Cochrane reviews show impact of lifestyle changes on obesity

Two Cochrane reviews, published today, show that a combination of diet, physical activity and behavioural change interventions may reduce weight in children and adolescents | OnMedica

fruits-850491_960_720.jpg

The two reviews look at the effects of diet, physical activity and behavioural interventions in treating children with overweight or obesity from six years old to early adulthood. They summarise the results of 114 studies which involved over 13,000 children and young people.

Labor or Cesarean for Superobese Women?

Rates of severe maternal and neonatal morbidity were similar among superobese women undergoing primary cesarean delivery versus a trial of labor, most often ending in vaginal delivery | Clinical Anesthesiology

signpost-2030781_960_720.png

Researchers say a prospective clinical trial is needed to determine whether one method of birth is superior to the other in mothers who are superobese.

According to Alexander Butwick, MBBS, FRCA, MS, among women who are superobese, rates of cesarean delivery are particularly high (≥50%), but little has been known about how delivery mode affects perinatal and neonatal outcomes. Dr. Butwick, who presented the findings at the 2016 annual meeting of the Society for Obstetric Anesthesia and Perinatology (abstract 01-02), is associate professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, in California.

Over the years, clinicians have observed that obesity is associated with an increased risk for obstetric, perinatal and anesthetic morbidities. Obese pregnant women are at an increased risk for gestational diabetes, preeclampsia, operative delivery, postpartum infection and venous thromboembolism.

Read the full article here

Weight Control in Adolescents

Chae, S-M. et al. Journal of Pediatric Nursing. Published online: December 18 2016

health-1805117_960_720

Highlights

  • Adolescents and teachers perceived that meaning of weight control in adolescents was overly weighted toward management of one’s appearance.
  • They showed permissive attitudes about increasing weight during adolescence as long as adolescents studied hard.
  • They suggested a school-based weight control program encouraging participation of every student to avoid discrimination against overweight or obesity.
  • Teacher involvement was emphasized to promote participation of adolescents in a weight control program.

Read the full abstract here

Improving the implementation of childrens healthy eating, physical activity and obesity prevention programmes

Wolfenden, L. et al. (2016) Cochrane Database of Systematic Reviews. Issue 10. DOI: 10.1002/14651858.CD011779.pub2.

sport-1320606_960_720

Background: Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so.

Authors’ conclusions: Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.

Read the full review here

Young women who are obese are often unaware of risks to fetus, experts warn

Freer, J. BMJ. 355:i5708

https://www.flickr.com/photos/doublexuan/7381025596

Image source: Jixuan Zhou – Flickr // CC BY-NC-SA 2.0

Young women who are overweight or obese are often unaware of being on a health trajectory that can cause biological risks to be passed on to unborn children, experts have warned.

An expert panel hosted by the Parliamentary Office of Science and Technology on Wednesday 19 October highlighted the increase in morbidity related to excess weight among mothers and their children over the past 10 years and the overwhelming evidence of health risks being passed from mother to child.

The panel—Lucilla Poston, head of the women’s health division at King’s College London, Mark Hanson, director of the University of Southampton’s Institute of Developmental Sciences, and Emma Reed, deputy director of the childhood obesity branch at the Department of Health for England—concluded that earlier nutritional interventions were needed for overweight and obese women in the United Kingdom.

Read the full article here

Preventing and Treating Adolescent Obesity: A Position Paper of the Society for Adolescent Health and Medicine

The Society for Adolescent Health and Medicine. (2016) Journal of Adolescent Health.59(5) pp. 602-606

https://creativecommons.org/licenses/by-nc-sa/2.0/

Image source: Jixuan Zhou – Flickr // CC BY-NC-SA 2.0

Executive Summary and Positions

Adolescent obesity is an international problem that is a major public health concern with short- and long-term health consequences. Its prevention and treatment require that all health care professionals (HCPs) work together. To date, very little evidence supports effective treatment approaches for adolescents.

This position paper provides expert consensus and evidence wherever possible to increase professionals’ ability to prevent, screen, treat, and advocate effectively for obesity prevention and healthy weight promotion. Our positions are summarized in the following section:

  1. .HCP should have the knowledge, skills, and resources to prevent and treat obesity while incorporating the biopsychosocial stages of adolescent development.
  2. For all adolescent patients, the committee recommends that HCP:
    a. Determine weight status by calculating body mass index (BMI) and identifying BMI percentile for age and sex.
    b. Assess for medical complications.
    c. Screen for behaviors, including nutrition and physical activity, and family history, that increase the risk of, or worsen, obesity.
    d. Reinforce healthy behaviors, and when appropriate, counsel adolescents regarding body-image, inappropriate dieting, and weight stigmatization.
  3. Once a diagnosis of obesity has been established, HCP should work with dietitians, behavioral health providers, and exercise specialists to guide the patient through an evaluation for comorbidities, deliver evidence-based lifestyle counseling, and if indicated, refer to more intensive treatment options such as weight loss surgery, monitored diets, or residential care.

HCPs are uniquely positioned to advocate for changes within and outside the health care setting to address the obesity epidemic. Areas for advocacy include: increasing availability of clinical and community resources to prevent and treat obesity; leveraging support for adolescent-focused research; promoting environmental and policy changes related to healthy eating and active living; improving reimbursement for multidisciplinary care; eliminating policies and practices that stigmatize obese adolescents both explicitly and implicitly; and integrating the prevention approaches of the obesity and eating disorder fields that address weight-related disorders.

Read the full article here

Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices

Gross, R. et al. The Journal of Pediatrics. Volume 174, July 2016, Pages 171–177.e2

https://creativecommons.org/licenses/by-nc/2.0/

Image source: Cascadian Farm // CC BY-NC 2.0

Objective: To determine the effects of a child obesity prevention intervention, beginning in pregnancy, on infant feeding practices in low-income Hispanic families.

Study design: The Starting Early randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomly allocated to a standard care control group or an intervention group participating in prenatal and postpartum individual nutrition/breastfeeding counseling and subsequent nutrition and parenting support groups coordinated with well-child visits. Outcome measures included infant feeding practices and maternal infant feeding knowledge at infant age 3 months, using questions adapted from the Infant Feeding Practices Study II and an infant 24-hour diet recall.

Results: A total of 456 families completed 3-month assessments. The intervention group had higher prevalence of exclusive breastfeeding on the 24-hour diet recall (42.7% vs 33.0%, P = .04) compared with controls. The intervention group reported a higher percentage of breastfeeding vs formula feeding per day (mean [SD] 67.7 [39.3] vs 59.7 [39.7], P = .03) and was less likely to introduce complementary foods and liquids compared with controls (6.3% vs 16.7%, P = .001). The intervention group had higher maternal infant feeding knowledge scores (Cohen d, 0.29, 95% CI .10-.48). The effect of Starting Early on breastfeeding was mediated by maternal infant feeding knowledge (Sobel test 2.86, P = .004).

Conclusions: Starting Early led to increased exclusive breastfeeding and reduced complementary foods and liquids in 3-month-old infants. Findings document a feasible and effective infrastructure for promoting breastfeeding in families at high risk for obesity in the context of a comprehensive obesity prevention intervention.

Read the abstract here