Steps to Growing Up Healthy: a Pediatric Primary Care Based Obesity Prevention Program for Young Children

Background Leading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity. Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints. Brief interventions with simple behavior change messages are needed to reach high-risk children, particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities. Steps to Growing Up Healthy (Added Value) is a randomized controlled trial testing the efficacy of brief motivational counseling (BMC) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers (CHW) in the prevention/reversal of obesity in Latino and Black children ages 2-4 years old. Methods/Design Mother-child dyads (targeted n=150) are recruited for this 12-month randomized trial at an inner-city pediatric primary care clinic and randomized to: 1) BMC delivered by clinicians and nurses at well, sick, and WIC visits with the goal of reducing obesogenic behaviors (BMC); 2) BMC plus monthly phone calls by a CHW (BMC+Phone); or 3) BMC plus monthly home visits by a CHW (BMC+Home). During BMC, the medical team facilitates the selection of a specific goal (i.e., reduce sugar sweetened beverage consumption) that is meaningful to the mother and teaches the mother simple behavioral strategies. Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress. Dyads are assessed at baseline and 12 months and the primary outcome is change in the child’s BMI percentile. We hypothesize that BMC+Phone and BMC+Home will produce greater reductions in BMI percentiles than BMC alone and that BMC+Home will produce greater reductions in BMI percentiles than BMC+Phone. Discussion Steps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children. The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families

Overweight and Obesity in Persons Living with HIV: Stigma and Health

Objective: Both obesity and HIV are highly stigmatized diseases; however, little is known about the psychological experience of individuals at the intersection of these two conditions. This cross-sectional study examined whether PLWH with overweight or obesity endorsed and experienced less anticipated and enacted stigma due to their weight status. Methods: PLWH (n = 671; 428 male and 196 females) were recruited from a holiday donation center in Atlanta, Georgia. Self-reports of medical history, HIV and weight stigma, body image, perceptions of weight status, and nutritional intake were collected. Results: 26.8% were overweight (BMI \u3e25-25.9 kg/m2) and 32.4% were obese (BMI \u3e30 kg/m2). No differences were seen in levels of anticipated or enacted stigma across weight categories. Body image across weight categories was also relatively equal. Post hoc analyses displayed a meditational effect of body image on internalized HIV stigma and BMI. BMI also served as a moderator on body image and internalized weight stigma, as body image increased so did internalized stigma. Differences were also seen in perceptions of weight status, with individuals that were overweight or obese perceiving themselves to be slightly underweight or about the right weight. Conclusion: Results suggests there were no differences in anticipated or experienced HIV stigma as a result of weight status; however, internalized stigma was closely related to body image. Overweight and obesity were the norm in this sample as well as poor dietary quality, emphasizing the need for weight management interventions that are sensitive to the unique challenges of PLWH

The Steps to Growing Up Healthy Study: Barriers to Initial Behavior Change in a Primary Care Based Obesity Prevention/Reversal Program for Young Children

BACKGROUND: Children of color are disproportionately affected by obesity creating a need for effective prevention/reversal programs. This study investigated a first dose response to a pediatric primary care-based obesity prevention program (Steps to Growing Up Healthy) targeting Hispanic and Black children. We examined whether mothers experienced barriers to behavior change and if maternal, child, environmental, or intervention variables predicted barrier status. METHODS: Hispanic and Black mothers and their children (N=234; 51%F; 88.9% Hispanic; 35.4±8.7months) were recruited from an urban pediatric primary care clinic. The intervention utilized brief motivational counseling delivered by clinicians and nurses with the goal of decreasing obesogenic behaviors. During a routine clinic visit, the medical team facilitated the selection of a specific goal (e.g., reduce SSB) that was meaningful to the mothers and taught mothers simple behavioral strategies (e.g., self-monitoring). Study staff conducted follow-up telephone calls 5-7 days after the visit, reviewed the selected goal, and assessed whether the mother experienced a barrier to behavior change. RESULTS: 16.8% of mothers reported a barrier to behavior change in the week following the first intervention dose. Logistic regression models identified mother’s confidence (pand child sex (p\u3c.01) as predictors of barrier status. Mothers who were “somewhat” or “not confident” were 6.21 times more likely to report a barrier than mothers who were very confident and mothers were 0.351 times more likely to identify a barrier if their child was male. CONCLUSION: Obesity prevention/reversal programs may be well served to address maternal confidence levels especially with regard to changing their son’s obesogenic behaviors

Meal-Related Acyl and Des-Acyl Ghrelin and Other Appetite-Related Hormones in People with Obesity and Binge Eating

OBJECTIVE: Potential mechanisms of abnormal food intake, such as dysregulation of meal-related appetite hormones, including acyl ghrelin (AG) and des-acyl ghrelin (DAG), were investigated among men and women with obesity, with and without binge eating (BE). METHODS: Participants (n = 42: 19 female, 23 male) were assigned to a liquid meal and water condition in counterbalanced order, and blood samples for measuring hormones were obtained before and after these conditions. RESULTS: Participants with BE had significantly lower fasting and postingestive AG concentrations than participants without BE in both conditions. During the meal condition, postprandial decreases in AG concentrations were significantly smaller for the BE group than for the non-BE group. There were no significant differences in DAG by BE group. Leptin increased significantly less after meals for those with BE compared with those without BE. There were no differences in other hormones by BE group. Fasting and postmeal hunger ratings were significantly higher for those with BE than for those without BE. CONCLUSIONS: In individuals with BE, lower fasting AG may be due to downregulation by habitual overeating, and a smaller postmeal decline in AG may contribute to overeating. Lower postmeal leptin concentrations may also contribute to overeating

Service priorities and unmet service needs among people living with HIV/AIDS: Results from a nationwide interview of HIV/AIDS housing organizations

Housing for people living with HIV/AIDS (PLWHA) has been linked to a number of positive physical and mental health outcomes, in addition to decreased sexual and drug-related risk behavior. The current study identified service priorities for PLWHA, services provided by HIV/AIDS housing agencies, and unmet service needs for PLWHA through a nationwide telephone survey of HIV/AIDS housing agencies in the USA. Housing, alcohol/drug treatment, and mental health services were identified as the three highest priorities for PLWHA and assistance finding employment, dental care, vocational assistance, and mental health services were the top needs not being met. Differences by geographical region were also examined. Findings indicate that while housing affords PLWHA access to services, there are still areas (e.g., mental health services) where gaps in linkages to care exist. © 2013 Taylor & Francis

Service priorities and unmet service needs among people living with HIV/AIDS: Results from a nationwide interview of HIV/AIDS housing organizations

Housing for people living with HIV/AIDS has been linked to a number of positive physical and mental health outcomes, in addition to decreased sexual and drug-related risk behavior. The current study identified service priorities for people living with HIV/AIDS, services provided by HIV/AIDS housing agencies, and unmet service needs for people living with HIV/AIDS through a nationwide telephone survey of HIV/AIDS housing agencies in the United States. Housing, alcohol/drug treatment, and mental health services were identified as the three highest priorities for people living with HIV/AIDS and assistance finding employment, dental care, vocational assistance, and mental health services were the top needs not being met. Differences by geographical region were also examined. Findings indicate that while housing affords people living with HIV/AIDS access to services, there are still areas (e.g., mental health services) where gaps in linkages to care exist