Childhood Obesity Prevention Programs: Comparative Effectiveness Presented by Youfa Wang, MD, PhD, MS Professor and Chair Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo, the State University of New York (SUNY)
58
Embed
Childhood Obesity Prevention Programs: Comparative ...Childhood Obesity Prevention Programs: Comparative Effectiveness Presented by Youfa Wang, MD, PhD, MS Professor and Chair Department
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Childhood Obesity Prevention Programs:
Comparative Effectiveness
Presented by Youfa Wang, MD, PhD, MS
Professor and Chair
Department of Epidemiology and Environmental Health
School of Public Health and Health Professions
University at Buffalo, the State University of New York (SUNY)
Outline of What to Expect
• Definitions, incidence, and prevalence of childhood obesity
• Grading the strength of a body of evidence
• Clinical questions addressed
• What was found
• What was learned about interventions to prevent childhood obesity
• How to use these findings
2
AHRQ Comparative Effectiveness Review
Process
3
Topic Nomination
Peer Review Public
Comment
Systematic Review
Meta Analysis
Expert Input
Final AHRQ report, Clinician Summaries, and Consumer
Research Summaries
Introduction
4
http://www.effectivehealthcare.ahrq.gov
Learning Objectives
• Identify types of obesity prevention programs.
• Discuss the evidence on the effectiveness and
safety of prevention programs.
• Identify limitations in the current evidence base
related to interventions addressing childhood
obesity.
• Summarize future research directions such as
additional studies, study design, and analyses.
5
6
What is
obesity in
children? How
prevalent is
obesity in
children?
What are the
consequences?
Prevalence of Childhood Obesity
7
Prevalence of Childhood Obesity
0
2
4
6
8
10
12
14
16
18
20
2 – 5 years 6 – 11 years 12 – 19 years
Pro
po
rtio
n o
bese
Age of Children
Prevalence in the US by age: 1976-1980 to 2009-2010
1976 –1980
2009 – 2010
8
Health Consequences of Childhood
Obesity
9
Obese children
Adverse health conditions
Cardiovascular outcomes
Psychosocial outcomes
Eating disorders
Depression Low
self-esteem
Metabolic outcomes
Medical Complications of Obesity
10
Biological Basis for Obesity
11
Individual/Biological
Susceptibility
Dietary & Physical Activity
Patterns
Body Fat Stores
Energy Regulation
In Out
Factors Affecting Childhood
Obesity
12
Individual examples
• Genetics
• Nutrition knowledge
• Nutrition attitude
• Body weight image
Home examples
• Parenting
• Home diet
• Parental weight status
School examples
• Nutrition service
• Curriculum
• Annual BMI
Community examples
• Sidewalks
• Parks
• Safety from traffic
• Crime rate
Regional and National examples
• Price of food
• Food assistance programs
Defining Obesity and Overweight
13
• Different classifications
• Obesity in children:
► Medical condition in which excess body fat may have
adverse effect on health.
► ≥ age-sex-specific 95th percentile body mass index
(BMI).
• Overweight in children:
► ≥ age-sex-specific 85th percentile BMI, but < 95th
percentile.
Prevention vs Treatment
Prevention
• AKA “intervention”
• Goal: Prevent children from becoming overweight or obese
• May help overweight or obese children lose or stabilize weight
• Focus of this presentation
Treatment
• AKA “weight loss” or
“weight management”
• Goal: Weight loss among
pediatric patients.
• See AHRQ report Effectiveness of Weight
Management Interventions in
Children: a Targeted Systematic
Review for the USPSTF
14
Analytic Framework: Evaluation of
Childhood Obesity Interventions
15
Obesity-Related Clinical
Outcomes
Cardiovascular outcomes
Metabolic outcomes
Psychosocial outcomes
Settings
KQ1 – School
KQ2 – Home
KQ3 – Primary care
KQ 4 – Child care
KQ 5 – Community-level
KQ6 – Consumer health
informatics
KQ7 – Multi-setting
Adverse Effects of Intervention
Burden of intervention
Eating disorders
Psychosocial outcomes
Impact on growth and development
Injury
Cost
Other adverse events
All children age
2-18 years
Primary Outcomes
Change in overweight and obese status
Prevalence of overweight and obese
BMI
Other adiposity measures
Intermediate Outcomes
Nutrition knowledge, attitudes, beliefs
Food purchasing behaviors
Dietary intake
Food access
Physical activity
Sedentary behavior
Scope of the Review
Population Children 2-18 years old, regardless of BMI
Interventions a) Diet, physical activity, or combination of diet and physical activity
b) Setting of intervention
Comparators No intervention, usual care, or other intervention
Outcomes
a) Primary: Weight-related outcomes (e.g., BMI, obesity or
overweight rates)
b) Intermediate: Dietary intake (e.g., fruits and vegetables, sugar-