Revisión sistemática: efectividad de las intervenciones para disminuir y controlar la obesidad y el sobrepeso en la población infantil 2000 a 2012

La obesidad y sobrepeso se han asociado con una mayor probabilidad de generar consecuencias negativas a la salud. En Colombia, según la Encuesta Nacional de la Situación Nutricional 2010 (ENSIN) la prevalencia de sobrepeso y obesidad en niños de 5 a 17 es del 17,5%. Por lo anterior es fundamental conocer las estrategias actualmente utilizadas para la prevención y tratamiento de la obesidad infantil y determinar cuales tienen mayor efectividad y seguridad, esto con el propósito de orientar las decisiones en beneficio de la resolución de esta problemática. Se realizó una revisión sistemática de la literatura, usando como herramienta de búsqueda en diferentes bases de datos. Fueron seleccionados estudios de ensayos controlados aleatorios sobre intervenciones para prevenir y controlar el sobrepeso y la obesidad en niños de 4 a 17 años de edad. Se desarrolló una matriz en la cual se determinó la heterogeneidad de las investigaciones incluidas dentro de la revisión. Según los estudios analizados se puede concluir que las intervenciones en general realizadas no mostraron cambios significativos en el IMC, solo se encontró un menor aumento del IMC en los grupos de intervención respecto a los grupos control. Es fundamental la realización de estudios sobre obesidad y sobrepeso en población infantil, los resultados obtenidos en los cambios en IMC han sido moderados, actualmente hay mucha controversia en los estudios reportados y se requiere que además la participación multidisciplinaria y multisectorial. Palabras Clave: Obesidad infantil, intervenciones aleatorias controladas, prevención de obesidad infantil, seguridad en tratamiento de obesidad y adherencia a tratamientos de obesidad.

Niveles de actividad física, condición física y tiempo en pantallas en escolares de Bogotá, Colombia: Estudio FUPRECOL

Examina la relación entre los niveles de actividad física (AF) de forma objetiva, la condición física (CF) y el tiempo de exposición a pantallas en niños y adolescentes de Bogotá, Colombia.

Effect and process evaluations of an early childhood obesity prevention intervention

The thesis develops a summative evaluation framework of the NOURISH Randomised Controlled Trial, and applies this to a selection of maternal feeding choice outcomes of the programme. The research is based on an ecological model of the complex set of factors that need to be acted upon to address childhood obesity. The novel approach extends the standard RCT effect evaluation, while also conducting an in-depth evaluation of the process of programme development and implementation. Research findings identify adaptations of intervention delivery that could improve its effectiveness and translatability, in a new cycle of the programme.

The Early Prevention of Obesity in CHildren (EPOCH) collaboration : an individual patient data prospective meta-analysis

Background: Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori. Methods/Design: The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children’s dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention-level characteristics. Discussion: Finalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013. Trial registration number: ACTRN12610000789066

Fitness and fatness in childhood obesity : implications of physical activity

Overweight and obesity are a significant cause of poor health worldwide, particularly in conjunction with low levels of physical activity (PA). PA is health-protective and essential for the physical growth and development of children, promoting physical and psychological health while simultaneously increasing the probability of remaining active as an adult. However, many obese children and adolescents have a unique set of physiological, biomechanical, and neuromuscular barriers to PA that they must overcome. It is essential to understand the influence of these barriers on an obese child's motivation in order to exercise and tailor exercise programs to the special needs of this population. Chapter Outline • Introduction • Defining Physical Activity, Exercise, and Physical Fitness • Physical Activity, Physical Fitness, And Motor Competence In Obese Children • Physical Activity and Obesity in Children • Physical Fitness in Obese Children • Balance and Gait in Obese Children • Motor Competence in Obese Children • Physical Activity Guidelines for Obese Children • Clinical Assessment of the Obese Child • Physical Activity Characteristics: Mode • Physical Activity Characteristics: Intensity • Physical Activity Characteristics: Frequency • Physical Activity Characteristics: Duration • Conclusion

Application of the Intervention Mapping protocol to develop Keys, a family child care home intervention to prevent early childhood obesity.

BACKGROUND: Many families rely on child care outside the home, making these settings important influences on child development. Nearly 1.5 million children in the U.S. spend time in family child care homes (FCCHs), where providers care for children in their own residences. There is some evidence that children in FCCHs are heavier than those cared for in centers. However, few interventions have targeted FCCHs for obesity prevention. This paper will describe the application of the Intervention Mapping (IM) framework to the development of a childhood obesity prevention intervention for FCCHs METHODS: Following the IM protocol, six steps were completed in the planning and development of an intervention targeting FCCHs: needs assessment, formulation of change objectives matrices, selection of theory-based methods and strategies, creation of intervention components and materials, adoption and implementation planning, and evaluation planning RESULTS: Application of the IM process resulted in the creation of the Keys to Healthy Family Child Care Homes program (Keys), which includes three modules: Healthy You, Healthy Home, and Healthy Business. Delivery of each module includes a workshop, educational binder and tool-kit resources, and four coaching contacts. Social Cognitive Theory and Self-Determination Theory helped guide development of change objective matrices, selection of behavior change strategies, and identification of outcome measures. The Keys program is currently being evaluated through a cluster-randomized controlled trial CONCLUSIONS: The IM process, while time-consuming, enabled rigorous and systematic development of intervention components that are directly tied to behavior change theory and may increase the potential for behavior change within the FCCHs.

Childhood obesity prevention in the 80th Texas legislative session

The increased number of obese children in the United States has prompted many efforts to reduce obesity by predominantly focusing resources to develop better education, awareness, nutrition and physical activity. There has been increased interest within communities and governments to turn to policy makers for help in taking action. The possibility for various health policies geared toward preventing childhood obesity is diverse in nature. In order to understand strategies taken by Texas legislatures to address childhood obesity, this study examines childhood obesity prevention policy recommendations and subsequently uses them to identify relevant legislation. This study follows identified legislation during the 80th Texas legislative session to gain an understanding of the steps that the Texas legislatures are currently taking to prevent childhood obesity. This study concludes that the Texas legislative process was successful at effecting changes in education policy. However, during this legislative session Texas legislators did not follow many strategies and recommendations which may be more effective at reducing childhood obesity. ^

A formative evaluation of the American Diabetes Association's Choosing Health and Sensible Exercise childhood obesity intervention

Background. The increasing prevalence of overweight among youth in the United States, and the parallel rise in related medical comorbidities has led to a growing need for efficient weight-management interventions. Purpose. The aim of this study was to evaluate the effects of the Choosing Health and Sensible Exercise (C.H.A.S.E.) childhood obesity prevention program on Body Mass Index (BMI), physical activity and dietary behaviors. Methods. This study utilized de-identified data collected during the fall 2006 session of the C.H.A.S.E. program. A total of 65 students at Woodview Elementary School and Deepwater Elementary School participated in this intervention. The C.H.A.S.E. program is a 10-week obesity prevention program that focuses on nutrition and physical activity education. Collection of height and weight data, and a health behavior survey was conducted during the first and last week of the intervention. Paired t-tests were used to determine statistically significant differences between pre- and post-intervention measurements. One-way analysis of variance was used to adjust for potential confounders, such as gender, age, BMI category ("normal weight", "at risk overweight", or "overweight"), and self-reported weight loss goals. Data were analyzed using STATA, v. 9.2. Results. A significant decrease in mean BMI (p< 0.05) was found after the 10-week intervention. While the results were statistically significant for the group as a whole, changes in BMI were not significant when stratified by age, sex, or ethnicity. The mean overall scores for the behavior survey did not change significantly pre- and post-intervention; however, significant differences were found in the dietary intention scale, indicating that students were more likely to intend to make healthier food choices (p<0.05). No statistically significant decreases in BMI were found when stratified for baseline BMI-for-age percentiles or baseline weight loss efforts (p>0.05). Conclusion. The results of this evaluation provide information that will be useful in planning and implementing an effective childhood obesity intervention in the future. Changes in the self-reported dietary intentions and BMI show that the C.H.A.S.E. program is capable of modifying food choice selection and decreasing BMI. Results from the behavior questionnaire indicate that students in the intervention program were making changes in a positive direction. Future implementation of the C.H.A.S.E. program, as well as other childhood obesity interventions, may want to consider incorporating additional strategies to increase knowledge and other behavioral constructs associated with decreased BMI. In addition, obesity prevention programs may want to increase parental involvement and increase the dose or intensity of the intervention. ^

It's time to be more serious about activating youngsters : lessons for childhood obesity

The epidemic of obesity is impacting an increasing proportion of children, adolescents and adults with a common feature being low levels of physical activity (PA). Despite having more knowledge than ever before about the benefits of PA for health and the growth and development of youngsters, we are only paying lip-service to the development of motor skills in children. Fun, enjoyment and basic skills are the essential underpinnings of meaningful participation in PA. A concurrent problem is the reported increase in sitting time with the most common sedentary behaviors being TV viewing and other screen-based games. Limitations of time have contributed to a displacement of active behaviors with inactive pursuits, which has contributed to reductions in activity energy expenditure. To redress the energy imbalance in overweight and obese children, we urgently need out-of-the-box multisectoral solutions. There is little to be gained from a shame and blame mentality where individuals, their parents, teachers and other groups are singled out as causes of the problem. Such an approach does little more than shift attention from the main game of prevention and management of the condition, which requires a concerted, whole-of-government approach (in each country). The failure to support and encourage all young people to participate in regular PA will increase the chance that our children will live shorter and less healthy lives than their parents. In short, we need novel environmental approaches to foster a systematic increase in PA. This paper provides examples of opportunities and challenges for PA strategies to prevent obesity with a particular emphasis on the school and home settings.

Outcomes of an early feeding practices intervention to prevent childhood obesity

Objective Use a randomised controlled trial (RCT) to evaluate outcomes of a universal intervention to promote protective feeding practices, which commenced in infancy and aimed to prevent childhood obesity Subjects and Methods The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 (SD=1.0) months at baseline. Mothers were randomly allocated to self-directed access to usual care or to attend two 6-session interactive group education modules that provided anticipatory guidance on early feeding practices. Outcomes were assessed six months after completion of the second information module, 20 months from baseline and when the children were two years old. Maternal feeding practices were self-reported using validated questionnaires and study-developed items. Study-measured child height and weight were used to calculate BMI Z-score. Results Retention at follow-up was 78%. Mothers in the intervention group reported using responsive feeding more frequently on 6/9 subscales and 8/8 items (Ps ≤.03) and overall less ‘controlling feeding practices’ (P<.001). They also more frequently used feeding practices (3/4 items; Ps <.01) likely to enhance food acceptance. No statistically significant differences were noted in anthropometric outcomes (BMI Z-score: P=.11), nor in prevalence of overweight/obesity (control 17.9% vs. intervention 13.8%, P=.23). Conclusions Evaluation of NOURISH at child age two years found that anticipatory guidance on complementary feeding, tailored to developmental stage, increased use by first-time mothers of 'protective' feeding practices that potentially support the development of healthy eating and growth patterns in young children.

Too early to proclaim the end of the war on childhood obesity

Parents winning childhood war on obesity, Australian Bureau of Statistics data reveals, screamed the headline. Sounds like a good news story to make every parent breathe a sigh of relief, but is it really true? The article in question quoted obesity expert and University of South Australia Professor Tim Olds, who argued that “the media and public health authorities are getting carried away” about childhood obesity. He pointed to the fact that recent ABS data showed rates of overweight and obesity in children plateaued between 2007/08 and between 2011/12. But that still means one in four Australian children is overweight or obese; it’s clear we still have a lot of work to do. As a nutritionist working with parents every day (both in practical obesity programs and in research into reducing this considerable health risk), I was concerned that the article could be taken at face value. Because there’s more, much more, to this story.

Australasian nutrition research for prevention and management of child obesity : innovation and progress in the last decade

The Food and Nutrition stream of Australasian Child and Adolescent Obesity Research Network (ACAORN) aims to improve the quality of dietary methodologies and the reporting of dietary intake within Australasian child obesity research (http://www.acaorn.org.au/streams/nutrition/). With 2012 marking ACAORN’s 10th anniversary, this commentary profiles a selection of child obesity nutrition research published over the last decade by Food and Nutrition Stream members. In addition, stream activities have included the development of an online selection guide to assist researchers in their selection of appropriate dietary intake methodologies (http://www.acaorn.org.au/streams/nutrition/dietary-intake/index.php). The quantity and quality of research to guide effective child obesity prevention and treatment has increased substantially over the last decade. ACAORN provides a successful case study of how research networks can provide a collegial atmosphere to foster and co-ordinate research efforts in an otherwise competitive environment.

Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change

Parent-centred interventions for childhood obesity aim to improve parents' skills and confidence in managing children's dietary and activity patterns, and in promoting a healthy lifestyle in their family. However, few studies assess changes in parenting over the course of treatment. This study describes the evaluation of a lifestyle-specific parenting program (Group Lifestyle Triple P) on multiple child and parent outcomes. One-hundred-and-one families with overweight and obese 4- to 11-year-old children participated in an intervention or waitlist control condition. The 12-week intervention was associated with significant reductions in child BMI z score and weight-related problem behaviour. At the end of the intervention, parents reported increased confidence in managing children's weight-related behaviour, and less frequent use of inconsistent or coercive parenting practices. All short-term intervention effects were maintained at one-year follow-up assessment, with additional improvements in child body size. The results support the efficacy of Group Lifestyle Triple P and suggest that parenting influences treatment outcomes. Further research is needed to evaluate the long-term effectiveness of the intervention and to elucidate the mechanisms of change. © 2010 Elsevier Ltd.

Examining the potential application of childhood stature in assessing adolescent overweight and obesity

Background: Increasing Overweight and Obesity (OwOb) prevalence in pediatric populations is becoming a public health concern in many countries. The purpose of this study was to determine if childhood stature components, particularly the Leg Length Index (LLI = [height - sitting height]! height), were useful in assessing risk of OwOb in adolescence. Methods: Data was from a longitudinal study conducted in south Ontario since 2004. Approximately 2360 students had body composition measurements including sitting height and standing height at baseline. Among them, 1167 children (573 girls, 594 boys) who had weight and height measured at the 5 th year follow-up, were included in this analysis. OwOb was defined using age and sex specific BMI (kg!m 2 ) cut-off points corresponding to adults' BMI ~ 25. Results: Overall, 34% (n=298) of adolescents were considered as OwOb. The results from logistic regression analysis indicated that with 1 unit increase in LLI the odds of OwOb decreased 24% (Odds Ratio, [95% Confidence Interval], 0.76, [0.66-0.87]) after adjusted for age, sex and baseline waist circumference. Further adjusting for birth weight, birth order, breastfeeding, child's physical activity, maternal smoking, education, mother's age at birth and mother's BMI, did not change the relationship. Our results also indicated that mother's smoking status is associated with LLI. Discussion: Although LLI measured at childhood in this study is related to OwOb risk in adolescents, the underlying mechanism is unclear and further study is needed.

Features of neighbourhood environments associated with obesity and related health behaviours in children: using multiple statistical approaches to identify obesogenic environments

Contexte: L'obésité chez les jeunes représente aujourd’hui un problème de santé publique à l’échelle mondiale. Afin d’identifier des cibles potentielles pour des stratégies populationnelles de prévention, les liens entre les caractéristiques du voisinage, l’obésité chez les jeunes et les habitudes de vie font de plus en plus l’objet d’études. Cependant, la recherche à ce jour comporte plusieurs incohérences. But: L’objectif général de cette thèse est d’étudier la contribution de différentes caractéristiques du voisinage relativement à l’obésité chez les jeunes et les habitudes de vie qui y sont associées. Les objectifs spécifiques consistent à: 1) Examiner les associations entre la présence de différents commerces d’alimentation dans les voisinages résidentiels et scolaires des enfants et leurs habitudes alimentaires; 2) Examiner comment l’exposition à certaines caractéristiques du voisinage résidentiel détermine l’obésité au niveau familial (chez le jeune, la mère et le père), ainsi que l’obésité individuelle pour chaque membre de la famille; 3) Identifier des combinaisons de facteurs de risque individuels, familiaux et du voisinage résidentiel qui prédisent le mieux l’obésité chez les jeunes, et déterminer si ces profils de facteurs de risque prédisent aussi un changement dans l’obésité après un suivi de deux ans. Méthodes: Les données proviennent de l’étude QUALITY, une cohorte québécoise de 630 jeunes, âgés de 8-10 ans au temps 1, avec une histoire d’obésité parentale. Les voisinages de 512 participants habitant la Région métropolitaine de Montréal ont été caractérisés à l’aide de : 1) données spatiales provenant du recensement et de bases de données administratives, calculées pour des zones tampons à partir du réseau routier et centrées sur le lieu de la résidence et de l’école; et 2) des observations menées par des évaluateurs dans le voisinage résidentiel. Les mesures du voisinage étudiées se rapportent aux caractéristiques de l’environnement bâti, social et alimentaire. L’obésité a été estimée aux temps 1 et 2 à l’aide de l’indice de masse corporelle (IMC) calculé à partir du poids et de la taille mesurés. Les habitudes alimentaires ont été mesurées au temps 1 à l'aide de trois rappels alimentaires. Les analyses effectuées comprennent, entres autres, des équations d'estimation généralisées, des régressions multiniveaux et des analyses prédictives basées sur des arbres de décision. Résultats: Les résultats démontrent la présence d’associations avec l’obésité chez les jeunes et les habitudes alimentaires pour certaines caractéristiques du voisinage. En particulier, la présence de dépanneurs et de restaurants-minutes dans le voisinage résidentiel et scolaire est associée avec de moins bonnes habitudes alimentaires. La présence accrue de trafic routier, ainsi qu’un faible niveau de prestige et d’urbanisation dans le voisinage résidentiel sont associés à l’obésité familiale. Enfin, les résultats montrent qu’habiter un voisinage obésogène, caractérisé par une défavorisation socioéconomique, la présence de moins de parcs et de plus de dépanneurs, prédit l'obésité chez les jeunes lorsque combiné à la présence de facteurs de risque individuels et familiaux. Conclusion: Cette thèse contribue aux écrits sur les voisinages et l’obésité chez les jeunes en considérant à la fois l'influence potentielle du voisinage résidentiel et scolaire ainsi que l’influence de l’environnement familial, en utilisant des méthodes objectives pour caractériser le voisinage et en utilisant des méthodes statistiques novatrices. Les résultats appuient en outre la notion que les efforts de prévention de l'obésité doivent cibler les multiples facteurs de risque de l'obésité chez les jeunes dans les environnements bâtis, sociaux et familiaux de ces jeunes.