iStart Smart: A Primary-Care Based and Community Partnered Childhood Obesity Management Program for Chinese-American Children: Feasibility Study

IntroductionChildhood obesity is a public health challenge. There is evidence for associations between parents’ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysisThis protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged ≤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infant’s 2, 4, 6, 12 and 13 month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A cost–outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and disseminationThis study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations.

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Developing a Socioculturally Nuanced Systems Model of Childhood Obesity in Manhattan’s Chinese American Community via Group Model Building

Journal of Obesity ◽

10.1155/2020/4819143 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Ewelina Swierad ◽

Terry T.-K. Huang ◽

Ellis Ballard ◽

Karen Flórez ◽

Sheng Li

Keyword(s):

Childhood Obesity ◽

Model Building ◽

Empirical Studies ◽

Chinese American ◽

Group Model ◽

Group Model Building ◽

Systems Model ◽

Time Availability ◽

Novel Method ◽

American Children

The purpose of this study was to develop a qualitative and socioculturally tailored systems model of childhood obesity in the Chinese American community in Manhattan’s Chinatown. We utilized group model building (GMB) methodology as a form of participatory systems modeling. The study was conducted in Manhattan’s Chinatown community. We recruited 16 Chinese American adults from the community. GMB workshops engendered a causal loop diagram (CLD), the visualization of a complex systems model illustrating the structures, feedbacks, and interdependencies among socioculturally specific pathways underlying childhood obesity, in Manhattan’s Chinatown community. The analysis of CLD revealed that participants considered the following factors to influence childhood obesity: (1) traditional social norms affecting body image, how children are raised, parental pressure to study, and trust in health of traditional foods; (2) grandparents’ responsibility for children; (3) limited time availability of parents at home; and (4) a significant amount of children’s time spent indoors. GMB represents a novel method to understand the complexity of childhood obesity in culturally specific populations and contexts. The study identified sociocultural subsystems that may underlie the development and perpetuation of childhood obesity among Chinese American children. Insights from the study can be useful in the design of future empirical studies and interventions.

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Effectiveness of a Primary Care-Based Pediatric Weight Management Program

Journal of Doctoral Nursing Practice ◽

10.1891/2380-9418.13.1.9 ◽

2020 ◽

Vol 13 (1) ◽

pp. 9-16

Author(s):

Uyen Le-Jenkins ◽

Diana Cartagena ◽

Michelle Renaud ◽

Tina Guston

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Weight Management ◽

Fruits And Vegetables ◽

Point Of Care ◽

Retrospective Chart Review ◽

Management Program ◽

Weight Management Program ◽

Anthropometric Measures ◽

Sugary Beverages

BackgroundChildhood obesity is a growing epidemic of great concern for our nation, including pediatric populations treated at military treatment facilities.ObjectiveThis study aims to retrospectively evaluate the effectiveness of a primary care–based structured weight management program in a sample of pediatric patients with obesity at a military treatment facility.MethodsThis study was a retrospective chart review of patients enrolled in the All About Me Program (AAMP) from August 1, 2011, through July 10, 2012. Baseline demographics, 5-2-1-0 behavioral targets, and anthropometric measures were obtained from 54 enrollees. Pre- and post-program weight, body mass index (BMI) percentile, and 5-2-1-0 behavioral targets were compared for 20 patients who completed the program which consisted of a total of five visits over 3 months.ResultsParticipants showed a significant reduction in their BMI, improvement in daily servings of fruits and vegetables, reduction in recreational screen time from baseline, improvement in daily physical activity, and reduction in consumption of sugary beverages.ConclusionsThese preliminary findings are a promising indicator that primary care–based obesity interventions may be effective for the management and treatment of pediatric obesity.Implications for NursingThis evidence-based toolkit provides a practical point-of-care guidance on the prevention, assessment, and treatment of childhood obesity and can be easily implemented in other primary care settings.

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Provider views on childhood obesity management in primary care settings: a mixed methods analysis

BMC Health Services Research ◽

10.1186/s12913-018-2870-y ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 12

Author(s):

Kyung E. Rhee ◽

Stephanie Kessl ◽

Sarah Lindback ◽

Marshall Littman ◽

Robert E. El-Kareh

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Childhood Obesity ◽

Obesity Management ◽

Primary Care Settings

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Peer Review #1 of "Successful childhood obesity management in primary care in Canada: what are the odds? (v0.1)"

10.7287/peerj.1327v0.1/reviews/1 ◽

2015 ◽

Author(s):

L Billot

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Peer Review ◽

Obesity Management

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Cooperation behaviour of primary care paediatricians: facilitators and barriers to multidisciplinary obesity management

European Journal of Public Health ◽

10.1093/eurpub/ckz244 ◽

2020 ◽

Vol 30 (3) ◽

pp. 407-414

Author(s):

Franca Brüggen ◽

Paul Gellert ◽

Nadja-Raphaela Baer ◽

Birgit Jödicke ◽

Jana Brauchmann ◽

...

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Health Care Professionals ◽

Missing Values ◽

Inpatient Rehabilitation ◽

Female Gender ◽

Structural Factors ◽

Obesity Management ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract Background Multidisciplinary management of obesity by primary care paediatricians, providing a promising approach to tackle childhood obesity includes cooperation with other health care professionals. However, facilitators for and barriers to multidisciplinary cooperation in ambulatory care are not yet well understood and are investigated in the present study. Methods A nationwide, cross-sectional survey of 83% of German primary care paediatricians was conducted, using a questionnaire based on qualitative expert interviews. Frequency of paediatricians’ cooperation with external partners (i.e. nutrition counsellors; sports groups; interdisciplinary obesity centres; inpatient rehabilitation centres; and endocrinologists) was assessed. Individual and structural factors were associated with cooperation patterns. Missing values were addressed using multiple imputation. Results Out of the 6081 primary care paediatricians approached, 2024 (33.3%) responded. Almost half of the respondents (40.8%) stated that they disengaged in the field of obesity prevention due to perceived inefficacy. Lack of financial reimbursement for consultation was agreed on by most of the respondents (90.4%). Identified barriers to cooperation included: higher proportion of patients with migration background, lack of time and available services. A more comprehensive conception of the professional role regarding overweight prevention, higher age, female gender, higher proportion of overweight/obese patients and practice location in urban or socially strained areas surfaced as facilitators for cooperation. Conclusion Low-perceived self-efficacy in obesity management and insufficient financial reimbursement for consultation are commonly stated among German paediatricians. For cooperation behaviour, however, other individual and structural factors seem to be relevant, which provide indications on how multidisciplinary childhood obesity management can be improved.

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Burden of child and adolescent obesity on health services in England

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-313009 ◽

2017 ◽

Vol 103 (3) ◽

pp. 247-254 ◽

Cited By ~ 1

Author(s):

Russell M Viner ◽

Sanjay Kinra ◽

Dasha Nicholls ◽

Tim Cole ◽

Anthony Kessel ◽

...

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Young People ◽

Secondary Care ◽

Service Use ◽

Lifestyle Modification ◽

Glycated Haemoglobin ◽

Obesity Management ◽

Care Assessment ◽

The Uk

ObjectiveTo assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England.DesignPathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data.SettingData on CYP aged 2–18 years from the Health Survey for England 2006 to 2013.Main outcome measuresClinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI ≥99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function).Results11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13–18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management.ConclusionsThere is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.

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