Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention.

Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.

A prediction equation for the estimation of cardiorespiratory fitness using an elliptical motion trainer.

OBJECTIVE: In the United States of America, 6.2 million individuals are using elliptical motion trainers in fitness centres. However, graded exercise test protocols to estimate peak oxygen consumption (VO(2peak)) using elliptical motion trainers have not been developed for the general population. METHODS: Fifty-nine subjects (mean age: 23.5 +/- 4.1 years) were randomly divided into a validation (VAL: n = 39) or cross-validation (XVAL: n = 20) group. Peak oxygen consumption (ml x kg(-1) x min(-1)) was measured via indirect calorimetry on an elliptical motion trainer for both groups. Subjects exercised at 150 strides x min(-1) against a resistance of four and a crossramp of 8%. The resistance was increased every two minutes by two units until exhaustion. For the VAL group, a stepwise regression analysis was used to predict VO(2peak) from resistance, maximal heart rate (HR(max)), body mass index (BMI), height and gender (female = 0, male = 1). RESULTS: The prediction equation derived from this study was VO(2peak) (ml x kg(-1) x min(-1)) = 187.39403 + 12.97271 (gender) - 1.45311 (height) - 1.21604 (BMI) - 0.19613 (HR(max)) + 1.57093 (resistance) (R2 = 0.76, SEE = 4.47, p < 0.05). Using this equation, the predicted VO(2peak) of the XVAL group was 45.18 +/- 6.42 ml x kg(-1) x min(-1), while the measured VO(2peak) was 43.55 +/- 6.23 ml x kg(-1) x min(-1) CONCLUSION: No significant difference was found between the measured and predicted VO(2peak) in the XVAL group. Therefore, it appears this protocol and equation will allow individuals to accurately estimate their VO(2peak) without using direct calorimetry. However future studies should investigate the validity of this protocol with diverse populations.

Associations between adiposity, family history of CHD and blood pressure in 3-8 year-old children.

The purpose of this study was to examine the relationships between overall and central adiposity, a family history of coronary heart disease (FHCHD), and blood pressure (BP) in young children. We were specifically interested in determining whether the relationship between adiposity and BP was modified by a FHCHD. Subjects were 130 (68 males, 62 females) young children (mean age 6.0 years). Indicators of adiposity included the body mass index, waist circumference, skinfold thickness, and body composition determined by dual energy X-ray absorbtiometry (DXA). BP was measured by standard procedures. FHCHD was reported by the parent on a questionnaire. Approximately 19% of the total sample was classified as overweight and almost 50% were classified as prehypertensive (22.4%) or hypertensive (24.8%). In the total sample, 21 of 27 correlations were significant and ranged from 0.03 to 0.52. Correlations for systolic blood pressure appeared to be stronger in female subjects. Most of the correlations for diastolic blood pressure and mean arterial pressure were significant in both sexes and, in general, ranged between 0.30 and 0.50. Overweight status was significantly associated with high BP (crude odds ratio=3.65, 95% confidence intervals 1.40-9.49). There were no significant associations between a positive FHCHD and BP, and the correlations between BMI, WC, and BP were similar in magnitude in subjects with and without a FHCHD. In conclusion, both overall and central adiposity are important determinants of resting BP in young children. A FHCHD was not associated with BP and nor were the associations between adiposity and BP modified by a FHCHD.

Active commuting to and from school and BMI in elementary school children-preliminary data.

BACKGROUND: United States National Health Objectives include increasing the proportion of trips made by walking to and from school for children who live within 1.6 km to 50%. The purpose of this objective is to increase the level of physical activity among children. However, the impact of walking, bicycling or skating (active commuting) to and from school on the prevalence of overweight is unknown. METHODS: Body mass index (BMI) was measured for 320 children (age 10.2+/-0.7 years) in September. Over 5 months, an active commuting index (SI) and daily physical activity were estimated via questionnaire. In April, BMI and body fat were measured. RESULTS: A significant positive association was found between April BMI and SI adjusting for September BMI (partial r=0.03, P<0.05). Positive associations were found between SI and physical activity before school (r=0.17, P<0.05) and daily moderate intensity physical activity (r=0.13, P<0.05). There were no significant association between SI and BF (P>0.05). CONCLUSIONS: This preliminary data suggests that active commuting does not appear to provide sufficient amounts of physical activity to attenuate BMI; however, it may contribute to the attainment of physical activity recommendations. Future research is needed to objectively measure the impact of active commuting on the prevalence of overweight.