Change in health-related quality of life in the context of pediatric obesity interventions: A meta-analytic review.

OBJECTIVE: To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. METHOD: Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. RESULTS: The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. CONCLUSION: This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities. (PsycINFO Database Record

Adaptation of the State-Trait Inventory for Cognitive and Somatic Anxiety for Use in Children: A Preliminary Analysis.

OBJECTIVE: Anxiety has both state/trait and cognitive/somatic dimensions, and these distinctions may be particularly relevant for children with medical problems. This two-part study adapted the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and confirmed its factor structure in a sample of children in a primary care clinic. METHODS: STICSA items were adapted for reading level and piloted in a small group of children. Next, 250 children (12.3 ± 2.7 years) completed the adapted version, the STICSA-C. RESULTS: Separate confirmatory factor analyses conducted on the State and Trait forms of the STICSA-C confirmed the two-factor structure of the original measure (i.e., cognitive and somatic anxiety) and suggested an improved parsimonious model. CONCLUSIONS: Support was found for use of the STICSA-C as a reasonably good internally consistent measure for assessing cognitive and somatic anxiety in pediatric samples. Further investigation of its reliability and validity with replication in pediatric populations is warranted.

Comparison of two measures of weight criticism in youth: associations with physical activity engagement and attitudes, weight status, and health-related quality of life.

The objective of this study was to examine the degree to which 2 measures of weight criticism, the Weight Criticism During Physical Activity (WCA) scale and the Perceptions of Teasing Scale (POTS), represent distinct constructs and in what circumstances each is most appropriately used. A community sample of 307 fourth and fifth graders completed these measures, as well as measures of health-related quality of life, physical activity engagement, and attitudes toward physical activity. Body mass index was also calculated. Results of confirmatory factor analysis indicated that the WCA scale and the POTS represented correlated but distinct constructs and related differently to measures of physical activity and weight status. Findings suggested that the WCA scale may be representing criticism regarding athletic competency, not criticism of weight status as described in the literature. The POTS subscales appear to be accurately described and used in the literature.

Weighing physical activity: the impact of a family-based group lifestyle intervention for pediatric obesity on participants' physical activity.

OBJECTIVES: To examine differences in self-reported physical activity (PA) between participants enrolled in the treatment versus active control condition of a pediatric obesity intervention, and to test associations between parent and child PA. METHODS: Participants (N = 93) included children aged 7-17 years and their parent. Analyses tested whether participants in the treatment condition reported greater PA at postintervention and 12-month follow-up compared with the control condition. Further, researchers examined change in PA across time and whether change in parent PA was associated with change in child PA. RESULTS: Children in the treatment condition reported greater PA at 12-month follow-up. Parents in the treatment group reported a significant increase in PA between baseline and postintervention. Change in parent PA was associated with changes in child PA across multiple periods. CONCLUSIONS: Family-based obesity interventions may promote long-term change in self-reported PA among youths, and change in parent PA may be a contributing factor.

Medium is the message: moderate parental control of feeding correlates with improved weight outcome in a pediatric obesity intervention.

OBJECTIVE: Previous studies have suggested complex associations among variables related to parental control of feeding and child/adolescent obesity. The current study examined associations between parental food control variables and weight outcomes in the context of a behaviorally based family treatment program. METHODS: Parents of youths (n = 93) enrolled in a clinical trial comparing 2 weight management interventions completed the Child Feeding Questionnaire pre- and post-treatment, and at a 12-month follow-up. RESULTS: Latent growth curve modeling indicated that mean levels of restriction decreased over the course of treatment in the Positively Fit (PF) condition. Youths in the PF treatment condition whose parents increased their restriction of food experienced greater decreases in zBMI over treatment. CONCLUSIONS: Results echo previous reports that high and low parental control over food intake are associated with higher zBMI. Moderate parental control can be associated with beneficial outcomes in youths enrolled in behavioral treatment programs for obesity.

Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity.

PURPOSE: To conduct a meta-analysis of randomized controlled trials examining the efficacy of comprehensive behavioral family lifestyle interventions (CBFLI) for pediatric obesity. METHOD: Common research databases were searched for articles through April 1, 2013. 20 different studies (42 effect sizes and 1,671 participants) met inclusion criteria. Risk of bias assessment and rating of quality of the evidence were conducted. RESULTS: The overall effect size for CBFLIs as compared with passive control groups over all time points was statistically significant (Hedge's g = 0.473, 95% confidence interval [.362, .584]) and suggestive of a small effect size. Duration of treatment, number of treatment sessions, the amount of time in treatment, child age, format of therapy (individual vs. group), form of contact, and study use of intent to treat analysis were all statistically significant moderators of effect size. CONCLUSION: CBFLIs demonstrated efficacy for improving weight outcomes in youths who are overweight or obese.

A meta-analysis of motivational interviewing interventions for pediatric health behavior change.

OBJECTIVE: Motivational interviewing (MI) is an empirically supported intervention that has shown effectiveness in moving people toward positive lifestyle choices. Although originally designed for adult substance users, MI has since expanded to other health concerns with a range of client age groups. The present study investigated the overall effectiveness of MI in the context of child and adolescent health behavior change and health outcomes. METHOD: A literature search using PsycINFO, PubMed, GoogleScholar, and Social Work Abstracts was performed. Thirty-seven empirical studies were included in this meta-analysis, encompassing 8 health domains. RESULTS: The overall effect size (Hedges's g) of MI in this population as compared to both other active treatments and no treatment was g = 0.282 (95% CI [0.242, 0.323], SE = 0.021), slightly higher than a small effect size and also slightly higher than what has been typically found in the substance literature. Effect sizes varied by health condition such that the health domains with the largest overall effect sizes were Type 1 diabetes, asthma, and calcium intake. CONCLUSIONS: The effectiveness of MI in pediatric domains was moderated by factors such as practitioner background, health domain, and the family member who participated. Unexpectedly, number of MI sessions and follow-up length were not significant moderators. MI seems to be most effective when both parent and child participate in sessions and when the cultural background of the practitioner matches the family. Overall, these findings indicate that MI is an effective and appropriate intervention for targeting child health behavior changes.