Lifestyle interventions to reduce diabetes and cardiovascular disease risk among children.

Diseases once associated with older adulthood, type 2 diabetes and cardiovascular disease, are increasingly diagnosed in children and adolescents. Interventions designed to assist adults in modifying dietary and physical activity habits have been shown to help prevent the development of type 2 diabetes and cardiovascular disease in adults. Given the unfortunate rise in both of these diseases in pediatric populations, it is increasingly important to begin prevention efforts in childhood or prenatally. There is strong empirical support for utilizing lifestyle interventions to prevent these diseases in adults; it is not clear whether the same holds true for pediatric populations. The present review examines lifestyle management efforts to prevent type 2 diabetes and cardiovascular disease in children across socioecological levels. Recommendations are made for expanding the traditional focus of lifestyle interventions from dietary and physical activity behaviors to target additional risks for these diseases such as smoking and depression in youth.

Psychosocial and familial impairment among overweight youth with social problems.

OBJECTIVE: Emerging research indicates that overweight children with social impairments are less responsive to weight control interventions over the long term. A better understanding of the breadth and psychosocial correlates of social problems among overweight youth is needed to optimize long-term weight outcomes. METHODS: A total of 201 overweight children, aged 7-12 years, participated in a randomized controlled trial of two weight maintenance interventions following family-based behavioral weight loss treatment. Children with HIGH (T ≥ 65) versus LOW (T<65) scores on the Child Behavior Checklist Social Problems subscale were compared on their own and their parents' pre-treatment levels of psychosocial impairment using multivariate analysis of variance. Hierarchical regression was used to identify parent and child predictors of social problems in the overall sample. RESULTS: HIGH (n = 71) children evidenced greater eating disorder psychopathology and lower self-worth, as well as a range of interpersonal difficulties, compared with LOW children (n = 130; ps<0.05). Compared with parents of LOW children, parents of HIGH children reported greater levels of their own general psychopathology (p<0.05). Parent psychopathology significantly added to the prediction of social problems in the full sample beyond child sex and z-BMI (ps<0.01). CONCLUSION: A substantial minority of overweight youth experience deficits across the social domain, and such deficits appear to be associated with impairment in a broad range of other psychosocial domains. Augmenting weight loss interventions with specialized treatment components to address child and parent psychosocial problems could enhance socially-impaired children's long-term weight outcomes and decrease risk for later development of psychiatric disturbances.

Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials.

CONTEXT: Evaluating the efficacy of pediatric weight loss treatments is critical. OBJECTIVE: This is the first meta-analysis of the efficacy of RCTs comparing pediatric lifestyle interventions to no-treatment or information/education-only controls. DATA SOURCES: Medline, PsycINFO, and Cochrane Controlled Trials Register. STUDY SELECTION: Fourteen RCTs targetting change in weight status were eligible, yielding 19 effect sizes. DATA EXTRACTION: Standardized coding was used to extract information on design, participant characteristics, interventions, and results. DATA SYNTHESIS: For trials with no-treatment controls, the mean effect size was 0.75 (k = 9, 95% confidence interval [CI] = 0.52-0.98) at end of treatment and 0.60 (k = 4, CI = 0.27-0.94) at follow-up. For trials with information/education-only controls, the mean ES was 0.48 (k = 4, CI = 0.13-0.82) at end of treatment and 0.91 (k = 2, CI = 0.32-1.50) at follow-up. No moderator effects were identified. CONCLUSIONS: Lifestyle interventions for pediatric overweight are efficacious in the short term with some evidence for extended persistence. Future research is required to identify moderators and mediators and to determine the optimal length and intensity of treatment required to produce enduring changes in weight status.

Differences in patterns of depression after treatment for breast cancer.

Depression is a significant problem for some breast cancer survivors after the end of treatment. This study assessed depression using the CES-D for 84 breast cancer patients at the conclusion of radiation treatment, and at 3 and 6 months post-treatment. Based on the pattern of CES-D scores, patients were divided into five groups: (1) Stay Depressed (scores above clinical cutoff for depression at all timepoints); (2) Recover (above threshold at baseline, but below at follow-up); (3) Become Depressed (below threshold at baseline, but above at follow-up); (4) Never Depressed (below threshold at all times); and (5) Vacillate (none of the above patterns). This study examined the relationships between depression groups and a variety of medical, demographic, and psychological measures, including anxiety and quality of life (QOL). Number of children at home significantly distinguished the groups, with the Become Depressed group having more children and the Vacillate group having fewer children. Anxiety levels were different among the groups, with Recover and Never Depressed groups having consistently lower anxiety scores. QOL scores also distinguished the groups in that Never Depressed patients demonstrated better QOL than all other groups. The findings have implications for understanding resilience in cancer patients.

Ending treatment: the course of emotional adjustment and quality of life among breast cancer survivors immediately following radiation therapy.

GOAL OF WORK: This study investigated changes in psychological adjustment and quality of life among breast cancer patients following completion of radiation therapy. PATIENTS AND METHODS: Ninety-four patients completed measures of depressed mood, anxiety, and quality of life via interview at five time points: the end of radiation therapy, 2 weeks posttreatment, the first radiation oncology follow-up appointment (4-6 weeks after treatment), 3 months posttreatment, and 6 months posttreatment. MAIN RESULTS: At the conclusion of radiation treatment, participants reported elevated levels of depression, low levels of anxiety, and diminished quality of life. By 2 weeks posttreatment, depression decreased significantly and overall quality of life improved significantly, as well as quality of life in the specific FACT-B domains of Physical and Functional Well Being and the Breast Cancer Subscale. Following that time, the only significant change involved further improvement in breast-cancer-specific concerns. CONCLUSIONS: Results suggest that the primary psychological changes associated with ending breast cancer treatment occur quickly following the conclusion of treatment. Thereafter, psychological status appears to stabilize. The implications of these findings for treatment and directions for future research are discussed.