In Their Own Words: Learning from Families Attending a Multidisciplinary Pediatric Weight Management Program at the YMCA

Background: A family-based multidisciplinary weight management program for obese children 7?11 years old was implemented by a pediatric weight management center and local YMCA. The purpose of this study was to explore parents' and children's perceptions of the program to gain insight about factors that may enhance engagement and retention of families in weight management treatment. Methods: Families were invited to participate in a telephone interview after their participation in the program. The interviews assessed satisfaction with program components, acceptability of the intervention, barriers to treatment participation, and suggestions for improvement. Results: A total of 34 semistructured telephone interviews were performed, including 19 parents and 15 children. The majority of children (mean age=9.2±1.5 years) interviewed were female (74%) and recipients of Medicaid (79%). The population was racially diverse (63% black, 26% white, 11% other). Results suggest families were generally very positive about the program and viewed the major components of the program as helpful (i.e., nutrition, exercise, behavior). Families particularly enjoyed exercise and cooking demonstrations, whereas self-monitoring activities and learning about behavior change strategies were less enjoyable. Parents noted that increasing the length of individual sessions would likely be beneficial. Families who did not complete the program cited factors such as transportation barriers (e.g., gas money, distance), scheduling conflicts, and unmet expectations as contributing to their decision to discontinue participation. Conclusions: This study may have implications for how to enhance family-based pediatric weight management programs for children ages 7?11 years.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140329/1/chi.2012.0106.pd

Incremental Hospital Charges Associated With Obesity as a Secondary Diagnosis in Children

Objective: The objective was to evaluate the association of obesity as a comorbidity with hospital charges, by comparing charges for pediatric hospitalizations with vs. without obesity as a secondary diagnosis. Methods: Using the 2000 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID), a nationally representative sample of pediatric hospital discharges, we identified the most common non‐pregnancy‐related principal diagnoses for children 2 to 18 years of age: asthma, pneumonia, affective disorders, and appendicitis. For each we compared mean charges and mean length of stay for hospitalizations with vs. without obesity as a secondary diagnosis, adjusting for relevant socio‐demographics and hospital type. Results: Among children's discharges in 2000, 1.1% listed obesity as a secondary diagnosis. These had a disproportionate likelihood of being older, black, Medicaid beneficiaries, and hospitalized at a general hospital. Adjusted mean hospital charges were significantly higher for discharges with obesity as a secondary diagnosis vs. those without: appendicitis ($14,134 vs.$11,049; p < 0.01), asthma ($7766 vs.$6043; p < 0.05), pneumonia ($12,228 vs.$9688; p < 0.05), and affective disorders ($8292 vs.$7769; p < 0.01). Whereas obesity as a secondary diagnosis was associated with a pattern of increased adjusted mean length of stay, only asthma and affective disorders had statistically significant differences (0.6 days) ( p < 0.01). Conclusion: This national analysis suggests obesity as a secondary diagnosis is associated with significantly higher charges for the most common reasons for pediatric hospitalizations. This presents a financial imperative for further research to evaluate factors that contribute to higher inpatient charges related to obesity as a comorbidity and underscores the need for obesity prevention initiatives.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93704/1/oby.2007.224.pd

Let's Face It: Patient and Parent Perspectives on Incorporating a Facebook Group into a Multidisciplinary Weight Management Program

Background: Social media may have the potential to enhance weight management efforts. However, the acceptability of incorporating this entity into pediatrics is unknown. The objective of this project was to explore patients' and parents' perspectives about developing a Facebook group as a component of a pediatric weight management program. Methods: Semistructured interviews were performed between September, 2011, and February, 2012, with patients and parents in a multidisciplinary weight management program. Interviews explored participants' perceptions of potential benefits, concerns, and preferences related to a program-specific Facebook group. Transcripts were reviewed and themes identified. The study concluded when thematic saturation was achieved. Results: Participants (n=32) were largely enthusiastic about the idea of a program-specific Facebook group for adolescents. Most preferred a secret group, where only participants would know of the group's existence or group members' identity. No parents expressed concern about security or privacy related to a program-specific Facebook group; one parent expressed concern about undesirable advertisements. Participants endorsed a variety of ideas for inclusion on the page, including weight loss tips, live chats with providers, quizzes, and an incentive system where participants could gain points for making healthy choices. Many parents requested a separate parent-focused page, an idea that was supported by the adolescents. Conclusions: This study suggests that participants perceive potential benefits from incorporating social media interventions into pediatric weight management efforts. Privacy and security issues do not appear to be major parental concerns. Future work should explore the impact of program-specific social media interventions on outcomes for patients in weight management programs.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140332/1/chi.2013.0047.pd

Waist circumference percentile thresholds for identifying adolescents with insulin resistance in clinical practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72493/1/j.1399-5448.2008.00474.x.pd

Slow and Steady: Readiness, Pretreatment Weekly Strengthening Activity, and Pediatric Weight Management Program Completion

Background: Pediatric weight management programs have substantial attrition rates, which have led to recommendations to assess readiness prior to enrollment. Both pretreatment readiness scales and behaviors, such as exercise, have been theorized to predict subsequent program completion. The purpose of this study was to explore the role of self-reported pretreatment exercise in adolescents on completion of a pediatric weight management program and to explore the predictive ability of standard readiness scales. Methods: A total of 146 obese (BMI≥95th percentile) pediatric (ages 11?18) participants joined a 6-month multidisciplinary weight management program between March, 2007, and July, 2010. Completers were compared retrospectively to noncompleters on demographic, readiness, and pretreatment exercise practices from clinic-developed intake questionnaires using univariate analyses. Regression analyses specified the degree to which these variables predicted program completion. Results: The 6-month completion rate was 53%. There was no relationship between self-reported readiness and program completion. Self-reported pretreatment weekly strengthening activity (SA) was significantly associated with program completion, compared to those who performed SA either never [univariate odds ratio (OR) 3.18, 95% confidence interval (CI) 1.51?6.68, p=0.002; multivariate OR 2.43, 95% CI 1.06?5.58, p=0.036] or daily (univariate OR 4.90, 95% CI 1.74?13.77, p=0.002; multivariate OR 4.69, 95% CI 1.45?15.14, p=0.010). No relationship was found between other forms of exercise and program completion. Conclusions: Self-reported pretreatment weekly SA, but not standard readiness scales, predicted pediatric weight management program completion.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140330/1/chi.2013.0006.pd

A Picture May Be Worth a Thousand Texts: Obese Adolescents' Perspectives on a Modified Photovoice Activity To Aid Weight Loss

Abstract Background: In an effort to enhance the vividness and personal relevance of a text messaging intervention to promote weight loss among obese adolescents, a modified Photovoice process was evaluated with adolescents in a weight management program. Methods: Photovoice is a method using photography to generate relevant images and stories from users. Participants were recruited from the Michigan Pediatric Outpatient Weight Evaluation and Reduction (MPOWER) program, a multidisciplinary weight management program for obese adolescents and their parents. Twenty-three adolescents with a mean BMI of 40 were asked to take pictures on three to five randomly assigned weight-related topics, such as ?something that reminds you to exercise,? and to text them to a research assistant. Adolescents then engaged in semistructured interviews about the experience. Detailed notes of the interviews were analyzed to identify themes. Results: Participants generally provided high ratings of the process, indicating that (1) deciding what pictures to take caused them to reflect on their weight loss experience, and (2) a mobile intervention incorporating personally relevant images (e.g., basketball as their favorite sport rather than sports in general) would increase treatment adherence. The submitted photographs frequently featured family members and friends, and participants indicated that family and friends played a major role in motivating and supporting them. Conclusions: This study suggests that a Photovoice component has the potential to enhance weight management programs for teens as part of a text messaging intervention and as an independent entity. Further work should evaluate the effect of this promising intervention on weight loss.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98440/1/chi%2E2011%2E0095.pd

OMG Do Not Say LOL: Obese Adolescents' Perspectives on the Content of Text Messages to Enhance Weight Loss Efforts

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93769/1/oby.2011.266.pd

Health, Nutrition and Healthcare Availability (Survey 2, Report 2)

With support and collaboration from the W.K. Kellogg Foundation through the America Healing initiative, researchers at the University of Michigan are leading the National Voices Project (NVP) from 2011-2015. The central goals of the NVP are to examine the sources of racial/ethnic inequity and other disparities for children in the United States today, identify interventions that address disparities effectively, and inform the public dialogue about racial healing and racial equality. The NVP offers a fresh perspective on community-level opportunities for children throughout the country, in the domains of health and nutrition, education, and economic security -- through the eyes of adults whose work and volunteer efforts affect such opportunities. In other words, the NVP reflects the perceptions of individuals throughout the United States who are in a position to improve children's opportunities in the future. The questionnaire for NVP Survey 2 was developed by the National Voices Project team at the University of Michigan, with input from WKKF collaborators. We examined how individuals who work or volunteer with children view opportunities for education, health and healthcare, and economic well-being related to children and adolescents. Many of the questions were identical to questions fielded for NVP Survey 1 in 2011, to facilitate comparisons of responses across these different samples and over time. New questions in NVP Survey 2 centered on respondents' perceptions of segregation and inequities in the communities they know best, and on respondents' awareness about efforts to bridge racial/ethnic inequities in those communities

Education and Learning Opportunities (NVP 2014, Report 3)

With support and collaboration from the W.K. Kellogg Foundation through the America Healing initiative,  researchers at the University of Michigan are leading the National Voices Project (NVP) from 2011-2016. The central goals of the NVP are to examine the sourcesof racial/ethnic inequity and other disparitiesfor children in the United States today and identify interventions that address disparities effectively.The NVP offers an unprecedented perspective on community-level opportunities for children throughout the country, in the domains of health and nutrition, education and learning, and economic security – through the eyes of adults whose occupations and volunteer work affect such opportunities. In other words, the NVP reflects the perceptions of individuals throughout the United States who are in a position to improve children's opportunities inthe future. We generally use the word "children" throughout the report to describe children from age 0-18 years, unless otherwise noted.Previous reports for NVP 2014 focused chiefly on respondent characteristics and findings regarding health,  healthcare, and nutrition. This report for NVP 2014 will center on findings related to children's education and learning

Education and Learning Opportunities (Survey 2, Report 3)

With support and collaboration from the W.K. Kellogg Foundation through the America Healing initiative, researchers at the University of Michigan are leading the National Voices Project (NVP) from 2011-2016. The central goals of the NVP are to examine the sources of racial/ethnic inequity and other disparities for children in the United States today, identify interventions that address disparities effectively, and inform the public dialogue about racial healing and racial equality.The NVP offers a fresh perspective on community-level opportunities for children throughout the country, in the domains of health and nutrition, education, and economic security – through the eyes of adults whose work and volunteer efforts affect such opportunities. In other words, the NVP reflects the perceptions of individuals throughout the United States who are in a position to improve children?s opportunities in the future.NVP Survey 1 was conducted in November-December 2011. NVP Survey 2 was fielded in August-September 2012. NVP Survey 2 differed from NVP Survey 1 in two key respects: 1) NVP Survey 2 included an oversample in communities included in the "Place Matters" initiative led by the Joint Center for Political and Economic Studies, a fellow grantee of the W.K. Kellogg Foundation. The oversample included sufficient numbers of responses to permit the NVP team to analyze differences across 6 specific "Place Matters" counties, and 2) Questions were asked in greater depth about efforts at community levels about bridging efforts to address racial/ethnic inequities.