Adolescent obesity in contextual settings: a scoping study of multilevel and hierarchical examinations.

Multilevel/hierarchical obesity studies analyze adolescent and family, neighbourhood and social settings' characteristics to generate data needed to design prevention interventions. This scoping study summarizes such studies' characteristics and key findings to provide information to decision makers, which allows them to quickly grasp the state of the evidence and potential policy implications for adolescent obesity prevention. PubMed, CINAHLplus, PsychINFO and Sociological Abstracts were searched for peer-reviewed studies spanning 1 January 2000-31 August 2014. Inclusion criteria included (i) outcome weight status, physical activity and weight status, or physical activity alone if the aim was obesity prevention; (ii) 12- to 19-year-old participants in a cross-sectional study, a separate analysis in a cross-sectional study or a longitudinal follow-up. Nineteen studies were published in the United States of America; four in Canada; two in Spain, China and Vietnam, respectively; and one in Germany. Self-efficacy, parental physical activity support, perceived neighbourhood support, social cohesion and access to recreational facilities were associated with increased activity levels; neighbourhood physical disorder and perceived lack of safety associated with reduced physical activity levels. Overweight or obesity was associated with sugar-sweetened beverage intake and household availability thereof; reduced odds were reported with fruit and vegetable intake and household availability of these, daily breakfast and family meal frequency. Potential adolescent obesity risk regulators may be found at the individual, family or social contextual levels.

Rigorous control conditions diminish treatment effects in weight loss-randomized controlled trials.

BACKGROUND: It has not been established whether control conditions with large weight losses (WLs) diminish expected treatment effects in WL or prevention of weight gain (PWG)-randomized controlled trials (RCTs). SUBJECTS/METHODS: We performed a meta-analysis of 239 WL/PWG RCTs that include a control group and at least one treatment group. A maximum likelihood meta-analysis framework was used to model and understand the relationship between treatment effects and control group outcomes. RESULTS: Under the informed model, an increase in control group WL of 1 kg corresponds with an expected shrinkage of the treatment effect by 0.309 kg (95% confidence interval (-0.480, -0.138), P=0.00081); this result is robust against violations of the model assumptions. CONCLUSIONS: We find that control conditions with large WLs diminish expected treatment effects. Our investigation may be helpful to clinicians as they design future WL/PWG studies.

Outside-of-school time obesity prevention and treatment interventions in African American youth.

Outside-of-school time (OST; i.e. before/after-school hours, summer time), theory-based interventions are potential strategies for addressing increased obesity among African American youth. This review assessed interventions across multiple settings that took place during OST among African American youth aged 5-18 years old. Seven databases were searched for studies published prior to October 2013; 28 prevention and treatment interventions that assessed weight or related behaviours as a primary or secondary outcome were identified. Overall, these studies reported heterogeneous intervention length, theoretical frameworks, methodological quality, outcomes, cultural adaption and community engagement; the latter two attributes have been identified as potentially important intervention strategies when working with African Americans. Although not always significant, generally, outcomes were in the desired direction. When examining programmes by time of intervention (i.e. after-school, summer time, time not specified or multiple time periods), much of the variability remained, but some similarities emerged. After-school studies generally had a positive impact on physical activity, fruit/vegetable consumption and caloric intake, or body composition. The single summer time intervention showed a trend towards reduced body mass index. Overall findings suggest that after-school and summer programmes, alone or perhaps in combination, offer potential benefits for African American youth and could favourably influence diet and physical activity behaviour.

Association of run-in periods with weight loss in obesity randomized controlled trials.

Study-level design characteristics that inform the optimal design of obesity randomized controlled trials (RCTs) have been examined in few studies. A pre-randomization run-in period is one such design element that may influence weight loss. We examined 311 obesity RCTs published between 1 January 2007 and 1 July 2009 that examine d weight loss or weight gain prevention as a primary or secondary end-point. Variables included run-in period, pre-post intervention weight loss, study duration (time), intervention type, percent female and degree of obesity. Linear regression was used to estimate weight loss as a function of (i) run-in (yes/no) and (ii) run-in, time, percent female, body mass index and intervention type. Interaction terms were also examined. Approximately 19% (18.6%) of the studies included a run-in period, with pharmaceutical studies having the highest frequency. Although all intervention types were associated with weight loss (Mean = 2.80 kg, SD = 3.52), the inclusion of a pre-randomization run-in was associated with less weight loss (P = 0.0017) compared with studies that did not include a run-in period. However, this association was not consistent across intervention types. Our results imply that in trials primarily targeting weight loss in adults, run-in periods may not be beneficial for improving weight loss outcomes in interventions.

Correlates of symptoms of depression and anxiety among clinic patients in Western Jamaica / Correlaciones de los síntomas de depresión y ansiedad entre los pacientes de los consultorios de Jamaica Occidental

OBJECTIVES: There is a paucity of studies on psychosocial disorders in clinic populations in Jamaica. Therefore, we sought to determine the prevalence and correlates of symptoms of depression and anxiety in a clinic population in western Jamaica. METHODS: A total of 338 participants from four outpatient clinics of the Western Regional Health Authority (WRHA) were screened for symptoms of depression and anxiety using questions from the Beck Depression Inventory-II and the Beck Anxiety Inventory. The Chi-square test was used to examine differences in symptoms of anxiety and depression by gender. Multivariate linear and logistic regression were used to examine the associations between symptoms and sociodemographic variables with significance set at p < 0.05. RESULTS: Approximately 30% of participants had moderate or severe depression symptoms while 18.6% had moderate or severe anxiety symptoms. Participants aged 30-39 years were more likely than older participants to have moderate or severe anxiety symptoms (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.39, 5.56). Women reported a statistically significant higher prevalence of anxiety symptoms (10.0% vs 7.1%, p = 0.003). There was also a statistically significant difference between anxiety means by gender. Furthermore, income was found to be a significant predictor of anxiety for women only (p = 0.0113). Married persons were more likely than those who had never married to have moderate or severe anxiety symptoms (OR: 2.57, 95% CI: 1.14, 5.76). CONCLUSIONS: Our findings suggest that the prevalence of depression may be higher than global estimates in similar outpatient settings. Screening and intervention efforts may need to focus on younger persons, women, and married persons.

OBJETIVOS: Son escasos los estudios realizados sobre trastornos psicosociales en la población clínica de Jamaica. Por lo tanto, intentamos determinar la prevalencia y las correlaciones de los síntomas de depresión y ansiedad en una población clínica en Jamaica occidental. MÉTODOS: Un total de 338 participantes de cuatro clínicas de atención ambulatoria de la Dirección Regional de la Salud (conocida por sus siglas en inglés WRHA) fueron expuestos a una prueba de tamizaje a fin de detectar síntomas de depresión y ansiedad usando preguntas del Inventario de Depresión de Beck II y el Inventario de Ansiedad de Beck. La prueba de Chi-cuadrado fue utilizada para examinar las diferencias en los síntomas de ansiedad y depresión por género. Se usó la regresión lineal y logística multivariada para examinar las asociaciones entre los síntomas y las variables sociodemográficas con significación de p < 0.05. RESULTADOS: Aproximadamente el 30% de los participantes presentaron síntomas de depresión moderada o severa, mientras que el 18.6% presentaron síntomas de ansiedad severa o moderada. Los participantes con edad de 30 a 39 años eran más proclives a presentar síntomas de ansiedad moderada o severa (odds-ratio [OR]: 2.0, 95% intervalo de confianza [IC]: 1.39, 5.56) que los participantes de mayor edad. Las mujeres reportaron una prevalencia mayor, estadísticamente significativa, de los síntomas de ansiedad (10.0% vs 7.1%, p = 0. 003). También hubo una diferencia estadísticamente significativa entre los promedios de ansiedad por género. Además, se halló que los ingresos constituyen un predictor significativo de ansiedad sólo para las mujeres (p = 0.0113). Las personas casadas tenían más probabilidades de presentar síntomas de ansiedad moderada o severa (OR: 2.57, IC del 95%: 1,14, 5.76) que las personas que nunca se habían casado. CONCLUSIONES: Nuestros hallazgos sugieren que la prevalencia de la depresión puede ser superior a la que indican los estimados globales para pacientes externos similares. El estudio señala la posibilidad de que los esfuerzos de tamizaje e intervención deban centrarse en las personas más jóvenes, las mujeres y las personas casadas.

Empirical evidence does not support an association between less ambitious pre-treatment goals and better treatment outcomes: a meta-analysis.

Setting realistic weight loss goals may play a role in weight loss. We abstracted data from randomized controlled trials and observational studies conducted between 1998 and 2012 concerning the association of weight loss goals with weight loss. Studies included those that (i) were conducted in humans; (ii) delivered a weight loss intervention; (iii) lasted ≥6 weeks; (iv) assessed baseline weight loss goals; (vi) assessed pre- and post-weight either in the form of body mass index or some other measure that could be converted to weight loss based on information included in the original study or later provided by the author(s); and (vii) assessed the correlation between weight loss goals and final weight loss or provided data to calculate the correlation. Studies that included interventions to modify weight loss goals were excluded. Eleven studies met inclusion criteria. The overall correlation between goal weight and weight at intervention completion was small and statistically insignificant (ρ=0.0 5 ; P = 0.20). The current evidence does not demonstrate that setting realistic goals leads to more favourable weight loss outcomes. Thus, our field may wish to reconsider the value of setting realistic goals in successful weight loss.

Correlates of symptoms of depression and anxiety among clinic patients in western Jamaica.

OBJECTIVES: There is a paucity of studies on psychosocial disorders in clinic populations in Jamaica. Therefore, we sought to determine the prevalence and correlates of symptoms of depression and anxiety in a clinic population in western Jamaica. METHODS: A total of 338 participants from four outpatient clinics of : A total of 338 participants from four outpatient clinics of the Western Regional Health Authority (WRHA) were screened for symptoms of depression and anxiety using questions from the Beck Depression Inventory-II and the Beck Anxiety Inventory. The Chi-square test was used to examine differences in symptoms of anxiety and depression by gender. Multivariate linear and logistic regression were used to examine the associations between symptoms and sociodemographic variables with significance set at p<0.05. RESULTS: Approximately 30% of participants had moderate or severe depression symptoms while 18.6% had moderate or severe anxiety symptoms. Participants aged 30-39 years were more likely than older participants to have moderate or severe anxiety symptoms (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.39, 5.56). Women reported a statistically significant higher prevalence of anxiety symptoms (10.0% vs 7.1%, p = 0.003). There was also a statistically significant difference between anxiety means by gender. Furthermore, income was found to be a significant predictor of anxiety for women only (p = 0.0113). Married persons were more likely than those who had never married to have moderate or severe anxiety symptoms (OR: 2.57, 95% CI: 1.14, 5.76). CONCLUSIONS: Our findings suggest that the prevalence of depression may be higher than global estimates in similar outpatient settings. Screening and intervention efforts may need to focus on younger persons, women, and married persons.

Short-term physical activity intervention decreases femoral bone marrow adipose tissue in young children: a pilot study.

Mechanical stimulation is necessary for maximization of geometrical properties of bone mineralization contributing to long-term strength. The amount of mineralization in bones has been reciprocally related to volume of bone marrow adipose tissue and this relationship is suggested to be an independent predictor of fracture. Physical activity represents an extrinsic factor that impacts both mineralization and marrow volume exerting permissive capacity of the growing skeleton to achieve its full genetic potential. Because geometry- and shape-determining processes primarily manifest during the linear growth period, the accelerated structural changes accompanying early childhood (ages 3 to 6 y) may have profound impact on lifelong bone health. The objective of this pilot study was to determine if a short-term physical activity intervention in young children would result in augmentation of geometric properties of bone. Three days per week the intervention group (n=10) participated in 30 min of moderate intensity physical activity, such as jumping, hopping and running, and stretching activities, whereas controls (n=10) underwent usual activities during the 10-week intervention period. Femoral bone marrow adipose tissue volume and total body composition were assessed by magnetic resonance imaging and dual-energy X-ray absorptiometry, respectively, at baseline and after 10 weeks. Although after 10-weeks, intergroup differences were not observed, a significant decrease in femoral marrow adipose tissue volume was observed in those participating in physical activity intervention. Our findings suggest that physical activity may improve bone quality via antagonistic effects on femoral bone marrow adipose tissue and possibly long-term agonistic effects on bone mineralization.

Getting carried away: a note showing baseline observation carried forward (BOCF) results can be calculated from published complete-cases results.

OBJECTIVE: Randomized controlled trials (RCTs) in obesity are plagued by missing data due to participant dropouts. Most methodologists and regulatory bodies agree that the primary analysis of such RCTs should be based on the intent-to-treat (ITT) principle, such that all randomized subjects are included in the analysis, even those who dropped out. Unfortunately, some authors do not include an ITT analysis in their published reports. Here we show that one form of ITT analysis, baseline observation carried forward (BOCF), can be performed utilizing only information available in a published complete-case (CC) analysis, permitting readers, editors, meta-analysts and regulators to easily conduct their own ITT analyses when the original authors do not report one. METHOD: We mathematically derive a simple method for estimating and testing treatment effects using the BOCF to allow a more conservative comparison of treatment effects when there are dropouts in a clinical trial. We provide two examples of this method using available CC analysis data from reported obesity trials to illustrate the application for readers who wish to determine a range of treatment effects based on published summary statistics. CONCLUSION: Commonly used CC analyses may lead to inflated type I error rates and/or treatment effect estimates. The method described herein can be useful for researchers who wish to estimate a conservative range of plausible treatment effects based on limited reported data. Limitations of this method are discussed.

Is funding source related to study reporting quality in obesity or nutrition randomized control trials in top-tier medical journals?

BACKGROUND: Faithful and complete reporting of trial results is essential to the validity of the scientific literature. An earlier systematic study of randomized controlled trials (RCTs) found that industry-funded RCTs appeared to be reported with greater quality than non-industry-funded RCTs. The aim of this study was to examine the association between systematic differences in reporting quality and funding status (that is, industry funding vs non-industry funding) among recent obesity and nutrition RCTs published in top-tier medical journals. METHODS: Thirty-eight obesity or nutrition intervention RCT articles were selected from high-profile, general medical journals (The Lancet, Annals of Internal Medicine, JAMA and the British Medical Journal) published between 2000 and 2007. Paired papers were selected from the same journal published in the same year, one with and the other without industry funding. The following identifying information was redacted: journal, title, authors, funding source and institution(s). Then three raters independently and blindly rated each paper according to the Chalmers method, and total reporting quality scores were calculated. FINDINGS: The inter-rater reliability (Cronbach's alpha) was 0.82 (95% confidence interval = 0.80-0.84). The total mean (M) and s.d. of Chalmers Index quality score (out of a possible 100) for industry-funded studies were M = 84.5, s.d. = 7.04 and for non-industry-funded studies they were M = 79.4, s.d. = 13.00. A Wilcoxon matched-pairs signed-ranks test indicates no significant rank difference in the distributions of total quality scores between funding sources, Z = -0.966, P = 0.334 (two tailed). INTERPRETATION: Recently published RCTs on nutrition and obesity that appear in top-tier journals seem to be equivalent in quality of reporting, regardless of funding source. This may be a result of recent reporting of quality statements and efforts of journal editors to raise all papers to a common standard.