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Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC)
(2016)
Background: Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting. Methods: Five hundred twenty-three parents and their 7-13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses. Conclusions: The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background.
OBJECTIVE: To examine factors associated with the maternal perception of the weight status in related and unrelated children and to examine whether associated health risks for children's physical and mental health are recognized. PATIENTS AND METHODS: Two hundred nineteen mothers with children between 3 and 6 years of age took part in this study. The participating mothers were recruited from inpatient clinics and kindergartens. Parents were presented with 9 silhouettes representing different age- and gender-specific BMI percentiles. Demographic and weight-related variables were assessed with regard to their influence on the accuracy of the maternal weight estimation in general and for their own child. RESULTS: Of the participating mothers, 64.5% identified the overweight silhouettes of preschool- aged children correctly. However, only 48.8% of the mothers identified the overweight silhouettes associated with an increased risk for physical health problems, and 38.7% identified the silhouettes associated with an increased mental health risk. Mothers with a lower educational background were more likely to misclassify the overweight silhouettes and underestimate the associated health problems. For their own child, only 40.3% of the mothers chose silhouettes that were in agreement with the objective weight status of their child. This underestimation was associated with a higher maternal and child weight status but not with a general inability to identify the weight status of children. CONCLUSIONS: Identifying unrelated overweight silhouettes is influenced by maternal education level, whereas estimating their own child's weight status is influenced by the weight status of the mother and the child. Hence, feedback on the child's risk to become overweight is necessary to increase maternal risk awareness and willingness to take part in prevention programs.
Battle of plates
(2017)
Objective: Approach-avoidance training (AAT) is a promising approach in obesity treatment. The present study examines whether an AAT is feasible and able to influence approach tendencies in children and adolescents, comparing implicit and explicit training approaches. Design/Setting/Subjects: Fifty-nine overweight children and adolescents (aged 8-16 years; twenty-six boys) participated in an AAT for food cues, learning to reject snack items and approach vegetable items. Reaction times in the AAT and an implicit association rest (IAT) were assessed pre- and post-intervention. Results: A significant increase in the AAT compatibility scores with a large effect (eta(2) = 0.18) was found. No differences between the implicit and explicit training approaches and no change in the IAT scores were observed. Conclusions: Automatic tendencies in children can be trained, too. The implementation of AAT in the treatment of obesity might support the modification of an unhealthy nutrition behaviour pattern. Further data from randomized controlled clinical trials are needed.
Evaluation of an approach-avoidance training intervention for children and adolescents with obesity
(2018)
This study evaluated the efficacy of approach-avoidance training as an additional treatment for children and adolescents with obesity seeking inpatient treatment. Two hundred thirty-two participants (8-16years, 53.9% girls) were randomly assigned either to multisession approach-avoidance (IG) or to placebo training (CG). As outcomes, cognitive biases post intervention, body mass index, eating behaviour, food intake, self-regulation, and weight-related quality of life were assessed, also at 6- and 12-month follow-up. Modification of approach-avoidance bias was observed, but lacked in transfer over sessions and in generalization to attention and association bias. After 6months, the IG reported less problematic food consumption, higher self-regulation, and higher quality of life; effects did not persist until the 12-month follow-up; no significant interaction effects were observed regarding weight course. Despite there was no direct effect on weight course, approach-avoidance training seems to be associated with promising effects on important pillars for weight loss. Further research concerning clinical effectiveness is warranted.
Obesity is associated with psychosocial strain and a lower quality of life. Health-related quality of life is an important indicator for evaluating intervention treatments. However, German disease-specific quality of life instruments are lacking. In this paper the development and psychometric results of a weight-specific quality of life questionnaire for overweight and obese children and adolescents (GQ-LQ-KJ) is described. To determine the psychometric properties of the instrument 448 children and adolescents treated for over-weight or obesity took part in the study. They filled in the quality of life questionnaire, the German version of the STAI for children, a body image avoidance questionnaire (BIAQ) and several subscales of a generic quality of life questionnaire, the Child Health Questionnaire (CHQ). Results support the item and scale properties. Furthermore we were able to form two economic parallel versions suitable for further intervention studies
Background
Body image distortion is highly prevalent among overweight individuals. Whilst there is evidence that body-dissatisfied women and those suffering from disordered eating show a negative attentional bias towards their own unattractive body parts and others’ attractive body parts, little is known about visual attention patterns in the area of obesity and with respect to males. Since eating disorders and obesity share common features in terms of distorted body image and body dissatisfaction, the aim of this study was to examine whether overweight men and women show a similar attentional bias.
Methods/Design
We analyzed eye movements in 30 overweight individuals (18 females) and 28 normalweight individuals (16 females) with respect to the participants’ own pictures as well as gender-
and BMI-matched control pictures (front and back view). Additionally, we assessed body image and disordered eating using validated questionnaires.
Discussion
The overweight sample rated their own body as less attractive and showed a more disturbed body image. Contrary to our assumptions, they focused significantly longer on attractive
compared to unattractive regions of both their own and the control body. For one’s own body, this was more pronounced for women. A higher weight status and more frequent body checking predicted attentional bias towards attractive body parts. We found that overweight adults exhibit an unexpected and stable pattern of selective attention, with a distinctive focus on their own attractive body regions despite higher levels of body dissatisfaction. This positive attentional bias may either be an indicator of a more pronounced pattern of attentional avoidance or a self-enhancing strategy. Further research is warranted to clarify these results.
Background
Body image distortion is highly prevalent among overweight individuals. Whilst there is evidence that body-dissatisfied women and those suffering from disordered eating show a negative attentional bias towards their own unattractive body parts and others' attractive body parts, little is known about visual attention patterns in the area of obesity and with respect to males. Since eating disorders and obesity share common features in terms of distorted body image and body dissatisfaction, the aim of this study was to examine whether overweight men and women show a similar attentional bias.
Methods/Design
We analyzed eye movements in 30 overweight individuals (18 females) and 28 normal-weight individuals (16 females) with respect to the participants' own pictures as well as gender- and BMI-matched control pictures (front and back view). Additionally, we assessed body image and disordered eating using validated questionnaires.
Discussion
The overweight sample rated their own body as less attractive and showed a more disturbed body image. Contrary to our assumptions, they focused significantly longer on attractive compared to unattractive regions of both their own and the control body. For one's own body, this was more pronounced for women. A higher weight status and more frequent body checking predicted attentional bias towards attractive body parts. We found that overweight adults exhibit an unexpected and stable pattern of selective attention, with a distinctive focus on their own attractive body regions despite higher levels of body dissatisfaction. This positive attentional bias may either be an indicator of a more pronounced pattern of attentional avoidance or a self-enhancing strategy. Further research is warranted to clarify these results.
Background: Functional abdominal pain (FAP) is not only a highly prevalent disease but also poses a considerable burden on children and their families. Untreated, FAP is highly persistent until adulthood, also leading to an increased risk of psychiatric disorders. Intervention studies underscore the efficacy of cognitive behavioral treatment approaches but are limited in terms of sample size, long-term follow-up data, controls and inclusion of psychosocial outcome data.
Methods/Design: In a multicenter randomized controlled trial, 112 children aged 7 to 12 years who fulfill the Rome III criteria for FAP will be allocated to an established cognitive behavioral training program for children with FAP (n = 56) or to an active control group (focusing on age-appropriate information delivery; n = 56). Randomization occurs centrally, blockwise and is stratified by center. This study is performed in five pediatric gastroenterology outpatient departments. Observer-blind assessments of outcome variables take place four times: pre-, post-, 3- and 12-months post-treatment. Primary outcome is the course of pain intensity and frequency. Secondary endpoints are health-related quality of life, pain-related coping and cognitions, as well as selfefficacy.
Discussion: This confirmatory randomized controlled clinical trial evaluates the efficacy of a cognitive behavioral intervention for children with FAP. By applying an active control group, time and attention processes can be controlled, and long-term follow-up data over the course of one year can be explored.
Our aim was to assess the psychosocial well-being of asthmatic children and adolescents, the influencing factors, and to determine the effect of inpatient rehabilitation on their quality of life; 226 asthmatic children and adolescents participated in the inpatient rehabilitation (IG). The comparison group (CG) included 92 asthmatic children and adolescents receiving standard medical treatments. Patients were aged between 8 and 16 years and were predominantly male. The health-related quality of life was measured with the German version of the "Paediatric Asthma Quality of Life Questionnaire." Interviews were carried out for IG 2 weeks before the commencement of their inpatient stay and 1 year after their stay ended. The same time schedule was carried out for CG. All patients reported a mild to moderate impairment of their quality of life. Girls described a slightly lower quality of life than boys. With increasing asthma severity, quality of life decreased. Inpatients described a lower quality of life than CG at enrollment. Inpatient rehabilitation resulted in a greater improvement of quality of life over time for IG than for CG. Gender and severity status had no effect on this time course. The only modestly affected quality of life may reflect the good adaptation to the disease and medical treatment. Children and adolescents in the IG recorded improvements in their quality of life. Differences in quality of life based on gender and disease severity were not shown to influence the improvements. In summary, inpatient rehabilitation results in an improvement of health-related quality of life. Further research concerning the psychosocial situation of children and adolescents in this setting is needed
Background Bringing up children with atopic dermatitis (AD) is widely perceived as being stressful because parenting demands considerable time and energy. There have been only a few studies to assess the extent of problems experienced by the parents. Objective To assess the psychosocial well-being of parents caring for a young child with AD and to examine the relationship between parental quality of life and disease-related and sociodemographic variables. Methods One hundred and eighty-seven parents of young children with AD attending an inpatient rehabilitation clinic participated in the study. At admission, parents completed a set of questionnaires (assessing health-related quality of life, coping with the disease, family functioning). Dermatologists assessed disease severity using the severity scoring of AD index (SCORAD). Results In general, parents cope well with their situation. Compared with normal values, high rates of psychological distress were observed in a subsample of parents of children with AD. Parents of children with a higher severity of disease reported a significantly higher impact on family functioning, a greater financial burden and a higher level of disease management. Parental disease management could be predicted by the familial situation, their personal well-being and the severity of disease of their child. Differences attributed to their child's gender or age were not observed. Conclusions Childhood AD has a profound impact on the emotional and social well-being of many of the parents. The results underline the importance of psychological treatment approaches designed to increase parental well-being and ability to cope with stress and social strain
Hauptziel Adipositas ist eine der Hauptindikationen in der Kinder- und Jugend-Rehabilitation. Für ältere Jugendliche und junge Erwachsene fehlen altersspezifische Therapieangebote fast vollständig. Ziel war es die Wünsche bezüglich der Inhalte und Methoden einer „perfekten Therapie“ im Rahmen eines Rehabilitationsaufenthalts zu untersuchen.
Methode Im Rahmen der YOUTH-Studie wurden 147 adipöse Jugendliche und junge Erwachsene beiderlei Geschlechts (zwischen 15 und 21 Jahren) mithilfe eines standardisierten Fragebogens befragt.
Ergebnis Insgesamt zeigten sich relativ wenige alters- und geschlechtsspezifische Unterschiede. Interdisziplinär geleitete, koedukative Gruppen mit Elterneinbindung wurden gewünscht. Wichtige Themen waren gesunde Ernährung sowie psychosoziale Aspekte. Auch der Prävention von Rückfällen wurde eine hohe Relevanz zugeschrieben.
Schlussfolgerung Psychosoziale Aspekte und die Vorbereitung auf mögliche Rückfallsituationen sollten integraler Bestandteil der Therapie sein.
Adipositas
(2006)