Geoff D Ball

• PhD, RD
• Professor at University of Alberta

Background: Obesity is a complex, chronic, stigmatized disease whereby abnormal or excess body fat may impair health or increase the risk of medical complications, and can reduce quality of life and shorten lifespan in children and families. We developed this guideline to provide evidence-based recommendations on options for managing pediatric obe...

The World Health Organization recommends using + 2 SD of body mass index z-score (zBMI) to define overweight/obesity (OWO) in children ages 2 to 5 years whereas + 1 SD is used as cut-point from 5 years onwards. Empirical evidence for using different cut-points across childhood is lacking. Our objective was to compare the ability of OWO in early chi...

Introduction Periodontitis is highly prevalent and disproportionately affects vulnerable populations, including older adults, racial and ethnic minorities, and low-income individuals. While periodontal therapies are largely effective, patient engagement in periodontal care is problematic. The study describes in this protocol aims to identify the to...

Objective Conduct a systematic review and meta‐analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity. Methods Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post‐baseline, including patient‐reported outcome measu...

Background: Physical activity (PA) is a mainstay for cardiovascular health. However, those with hypertrophic cardiomyopathy (HCM) are often counselled to limit PA due to the potential risk of sudden cardiac death. The emphasis placed on restriction has put this population more susceptible for acquired cardiovascular (CV) risk factors, and poor long...

Objective To summarize the literature on bariatric surgery for managing pediatric obesity, including intervention effects to improve patient‐reported outcome measures (PROMs), cardiometabolic risk factors, anthropometry, and assess adverse events (AEs). Methods Eligible studies were published between January 2012 and January 2022 and included rand...

Objectives To examine individual, family, and program characteristics associated with changes in anthropometric and cardiometabolic health indicators in children with overweight or obesity after participating in multidisciplinary obesity management for 12 months. Methods Participants included children 2–17 years old with overweight or obesity enro...

Objective To summarize the literature on pharmacotherapy for managing paediatric obesity. Methods A systematic review and meta‐analysis were conducted of randomized controlled trials (RCTs) with <18‐year‐olds of pharmacotherapeutic agents published up to November 2022. Estimates of effect for outcomes were presented relative to minimal important d...

The purpose of this article, part 1 of 2 on randomised controlled trials (RCTs), is to provide readers (eg, clinicians, patients, health service and policy decision-makers) of the nutrition literature structured guidance on interpreting RCTs. Evaluation of a given RCT involves several considerations, including the potential for risk of bias, the as...

Background: Although adolescents with obesity have an increased risk of cardiometabolic disease, a subset maintains a healthy cardiometabolic profile. Unhealthy lifestyle behaviors may determine cardiometabolic risk. We aimed to characterize the lifestyle behaviors of adolescents with obesity, compare differences between metabolically healthy obesi...

Background: The built environment can impact health outcomes. Our purpose was to examine relationships between built environment variables related to physical activity and excess weight in preschoolers. Methods: In this retrospective, population-level study of 4- to 6-year-olds, anthropometric measurements were taken between 2009 and 2017 in Calgar...

Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. Thi...

Background The metabolic load‐capacity index (LCI), which represents the ratio of adipose to skeletal muscle tissue‐containing compartments, is potentially associated with cardiometabolic diseases. Objectives To examine the associations between the LCI and cardiometabolic risk factors in children and youth with obesity. Methods This is a cross‐se...

Introduction Previous reviews on active learning in dental education have not comprehensibly summarized the research activity on this topic as they have largely focused on specific active learning strategies. This scoping review aimed to map the breadth and depth of the research activity on active learning strategies in undergraduate classroom dent...

Objective To assess the impact of reducing saturated fat or fatty foods, or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of mortality and major cancer and cardiometabolic outcomes in adults. Methods We searched MEDLINE, EMBASE, CINAHL, and references of included studies for systematic reviews and meta-analyses...

We interviewed families to explore their views on the role of family navigation (FN) to improve access to and use of health services for managing pediatric obesity. From March to December, 2020, we conducted individual, structured telephone interviews with adolescents with obesity (13-17 years old) and their caregivers from Edmonton and Calgary, Ca...

Purpose: 1) To explore how children with spina bifida (SB) and their parents understand bodyweight, health and weight management; and 2) To identify what services and supports children with SB and their families feel are most appropriate to help them manage their health and weight. Methods: The study used interpretive description within a qualit...

Background: Recruitment of participants continues to be a challenge that researchers must overcome to yield successful study results. Over the past decade, there has been a dramatic increase in the use of social media platforms to recruit research participants. We conducted a secondary analysis of the Aim2Be randomized controlled trial (RCT) to ex...

Background: Children with disabilities are twice as likely to have overweight/obesity than their typically developing peers. Higher weights in these individuals may compound challenges already experienced with their disability, including mobility and activities of daily living. However, children with disabilities often find it challenging accessing...

To examine the (i) relationships between various body mass index (BMI)-derived metrics for measuring severe obesity (SO) over time based the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) references and (ii) ability of these metrics to discriminate children and adolescents based on the presence of cardiometabol...

Introduction Les déterminants sociaux de la santé peuvent avoir une incidence sur le poids des enfants. Notre objectif était d’étudier les relations entre les déterminants sociaux de la santé et le poids des enfants d’âge préscolaire. Méthodologie Cette étude de cohorte rétrospective portait sur 169 465 enfants (âgés de 4 à 6 ans) dont les mesures...

Introduction Social determinants of health (SDH) may influence children’s weight status. Our objective was to examine relationships between SDH and preschoolers’ weight status. Methods This retrospective cohort study included 169 465 children (aged 4–6 years) with anthropometric measurements taken at immunization visits from 2009 to 2017 in Edmont...

Background Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. Objective The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweig...

Background: The objectives of this systematic review were to synthesize qualitative evidence on the impacts of COVID-19 restrictions on physical activity (PA) for children and youth, and explore factors perceived to influence those impacts. Methods: Five databases (MEDLINE, Embase, SPORTDiscus, ERIC, and CINAHL) were searched initially in June 2...

Purpose: To examine cross-sectional and longitudinal relationships between body mass index (BMI)-derived metrics for measuring severe obesity (SO) using the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) references and cardiometabolic risk factors in children and adolescents. Methods: In this cohort study compl...

Objective A systematic review of value and preference studies conducted in children and their caregivers related to the estimated benefits and harms of interventions for managing paediatric obesity. Methods We searched Ovid Medline (1946–2022), Ovid Embase (1974–2022), EBSCO CINAHL (inception to 2022), Elsevier Scopus (inception to 2022), and ProQ...

Background Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families’ access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outco...

Background Patient-oriented research (POR) aligns research with stakeholders’ priorities to improve health services and outcomes. Community-based health care settings offer an opportunity to engage stakeholders to determine the most important research topics to them. Our objectives were to identify unanswered questions that stakeholders had regardi...

Purpose: Mobile health (mHealth) apps may support improved health behavior practice among youth living in larger bodies. However, long-term use is low, limiting effectiveness. This study evaluated whether youths' motivation, satisfaction, engagement with social features, or parent co-participation supported long-term use of an app named Aim2Be. Me...

Background The co-presentation of severe obesity (SO) and global developmental delay (GDD) in Canadian preschool children has not been examined. However, SO and GDD may require syndromic diagnoses and unique management considerations. Objectives To determine (1) minimum incidence; (2) age of onset and risk factors; and (3) health care utilization...

Motivational interviewing (MI) is an evidence‐based counseling approach that can help individuals make positive behavioral and cognitive changes for managing obesity. We conducted a scoping review to summarize evidence on fidelity and key elements of MI‐based interventions for managing adolescent obesity and examine the reporting of these intervent...

BACKGROUND: Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families’ access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outc...

Objective To assess stakeholder ratings of health indicators and subgroup analyses in systematic reviews used to update the Canadian Clinical Practice Guideline for Managing Paediatric Obesity. Methods Stakeholders (caregivers of children with obesity and Clinical Practice Guideline Steering Committee members) completed an online survey between Ap...

Background Impaired family functioning has been associated with obesity in children and adolescents, but few longitudinal studies exist. We examined whether family functioning from early to mid-childhood is associated with overweight and obesity in later childhood and adolescence. Methods We examined data from the Quebec Longitudinal Study of Chil...

Background: Obesity interventions for parents of children with obesity can improve children's weight and health. This randomized controlled trial (RCT) evaluated whether a parent-based intervention based on cognitive behavioral therapy (CBT) principles was superior to a parent-based intervention based on a psychoeducation program (PEP) in improving...

BACKGROUND Aim2Be is a gamified lifestyle app designed to promote lifestyle behaviour change among Canadian adolescents and their families. OBJECTIVE Our primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (Body Mass Index Z-score (zBMI)) and improve lifestyle behaviours among adolescents...

BACKGROUND: Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals' patterns of interactions with specific app features (digital phenotypes). OBJECTIVE: This study identified digital phenotypes among 214 parent-child dyads who used the...

Background: Since the first national guideline for managing obesity in adults and children in Canada was published in 2007, new evidence has emerged and guideline standards have evolved. Our purpose is to describe the protocol used to update the Canadian clinical practice guideline for managing pediatric obesity. Methods: This guideline will upd...

Background We developed a multicomponent, family-based intervention for young children with obesity consisting of parent group sessions, home nursing visits, and multidisciplinary clinical encounters. Our objective was to assess intervention feasibility, acceptability, and implementation. Methods From 2017 to 2020, we conducted a multiple methods...

Objectives To examine characteristics of children referred for obesity management based on referral frequency, child- and referrer-related variables associated with re-referral, and determine whether re-referral increased treatment initiation. Study design This population-level, retrospective analysis included all 2–17 year olds referred for obesi...

(1) To explore individual and family characteristics related to anthropometric and cardiometabolic health indicators and (2) examine whether characteristics that correlate with cardiometabolic health indicators differ across severity of obesity at time of entry to Canadian pediatric weight management clinics. We conducted a cross-sectional analysis...

BACKGROUND Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals’ patterns of interactions with specific app features (digital phenotypes). OBJECTIVE This study aims to identify digital phenotypes among 214 parent-child dyads who used...

Our study purpose was to determine the prevalence of metabolically healthy obesity (MHO) and examine factors associated with MHO in children with obesity. This cross-sectional study was a secondary, exploratory analysis of data that included 2-17 years old with a body mass index (BMI) ≥85th percentile from the CANadian Pediatric Weight management R...

Purpose: To describe (i) nutrition policies in childcare centres, (ii) the resources and processes used to enable policy implementation, and (iii) the association between policy implementation and childcare centres’ or administrators’ characteristics. Methods: Between October 2018 and June 2019 a web-based survey that addressed nutrition policy, po...

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a c...

Background: A physician or health care provider (HCP) referral is usually needed for children to access multidisciplinary health services for obesity management; however, offering families the option to self-refer can enhance equity and access to care. Methods: We completed a retrospective medical record review to explore patient characteristics an...

Enrollment of international post-secondary students is increasing across Canadian campuses. International post-secondary students may experience challenges in accessing nutritious foods that meet their dietary needs and food preferences. These challenges can pose negative impacts on their health, well-being, and academic achievement. Our aim was to...

Background Stakeholders can provide valuable input to improve scheduling pediatric ambulatory clinic appointments, a complex process that requires effective planning and communication between parents, administrative staff, and clinicians. The purpose of our study was to characterize recommendations from parents, administrative staff, and clinicians...

Background: Clinical practice guidelines for pediatric weight management highlight the importance of family-based behavioral strategies to enhance health behaviors. Little is known, however, of how clinics implement these programs. The study objectives were to (1) describe how Canadian pediatric weight management clinics deliver care and (2) evalua...

Background: Severe obesity is increasingly common in youth and young adults, but outcomes following bariatric surgery remain largely unknown. The purpose of this study was to examine the trends, clinical characteristics, and postoperative outcomes of youth who underwent bariatric surgery. Methods: This retrospective cohort study was conducted us...

Background: Mobile-Health interventions offer a promising alternative to in-person interventions for promoting behaviour change, especially among children as they readily engage with technology. Objectives: To evaluate the efficacy of a smart-phone delivered intervention (Aim2Be; a gamified lifestyle modification app) to reduce adiposity and improv...

Background It is recommended that primary care-based physicians refer children with overweight and obesity to multidisciplinary paediatric obesity management, which can help to improve weight and health. Objective To determine predictors of referral to multidisciplinary paediatric obesity management. Methods This retrospective, population-level s...

Background Accumulating evidence suggests that the metabolic effects of metformin and fermentable fibers are mediated, in part, through diverging or overlapping effects on the composition and metabolic functions of the gut microbiome. Pre-clinical animal models have established that the addition of fiber to metformin monotherapy improves glucose to...

Purpose This qualitative study aimed to explore the experiences of parents supporting their child with Autism Spectrum Disorder (ASD) and overweight or obesity (OW/OB), including their weight management support needs. Methods Interview transcripts were analysed using inductive thematic analysis. Nine parents (n = 9 mothers) of ten children with AS...

Background: The purpose of this study was to evaluate the effectiveness of a 10-week blended family-based childhood obesity management program, relative to a wait-list control, in improving child body mass index (BMI) z-scores, child lifestyle behaviors, parental support for healthy eating and physical activity, and self-regulation for healthy eati...

Objective Scheduling ambulatory clinic appointments includes a complex set of factors and diverse stakeholders. Families, administrative staff and clinicians may have varied experiences with scheduling clinic appointments. The objective of our study was to understand stakeholders’ perceptions and experiences with scheduling pediatric ambulatory cli...

Introduction Cardiovascular disease (CVD) originates in childhood and risk is exacerbated in obesity. Mechanisms of the etiologic link between early adiposity and CVD‐risk remain unclear. Postprandial or non‐fasting dyslipidemia is characterized by elevated plasma triglycerides (TG) and intestinal‐apolipoprotein(apo)B48‐remnants following a high‐fa...

Objective To conduct a systematic review of the literature for strategies designed to reduce attrition in managing paediatric obesity. Methods We searched Ovid Medline (1946 to May 6, 2020), Ovid Embase (1974 to May 6, 2020), EBSCO CINAHL (inception to May 6, 2020), Elsevier Scopus (inception to April 14, 2020), and ProQuest Dissertations & Theses...

Background: Clinical practice guidelines (CPGs) include evidence-based recommendations for managing obesity in adolescents. However, information on how health care providers (HCPs) implement these recommendations in day-to-day practice is limited. Our objectives were to explore how HCPs deliver weight management health services to adolescents with...

Background Childhood overweight and obesity are associated with adverse physical, social, and psychological outcomes. Objectives We conducted an overview of Cochrane systematic reviews on the effectiveness and risks of interventions to treat overweight and obesity in children and adolescents. Methods In June 2019, we searched the Cochrane Databas...

Childcare settings are ideal for health promotion; however, they may not provide food environments that support children's healthy eating behaviours. To address this problem, researchers and practitioners have designed interventions with the aid of Theories, Models and Frameworks (TMFs) with the aim to improve centre-based childcare food environmen...

Background: Health care providers (HCPs) report barriers to effective communication with adolescents with obesity when discussing lifestyle behavior change and may benefit from tailored health communication tools to use during consultations with this uniquely challenging group of patients. Our purpose was to describe the content, design, production...

Purpose To explore the selection, use, and reporting of theories, models, and frameworks (TMFs) in implementation studies that promoted healthy eating in center-based childcare. Data Source We searched 11 databases for articles published between January 1990 and October 2018. We also conducted a hand search of studies and consulted subject matter...

Introduction Cow’s milk is a dietary staple for children in North America. Though clinical guidelines suggest children transition from whole (3.25% fat) milk to reduced (1% or 2%) fat milk at age 2 years, recent epidemiological evidence supports a link between whole milk consumption and lower adiposity in children. The purpose of this trial is to d...

Aims and objectives To (i) characterize and determine proportions of referred and enrolled children and (ii) explore public health nurses’ (PHNs) experiences, perspectives, and recommendations regarding a new nurse‐led referral pathway for pediatric weight management. Background Children with obesity and their families in Canada access specialized...

Objective To determine the relative effectiveness of dietary macronutrient patterns and popular named diet programmes for weight loss and cardiovascular risk factor improvement among adults who are overweight or obese. Design Systematic review and network meta-analysis of randomised trials. Data sources Medline, Embase, CINAHL, AMED, and CENTRAL...

Background: The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success...

Background: Adolescents and providers can benefit from practical tools targeting lifestyle modification for obesity prevention and management. We created Conversation Cards for Adolescents© (CCAs), a patient-centered communication and behavior change tool for adolescents and providers to use in clinical practice. The purpose of our study is to (i)...

Pediatric obesity is a major public health issue. Lifestyle and behavioral interventions are the foundation of pediatric weight management; however, intervention effectiveness is compromised when families (children, youth, and/or parent[s]) discontinue care prematurely. Intervention attrition minimizes the potential health benefits derived from int...

Background: Lifestyle modifications represent the first line of treatment in obesity management; however, many adolescents with obesity do not meet lifestyle recommendations. Given that adolescents are rarely consulted during health policy development and in the design of lifestyle interventions, their first-hand experiences, preferences, and prio...

Background: This study aimed to use implicit retraining to change automatic associations between body size and physical activity (PA) in women with obesity to reduce weight bias internalisation (WBI). Methods: A Solomon-square experimental design was used to determine the effect of a four-week online implicit retraining intervention on WBI (prim...

Introduction Family-based behavioural weight management interventions are efficacious and widely used to address childhood obesity. Curriculum and strategies vary extensively and scale-up often depends on ensuring that the intervention fits the adoption context. Aims and objectives To evaluate the impact and implementation of a ‘made in British Co...

Background The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person family-based multidisciplinary interventions that target lifestyle behaviours (e.g. diet, physical activity, and sedentary behaviours). These programs are costly to operate, have limited success, a...

Background: The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person family-based multidisciplinary interventions that target lifestyle behaviours (e.g. diet, physical activity, and sedentary behaviours). These programs are costly to operate, have limited success,...

[This corrects the article DOI: 10.1371/journal.pone.0209219.].

We evaluated changes in overweight, obesity, and severe obesity in a population of 4‐ to 6‐year‐olds from 2010 to 2017. Anthropometric data were collected during children's preschool immunization visits in Edmonton and Calgary, Alberta, Canada. Body mass index (BMI), BMI z scores, and weight status categories were based on the World Health Organiza...

Aim: Long term evaluations of childhood obesity treatments are needed. We examined changes in weight and cardiometabolic risk one year after children completed individual family or group-based weight management interventions. Methods: In 2009-2010, 6-12 year-old children with overweight or obesity from Finnmark and Troms (Norway) were recruited...

Background: Paediatric obesity management remains generalised to dietary and exercise modifications with an underappreciation for the contributions of eating behaviours and appetitive traits in the development of obesity. Objectives: To determine whether treatment-seeking children and adolescents with obesity cluster into phenotypes based on kno...

Background: In Canada and the United States, most families referred for pediatric weight management services do not start treatment. Of families who initiate care, many discontinue before the program ends. Parents and youth have reported difficulties in accessing services as an important barrier to starting or completing programming. The purpose of...

Background: Disease severity in paediatric obesity is usually defined using the body-mass index (BMI). Although informative at the population level, its usefulness on an individual level has limitations. The use of a clinical staging system-Edmonton Obesity Staging System for Pediatrics (EOSS-P)-in identifying health risk has been proposed. This s...

For the current issue of the Journal, we asked Drs. Laura Anderson and Geoff Ball to comment on and put into context three recent Cochrane Reviews on interventions for managing overweight and obese in children. Background Child overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. Obje...

Objective. To explore adolescents’ and health care providers’ (HCPs) perspectives on adolescents’ involvement in decision-making within multidisciplinary clinical care for pediatric weight management. Methods. In this multi-centre, qualitative description study, we purposefully recruited 13-17 year olds with overweight or obesity and HCPs from two...

Food insecurity negatively impacts the health and well-being of postsecondary students attending college and university. Students may be especially vulnerable for food insecurity if they care for children. This qualitative study explored the experience of food insecurity among nine food-insecure university students with children who accessed a food...

Background Many adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management. Objective To explore barriers and enablers that influenced the adoption of lifestyle behavior changes among adolescents receiving multidisciplinary clinical care for...

Patient engagement panel contract. (PDF)

Objective: To determine parents' (1) accuracy in using portion size estimation aids (PSEAs) to estimate portion sizes and (2) use of PSEAs at home. Methods: Parents (n = 37) of children in a pediatric weight management clinic were recruited, enrolled in a parallel-design, randomized, controlled trial, and assigned to receive a 2-dimensional (2D)...

We conducted a scoping review to identify definitions of metabolically healthy obesity (MHO), describe gaps in the literature, and establish a universal definition of MHO in children. We searched electronic databases from January 1980 to June 2017 and grey literature. Experimental, quasi‐experimental, or observational studies were eligible for incl...

Purpose The purpose of this paper is to conduct a narrative review of the food insecurity literature pertaining to university and college students studying in Very High Human Development Index countries. It aims to document food insecurity prevalence, risk factors for and consequences of food insecurity and food insecurity coping strategies among...

Background: There is increasing recognition of the value of "real-world evidence" in evaluating health care services. Registry-based, observational studies conducted in clinical settings represent a relevant model to achieve this directive. Starting in 2010, we undertook a longitudinal, observational study (the CANadian Pediatric Weight management...

Objectives: To characterize the children who were referred, determine the proportion of referred children who enrolled, and examine factors associated with enrollment in multidisciplinary clinical care for pediatric weight management. Study design: This cross-sectional study included the population of children (2-17 years of age; body mass index...