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

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

A weight-management camp followed by weekly after-school lifestyle education sessions as an obesity intervention for Qatari children: a prospective cohort study

Background Weight-management camp interventions for obese children are eff ective for short-term weight loss. However, there is little evidence indicating how gains made with such interventions can be maintained in the longer term. The present prospective cohort study investigated eff ectiveness of an intervention consisting of a weightmanagement camp followed by weekly lifestyle education sessions. Methods Obese children from eight Qatari schools participated in the intervention from Jan 27 to May 20, 2015. It started with a 2 week weight-management camp involving physical and social activities, lifestyle learning, and dietary control. Participants then attended school as usual for 3 weeks. Ten, weekly after-school club sessions were then held, each lasting 2 h, involving further lifestyle education and engagement of participants’ parents, with the aim of encouraging consolidation of learning that had taken place at the camp, and continuation of healthy behaviours. A control group of obese children from the same Qatari schools received no intervention. The primary outcome variable was body-mass index SD scores (BMI SDS). Wilcoxon signed rank tests were used to assess changes in BMI SDS. Informed consent was obtained from participants and their parents. Ethics approval was granted by the Qatar University Institutional Review Board. Findings 56 children (42 girls) aged 9–13 years (mean 10·9, SD 1·1) took part in the intervention. BMI SDS ranged from 1·17 to 4·00 (mean 2·51, SD 0·62). The control group consisted of 37 children (27 girls) aged 8–12 years (mean 10·3, SD 1·1) with BMI SDS 1·40–3·98 (2·78, 0·43). Between the start of camp and the end of the clubs, there was no signifi cant change in control group BMI SDS (mean –0·004, SD 0·29; p=0·784), but signifi cant reduction in the intervention group BMI SDS (–0·10, 0·20; p=0·0003). Signifi cant BMI SDS reduction occurred for the intervention group during weight-management camp (–0·13, 0·12; p<0·0001) and after-school club (–0·12, 0·19; p<0·0001) stages; signifi cant BMI SDS increase occurred between these stages (0·15, 0·16; p<0·0001). Interpretation This small-sample study suggests that weekly lifestyle education sessions can be eff ective in helping to sustain weight-loss achievements from more intensive childhood obesity interventions. Half of the intervention group achieved an overall BMI SDS reduction of at least 0·10, which has been shown to be associated with important reductions in insulin and total cholesterol. Funding This research was supported by the National PrioritieNational Priorities Research Program Qatar Foundation (grant X-036-3–01)

Testing a multicomponent lifestyle intervention for combatting childhood obesity

Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity. Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8-14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in. Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively). Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions