Using innovative approaches to manage child and adolescent obesity in a multidisciplinary level 3 service (connect) within a value based healthcare programme

2019 ◽  
Author(s):  
Simon Williams ◽  
Olivia Collepriest ◽  
Battista Enzo Di ◽  
Ashley Freeman ◽  
Claire Hailwood ◽  
...  
Keyword(s):  
Child And Adolescent ◽  
Adolescent Obesity ◽  
Healthcare Programme ◽  
A Value ◽  
Level 3 ◽  
Innovative Approaches

scholarly journals The Potential Role of Exosomes in Child and Adolescent Obesity

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 196
Author(s):  
Ioanna Maligianni ◽  
Christos Yapijakis ◽  
Flora Bacopoulou ◽  
George Chrousos
Keyword(s):  
Child And Adolescent ◽  
Cardiovascular Complications ◽  
Adolescent Obesity ◽  
Overweight And Obesity ◽  
Calorie Intake ◽  
Target Cells ◽  
Special Role ◽  
Exosomal Mirnas ◽  
Risk Biomarkers

Child and adolescent obesity constitute one of the greatest contemporary public health menaces. The enduring disproportion between calorie intake and energy consumption, determined by a complex interaction of genetic, epigenetic, and environmental factors, finally leads to the development of overweight and obesity. Child and adolescent overweight/obesity promotes smoldering systemic inflammation (“para-inflammation”) and increases the likelihood of later metabolic and cardiovascular complications, including metabolic syndrome and its components, which progressively deteriorate during adulthood. Exosomes are endosome-derived extracellular vesicles that are secreted by a variety of cells, are naturally taken-up by target cells, and may be involved in many physiological and pathological processes. Over the last decade, intensive research has been conducted regarding the special role of exosomes and the non-coding (nc) RNAs they contain (primarily micro (mi) RNAs, long (l) non-coding RNAs, messenger (m) RNAs and other molecules) in inter-cellular communications. Through their action as communication mediators, exosomes may contribute to the pathogenesis of obesity and associated disorders. There is increasing evidence that exosomal miRNAs and lncRNAs are involved in pivotal processes of adipocyte biology and that, possibly, play important roles in gene regulation linked to human obesity. This review aims to improve our understanding of the roles of exosomes and their cargo in the development of obesity and related metabolic and inflammatory disorders. We examined their potential roles in adipose tissue physiology and reviewed the scarce data regarding the altered patterns of circulating miRNAs and lncRNAs observed in obese children and adolescents, compared them to the equivalent, more abundant existing findings of adult studies, and speculated on their proposed mechanisms of action. Exosomal miRNAs and lncRNAs could be applied as cardiometabolic risk biomarkers, useful in the early diagnosis and prevention of obesity. Furthermore, the targeting of crucial circulating exosomal cargo to tissues involved in the pathogenesis and maintenance of obesity could provide a novel therapeutic approach to this devastating and management-resistant pandemic.

Management of Child and Adolescent Obesity: Attitudes, Barriers, Skills, and Training Needs Among Health Care Professionals

PEDIATRICS ◽  
2002 ◽  
Vol 110 (Supplement_1) ◽  
pp. 210-214 ◽  
Author(s):  
Mary T. Story ◽  
Dianne R. Neumark-Stzainer ◽  
Nancy E. Sherwood ◽  
Katrina Holt ◽  
Denise Sofka ◽  
...  
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Health Care Professionals ◽  
Management Strategies ◽  
Child And Adolescent ◽  
Adolescent Obesity ◽  
Behavioral Management ◽  
Registered Dietitians ◽  
Pediatric Nurse Practitioners ◽  
And Training

Objective. The primary aim of this study was to evaluate among health care professionals their attitudes, perceived barriers, perceived skill level, and training needs in the management of child and adolescent obesity. Methods. A national needs assessment consisting of a mailed questionnaire was conducted among a random sample of health care professionals. The survey was completed by 202 pediatricians, 293 pediatric nurse practitioners, and 444 registered dietitians. Results. The majority of all respondents felt that childhood obesity was a condition that needs treatment (75%–93%), and affects chronic disease risk (76%–89%) and future quality of life (83%–93%). The most frequent barriers were lack of parent involvement, lack of patient motivation, and lack of support services. Registered dietitians were less likely to identify barriers to treatment compared with pediatricians or pediatric nurse practitioners. The most common areas of self-perceived low proficiency were in the use of behavioral management strategies, guidance in parenting techniques, and addressing family conflicts. All 3 groups expressed high interest in additional training on obesity management of children and adolescents, especially in the area of behavioral management strategies and parenting techniques. Those practitioners with >10 years of practice reported the greatest interest in training. Conclusions. Pediatric practitioners view child and adolescent obesity with concern and feel that intervention is important. However, several important barriers interfere with treatment efforts and will need to be addressed. There is also a need for increased training opportunities related to obesity prevention and treatment. The results of this study provide directions and priorities for training, education, and advocacy efforts.

Two-year outcomes of Whānau Pakari: a novel home-based intervention for child and adolescent obesity

2019 ◽  
Vol 13 (3) ◽  
pp. 274-275
Author(s):  
Yvonne Anderson ◽  
Lisa Wynter ◽  
Cameron Grant ◽  
Cervantée Wild ◽  
Niamh O'Sullivan ◽  
...  
Keyword(s):  
Child And Adolescent ◽  
Adolescent Obesity ◽  
Home Based ◽  
Home Based Intervention

Comparison of different BMI cut-offs to screen for child and adolescent obesity in urban China

2020 ◽  
Vol 23 (14) ◽  
pp. 2485-2493
Author(s):  
Kun Qian ◽  
Linglin Tan ◽  
Shijian Li ◽  
Ziang Li ◽  
Feng Yu ◽  
...  
Keyword(s):  
Task Force ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Child And Adolescent ◽  
Adolescent Obesity ◽  
Urban China ◽  
Fat Percentage ◽  
Cross Sectional ◽  
Worst Case ◽  
Community Healthcare

AbstractObjectives:To determine which set of BMI cut-offs is the most appropriate to define child and adolescent obesity in urban China.Design:A cross-sectional study was carried out between 1 November and 31 December in 2017.Setting:Community Healthcare Center in Minhang District, Shanghai, China.Participants:A total of 12 426 children and adolescents aged 7–17 years were selected by cluster random sampling. Bioelectrical impedance analysis was the gold standard to measure body composition.Results:Comparisons of three sets of BMI cut-offs by sensitivity and κ value revealed that the Working Group on Obesity in China (WGOC) (sensitivity 39·9–84·0 %; κ 0·51–0·79) and WHO (sensitivity 25·5–74·5 %; κ 0·35–0·78) cut-offs were not superior to the International Obesity Task Force (IOTF) (sensitivity 47·9–92·4 %; κ 0·58–0·85) cut-offs across all subgroups. The WGOC and WHO cut-offs yielded higher misclassification rates, in the worst case, categorising 11·2 % of girls with high adiposity as normal and 44·4 % of them as overweight, while the IOTF cut-offs categorised 2·3 % as normal and 30·7 % as overweight. Individuals who were classified by the IOTF cut-offs as overweight had the lowest ratios of high adiposity (4·2–41·6 %) than by the BMI cut-offs for each subgroup. Among pubertal girls, none of the BMI-based cut-offs indicated excellent agreement with body fat percentage, and κ value of the WHO cut-offs (0·35 (95 % CI 0·29, 0·41)) was lower than the other two sets of BMI cut-offs (all P < 0·001).Conclusions:The IOTF cut-offs for Asian should be recommended for child obesity screening in urban China. Pubertal individuals need a more accurate indicator of obesity screening.

scholarly journals Semiparametric Estimation of the Impacts of Longitudinal Interventions on Adolescent Obesity using Targeted Maximum-Likelihood: Accessible Estimation with the ltmle Package

2014 ◽  
Vol 2 (1) ◽  
pp. 95-108 ◽  
Author(s):  
Anna L. Decker ◽  
Alan Hubbard ◽  
Catherine M. Crespi ◽  
Edmund Y.W. Seto ◽  
May C. Wang
Keyword(s):  
Physical Activity ◽  
Maximum Likelihood ◽  
Causal Inference ◽  
Semiparametric Estimation ◽  
Child And Adolescent ◽  
Adolescent Obesity ◽  
Health Concern ◽  
Longitudinal Impact ◽  
Targeted Maximum Likelihood ◽  
Longitudinal Treatment

AbstractWhile child and adolescent obesity is a serious public health concern, few studies have utilized parameters based on the causal inference literature to examine the potential impacts of early intervention. The purpose of this analysis was to estimate the causal effects of early interventions to improve physical activity and diet during adolescence on body mass index (BMI), a measure of adiposity, using improved techniques. The most widespread statistical method in studies of child and adolescent obesity is multivariable regression, with the parameter of interest being the coefficient on the variable of interest. This approach does not appropriately adjust for time-dependent confounding, and the modeling assumptions may not always be met. An alternative parameter to estimate is one motivated by the causal inference literature, which can be interpreted as the mean change in the outcome under interventions to set the exposure of interest. The underlying data-generating distribution, upon which the estimator is based, can be estimated via a parametric or semi-parametric approach. Using data from the National Heart, Lung, and Blood Institute Growth and Health Study, a 10-year prospective cohort study of adolescent girls, we estimated the longitudinal impact of physical activity and diet interventions on 10-year BMI z-scores via a parameter motivated by the causal inference literature, using both parametric and semi-parametric estimation approaches. The parameters of interest were estimated with a recently released R package, ltmle, for estimating means based upon general longitudinal treatment regimes. We found that early, sustained intervention on total calories had a greater impact than a physical activity intervention or non-sustained interventions. Multivariable linear regression yielded inflated effect estimates compared to estimates based on targeted maximum-likelihood estimation and data-adaptive super learning. Our analysis demonstrates that sophisticated, optimal semiparametric estimation of longitudinal treatment-specific means via ltmle provides an incredibly powerful, yet easy-to-use tool, removing impediments for putting theory into practice.

scholarly journals Trends in child and adolescent obesity prevalence according to socioeconomic position: protocol for a systematic review

2014 ◽  
Vol 3 (1) ◽  
Author(s):  
Alexandra Chung ◽  
Kathryn Backholer ◽  
Evelyn Wong ◽  
Claire Palermo ◽  
Catherine Keating ◽  
...  
Keyword(s):  
Systematic Review ◽  
Socioeconomic Position ◽  
Child And Adolescent ◽  
Adolescent Obesity ◽  
Obesity Prevalence
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