Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Pathways to Eating in Children and Adolescents with Obesity
Childhood and Adolescent Obesity ConferenceOttawa, OntarioOctober 25, 2016
Hayyah Clairman, B.Sc. (Hons.)M.Sc. Student, Institute of Medical Science, University of TorontoDivision of Endocrinology, The Hospital for Sick Children
Conflict of InterestI have no conflicts of interest to disclose.
2
Introduction & Eating Behaviours
3
Current Treatment
4
+Images from: http://www.clipartkid.com/fitness-physical-exercise-cliparts/, http://www.healthy-diet-healthy-you.com/new_food_pyramid.html
One Size Does Not Fit All
5Image from: http://musingsoninfection.blogspot.ca/2014/02/infection-prevention-one-size-does-not.html
Children with Obesity vs Non-Obese Peers
(Braet & van Strien, 1997)
6
Children with Obesity vs Non-Obese Peers
(Hoffmann et al, 2015)
7
Eating Mechanisms Co-occur in Children with Obesity
8
(Reinblatt et al, 2015)
Appetite Regulation is Complex
9Image from: Van Vugt (2010) Brain imaging studies of appetite in the context of obesity and the menstrual cycle. Human Reproduction Update 16(3): 276-292
10
Eating Mechanisms
Objectives
Objectives1) To determine the clustering properties of eating mechanisms in children and adolescents with obesity
2) To relate identified phenotypes to demographic, anthropometric, and eating environment measures
12
Methodology
Study PopulationAges 10-18 years
English-speaking
Enrolled in CIHR-funded CANPWR (Baseline or 12 month visit)
14
Data CollectionResponses to 2 child/adolescent self-report and 2 parent-for-child-report questionnaires
Questionnaires (total items: parent = 31, child = 25): EDE-Q: Loss of control eatingDEBQ: Emotional, Restrained, and External Eating subscalesHQ: Total hyperphagia scoreSWAN: Hyperactivity/Impulsivity and Inattention subscales
15
Analytic Plan
16
Cross-Sectional AnalysisObjective #1: Latent Profile Analysis (LPA)
Phenotypes identified using indicator variables (mechanisms)
Membership assigned to “latent” cluster from similarities between variables
Sample size of 250-300 is comparable to similar analyses
17
Sample Model: 4 Clusters/Phenotypes
18
IMPULSIVITYRESPONSE TO EXTERNAL CUES
LOSS OF CONTROLEATING
INATTENTION
HYPERPHAGIA
RESPONSE TO EXTERNAL CUES
LOSS OF CONTROLEATING
RESTRAINEDEATING
EMOTIONAL EATING
HyperphagicEmotional-Restrained
Impulsive-External
Distracted-Uninhibited
Strategies for Treatment
19
IMPULSIVITYRESPONSE TO EXTERNAL CUES
LOSS OF CONTROLEATING
INATTENTION
HYPERPHAGIA
RESPONSE TO EXTERNAL CUES
LOSS OF CONTROLEATING
RESTRAINEDEATING
EMOTIONAL EATING
HyperphagicEmotional-Restrained
Impulsive-External
Distracted-Uninhibited
DBT/CBT Behavioural Therapy/Medication
Mindfulness ADHD coach/Medication for ADHD
Cross-Sectional AnalysisObjective #2: Analysis of Variance (ANOVA)
Clinical characteristics will be compared across phenotypes
Demographics (e.g. age, sex, family structure)
Anthropometrics (BMI)
Eating Environment (e.g. meals with family, meals in front of TV)
20
Current Progress & Significance
Recruitment8 CANPWR sites
~220 participants to date
300 anticipated by January 2017
22
Significance Identifying latent phenotypes in children and adolescents with obesity will lead to increased investigation into better targeted weight-management interventions
23
AcknowledgementsSupervisor: Dr. Jill Hamilton
Thesis Committee:Dr. Debra KatzmanDr. Valerie Taylor
Hamilton Research Team:Kristina CordeiroKatharine HamiltonPing LiShawna Steele
24
Sickkids STOMP Team
CANPWR Investigators
Funding:
Questions
25Image from: http://www.123rf.com/stock-photo/eating_questions.html
Extra Slides
26
Recruitment UpdateBC Children’s (Vancouver) 3Alberta CH (Calgary) 37 Stollery CH (Edmonton) 19McMaster (Hamilton) 61Credit Valley (Toronto) 21SickKids (Toronto) 53CHEO (Ottawa) 29Montreal CH (Montreal) 0
TOTAL 223
27