Clothing Size Dissatisfaction: A Stronger Predictor of Size-related Avoidance than Body Mass Index

Participants in the current study (N = 2,997) were age and race-representative U.S. adults perceiving themselves as larger in body size than their ideal. Participants completed an internet survey inquiring about size and size-related avoidance behavior. Body mass index (BMI) was measured as well as a novel construct called relative size (RS; current-ideal size) to predict a variety of avoidance behaviors using a 10-item scale. A principal components analysis was performed on the 10-item avoidance scale, and components entitled general avoidance and body display avoidance emerged. Multiple regression analyses were then performed to examine gender differences in avoidance as well as the posited predictive utility of RS above and beyond BMI for the two components of avoidance using the following hierarchical series: BMI, RS, gender, gender/BMI interaction, and gender/RS interaction. RS was found to offer more predictive utility for general avoidance than BMI. For body display avoidance, results suggested that female gender was the sole significant predictor. We believe our findings reinforce previous literature stating that poor body image has more of an adverse impact on the lives of women compared to men and that one’s perception of size can deter involvement in varied life events

Change in health-related quality of life in the context of pediatric obesity interventions: A meta-analytic review.

Objective: To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. Method: Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. Results: The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. Conclusion: This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Differences in Utilization of Levels of Integrated Primary Care in Patients with High and Low Behavioral and Physical Health Demands

Integrated primary care (IPC) may help palliate the demand for mental health services and barriers to such care. There are varying degrees of integration (Blount, 2003; Doherty, 1995; Strosahl, 1998), with suppositions that certain patients may fare better in certain levels/models of IPC than in others (Doherty, McDaniel, & Baird, 1996; Mauer, 2006). No research to date has examined the interface between levels of care and patient behavioral and physical health demands, hence the aim of the current study. The current study utilized Mauer’s (2006) Four Quadrant Model to ascertain patient differences in behavioral and physical health demands and utilization across three levels of care: co-located, integrated, and a hybrid (receipt of both colocated and integrated care) for a general adult population within a community-based nurse practitioner-led FQHC. Total time spent in behavioral health treatment, total number of behavioral health sessions, number of presenting behavioral health concerns at baseline, and number of behavioral health no-shows and cancellations since baseline, differed significantly across the levels of integration. Number of past-year medical visits, number of chronic illnesses, and number of active medications at baseline did not differ significantly between groups, indicating that patient differences between levels of care were based more on behavioral health variations than physical variables. Moreover, patients were no more or less likely to be represented in one level/model of care over another based on patient quadrants, or combinations of high and low physical and behavioral health demands. This study is the first to our knowledge to examine the intersect of patient quadrants and levels/models of IPC. Future research should examine the intersect and impact of level/model of care and patient behavioral and physical health demands on outcome

Shared Reading and Media Exposure in Infants: Preliminary Findings from the ReadNPlay Initiative

The obesity problem in the U.S. is of epidemic proportions and affects even the youngest members of society. For instance, 10% percent of U.S. infants have excess weight for length, and early onset of obesity incites later risk. The American Academy of Pediatrics (AAP) Council on Communications and Media has linked media exposure to obesity as well as sleep, behavior issues, inattention, and decreased parent-child interaction in young children. Further, the AAP concludes that no known health benefits exist for media exposure in children under 2 and discourage use in this age range. Reading has been shown to increase secure attachment in infants and to increase the quality of parent-child interaction in addition to positive gains in child literacy. Additionally, two existing studies found that reading reduces screen time, thus serving as a healthy alternative to media exposure. Despite these findings, and the importance of anticipatory guidance in pediatric primary care for discussing shared reading, only 15% of pediatricians talk to families about media exposure. ReadNPlay for a Bright Future is a multi-disciplinary, multicomponent pilot study and healthy weight promotion initiative for families with infants aged birth to 24 months to create health-promoting home environments, set goals, and monitor progress regarding reading and active play. The setting for this study is an academic pediatric primary care practice serving a primarily Caucasian, socio-economically disadvantaged population in Southern Appalachia, with involvement from pediatricians, nurses, and a behavioral health consultant. A novel communicative tool, the ReadNPlay Baby Book, along with provider training in brief motivational interviewing, posters, social media, and participation incentives (e.g., free children’s books) are being used to improve counseling on healthy active living behaviors during infant well child visits. The current research endeavor is focused on the Play More: Shut Off the Screens aspect of the ReadNPlay initiative and utilizes data from a baseline survey completed by 40 mothers with infants aged 9-12 months and 40 mothers with infants aged 13-24 months to assess trends in one form of media exposure, television watching, and reading in this population. While the AAP recommends that children under 2 years do not watch TV, mothers in this study reported that 80% of infants 9-12 months and 87% of infants 13-24 months watched at least 30 minutes on a typical day. Sixty percent of mothers of infants 9-12 months and 82.5% of mothers of infants 13-24 months reported reading 2013 Appalachian Student Research Forum Page 71 or looking at books with their child on most days of a typical week, perhaps as a result of an existing Reach Out and Read Initiative in the practice. The current study adds to the dearth of research regarding risk factors during infancy for future development of obesity. Future research may examine whether increases in reading time may decrease time spent in media exposure

Adapting CATCH Kids Club and the NIH We Can! Curricula to Prevent Child Obesity in Afterschool Settings (Winning with Wellness): Results from Focus Groups with Afterschool Personnel and Parents

Approximately 35.5% of U.S. children ages 6-11 are overweight or obese. Obesity prevention programs in the school setting have produced mixed results, but interventions conducted in the afterschool setting may increase healthy eating (HE) and physical activity (PA) beyond efforts in a typical school day. Studies to date have shown some success in increasing PA in this setting. Moreover, 23% of children grades K-5 attend afterschool care programs. Treatment successes using a family-based approach warrants parental involvement in this setting, but few studies have examined the impact of parent inclusion. The CATCH Kids Club is a curriculum aimed to increase HE and PA in the afterschool care setting with children grades K-5. The NIH We Can! is a family-based intervention geared towards parents of children ages 8-13 and aims to assist families in increasing HE and PA as well as reducing screen time. The current study sought to understand 1) school community perceptions of child obesity, nutrition, and PA, 2) current efforts of the afterschool care program to promote HE and PA, and 3) how a combined student- and parent- focused intervention could be integrated into afterschool care. Researchers conducted focus groups and tested measurement instruments with afterschool personnel and parents of children in the afterschool care program. All personnel (N = 12; 83% Female; 92% Caucasian) agreed that greater afterschool care health promotion efforts could be made. Over half the sample (58%) described afterschool snacks as “not very healthy” or “not at all healthy” and placed the average amount of daily PA at 1 hour. Barriers to healthy habits included mandates on individually wrapped snack purchases and space available for PA. Personnel demonstrated interest in learning the CATCH curriculum. However, personnel were concerned about amount of staff needed to deliver the program, effects of varying attendance levels of students, and parent participation due to busy schedules. Results revealed that parents (N = 8; 75% female; 100% Caucasian) had little knowledge of what occurred during the afterschool care program including types of snacks provided and amount of PA received. All parents were supportive of the implementation of CATCH Kids Club, and all expressed interest in participating in the We Can! sessions. Parents reported preference for short (30-45 minute), bimonthly sessions occurring upon child pick-up. Results suggest that delivering 2012 Appalachian Student Research Forum Page 81 CATCH Kids Club and the NIH We Can! curricula in the afterschool setting would be of interest to both personnel and parents and would be feasible if time-limited and convenient. These findings will contribute to the development of an afterschool care program pilot intervention, Wellness Partners, directed at both students 5-11 years of age and their parents using modified CATCH Kids Club and NIH We Can! curricula. This cluster randomized controlled pilot study utilizing both quantitative and qualitative methodologies will provide preliminary data to further refine and conduct a fully-powered, large scale trial of the intervention’s efficacy in preventing obesit

Change in Health-Related Quality of Life in the Context of Pediatric Obesity Interventions: A Meta-Analytic Review

Objective: To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. Method: Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. Results: The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. Conclusion: This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities

Parent Report of Child\u27s Health-Related Quality of Life after a Primary-Care-Based Weight Management Program

Background: Health-related quality of life (HRQoL) has been recognized as an important target and health outcome in obesity research. The current study aimed to examine HRQoL in overweight or obese children after a 10-week primary-care–based weight management program, Parent-Led Activity and Nutrition for Healthy Living, in southern Appalachia. Methods: Sixty-seven children (ages 5–12 years) and their caregivers were recruited from four primary care clinics, two of which were randomized to receive the intervention. Caregivers in the intervention groups received two brief motivational interviewing visits and four group sessions led by providers as well as four phone follow-ups with research staff. Caregivers completed the PedsQL and demographic questionnaires at baseline and at 3, 6, and 12 months postintervention. Child height and weight were collected to determine standardized BMI. Results: Caregivers of children receiving the weight control intervention reported no statistically significant improvements in child total HRQoL, as compared to the control group, across the course of treatment (β=0.178; 95% confidence interval, −0.681, 1.037; p=0.687). Additionally, no statistically significant improvements were found across other HRQoL domains. Conclusions: Future studies examining HRQoL outcomes in primary care may consider treatment dose as well as methodological factors, such as utilization of multiple informants and different measures, when designing studies and interpreting outcomes

Community Partnerships to Promote Healthy Active Living

Purpose To describe outcomes of community partnerships for promoting healthy active living among families with young children in the ReadNPlay for a Bright Future Project. Methods ReadNPlay for a Bright Future was developed through grant support from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee AAP Chapter. ReadNPlay is a coordinated, multi-level, multi-component initiative promoting healthy active living among families with young children during infant-toddler health supervision visits and in childcare and other community settings. The project site is located in rural southern Appalachia, an area of the country with a high prevalence of obesity. Materials and messages developed by the project team were finalized during a community forum with stakeholders held in Northeast Tennessee in fall 2012. Four themes emerged as a focus for the initiative: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. Partnerships with the regional children\u27s hospital, childcare providers, health department, public libraries, and farmers\u27 markets were supported through on-going communication via email, social media, and individual meetings. Availability of two $750 pediatric resident mini-grants and structure afforded by the residency program\u27s existing community pediatrics rotation facilitated development and implementation of community initiatives for this project. Results Project posters displayed in community settings, use of social media, and periodic community events are reinforcing efforts to promote healthy active living in the clinical setting. A new event for families with infants/toddlers was added to the children\u27s hospital annual Kids Run, involving over 120 families during the first year. Walk N\u27 Rollers received free Reach Out and Read books and were surprised at the sugar content of juice and other beverages displayed in sippy cups as part of a “Sugar Quiz.” Information disseminated through regional child care centers will promote participation in a summer Walk N\u27 Roll program in addition to this annual event. At a regional childcare provider conference, ReadNPlay workshops with over 100 infant-toddler teachers and 40 families were conducted and information on Tennessee\u27s “Gold Sneaker” designation for compliance with state nutrition and physical activity policies was shared (only 6$10 farmers\u27 market vouchers at their 12-15 month well child visit to encourage consumption of fruits and vegetables. 18-month statistics on social media reach, walking program participation, new Gold Sneaker designations, and farmers\u27 market program participation will be presented. Conclusion This presentation will illustrate how pediatric residency programs and practitioners may partner with existing community organizations and initiatives to promote healthy active living in families with young children