Upload
ilyas-baloch
View
218
Download
0
Embed Size (px)
Citation preview
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
1/11
L i t e r a t u r e R e v i e w | 1
A Literature Review of Prevention and Treatment Plans of Overweight and Obese Children and
Adults for Medical Professionals
Talha Masood
Masters in Public Health Candidate
Lake Erie College of Osteopathic Medicine Student, First Year
Des Moines University
December, 2010
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
2/11
L i t e r a t u r e R e v i e w | 2
Introduction
Iowans Fit for Life is a state-wide initiative which aims for all Iowans to enjoy balanced
nutrition, lead physically active lives, and live in healthy communities. More specifically,
Iowans Fit for Life seeks to set priorities for sound policy, programs, resources and messages,
and to equip communities and organizations to support an environment that encourages healthy
choices about eating and physical activity.
The purpose of this literature review is to inform physicians about the latest research on
four points related to overweight and obesity prevention. These points include childhood obesity
prevention recommendations from the American Academy of Pediatrics; motivational
interviewing in the healthcare setting, implementation of behavior change health contracts, and
physician attitudes towards obesity prevention.
Defining Obesity
Adult obesity has been widespread and growing throughout America and other
Westernized countries for quite some time (Flegal, 2007). There have been hundreds of research
studies on obesity. But before any real attempt to integrate them into a comprehensive study can
be made, definitions must be established. This process of finding a universal definition for
obesity has led to many differences in the field of obesity research. A study done by Mei (2002)
focused on comparing multiple body-composition screening indexes for the assessment of body
fatness in children and adolescents aged 2 to 19. Age-and-sex specific body mass index (BMI)
was compared with the Rohrer index (RI) and also with weight-for-height screening in this group
of subjects. Using nationally representative data from surveys of over 10,000 standardized
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
3/11
L i t e r a t u r e R e v i e w | 3
measurements for people between the ages of 2 to 19, it was found that the BMI was a better
predictor of overweight than the RI (Mei, 2002).
Mei (2002) showed that the BMI was indeed an appropriate predictor for overweight and
obesity. However, this study did not solve the problem of defining obesity within the scope of
BMI. Further research still needed to be done in regards to the understanding how and when to
use the BMI and how to differentiate between using the BMI and BMI percentiles for children
and adults. Krebs (2007) found that there was an absence of established criteria when it came to
cutoff points for children based on distributing anthropometric measurements. In this review of
research studies, Krebs outlined the differences between childhood obesity and adult obesity in
regards to BMI. Children were measured by BMI percentiles, whereas adults were measured by
the BMI alone (Krebs, 2007). This has been upheld by the Centers for Disease Control and
Prevention. Adult overweight is defined as a BMI between 25 and 29.9 and adult obesity is
defined as having a BMI greater than 30. Childhood overweight is defined as a BMI at or above
the 85th
percentile and lower than the 95th
percentile. Childhood obesity is defined as having a
BMI of greater than or equal to the 95th
percentile for children of the same age and sex. Rather
than using a specific BMI to determine obesity among children, their weight status is based on
age and sex specific scales. This is because a childs body composition fluctuates with age and
sex more than an adults body (Centers for Disease Control and Prevention, 2009).
Childhood Obesity Prevention Recommendations
There are three forms of prevention: primary, secondary, and tertiary. Primary
prevention is tailored towards reducing the occurrence of the disease before it results. Secondary
prevention is geared towards reducing the progress of a disease once it begins. Tertiary
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
4/11
L i t e r a t u r e R e v i e w | 4
prevention is related to reducing the limitations of disability from the disease (Friis & Sellers,
2009).
It should be noted that overweight and obesity lead to many other symptoms, such as:
sleep problems, respiratory problems, gastrointestinal problems, endocrine disorders, menstrual
irregularities, orthopedic problems, mental health problems, genitourinary problems, and skin
conditions (Krebs, 2007). For this reason, a variety of current research on obesity is dedicated
towards primary prevention of obesity.
The major goals outlined in The White House Task Force on Childhood Obesity Report
to the President (2010) focus on prevention: reducing childhood obesity in early childhood by
focusing on prenatal care, breastfeeding, reducing chemical exposures, reducing screen time, and
instilling the importance of education; empowering parents and guardians with the ability to
make nutrition information more readable and available, and marketing healthy food in a more
efficient manner; getting healthier food into schools; having access to healthy, affordable food;
and increasing physical activity. The American Academy of Pediatrics (AAP) also recommends
the calculation and plotting of BMI once a year in all children and adolescents (Committee on
Nutrition, 2003). Furthermore, the AAP also recommends the use of its 5-2-1-0 plan: 5 fruits
and vegetables every day, 2 hours or less per day of screen time, 1 hour of physical activity each
day, and 0 servings of sugar-sweetened drinks.
As physicians, research indicates that education may be the best form of overweight and
obesity prevention among children and adults (Krebs, 2007). However, it is important to
understand the difficulty of treating obesity. Children of obese parents have double the risk of
becoming obese and have many of the same preferences in diet and lifestyles (Zlot, 2007). This
not only predisposes children to obesity genetically, but it makes it increasingly difficult as the
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
5/11
L i t e r a t u r e R e v i e w | 5
environment they live in is rich with the temptations of an obese lifestyle. There are 170,000 fast
food restaurants and three million soft drink vending machines in the United States (Chopra,
2002). Todays children will be tomorrows adults. This objective reality poses a very real
threat to our nations health.
In a review done by Iowans Fit for Life regarding obesity in Iowa, it was shown that the
trends in overweight and obesity in Iowa mirror the trends of the nation. The suggestions at the
end of the study were directed at specific populations. To adults that were overweight and obese,
the plan was to aim for a slow, steady weight loss by increasing physical activity (to at least 60
minutes of moderate intensity exercise most days of the week) and decreasing caloric intake,
while making sure to establish a healthy diet. For children, it was recommended that they should
consult a health care provider before beginning a weight-reduction diet. The forms of primary
prevention that were recommended were to: create and enhance access to places for physical
activity, enhance physical education in schools and child care settings, and support urban design
and transportation policies that would result in better neighborhoods for families to exercise
(Iowans Fit for Life, 2010).
Krebs (2007) concludes, Nevertheless, the access to children and their health
information, the authority and respect that physicians and other clinicians earn from families, and
the potential to apply their knowledge to the very real medical aspects of obesity and its
associated conditions, make an imperative that all clinicians be familiar with at least a
rudimentary assessment of overweight or obese child.
Motivational Interviewing
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
6/11
L i t e r a t u r e R e v i e w | 6
Motivational interviewing is a newly designed tool which aims to help physicians
enhance their relationship with their patients. It is a client-centered, directive method that seeks
to instill intrinsic motivation by resolving any semblances of ambivalence (Wagner, 2010).
Research on the efficacy of motivational interviewing has shown clinical significance. One
study showed that a 51% improvement rate was shown after undergoing motivational
interviewing in regards to treating problem behaviors, such as: alcohol, drugs, diet, and exercise
(Burke, 2003).
The major tenet of motivational interviewing is what Carl Rogers described in 1951 in his
studies with psychotherapy as the principle of empathy. Rogers showed that ambivalence from
the patient is not something that should be seen as an irregularity or a pathology, but rather as a
normal human process (Burke, 2003). Motivational interviewing has adopted this belief and
seeks to be client-oriented in its approach to interviewing. In the medical field, the focus is on
the patient. Using motivational interviewing, the physician allows the patient to talk. The
physician is tasked with steering the conversation into a realistic and positive area so that the
patient feels empowered to make changes on his or her own. This can prove to be helpful in
targeting childhood and adult obesity. The goal of motivational interviewing in the area of
obesity is to get the patient to open up to the physician and to come an agreement with the
physician regarding an intervention that seems the most realistic and optimistic to them.
Behavior Change Health Contracts
Patient non-compliance has been an area of concern regarding the patient-physician
relationship, and has been around for a long time. Some of the determining factors in patient
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
7/11
L i t e r a t u r e R e v i e w | 7
compliance are: demographic factors, condition or disease, psychological factors, health belief
model, physician-patient relationship, treatment regimen, and setting (Griffith, 1990).
An innovative approach to dealing with the problem of non-compliance, especially in the
realm of obesity prevention, has been to establish health contracts between the patient and
physician. In association with motivational interviewing, health contracts are sought to solidify a
behavior change. Using a behavior change theory, such as the Transtheoretical Model (TTM),
can help physicians with creating lasting behavior changes. The health contract actually fits into
one of the steps of the TTM. This behavior change theory has six steps: 1. Pre-contemplation, 2.
Contemplation, 3. Preparation (this is where the health contract canoe used), 4. Action, 5.
Maintenance, and 6. Termination (Velicer, 1998).
Physician attitudes towards obesity prevention
In a survey of 620 physicians, it was found that most primary care physicians found
physical inactivity as the biggest reason for obesity. More than half of the primary care
physicians also found their obese patients as awkward, unattractive, ugly, and noncompliant.
Fifty-four percent of these physicians said they would spend more of their time on weight-
management if they were reimbursed for it in an appropriate manner (Foster, 2003).
Foster (2003) concluded that most primary care physicians share the same negative
stereotypes of obese people as the rest of the nationthat obesity is largely a behavioral
problem; and spending time treating obesity is harder than most other chronic conditions. This
same view was adopted internationallyin Australia, most general practitioners did not choose
the treatment plan which required them to support their patient in achieving and maintaining a
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
8/11
8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
9/11
L i t e r a t u r e R e v i e w | 9
References
Burke, B. L. (2003). The Efficacy of motivational interviewing: a meta-analysis of controlled
clinical trials.Journal of Consulting and Clinical Psychology, 71(5), Retrieved from
http://www.vcu.edu/idas/pdfs/efficacy%20of%20MI-meta-analysis.pdf
Campbell, K. (2000). Obesity management: Australian general practitioners attitudes and
practices. Obesity Research, 8(6), Retrieved from
http://www.sochob.cl/pdf/tratamiento_obesidad/Obesity%20Management%20Australian
%20General%20Practitioners%20Attitudes%20and%20Practices.pdf
Centers for Disease Control and Prevention (2009). Childhood Overweight and Obesity. CDC,
Retrieved July 23, 2009, fromhttp://www.cdc.gov/obesity/childhood/index.html
Chopra, M. (2002). A global response to a global problem: the epidemic.Bulletin of the World
Health Organization, Retrieved July 17, 2009, from
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2567699&blobtype=pdf
Committee on Nutrition. (2003). Prevention of Pediatric Overweight and Obesity. American
Academy of Pediatrics. 112(2).
Flegal, K. (2007). The Epidemiology of Obesity. Gastroenterology, Retrieved July 3, 2009, from
http://nchspressroom.files.wordpress.com/2007/07/gastropaper.pdf
Foster, G. D. (2003). Primary care physicians attitudes about obesity and its treatment. Obesity
Research, 11(10), Retrieved from
http://www.vcu.edu/idas/pdfs/efficacy%20of%20MI-meta-analysis.pdfhttp://www.vcu.edu/idas/pdfs/efficacy%20of%20MI-meta-analysis.pdfhttp://www.sochob.cl/pdf/tratamiento_obesidad/Obesity%20Management%20Australian%20General%20Practitioners%20Attitudes%20and%20Practices.pdfhttp://www.sochob.cl/pdf/tratamiento_obesidad/Obesity%20Management%20Australian%20General%20Practitioners%20Attitudes%20and%20Practices.pdfhttp://www.sochob.cl/pdf/tratamiento_obesidad/Obesity%20Management%20Australian%20General%20Practitioners%20Attitudes%20and%20Practices.pdfhttp://www.cdc.gov/obesity/childhood/index.htmlhttp://www.cdc.gov/obesity/childhood/index.htmlhttp://www.cdc.gov/obesity/childhood/index.htmlhttp://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2567699&blobtype=pdfhttp://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2567699&blobtype=pdfhttp://nchspressroom.files.wordpress.com/2007/07/gastropaper.pdfhttp://nchspressroom.files.wordpress.com/2007/07/gastropaper.pdfhttp://nchspressroom.files.wordpress.com/2007/07/gastropaper.pdfhttp://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2567699&blobtype=pdfhttp://www.cdc.gov/obesity/childhood/index.htmlhttp://www.sochob.cl/pdf/tratamiento_obesidad/Obesity%20Management%20Australian%20General%20Practitioners%20Attitudes%20and%20Practices.pdfhttp://www.sochob.cl/pdf/tratamiento_obesidad/Obesity%20Management%20Australian%20General%20Practitioners%20Attitudes%20and%20Practices.pdfhttp://www.vcu.edu/idas/pdfs/efficacy%20of%20MI-meta-analysis.pdf8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
10/11
L i t e r a t u r e R e v i e w | 10
http://www.sochob.cl/pdf/obesidad_comorbilidades/Primary%20Care%20Physicians%20
Attitudes%20about%20Obesity%20and%20Its%20Treatment.pdf
Friis, R. H. & Sellers, T. A. (2009). Epidemiology for Public Health Practice. 4thedition. Jones
and Bartlett: Sudbury, MA.
Griffith, S. (1990). A Review of the factors associated with patient compliance and the taking of
prescribed medicines.British Journal of General Practice, 40. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-
0026.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-
0026.pdf
Iowans Fit for Life. (2010). The Health of Iowa: Impact of overweight and obesity.Nutrition and
Physical Activity Summary Burden Report Iowa Department of Public Health, Retrieved
fromhttp://www.idph.state.ia.us/iowansfitforlife/common/pdf/impact_obesity.pdf
Krebs, N. F. (2007). Assessment of child and adolescent overweight and obesity. Pediatrics, 120.
Retrieved fromhttp://pediatrics.aappublications.org/cgi/reprint/120/Supplement_4/S193
Mei, Z. (2002). Validity of body mass index compared with other body-composition screening
indexes for the assessment of body fatness in children and adolescents. American Journal
of Clinical Nutrition, 75(6), Retrieved fromhttp://www.ajcn.org/cgi/reprint/75/6/978
http://www.sochob.cl/pdf/obesidad_comorbilidades/Primary%20Care%20Physicians%20Attitudes%20about%20Obesity%20and%20Its%20Treatment.pdfhttp://www.sochob.cl/pdf/obesidad_comorbilidades/Primary%20Care%20Physicians%20Attitudes%20about%20Obesity%20and%20Its%20Treatment.pdfhttp://www.sochob.cl/pdf/obesidad_comorbilidades/Primary%20Care%20Physicians%20Attitudes%20about%20Obesity%20and%20Its%20Treatment.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp://www.idph.state.ia.us/iowansfitforlife/common/pdf/impact_obesity.pdfhttp://www.idph.state.ia.us/iowansfitforlife/common/pdf/impact_obesity.pdfhttp://www.idph.state.ia.us/iowansfitforlife/common/pdf/impact_obesity.pdfhttp://pediatrics.aappublications.org/cgi/reprint/120/Supplement_4/S193http://pediatrics.aappublications.org/cgi/reprint/120/Supplement_4/S193http://pediatrics.aappublications.org/cgi/reprint/120/Supplement_4/S193http://www.ajcn.org/cgi/reprint/75/6/978http://www.ajcn.org/cgi/reprint/75/6/978http://www.ajcn.org/cgi/reprint/75/6/978http://www.ajcn.org/cgi/reprint/75/6/978http://pediatrics.aappublications.org/cgi/reprint/120/Supplement_4/S193http://www.idph.state.ia.us/iowansfitforlife/common/pdf/impact_obesity.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1371078/pdf/brjgenprac00082-0026.pdfhttp://www.sochob.cl/pdf/obesidad_comorbilidades/Primary%20Care%20Physicians%20Attitudes%20about%20Obesity%20and%20Its%20Treatment.pdfhttp://www.sochob.cl/pdf/obesidad_comorbilidades/Primary%20Care%20Physicians%20Attitudes%20about%20Obesity%20and%20Its%20Treatment.pdf8/13/2019 Literature Review of Overweight and Obese Children and Adults Revision
11/11
L i t e r a t u r e R e v i e w | 11
Velicer, W. F. (1998). Detailed overview of the transtheoretical model. Cancer Prevention
Research Center , Retrieved from
http://www.uri.edu/research/cprc/TTM/detailedoverview.htm
Wagner, C. (2010).Motivation interviewing: resources for clinicians, researchers, and trainers.
Retrieved fromhttp://www.motivationalinterview.org/
White House Task Force on Childhood Obesity. (2010). Solving the problem of childhood
obesity within a generation. Let's Move, Retrieved from
http://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_FullReport.
Zlot, A. (2007). Addressing the Obesity Epidemic: A Genomics Perspective. Preventing Chronic
Disease, 4, Retrieved June 18, 2009, from
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1893129&blobtype=pdf
http://www.uri.edu/research/cprc/TTM/detailedoverview.htmhttp://www.uri.edu/research/cprc/TTM/detailedoverview.htmhttp://www.motivationalinterview.org/http://www.motivationalinterview.org/http://www.motivationalinterview.org/http://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_FullReport.pdfhttp://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_FullReport.pdfhttp://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_FullReport.pdfhttp://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1893129&blobtype=pdfhttp://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1893129&blobtype=pdfhttp://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1893129&blobtype=pdfhttp://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_FullReport.pdfhttp://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_FullReport.pdfhttp://www.motivationalinterview.org/http://www.uri.edu/research/cprc/TTM/detailedoverview.htm