Family-based behavioral treatment of children with severe obesity : Effectiveness and perceived barriers

Bakgrunn: Få studier har prøvd ut familiebasert kognitiv atferdsterapi (FBT) innenfor den offentlige helsetjenesten. Mål: Sammenligne effekten av ett FBT program med forsterket fokus på sosialt miljø (FBSFT) og standard behandlingen (TAU) gitt ved Poliklinikk for overvekt, Haukeland Universitetssykehus (PFO), og å undersøke barrierer for deltakelse i FBSFT. Videre å undersøke forskjeller i søvnatferd hos barn med alvorlig fedme og normalvekt, og om søvn er relatert til annen ugunstig livsstils-atferd. Metode: Randomisert kontrollert studie med venteliste-kontroller som inkluderte 114 barn (gjennomsnittsalder 12,6 år) med alvorlig fedme rekruttert ved PFO. Videre ble en gruppe barn med normalvekt (n = 85) rekruttert for en kasus-kontroll-studie av søvnatferd. Målemetoder benyttet inkluderte vektrelaterte mål, objektive søvn/aktivitetsmål og spørreskjemaer («Nederlandsk spørsmålsliste om spiseatferd» og «Barrierer for behandlingsdeltakelse skalaen»). Resultater: FBSFT reduserte KMI standardavvik scoren til deltakerne signifikant mer fra før- til etter behandling enn TAU (p <0.001), forskjellen i endring mellom gruppene var på 0.19 standardavvik. Familier som avsluttet FBSFT prematurt rapporterte signifikant flere barrierer relatert til stress/hindringer (p = 0.010) og opplevd relevans av behandlingen (p <0.001) sammenlignet med familiene som fullførte behandlingen. Barn med alvorlig fedme hadde signifikant senere tidspunkt for søvn sammenlignet med normalvektige barn (p < 0.001), og i barnepopulasjonen totalt sett var senere tidspunkt for søvn relatert til mer skjermtid (p = 0.030) og mindre tid i fysisk aktivitet av moderat til høy intensitet (p = 0.015). Konklusjon: FBSFT gav bedre effekt på vektrelaterte mål sammenlignet med TAU, et funn som støtter videre implementering av FBSFT i den offentlige helsetjenesten. Videre er det sannsynlig at familier avslutter FBSFT prematurt dersom de opplever mer stressrelaterte barrierer og at behandlingen ikke møter familiens forventinger og behov, dette funnet tydeliggjør at det er viktig å kartlegge hindringer for deltakelse hos pasientene. Senere tidspunkt for søvn i løpet av døgnet utgjør muligens en risikofaktor for fedme hos barn, og denne sammenhengen må undersøkes videre.Background: Few studies have evaluated the effect of family-based behavioral treatment (FBT) in real-world health-care settings. Aims: To evaluate the effectiveness of family-based behavioral social facilitation treatment (FBSFT), an enhanced FBT program, for pediatric obesity, compared with treatment as usual (TAU); to assess for perceived barriers to treatment participation in families, as well as differences in sleep behaviors among children with severe obesity, compared to peers with normal weight; and to examine the relationship between sleep and other behavioral factors known to cause obesity in children. Methods: This was a randomized controlled trial using a wait-list control design. A total of 114 children (mean age 12.6 years) with severe obesity were recruited from the Obesity Outpatient Clinic, Haukeland University Hospital. A matched group of children with normal weight (n = 85) were also recruited for case-control comparison of sleep behaviors. Measurements included body mass index (BMI)-related metrics, objective sleep/physical activity measures, and relevant questionnaires (the Dutch Eating Behavior Questionnaire and the Barriers to Treatment Participation Scale). Results: A significantly greater decrease in BMI standard deviation scores was obtained from pre- to posttreatment with FBSFT, compared to TAU, with a between-group difference of 0.19 units (p <0.001). Noncompleters of FBSFT reported significantly more barriers to participation related to stressors and obstacles (p = 0.010) and perceived relevance of treatment (p <0.001), compared to completers. Children with severe obesity had significant later sleep timing, compared to normal-weight peers (p <0.001). Later sleep timing was also associated with more screen time (p = 0.030) and less time in moderate-to-vigorous physical activity (p = 0.015). Conclusion: Significantly greater improvement in BMI-related outcomes was obtained with FBSFT, compared to TAU. Families were more likely to terminate FBSFT prematurely when facing stress-related barriers or when treatment was not meeting their expectations/needs. Sleep timing could represent an independent risk factor for pediatric obesity. The study results here support a more widespread implementation of FBSFT, and emphasize the importance of investigating barriers to participation to enhance retention rates.Doktorgradsavhandlin

Polysomnographic comparison of sleep in children with obesity and normal weight without suspected sleep-related breathing disorder

Short sleep and obstructive apneas/hypopneas have been shown to be associated with childhood obesity. Still, few studies have compared sleep in children with obesity, without suspected sleep disordered breathing and normal weight peers by objective sleep measures and compared results with subjective parent assessment of sleep. Children with obesity aged 7–13 years (N = 44) and a matched group of normal weight children (N = 42) completed clinical polysomnography (Embla A10 Recording System). Parents scored their children's sleep on the Children's Sleep Habits Questionnaire (CSHQ). Mann–Whitney U tests were used to compare groups. There was a higher obstructive apnea/hypopnea index (AHI) (median obesity = 1.20 vs. median normal = 0.66; z = −1.33, U = 560.50, p = 0.002) and number of oxygen desaturation events per hour (median obesity = 0.7 vs. median normal = 0.2; z = −3.45, U = 402.50, p = 0.001) in the children with obesity compared to children with normal weight. The children with obesity had a significantly longer sleep duration (median obesity 8:50 h = vs. median normal = 8:32 h; z = −2.05, U = 687.00, p = 0.041), longer stage N2 sleep (median obesity = 87 min vs. median normal = 52 min; z = −2.87, U = 576.50, p = 0. 004) and shorter REM sleep (median obesity = 94 min vs. median normal = 121 min; z = 5.05, U = 1477.00, p ≤ .001). No differences were observed for time in sleep stage N1 and N3, wake time after sleep onset or the total arousal index . Further, no group differences were found on the CSHQ sleep-disordered breathing sub-scale (p = 0.399). The children with obesity demonstrated significantly more mild to moderate sleep disordered breathing than children with normal weight, although this was not corroborated by parent report.publishedVersio

Perceived barriers in family-based behavioural treatment of paediatric obesity – Results from the FABO study

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Background: To date, few studies have investigated perceived barriers among those who participate in and drop out of family-based behavioural treatment (FBT) for paediatric obesity. Examining experienced barriers during treatment, and their role in participation and completion of treatment has important implications for clinical practice. Objectives: To compare perceived barriers to participating in a family-based behavioural social facilitation treatment (FBSFT) for obesity among families who completed and did not complete treatment. Methods: Data were analysed from 90 families of children and adolescents (mean (M) age = 12.8 years, standard deviation (SD) = 3.05) with severe obesity enrolled in a 17-session FBSFT program. After completing 12 sessions or at the time of dropout, parents and therapists completed the Barriers to Treatment Participation Scale (BTPS), a 5-point Likert scale (1 = never a problem, 5 = very often a problem) which includes four subscales: 1. Stressors and obstacles that compete with treatment, 2. Treatment demands and issues, 3. Perceived relevance of treatment, 4. Relationship with the therapist. Results: Families who did not complete treatment scored significantly higher on the BTPS subscales stressors and obstacles that compete with treatment (M = 2.03, SD = 0.53 vs. M = 1.70, SD = 0.42), p = 0.010 and perceived relevance of treatment (M = 2.27, SD = 0.48 vs. M = 1.80, SD = 0.50), p < 0.001 than families who completed treatment. No other significant differences between groups were observed. Conclusion: Families are more likely to drop out of FBSFT when experiencing a high burden from life stressors or when treatment is not meeting the expectations and perceived needs of the family.publishedVersio

Family-based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial

To compare the effectiveness of family-based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel-design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6–18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT (n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU (n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut-off for overweight (%IOTF-25). Secondary outcomes included changes in sleep, physical activity, and eating behaviour. From pre- to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10–0.28, p < .001) and %IOTF-25 (5.48%, 95%CI: 2.74–8.22, p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: −0.22 to −0.10, p < .001) and %IOTF-25 (6.53%, 95% CI: −8.45 to −4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: −0.03 to 0.09, p = .30) and %IOTF-25 (−1.04%, 95% CI: −2.99 to −0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre- to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight-related outcomes compared to TAU.publishedVersio

Polysomnographic comparison of sleep in children with obesity and normal weight without suspected sleep-related breathing disorder

Short sleep and obstructive apneas/hypopneas have been shown to be associated with childhood obesity. Still, few studies have compared sleep in children with obesity, without suspected sleep disordered breathing and normal weight peers by objective sleep measures and compared results with subjective parent assessment of sleep. Children with obesity aged 7–13 years (N = 44) and a matched group of normal weight children (N = 42) completed clinical polysomnography (Embla A10 Recording System). Parents scored their children's sleep on the Children's Sleep Habits Questionnaire (CSHQ). Mann–Whitney U tests were used to compare groups. There was a higher obstructive apnea/hypopnea index (AHI) (median obesity = 1.20 vs. median normal = 0.66; z = −1.33, U = 560.50, p = 0.002) and number of oxygen desaturation events per hour (median obesity = 0.7 vs. median normal = 0.2; z = −3.45, U = 402.50, p = 0.001) in the children with obesity compared to children with normal weight. The children with obesity had a significantly longer sleep duration (median obesity 8:50 h = vs. median normal = 8:32 h; z = −2.05, U = 687.00, p = 0.041), longer stage N2 sleep (median obesity = 87 min vs. median normal = 52 min; z = −2.87, U = 576.50, p = 0. 004) and shorter REM sleep (median obesity = 94 min vs. median normal = 121 min; z = 5.05, U = 1477.00, p ≤ .001). No differences were observed for time in sleep stage N1 and N3, wake time after sleep onset or the total arousal index . Further, no group differences were found on the CSHQ sleep-disordered breathing sub-scale (p = 0.399). The children with obesity demonstrated significantly more mild to moderate sleep disordered breathing than children with normal weight, although this was not corroborated by parent report

Differences in sleep patterns between patients with anorexia nervosa and healthy controls: a cross-sectional study

Abstract Background Sleep difficulties are common in patients with anorexia nervosa (AN), but objective assessments have mostly been performed in hospital and laboratory settings. We aimed to identify differences in sleep patterns between patients with AN and healthy controls (HC) in their free-living environments, and potential associations between sleep patterns and clinical symptoms in patients with AN. Methods This cross-sectional study analyzed 20 patients with AN prior to them starting outpatient treatment and 23 HC. Sleep patterns were measured objectively using an accelerometer (Philips Actiwatch 2) for 7 consecutive days. Average sleep onset, sleep offset, total sleep time, sleep efficiency, wake after sleep onset (WASO) and mid-sleep awakenings lasting ≥ 5 min were compared between patients with AN and HC using nonparametric statistical analyses. Associations of sleep patterns with body mass index, eating-disorder symptoms, eating-disorder-associated impairment, and symptoms of depression were assessed in the patient group. Results Compared with HC, patients with AN had shorter WASO [median (interquartile range(IQR)): 33 vs. 42 min], but a longer average duration of mid-sleep awakenings lasting ≥ 5 min [median (IQR): 9 vs. 6 min, p = 0.006] and had more nights with no sleep (six nights in four patients with AN vs. zero nights in HC). There were no differences between patients with AN and HC regarding other sleep parameters and no significant correlations between sleep patterns and clinical parameters in patients with AN. However, HC presented a Intraindividual variability pattern that was closer to a normal distribution, whereas patients with AN tended to either have very regular or large variability in sleep onset time (AN; n = 7  75th percentile vs. HC; n = 4  75th percentile) during the week of sleep recordings. Conclusion Patients with AN seem to spend more time awake during the night and have more nights without sleep than do HC, even though their average weekly sleep duration did not differ from that in HC. The intraindividual variability in sleep pattern seems to be an important parameter that should be assessed when studying sleep in patients with AN. Trial registration ClinicalTroals.gov. Identifier: NCT02745067. Registered: April 20, 2016

Objectively measured physical activity among treatment seeking children and adolescents with severe obesity and normal weight peers

Background: Treatment seeking children and adolescents with severe obesity often experience barriers to physical activity. Studies objectively measuring physical activity in this group and investigating explanatory factors for physical activity levels could inform clinical practice. Objectives: This study aimed to compare objectively measured physical activity levels among treatment seeking children and adolescents with severe obesity and normal weight peers, and to investigate explanatory factors for time spent in moderate physical activity and vigorous physical activity among children and adolescents with severe obesity. Methods: Children with severe obesity (n = 85) were matched 1:1 by age, gender, and the season for accelerometer measurements with normal weight peers (n = 85). Children wore accelerometers for seven consecutive days, yielding measures of physical activity, sleep duration and timing. Parents reported on screen time, parental body mass index and participation in organized sports. Results: Children and adolescents with severe obesity spent significantly less time in moderate physical activity (12 min, p < 0.001) and vigorous physical activity (21 min, p < 0.001) per day compared to normal weight peers. No difference for time spent in sedentary activity was found between groups. For participants with severe obesity, age ≤12 years (p = 0.009) and participation in organized sports (p = 0.023) were related to more moderate physical activity, while age ≤12 years (p = 0.038) and early sleep timing (p = 0.019) were related to more vigorous physical activity. Conclusion: Children and adolescents with severe obesity were less physically active than their normal weight peers. Factors related to more moderate and vigorous physical activity in children with severe obesity were lower age, participation in organized sports and earlier sleep timing