase, and Web of Science will be systematically searched using pretested search strategies. Randomized and non-randomized controlled trials, pragmatic trials, case–control, and comparative cohort studies will be eligible. Primary outcomes will be progression-free survival, disease-free survival, and overall survival. The literature retrieved will be selected based on predefined inclusion and exclusion criteria. Relevant data will be extracted from included references into a pre-designed table. The risk of bias will be assessed, and the report of the results will follow PRISMA recommendations and include any deviations from this protocol. The increasing prevalence of breast and prostate cancer and limitations of current therapeutic approaches require a closer look at alternatives. Additionally, to explore new therapeutic agents, modalities of administration should be rigorously reviewed to determine the best regimens for patients. This proposed systematic review aims to summarize and evaluate the current knowledge regarding intermittent endocrine cancer therapy to provide a basis for further research

FAIR+R: Making Clinical Data Reliable Through Qualitative Metadata

Metadata are often the first access to data repositories for researchers within secondary use. Through automatic metadata generation and metadata harvesting the amount of data about data has been growing ever since. In order to make data not only FAIR but also reliable, the aspect of metadata quality has to be considered. But as earlier assessments of metadata of different repositories showed, metadata quality still lacks behind its capability. Providing an extensive literature review the authors conclude nine measures to assess metadata in relation to clinical care repositories, such as Medical Data Integration Centers (MeDICs). Proceeding from these measures the authors propose an addition of the FAIR Guiding Principles by adding a fifth block for Reliability including three principles, that resulted from the measures presented. The results form the basis for the future work of an assessment of metadata, that is stored in a MeDIC

Associations of time-restricted eating with health-related quality of life and sleep in adults: a secondary analysis of two pre-post pilot studies

Background!#!Therapeutic fasting may improve health-related quality of life (HRQoL) and sleep but is not applicable for everyone. Time-restricted eating (TRE) offers a low threshold alternative but research on associations with HRQoL and sleep is rare.!##!Methods!#!We conducted a secondary analysis of two pilot studies in a pre-post design, which examined TRE in healthy employees at the Ulm University and in abdominal obese patients in a general practitioners office. Participants reported their HRQoL (EQ-5D visual analogue scale) before and after 3 months of restricting their daily eating to 8-9 h. They kept a diary to protocol timing of first and last meal, sleep quality (analogue scale) and duration. Pearson's correlation coefficient was applied to test bivariate correlations between continuous variables and linear regression analyses were conducted to identify associated factors with the pre-post differences in HRQoL and the differences in sleep quality.!##!Results!#!Ninety-nine participants (aged aged 48.9 ± 1.1, 83.8% female) reached the fasting target of 15-16 h on average on 77.2 ± 18.7% of all recorded days. HRQoL increased by 7.8 ± 12.6 and sleep quality by 9.6 ± 13.9 points, but sleep duration was not extended. Regression analysis revealed mean fasting duration and baseline sleep quality as significant factors associated with changes in HRQoL. Improvements in sleep quality correlated with baseline sleep quality and HRQoL at follow-up but not with fasting. Changes in anthropometry did not correlate with the HRQoL or sleep quality.!##!Conclusions!#!TRE correlates with increased HRQoL and sleep quality independent from weight loss. TRE is easily applicable with or without medical supervision. The potential effects of TRE on health and sleep should be further investigated in larger randomized trials.!##!Trial registration!#!German Register for Clinical Trials (DRKS), DRKS-ID: DRKS00015057 . Registered 4 July 2018