Obesity in Preschoolers: Behavioral Correlates and Directions for Treatment

Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Obesity (Impact Factor: 4.39). 07/2011; 20(1):3-29. DOI: 10.1038/oby.2011.201
Source: PubMed

ABSTRACT Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.

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Available from: Lori J Stark, Nov 08, 2014
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    • "Unless, effective and sustainable interventions are developed to reverse these trends, future generations will face significant health challenges. Overweight and obesity patterns often cluster in families and evidence supports parental influence as a contributing factor to rates of overweight and obesity among children [5] [6] [7]. It is imperative then that efforts to improve behaviors associated with obesity target both adults and children of the same household. "
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    ABSTRACT: To describe a systematic assessment of patient educational materials for the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population. Process included: (1) expert review of educational content, (2) assessment of the quality of materials including use of the Suitability Assessment of Materials (SAM) tool, and (3) material review and revision with target population. 12 core modules were developed and assessed in an iterative process. Average readability was at the 6th grade reading level (SMOG Index 5.63±0.76, and Fry graph 6.0±0.85). SAM evaluation resulted in adjustments to literacy demand, layout & typography, and learning stimulation & motivation. Cognitive interviews with target population revealed additional changes incorporated to enhance participant's perception of acceptability and feasibility for behavior change. The GROW modules are a collection of evidence-based materials appropriate for parents with low health literacy and their preschool aged children, that target the prevention of childhood overweight/obesity. Most trials addressing the treatment or prevention of childhood obesity use written materials. Due to the ubiquitous prevalence of limited health literacy, our described methods may assist researchers in ensuring their content is both understood and actionable.
    Patient Education and Counseling 08/2013; 93(3). DOI:10.1016/j.pec.2013.08.010 · 2.60 Impact Factor
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    • "Findings from our study begin to address this gap. The modest diet and activity changes observed for preschoolers in our study support the literature suggesting that lifestyle behavior modification in early childhood is particularly challenging (Kuhl et al., 2012). Ensuring preschoolers consume a healthy diet and are physically active is undoubtedly important to their overall growth and development. "
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    ABSTRACT: Objective: Preschoolers (ages 2-5 years) have been significantly underrepresented in the obesity treatment outcome literature, despite estimates that 12.1% are already obese. As such, little is known about the most important intervention targets for weight management within this age group. The aims of this study were (a) to examine lifestyle behavior changes for 30 obese preschoolers participating in a weight-control intervention and (b) to explore which lifestyle behavior changes predicted changes in body mass index (BMI) z score. Method: Preschooler height, weight, diet (three 24-hr recalls), physical activity (accelerometry), and television use (parent report) were measured at baseline and posttreatment (6 months). A linear regression was conducted to examine pre- to posttreatment changes in diet (i.e., intake of calories, sugar-sweetened beverages, fruits and vegetables, and sweet and salty snacks) and activity (i.e., moderate-to-vigorous activity and television use) behaviors on changes in BMI z score. Results: Despite significant reductions in sugar-sweetened beverage intake and television use, and increases in fruit and vegetable intake, only reductions in absolute caloric intake significantly predicted reductions in BMI z score. Conclusion: Our findings suggest that attaining healthy caloric goals may be the most important component of weight-control interventions for preschoolers. Future research using innovative methodologies, such as the Multiphase Optimization Strategy, may be helpful to prospectively identifying the lifestyle behavior changes that are most effective in helping families to achieve healthy weight outcomes for preschoolers and thereby improve intervention efficiency and decrease treatment burden for families. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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    • "Children also readily form preferences for high fat foods, which are commonly served as dessert (Birch, 1992; Cooke & Wardle, 2005). Since these types of foods may have high reward properties to stimulate eating even in the absence of hunger, modifying the timing of serving dessert might be particularly powerful in preschool aged children who have demonstrated a strong preference for high-fat and high-sugar foods commonly served as dessert (Birch, 1992; Cooke & Wardle, 2005; Kuhl et al., 2012). To determine if modifying when dessert is served would have an impact on children's total energy consumed at meals, the portion size of the meal must be increased to determine if children will increase intake at a meal. "
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