Pediatric Center for Weight and Health

Edmonton, Canada

Pediatric Center for Weight and Health

Edmonton, Canada
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Ball G.D.C.,Pediatric Center for Weight and Health | Garcia A.P.,Pediatric Center for Weight and Health | Chanoine J.-P.,British Columbias Childrens Hospital | Morrison K.M.,McMaster University | And 4 more authors.
BMC Health Services Research | Year: 2012

Background: At least two million Canadian children meet established criteria for weight management. Due to the adverse health consequences of obesity, most pediatric weight management research has examined the efficacy and effectiveness of interventions to improve lifestyle behaviors, reduce co-morbidities, and enable weight management. However, little information is available on families' decisions to initiate, continue, and terminate weight management care. This is an important knowledge gap since a substantial number of families fail to initiate care after being referred for weight management while many families who initiate care discontinue it after a brief period of time. This research aims to understand the interplay between individual, family, environmental, and systemic factors that influence families' decisions regarding the management of pediatric obesity. Methods/Design. Individual interviews will be conducted with children and youth with obesity (n = 100) and their parents (n = 100) for a total number of 200 interviews with 100 families. Families will be recruited from four Canadian multi-disciplinary pediatric weight management centers in Vancouver, Edmonton, Hamilton, and Montreal. Participants will be purposefully-sampled into the following groups: (i) Non-Initiators (5 families/site): referred for weight management within the past 6 months and did not follow-up the referral; (ii) Initiators (10 families/site): referred for weight management within the past 6 months and did follow-up the referral with at least one clinic appointment; and (iii) Continuers (10 families/site): participated in a formal weight management intervention within the past 12 months and did continue with follow-up care for at least 6 months. Interviews will be digitally recorded and analyzed using an ecological framework, which will enable a multi-level evaluation of proximal and distal factors that underlie families' decisions regarding initiation, continuation, and termination of care. Demographic and anthropometric/clinical data will also be collected. Discussion. A better understanding of family involvement in pediatric weight management care will help to improve existing health services in this area. Study data will be used in future research to develop a validated survey that clinicians working in pediatric obesity management can use to understand and enhance their own health services delivery. © 2012 Ball et al.; licensee BioMed Central Ltd.

Ball G.D.C.,University of Alberta | Ball G.D.C.,Pediatric Center for Weight and Health | Ambler K.A.,University of Alberta | Chanoine J.-P.,University of British Columbia
International Journal of Pediatric Obesity | Year: 2011

Our purpose was to conduct a national environmental scan of pediatric weight management programs in Canada. Data were entered by program representatives regarding the history, structure, and function of their weight management programs using an online survey that our team developed in partnership with the Canadian Obesity Network ( Of the 18 programs that were identified, all included multidisciplinary teams that take a family-centred, lifestyle/behavioural therapeutic approach; health services were accessed primarily through physician referral. Most programs were launched in the past five years with public funding and enrolled ∼125 clients/year into one-on-one and/or group-based weight management care. Although many participated in research and were affiliated with academic institutions, most did not systematically evaluate their obesity-related programming. Based on these observations, recommendations related to program evaluation, health services delivery, and network collaborations are provided to inform future directions for research and clinical care that have both domestic and international relevance. © 2011 Informa Healthcare.

Ball G.D.C.,Pediatric Center for Weight and Health | Ambler K.A.,Pediatric Center for Weight and Health | Keaschuk R.A.,Northgate Health Center | Rosychuk R.J.,University of Alberta | And 5 more authors.
BMC Pediatrics | Year: 2012

Background: There is an urgent need to develop and evaluate weight management interventions to address childhood obesity. Recent research suggests that interventions designed for parents exclusively, which have been named parents as agents of change (PAC) approaches, have yielded positive outcomes for managing pediatric obesity. To date, no research has combined a PAC intervention approach with cognitive behavioural therapy (CBT) to examine whether these combined elements enhance intervention effectiveness. This paper describes the protocol our team is using to examine two PAC-based interventions for pediatric weight management. We hypothesize that children with obesity whose parents complete a CBT-based PAC intervention will achieve greater reductions in adiposity and improvements in cardiometabolic risk factors, lifestyle behaviours, and psychosocial outcomes than children whose parents complete a psycho-education-based PAC intervention (PEP).Methods/Design: This study is a pragmatic, two-armed, parallel, single-blinded, superiority, randomized clinical trial. The primary objective is to examine the differential effects of a CBT-based PAC vs PEP-based PAC intervention on children's BMI z-score (primary outcome). Secondary objectives are to assess intervention-mediated changes in cardiometabolic, lifestyle, and psychosocial variables in children and parents. Both interventions are similar in frequency of contact, session duration, group facilitation, lifestyle behaviour goals, and educational content. However, the interventions differ insofar as the CBT-based intervention incorporates theory-based concepts to help parents link their thoughts, feelings, and behaviours; these cognitive activities are enabled by group leaders who possess formal training in CBT. Mothers and fathers of children (8-12 years of age; BMI ≥85th percentile) are eligible to participate if they are proficient in English (written and spoken) and agree for at least one parent to attend group-based sessions on a weekly basis. Anthropometry, cardiometabolic risk factors, lifestyle behaviours, and psychosocial health of children and parents are assessed at pre-intervention, post-intervention, 6-, and 12-months follow-up.Discussion: This study is designed to extend findings from earlier efficacy studies and provide data on the effect of a CBT-based PAC intervention for managing pediatric obesity in a real-world, outpatient clinical setting.Trial Registration: identifier: NCT01267097. © 2012 Ball et al.; licensee BioMed Central Ltd.

Salawi H.A.,University of Alberta | Ambler K.A.,University of Alberta | Padwal R.S.,University of Alberta | Mager D.R.,University of Alberta | And 3 more authors.
BMC Pediatrics | Year: 2014

Background: Severe obesity (SO) in pediatrics has become increasing prevalent in recent decades.The objective of our study was to examine differences in demographic, anthropometric, cardiometabolic, and lifestyle variables in children and youth with SO versus their less overweight/obese (OW/OB) peers.Methods: A retrospective medical record review of 6-19 year old participants enrolled in an outpatient pediatric weight management clinic was conducted. SO (body mass index [BMI] ≥99th percentile) and OW/OB (BMI ≥85th and <99th percentile) groups were created according to Centers for Disease Control and Prevention definitions. Demographic, anthropometric, cardiometabolic and lifestyle data reported at baseline (pre-intervention) were retrieved.Results: Of the 345 participants, most were girls (56.2%), Caucasian (78.7%), and had family incomes > $50,000/year (65.7%). The SO group (n = 161) had lower HDL-cholesterol and higher liver enzymes, insulin resistance and blood pressure than the OW/OB group (n = 184; all p < 0.01). They also reported higher total energy intakes, fewer steps/day, less moderate-to-vigorous physical activity, and more leisure time screen time (all p < 0.02) than their leaner peers. Compared to the OW/OB group, a higher proportion of individuals in the SO group possessed cardiometabolic risk factors, including high triglycerides (45.8% vs 58.5%), alanine aminotransferase (55.4% vs 81.4%), insulin resistance (55.6% vs 82.1%), systolic blood pressure (11.5% vs 27.3%), diastolic blood pressure (17.8% vs 30.0%), and low HDL-cholesterol (44.6% vs 64.6%; all p < 0.02). Aside from the ~75% of participants (groups combined) who met the daily recommended intakes of grain and meat products, <50% of boys and girls met any of the remaining nutrition and physical activity-related recommendations. Compared to the OW/OB group, greater proportions of children and youth in the SO group failed to meet moderate-to-vigorous physical activity (48.4% vs 31.9%) and leisure-time-screen-time recommendations (43.4% vs 28.3%; both p < 0.05).Conclusion: Children and youth with SO have a worse cardiometabolic profile and less favorable lifestyle habits than their OW/OB peers. These differences emphasize the heightened obesity-related health risks associated with SO in the pediatric years. © 2014 Salawi et al.; licensee BioMed Central Ltd.

Ambler K.A.,University of Alberta | Ambler K.A.,Pediatric Center for Weight and Health | Hagedorn D.W.,University of Calgary | Ball G.D.,University of Alberta | Ball G.D.,Pediatric Center for Weight and Health
BMC Health Services Research | Year: 2010

Background. Limited access to weight management care can have a negative impact on the health and well-being of obese children and youth. Our objectives were to describe the characteristics of clients referred to a pediatric weight management centre and explore potential differences according to proximity. Methods. All demographic and anthropometric data were abstracted from standardized, one-page referral forms, which were received by a pediatric weight management centre in Edmonton, AB (Canada) between April, 2005 and April, 2009. Results. Referrals (n = 555; 52% male; age [mean standard deviation]: 12.4 2.6 y; BMI: 32.3 6.8 kg/m2; BMI percentile: 98.4 1.7; BMI z-score: 2.3 0.4) were received from 311 physicians. Approximately 95% of referrals were for boys and girls classified as obese or very obese. Based on postal code data, individuals were dichotomized as either living within (local; n = 455) or beyond (distant; n = 100) the Edmonton Census Metropolitan Area. Numerous families resided several hundred kilometres away from our centre. Overall, distant clients were taller, weighed more, and were more overweight than their local counterparts. For distant clients, the degree of overweight was higher in youth versus children. Conclusion. Pediatric weight management services must be designed to optimize access to health services, especially for distant clients who may be at increased obesity-related health risk. © 2010 Ambler et al; licensee BioMed Central Ltd.

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