Rationale and design of the STAR randomized controlled trial to accelerate adoption of childhood obesity comparative effectiveness research.

Background: Comparative effectiveness research (CER) evidence on childhood obesity provides the basis for effective screening and management strategies in pediatric primary care. The uses of health information technology including decision support tools in the electronic health records (EHRs), as well as remote and mobile support to families, offer the potential to accelerate the adoption of childhood obesity CER evidence.

Methods/design: The Study of Technology to Accelerate Research (STAR) is a three-arm, cluster-randomized controlled trial being conducted in 14 pediatric offices in Massachusetts designed to enroll 800, 6 to 12 year old children with a body mass index (BMI)≥ 95th percentile seen in primary care at those practices.

A qualitative study of gestational weight gain counseling and tracking.

Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated.

Nutritional quality of foods and beverages on child-care centre menus in Mexico.

Objective: The purpose of the present study was to assess the nutritional quality of foods and beverages listed on menus serving children in government-sponsored child-care centres throughout Mexico.

Design: For this cross-sectional menu assessment, we compared (i) food groups and portion sizes of foods and beverages on the menus with MyPlate recommendations and (ii) macronutrients, sugar and fibre with Daily Reference Intake standards.

Setting: Menus reflected foods and beverages served to children attending one of 142 government-sponsored child-care centres throughout Mexico.

Healthy Habits, Happy Homes: methods and baseline data of a randomized controlled trial to improve household routines for obesity prevention.

Objective: To develop a home-based intervention for parents of 2-5 year old children to promote household routines to prevent overweight/obesity.

Methods: We recruited 121 children from health centers in Boston between 2011 and 2012 and randomized 62 to intervention and 59 to the control condition. The 6-month intervention included 1) motivational coaching at home and by phone with a health educator, 2) mailed educational materials, and 3) weekly text messages.

Opportunities to Strengthen Childhood Obesity Prevention in Two Mexican Health Care Settings.

Background: The purpose of this study was to examine Mexican caregivers' perceptions of the role of primary care in childhood obesity management, understand the barriers and facilitators of behavior change, and identify opportunities to strengthen obesity prevention and treatment in clinical settings.

Methods: We conducted 52 in-depth interviews with parents and caregivers of overweight and obese children age 2-5 years in 4 Ministry of Health (public, low SES) and 4 Social Security Institute (insured, higher SES) primary care clinics in Mexico City and did systematic thematic analysis.

Results: In both health systems, caregivers acknowledged childhood overweight but not its adverse health consequences.

Are you talking to ME? The importance of ethnicity and culture in childhood obesity prevention and management.

Childhood obesity is prevalent, is of consequence, and disproportionately affects racial/ethnic minority populations. By the preschool years, racial/ethnic disparities in obesity prevalence and substantial differences in many risk factors for obesity are already present, suggesting that disparities in obesity prevalence have their origins in the earliest stages of life. The reasons for racial/ethnic variation in obesity are complex and may include differences in cultural beliefs and practices, level of acculturation, ethnicity-based differences in body image, and perceptions of media, sleep, and physical activity.

The association of urbanicity with infant sleep duration.

Short sleep duration is associated with multiple adverse child outcomes. We examined associations of the built environment with infant sleep duration among 1226 participants in a pre-birth cohort. From residential addresses, we used a geographic information system to determine urbanicity, population density, and closeness to major roadways.

Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions.

Childhood obesity is currently one of the most prevailing and challenging public health issues among industrialized countries and of international priority. The global prevalence of obesity poses such a serious concern that the World Health Organization (WHO) has described it as a "global epidemic." Recent literature suggests that the genesis of the problem occurs in the first years of life as feeding patterns, dietary habits, and parental feeding practices are established.

Decreasing prevalence of obesity among young children in Massachusetts from 2004 to 2008.

Objective: To examine whether the obesity prevalence is increasing, level, or decreasing among young US children (aged <6 years) in the past decade; and to compare regional data to those of 2 national databases.

Methods: We analyzed data from 108 762 well-child visits (36 827 children) at a multisite pediatric practice in eastern Massachusetts during 1999-2008. By using the Centers for Disease Control and Prevention 2000 gender-specific growth charts, we defined obesity as weight-for-length ≥95th percentile for children aged <24 months and BMI ≥95th percentile for children aged 24 to <72 months.

Childhood body mass index trajectories: modeling, characterizing, pairwise correlations and socio-demographic predictors of trajectory characteristics.

Background: Modeling childhood body mass index (BMI) trajectories, versus estimating change in BMI between specific ages, may improve prediction of later body-size-related outcomes. Prior studies of BMI trajectories are limited by restricted age periods and insufficient use of trajectory information.

Methods: Among 3,289 children seen at 81,550 pediatric well-child visits from infancy to 18 years between 1980 and 2008, we fit individual BMI trajectories using mixed effect models with fractional polynomial functions.

Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial.

Relatively little research has assessed the association between obesogenic behaviors in parents and their children. The objective of the present analysis was to examine cross-sectional associations in television (TV)/video viewing, sugar-sweetened beverage intake, and fast food intake between mothers and their preschool aged children. We studied baseline data among 428 participants in High Five for Kids, a randomized controlled trial of behavior change among overweight and obese children of ages 2-6.

Lifecourse approach to racial/ethnic disparities in childhood obesity.

Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences.

Provider perspectives on electronic decision supports for obesity prevention.

Despite the availability of national evidenced-based guidelines related to pediatric obesity screening and prevention, multiple studies have shown that primary care physicians find it difficult to adhere to them or are unfamiliar with them altogether. This article presents physicians' perspectives on the use of electronic decision support tools, an alert and Smart Set, to accelerate the adoption of obesity-related recommendations into their practice. The authors interviewed providers using a test encounter walk-through technique that revealed a number of barriers to using electronic decision supports for obesity care in primary care settings.

Systematic review of effective strategies for reducing screen time among young children.

Screen-media use among young children is highly prevalent, disproportionately high among children from lower-income families and racial/ethnic minorities, and may have adverse effects on obesity risk. Few systematic reviews have examined early intervention strategies to limit TV or total screen time; none have examined strategies to discourage parents from putting TVs in their children's bedrooms or remove TVs if they are already there. In order to identify strategies to reduce TV viewing or total screen time among children <12 years of age, we conducted a systematic review of seven electronic databases to June 2011, using the terms "intervention" and "television," "media," or "screen time.

Similarity of the CDC and WHO weight-for-length growth charts in predicting risk of obesity at age 5 years.

The World Health Organization (WHO) 2006 weight-for-length (WFL) or BMI growth charts are now recommended as the new standard for children under 24 months. The objective of this study was to examine associations of ever being overweight during 1-24 months, based on the older Centers for Disease Control and Prevention (CDC) and WHO cutpoints, with risk of obesity at age 5 years. From well-child visits to a Massachusetts multi-site group practice during 1980-2008, we studied 15,488 children with length/height and weight measurements at 1, 6, 12, 18, and 24 months, and at 5 years.

Crossing growth percentiles in infancy and risk of obesity in childhood.

Objective: To examine the associations of upward crossing of major percentiles in weight-for-length in the first 24 months of life with the prevalence of obesity at ages 5 and 10 years.

Design: Longitudinal study.

Setting: Multisite clinical practice.

Obesity determinants in Mexican preschool children: parental perceptions and practices related to feeding and physical activity.

Background And Aims: Obesity represents a major public health problem worldwide. In Mexico, overweight and obesity have increased dramatically, affecting 26% of school-aged children. The aim of this study was to explore perceptions and practices of key obesity determinants among parents of preschool children attending child care centers.

Can the Internet be used to reach parents for family-based childhood obesity interventions?

Objective: This study aimed to identify socioeconomic correlates of computer/Internet use among parents of overweight preschool-aged children.

Methods: A total of 470 baseline participants in a trial to prevent obesity in children 2 to 6.9 years old with body mass index ≥ 95th percentile or 85th to 95th percentile with one overweight parent were studied.

Age of achievement of gross motor milestones in infancy and adiposity at age 3 years.

Early life physical activity may help prevent obesity but is difficult to measure. The purpose of this study was to examine associations of age of achievement of gross motor milestones in infancy with adiposity at age 3 years. Seven forty one mother/infant dyads participated in a longitudinal study in Massachusetts.

Health information technology to guide pediatric obesity management.

The purpose of this study was to examine pediatricians' familiarity with expert committee recommendations on the management of childhood obesity and their use of health information technology for obesity-related care. The authors interviewed 35 pediatricians from 17 primary care practices using an electronic health record; immersion crystallization facilitated analysis of the qualitative data. Nearly all pediatricians were unfamiliar with expert recommendations; however, all participants reported using growth charts and providing nutrition and physical activity counseling.

Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study.

Objective: To examine the effectiveness of a primary care-based obesity intervention over the first year (6 intervention contacts) of a planned 2-year study.

Design: Cluster randomized controlled trial.

Setting: Ten pediatric practices, 5 intervention and 5 usual care.

Longitudinal association of maternal attempt to lose weight during the postpartum period and child obesity at age 3 years.

The effect of maternal attempt to lose weight during the postpartum period on later child weight has not been explored. Among 1,044 mother-infant pairs in Project Viva, we estimated longitudinal associations of maternal attempt to lose weight during the postpartum period with child weight and adiposity at age 3 years and examined differences in associations by type of weight loss strategy used. Using covariate-adjusted linear and logistic regression models, we estimated associations before and after adjusting for maternal weight-related variables including prepregnancy BMI.

Timing of solid food introduction and risk of obesity in preschool-aged children.

Objective: To examine the association between timing of introduction of solid foods during infancy and obesity at 3 years of age.

Methods: We studied 847 children in Project Viva, a prospective pre-birth cohort study. The primary outcome was obesity at 3 years of age (BMI for age and gender ≥ 95th percentile).