Children\u27s and Parents\u27 Depression in Relation to Family-Based Behavioral Weight Loss Treatment Outcome

Baseline parent-report of child depression and parent self-reported depression have been found to predict childrenΓÇÖs outcome in family-based behavioral weight loss treatment: FBT), although less is known about how child self-reported depression, changes in depression over time, and depression assessed via multiple informants is associated with FBT outcome. Two hundred and forty-one overweight children and their parents entered FBT, and 178 completed the pre- and post-FBT assessments. Depression was assessed via child and parent self-report, and parent-report on child. Linear regression examined child and parent depression: both baseline and change from baseline to post-FBT) as predictors of child FBT outcome: change in percent overweight). Regression models also evaluated the additive value of assessing depression via multiple informants: child and parent). Baseline depression: child self-report, parent self-report, parent-report on child) failed to significantly predict FBT outcome. In addition, the main effects of change in depression: child self-report, parent self-report, parent-report on child) were not significant. However, the interaction between baseline child self-reported depression and parent-report on child depression significantly predicted child FBT outcome. Furthermore, the interactions between change in child and parent depression significantly predicted child FBT outcome: 1) child self-reported depression change and parent self-reported depression change; and 2) child self-reported depression change and parent-report on child depression change. In the three significant models, children who experienced increased depressive symptoms and whose parents also reported an increase in depressive symptoms: either in their self-report or in their report of childrenΓÇÖs depression) exhibited the poorest FBT outcome. When evaluating depression via child self-report, parent self-report, and parent-report on child, the childrenΓÇÖs and parentsΓÇÖ self-reports did not independently predict child FBT outcome, but rather evaluating heightened depression scores on multiple measures: e.g., child self-report and parent-report on child) was significantly predictive. Early identification of and intervention for depression may enhance the tailoring of FBT and improve treatment outcome

Behavioral Weight Loss Treatment for Youth Treated With Antipsychotic Medications

Background: Youth who are being treated with antipsychotic medications are at increased risk for the development of obesity and type 2 diabetes. Behavioral weight loss treatments show promise for reducing obesity and diabetes risk among adults treated with these drugs, but such treatments have not previously been studied in youth. Objective: We describe a rationale for behavioral weight loss intervention for high-weight youth being treated with antipsychotic medications. We report behavioral, anthropomorphic, and metabolic findings from a case series of obese adolescents taking antipsychotic medications who participated in a short-term, family-based behavioral weight loss intervention. Methods: We adapted the Traffic Light Plan, a 16-week family-based weight loss intervention that promotes healthy energy balance using the colors of the traffic light to categorize the nutritional value of foods and the intensity of physical activity. We then added a social and ecological framework to address health behavior change in multiple social contexts. The intervention was administered to three obese adolescents with long-term antipsychotic medication exposure. The efficacy of the intervention was evaluated with a battery of anthropomorphic and metabolic assessments, including weight, body mass index percentile, whole body adiposity, liver fat content, and fasting plasma glucose and lipid levels. Participants and their parents also filled out a treatment satisfaction questionnaire after study completion. Results: Two boys and one girl, all of whom were 14 years old, participated in this study. All three participants attended all 16 sessions of the intervention and experienced beneficial changes in adiposity, fasting lipid levels, and liver fat content associated with weight stabilization or weight loss. Adolescents and their parents all reported a high level of satisfaction with the treatment. Conclusions: Family-based behavioral weight loss treatment can be feasibly delivered and is acceptable to youth taking antipsychotic medications and their families. Randomized controlled trials are needed to fully evaluate the effectiveness and acceptability of these treatments for these individuals

Development and Evaluation of a Provider Training Program for Family-Based Obesity Treatment

Introduction. To address obesity among children and families, higher numbers of trained providers are needed to identify obesity and initiate treatment. Nurses may be well-positioned to deliver such services given their diverse roles in pediatric healthcare, and this study was conducted in partnership with a school of nursing to evaluate two training methods for obesity screening and initial goal setting. Methods. Nursing students (N = 63) were randomized to either Live Interactive Training or Web-facilitated Self-study Training. Pre-training, post-training, and one-month follow-up assessments were conducted to determine the feasibility, acceptability, and impact (knowledge and skill demonstration) of Live versus Web training. Skill was assessed by standardized simulation scenarios. Results. Nearly all (98%) of the participants completed the three assessments, demonstrating the feasibility of the training and evaluation processes. Each training modality was rated as acceptable, but the acceptability rating was significantly higher in the Live versus Web training, F(1, 61) = 31.22, p \u3c .001. There was not a significant difference in knowledge or skill between the conditions at any timepoint; rather, knowledge and skill significantly increased in both conditions, with post-training and follow-up scores demonstrating significant improvement compared to pre-training scores (all ps \u3c .001). Engagement in the screening and intervention strategies during the follow-up interval was significantly higher in Live versus Web training (ps \u3c .01). Conclusions. The overall training and assessment package for obesity screening and initial goal setting was feasible, acceptable, and effective in improving knowledge and skill among a cohort of nursing students. Both training approaches (Live and Web) were associated with improvements in knowledge and skill, and Live training was associated with greater acceptability and content engagement at follow-up. Given the scalability of online approaches, the inclusion of some of the interactive components from the live training condition in a web-based training may augment these outcomes while optimizing accessibility and engagement. Further exploration of these findings is warranted, including a larger and more diverse sample, longer duration of training and assessment intervals, and delivery to real patients. Future research may yield a greater understanding of feasible, practical, and effective training programs to enhance providers’ abilities to identify and address obesity among their patients and promote better health care delivery for children and families

Healthcare provider advice on gestational weight gain: uncovering a need for more effective weight counselling

Limited research has examined the factors related to knowledge of gestational weight gain (GWG) recommendations and the receipt of advice from healthcare providers regarding GWG recommendations among women with pre-pregnancy overweight/obesity. Women with pre-pregnancy overweight/obesity (N = 191) reported the amount of gestational weight they believed they should gain and that healthcare providers advised them to gain. Only 24% (n = 46) of women had a correct knowledge of GWG recommendations. Women were less likely to have a correct knowledge of GWG recommendations if they had pre-pregnancy obesity, were of a minority race, or were socioeconomically disadvantaged. Meanwhile, only 17% (n = 32) of women reported being correctly advised about GWG recommendations by healthcare providers. There were no differences between women who did and did not report being correctly advised about GWG recommendations from healthcare providers. These findings indicate that women with pre-pregnancy overweight/obesity lack knowledge of GWG recommendations and report being incorrectly advised about GWG recommendations from healthcare providers.Impact statement What is already known on this subject? Extant literature indicates that women’s knowledge of gestational weight gain (GWG) recommendations and women’s receipt of information from their healthcare providers regarding GWG recommendations are predictive of meeting the Institute of Medicine guidelines for GWG. What do the results of this study add? Findings from the present study indicate that the majority of women with pre-pregnancy overweight/obesity lack knowledge of GWG recommendations and report that education on GWG recommendations from healthcare providers is an aspect of their prenatal care that is largely insufficient. Although there were no differences between women who did and did not report being correctly advised about GWG recommendations by healthcare providers, women were less likely to have a correct knowledge of GWG recommendations if they had pre-pregnancy obesity, were of a minority race, or were socioeconomically disadvantaged. What are the implications of these findings for clinical practise and/or further research? These findings highlight a need for more effective tailoring of prenatal care to ensure that women receive accurate advice from healthcare providers regarding GWG recommendations

Study Protocol: A randomized controlled trial evaluating the effect of family-based behavioral treatment of childhood and adolescent obesity–The FABO-study

Abstract Background The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children’s family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice. Methods Randomized controlled trial (RCT), in which families (n = 120) are recruited from the children and adolescents (ages 6–18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off ≥ 35, or IOTF ≥ 30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change. Outcome variables include body mass index (BMI; kg/m2), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires. Discussion This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity. Trial registration ClinicalTrails.gov NCT02687516 . Registered 16th of February, 201

Damage tolerance of nuclear graphite at elevated temperatures

Nuclear-grade graphite is a critically important high-temperature structural material for current and potentially next generation of fission reactors worldwide. It is imperative to understand its damage-tolerant behaviour and to discern the mechanisms of damage evolution under in-service conditions. Here we perform in situ mechanical testing with synchrotron X-ray computed micro-tomography at temperatures between ambient and 1,000 °C on a nuclear-grade Gilsocarbon graphite.We find that both the strength and fracture toughness of this graphite are improved at elevated temperature. Whereas this behaviour is consistent with observations of the closure of microcracks formed parallel to the covalent-sp2-bonded graphene layers at higher temperatures, which accommodate the more than tenfold larger thermal expansion perpendicular to these layers, we attribute the elevation in strength and toughness primarily to changes in the residual stress state at 800–1,000 °C, specifically to the reduction in significant levels of residual tensile stresses in the graphite that are ‘frozen-in’ following processing