Obesity in Adolescence

This chapter reviews research addressing obesity during adolescence. Epidemiologic findings indicate that obesity has increased dramatically in adolescents during the past several decades so that currently approximately one-third of adolescents in the United States are overweight, with about 17 % considered obese. Rates of obesity are greater among youth from ethnic minority and lower-income families. Overweight adolescents have a high likelihood of remaining overweight as adults. Etiologic factors indicate the important role of hereditary, early growth, and environmental factors, with behavioral factors of excessive caloric intake and decreased energy expenditure resulting in positive energy balance and increased adiposity over time. Review of the correlates of obesity reveals that adolescents have increased risk for several physical health disorders, including high blood pressure, high cholesterol, metabolic syndrome, type 2 diabetes, orthopedic problems, sleep apnea, asthma, and fatty liver disease. Psychosocial correlates of obesity in adolescents include increased risk for problems related to body image problems, self-esteem, social isolation and discrimination, depression, and reduced quality of life. Research on interventions for obesity in adolescents reveals the challenges of weight control over time; however there is some support for the efficacy of behavioral interventions targeting reduced caloric intake, increased physical activity, and reduced sedentary behavior. Medical interventions including pharmacological and surgical approaches have shown some efficacy, but more research is needed to demonstrate their safety and acceptability, as well as long-term effects. In recent years, Internet-delivered behavioral interventions have shown some promise and these approaches will likely be needed in order to more effectively reach the population of overweight adolescents. Given the tremendous challenge in successfully treating obesity during adolescence, and the costs of its continuation into adulthood, a public health approach is needed to address the environmental factors that are responsible for the increased incidence of obesity in youth

Going Above and Beyond: Exemplar Diversity Training in Pediatric Psychology

Diversity and health disparities have been highlighted as 1 of the 10 core crosscutting knowledge competencies for pediatric psychology training. Specifics about the actual implementation and integration of diversity training across various types of pediatric psychology programs are largely unknown. We surveyed program directors of graduate and predoctoral internship programs listed on the Society of Pediatric Psychology website (N = 103) about their diversity training experiences that went above and beyond what is typically required (e.g., graduate courses, continuing education). We received responses from 23 programs; 14 of these programs reported having expanded diversity training primarily at the readiness for practice (n = 15) level, followed by readiness for practicum (n = 5) and readiness for graduate school (n = 2) levels. Seven programs had diversity training that spanned more than 1 training level. We provided in-depth descriptions of exemplar diversity training at 5 programs spanning multiple training levels. Institutions aiming to integrate diversity programming into their training, with the goal of meeting recommended guidelines, can use this article as a practical guide. Future studies exploring the impact of integrated diversity training and impact on students at varying developmental levels are needed

A problem-solving intervention for children with persistent asthma: a pilot of a randomized trial at a pediatric summer camp

Pediatric summer camps are emerging as a means to increase social support and improve children's attitudes about their chronic illness. Because of the high rate of camp attendance, it may be feasible to implement interventions within that setting; however, it has yet to be determined what components of camp are beneficial. The objective of this pilot study was to determine the efficacy of a problem-solving intervention targeting disease management in improving psychosocial functioning of children with persistent asthma, over and above the benefits of participation in a pediatric summer camp. Fifty campers were randomly assigned to receive camp plus a nightly problem-solving intervention activity or camp as usual. Changes in self-reported asthma knowledge and problem-solving skills and self- and parent-reported child self- and social competence health-related quality of life were assessed thrice: before camp, on the last day of camp, and 3-months post-camp. There were no significant differences between the problem-solving intervention group and the camp as usual group in change across psychosocial variables from before camp to last day of camp or before camp to 3-months post-camp. Increases in asthma knowledge and problem-solving were found 3-months post-camp when groups were combined. Although support was found for improvements in disease knowledge and problem-solving skills after camp participation, there were no identified benefits to the problem-solving intervention. Children with asthma who participated in camp were functioning at a high level in terms of knowledge, problem-solving, and social and self-competence, suggesting that interventions may be more effective if targeted to patients with identified problems with disease management

Evidence-based Assessment Strategies for Working with Ethnic Minority Youth

Conducting comprehensive and culturally appropriate assessment in pediatric medical settings can be challenging. Previous systematic reviews of assessment measures have sought to develop criteria for considering a measure to be “evidence-based” (e.g., Cohen et al., 2008). These reviews have not, however, addressed the growing need for providers to integrate evidence-based assessment and cultural competency specifically when working with ethnic minority children and families. The present paper has the following aims: (a) to present a framework for conducting assessment with families from diverse cultural backgrounds, (b) to provide recommendations for the clinician who is selecting measures for use with cultural minority patients and families, and (c) to discuss the limitations of the existing literature in helping clinicians make these determinations and provide future directions for researchers and clinicians. Case examples are used to illustrate some of the challenges that clinicians face in this area

Psychological support for children with diabetes: are the guidelines being met?

The significant role of psychosocial factors in the management of type 1 diabetes in youth has been well documented. The International Society for Pediatric and Adolescent Diabetes (ISPAD) therefore published the Clinical Practice Consensus Guidelines for psychological care of young patients. However, it is unclear if and how these guidelines are being implemented. A questionnaire was created to assess implementation of the guidelines and directed to physicians through the ISPAD listserve via a web-based survey. One hundred fifty-five participants from 47 countries completed the survey. Ninety-six percent of respondents reported that they work in a team with other professionals, and 95 % of teams discuss psychological difficulties associated with diabetes management. Seventy-two percent of respondents reported having "easy access" to a mental health specialist (MHS). In 56 % of practice settings, the MHS is considered to be part of the team; 43 % participate in routine clinic visits and 26 % see all patients. Seventy percent screen for psychological problems and 57 % assess family functioning. Psychosocial or behavioral interventions addressing psychosocial and regimen adherence difficulties are offered by 79 % of teams. Psychological care is available for many children with diabetes worldwide. Yet, nearly 30 % of teams do not have access to a MHS. More training in the recognition of psychosocial problems and counseling skills is warranted. More advocacy is needed to increase availability and utilization of psychological services in routine diabetes care

Grandparent Involvement and Children's Health Outcomes: The Current State of the Literature

Introduction: Grandparents are often highly involved as secondary caregivers for their grandchildren and may influence children's psychological and physical health outcomes. The purpose of the current review was to gather and synthesize research findings on the effects of grandparent involvement on children's physical health outcomes. Method: PubMed, PsycInfo, and MedLine were searched by 3 independent reviewers for articles that reported on grandparent involvement and children's health. Twenty-six articles were included for final review based on selection criteria. Results: Relatively few studies have examined the effects of grandparent involvement on children's health outcomes; therefore, the degree of their influence remains unclear. Four categories of children's health outcomes (disease/illness, weight, eating behaviors, and injury/safety) emerged during this review. Results indicated that the majority of studies available reported a negative effect of grandparent involvement on child's weight status. However, it is important to note that in most of these studies, the effects of grandparent involvement were not a primary outcome, and the amount of time grandparents spent with their grandchildren was not accounted for. Many studies in this review were qualitative studies, limiting the types of analyses that could be conducted. In addition, few longitudinal studies have been conducted in this area. Discussion: Based on this review, it is clear that grandparents are involved in caretaking for children across many cultures but to understand their role in children's health outcomes, more systematic and longitudinal research needs to be conducted