More Lessons Learned

evaluation-of-act-1220

Back in 2003, by passing Act 1220, the state of Arkansas embarked on an extensive obesity prevention project that required collaboration among government institutions and many varieties of professionals who worked for the public education system. Anxious to be in from the start on such an ambitious undertaking, the Robert Wood Johnson Foundation put up the money for an “evaluation of the process and impact of the law’s implementation.” A research team designed the evaluation, and laid out the preparatory steps.

One of the original purposes was to provide body mass index (BMI) screenings for all students every year, and notify parents of the resulting scores. Objections came from many directions, including parents who were against the mandatory nature of the screening. That resistance was apparently based on a misunderstanding, because parents who did not want their children measured were allowed to opt out with no bad consequences.

Others objected to the cost of printing consent forms and mailing the test results to parents. Eventually, everything got underway.

The report, “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012” is a downloadable PDF file, 40 pages in length, compiled from nine years of data. It is a massive resource, with pointers to other resources, as well the history of how all the parts fit together. There seems to be an awful lot of repetitive effort to “reinvent the wheel” in cities and states all over America.

Information about how one endeavor came into being is always helpful. Hopefully, other political and public service entities want to emulate success — and avoid pitfalls — when designing a program. To learn from the mistakes of others, as well as from their brilliant innovations, can obviously save lives, money, and time.

But that’s not all

Along with the annual BMI screenings, the law also required schools to disclose their contracts with food and beverage companies, and to restrict the access of elementary school students to vending machines. On the bureaucratic side, each school district was to create a Nutrition and Physical Activity Advisory Committees with membership open to teachers, community leaders, and of course parents. Also, a Child Health Advisory Committee would be established to review the evidence as it came in, and recommend further refinements of the policies regarding nutritional standards and physical activity requirements.

In 2005, the Child Health Advisory Committee fulfilled its role by making additional recommendations. The new rules forbade the use of foods or beverages, including vending machine access, as “rewards for academic, classroom, or sport performances and/or activities” — a precept that Dr. Pretlow highly acclaims. Using edible or drinkable treats as a reward is always a mistake, whether done by teachers or parents.

The Committee tweaked the portion sizes of the vending machine offerings and required that fruits and fruit juices be as readily available as junk food. Schools were told that all students must have 30 minutes of physical activity per day, and new rules were made about Physical Education (PE) teacher certification and PE class sizes.

Like so many other things, the success of a far-reaching, large-scale program is multi-factorial. The report includes this paragraph:

The co-occurrence of these programs and initiatives supporting the implementation of Act 1220 require a cautious interpretation of evaluation findings. Changes in school environments, policies and practices, as well as any changes in individual or family behaviors that may be observed cannot be attributed solely to the influence of Act 1220. However, it is clear that Act 1220 was an early stimulus for child health activity, particularly school policy and environmental change…

The resulting changes are broken down into 10 discrete Lessons, which we will look at next time.

Your responses and feedback are welcome!

Source: “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012,” RWJF.org, Feb 2014
Image by Robert Wood Johnson Foundation; Fair Use

Up-to-Date Quality of Life Roundup

family-baking

This should bring us up to date on all the previous Childhood Obesity News posts concerning the very important aspect of life known as quality, with a trio of pieces all based on the same question: Are obese kids miserable? According to many indications, the answer is yes, although getting confirmation of what seems rather obvious is not as easy as it sounds.

Outsiders are often tempted to break down large problems into well-defined categories, and consequently sometimes end up kidding themselves about what actually goes on. But there do seem to be three distinct groups.

Dr. Pretlow has found that children and teens who can express themselves anonymously, via his Weigh2Rock website, are very forthcoming about their sufferings. In person, not so much, as the participants in the various WeightLoss2Go studies have shown. When faced with a researcher or medical professional, a person’s impulse to give voice to feelings often fades.

When they grow older, the same people can be fountains of information, and this is true whether they are still overweight/obese or whether they have learned what keeps their particular bodies at a reasonable size. Sometimes, the stories of morbidly obese people wind up being told by third parties, and they can be horrifying.

Many influences on childhood obesity

Kids who are on the “no” side of obese-child misery are there for various reasons. If they are born into a family where pretty much all the relatives are overweight, in a neighborhood and culture where obesity is common, there may not be much reason for unhappiness. Eventually, incipient diabetes and other medical problems will gain prominence, but it is possible to have a very happy childhood.

However, it appears that an increasing number of teenagers have become infected by the “fat acceptance” mindset, to the point where this way of thinking is dangerous, and will certainly affect their quality of life somewhere down the line. When societal norms are harmful and hateful — like racism, misogyny, greed, and so forth — defiance of those norms can be a very good thing. But to fight for the right to be fat, while insisting on not only respect, but praise, for taking that stand, can lead to nothing but a bad end.

Why is quality of life question so urgent?

In order to undertake a big project like losing 50 pounds and (more important) keeping it off, a person needs plenty of motivation. Traditionally, people make significant life changes in order to escape unhappiness. So here’s the problem: If obese children and teens are happy, and satisfied with their quality of life, what other engine could possibly supply power for the difficult task of slimming down and reclaiming a healthier body? That makes it a vital topic indeed.

Allow us to recommend these previous gatherings of ideas:

“Quality of Life Roundup”
“Roundup: Quality of Life”
“The Continued “Quality of Life” Roundup”

Your responses and feedback are welcome!

Photo credit: johnyk_74 via Visualhunt/CC BY-NC-SA

More on EMA and Childhood Obesity

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Recently we discussed a study carried out by a team from Children’s Hospital of Pittsburgh, and specifically from the Weight Management Center, combining Ecological Momentary Assessment (EMA) and Ecological Momentary Intervention (EMI). These researchers, who of course looked at previous studies before designing their own, mentioned a troubling side note — one indicating that, as always, more research is needed:

Moreover, given exclusion criteria in many pediatric obesity trials, children with mood disorders (depression) and medical comorbidities (sleep problems) do not receive the interventions. Domains such as mood and sleep may be essential dimensions of assessment as mediators or moderators of weight-loss treatment.

A 2010 study looked into “the feasibility, acceptability, and validity” of an EMA protocol using mobile phones. There were 121 kids between the ages of 9 and 13. The number of girls and boys were very close to equal, and 40% of the subjects were either already overweight or at risk.

They were monitored mostly outside of school hours, from Friday afternoon to Monday evening, and were surveyed between three and seven times per day. The report says:

Items assessed current activity (e.g., watching TV/movies, playing video games, active play/sports/exercising). Children simultaneously wore an Actigraph GT2M accelerometer. EMA survey responses were time-matched to total step counts and minutes of moderate-to-vigorous physical activity (MVPA) occurring in the 30 min before each EMA survey prompt.

The ideas behind EMA and EMI are obviously proliferating, reaching such institutions as the Center for Childhood Obesity Research. The Center conducts interdisciplinary research to help build the evidence base that will hopefully reveal what causes the increasingly alarming statistics.

The officials who make policy need to know these things, and so do clinical practitioners and therapists of all kinds. The Center’s literature states:

This center combines the research strengths of the College of Health & Human Development, including preventive interventions; attention to biology, behavior, and family relationships; medical and community partnerships; and real time ecological momentary assessment of health via data from sensors, accelerometers, and smartphone technology.

Making use of data already collected and curated, researchers in Warsaw, Poland, conducted a meta study whose results were published in 2013. Their goal was to “assess the value of ecological momentary assessment in evaluating physical activity among children, adolescents, and adults,” and also determine whether EMA lives up to the urgent need for validity, reliability, objectivity, norms, and standardization.

Frankly, there was not that much to pick from, because the whole notion of using EMA to evaluate kids’ physical activity is relatively new. The team looked at 20 journal articles, all concerning studies in which EMA procedures were “precisely documented and confirmed to be feasible.” The conclusions were:

Ecological momentary assessment is a valid, reliable, and feasible approach to evaluate activity and sedentary behavior. Researchers should be aware that while ecological momentary assessment offers many benefits, it simultaneously imposes many limitations which should be considered when studying physical activity.

Out of the 20 articles team scrutinized, 14 addressed physical activity versus sedentary lifestyle in kids and teens, and six were about EMA and adults. They found that the electronic tools like phone surveys and electronic diaries are used more with the younger set. Now, what about measurement characteristics?

The findings demonstrate that the EMA approach constitutes a valid, reliable, and feasible measurement tool, which clearly indicates that EMA can be considered a suitable method for assessing PA among children, adolescents, and adults.

Your responses and feedback are welcome!

Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,” NIH.gov, December 2009
Source: “Investigating children’s physical activity and sedentary behavior using ecological momentary assessment with mobile phones,” NIH.gov, December 2010
Source: “The Center for Childhood Obesity Research,” Psu.edu, undated
Source: “Using Ecological Momentary Assessment to Evaluate Current Physical Activity,” NIH.gov, July 2013
Photo credit: kellybdc via Visualhunt/CC BY

Good News From “Eating Disorders: The Journal of Treatment & Prevention”

eating-disorders-cover

Recently, Dr. Pretlow learned that he has received an award from Eating Disorders: The Journal of Treatment & Prevention (EDJT). His article, “Addiction to Highly Pleasurable Food as a Cause of the Childhood Obesity Epidemic: A Qualitative Internet Study,” was named one of the top 25 in the journal’s history. Dr. Pretlow’s contribution appeared in 2011, in Volume 19, Issue 4 of EDJTP.

When the history of this publication is mentioned, please understand that it encompasses more than 1,100 articles altogether. Since it began 25 years ago, that means an average of only one piece of writing per year was chosen. The entire list can be seen at Taylor & Francis Online.

EDJTP founder and Editor-in-Chief, Leigh Cohn, wrote:

As the Senior Editors and I retire, we decided to create this Top 25 Articles list as a way to look back at our years with the journal. The awards and Last Words from us are in Volume 25, Issue 5.

One of these Last Words is “Goodbye, Eating Disorders,” written by Cohn, which relates how the journal was born and recalls some of the startling revelations that the job brought to light. It came as something of a surprise, for instance, to learn how many men struggle with eating disorders, since traditionally (and stereotypically) this type of problem has registered on the public consciousness as a predominantly female issue.

In what might be a slightly bemused tone, he says, “Inadvertently, I found myself at the epicenter of the eating disorders community.” Over the ensuing quarter of a century, that community has grown amazingly, and the growth was not free of conflict.

Cohn writes:

I began to question the validity of treatment and prevention studies, because I would sometimes hear terrible things about certain doctors, even though they were highly respected in academia as authors and speakers. Individuals shared horror stories about certain experiences at treatment facilities that were considered state of the art. Conversely, someone else would declare that they recovered under that same doctor or treatment center.

Before saying goodbye, Leigh Cohn introduces the new co-editors-in-chief. One is Catherine Cook-Cottone, a psychologist who is also an associate professor at the State University of New York in Buffalo. The other is Leslie Karwoski Anderson, Director of Training and a Clinical Associate Professor at UC San Diego’s Eating Disorders Center, whose expertise lies also in editorial matters.

As if all this were not significant enough, here is the impressive part: “The three of us have spent two years on this transition…” Many human-led enterprises could benefit from such careful preparation.

Another feature of the current issue of EDJTP is the four-part farewell authored by all the senior editors, including Arnold E. Andersen, M.D., and Margo Maine, Ph.D. Like any specialized field, obesity can be a small world, and founding Senior Editor John P. Foreyt has crossed paths with Dr. Pretlow before, at a conference two decades in the past.

Dr. Pretlow says:

Dr. John Foreyt, a psychologist and Director of the Behavioral Medicine Research Center at Baylor College of Medicine in the US, spoke about the psychological causes of obesity. After his talk I asked Dr. Foreyt, “What percent of the causes of obesity are psychological?” He replied “99%.” I was shocked by his answer.

That excerpt is from Dr. Pretlow’s opening remarks while chairing a symposium at the World Congress of Psychiatry in Berlin last month.

Dr. Pretlow sees obesity as primarily a psychological problem that resembles an addictive process to the point where it can be successfully treated by the same modalities that work for people hooked on hard drugs. He supports the application of addiction-model methods for treatment of disordered overeating and obesity.

Your responses and feedback are welcome!

Source: “Goodbye, Eating Disorders,” tandfonline.com, 11/06/17
Source: “Eating disorders: A 25-year perspective,” tandfonline, 11/06/17
Image: Fair Use

Ecological Momentary Assessment and Childhood Obesity

writing-at-breakfast

Ecological Momentary Assessment (EMA) was developed for the benefit of researchers looking for a better way to collect data, and it helps patients, too. The particular subsets of patients we are interested in are overweight and obese children and adolescents. Once EMA had been shown to benefit adults health professionals were eager to employ it with younger people, and the signs are encouraging.

In this kind of research, the subjects agree to perform certain actions, and everything depends on the whether they actually follow through on what they’ve signed up for. A better compliance rate means better data for the researchers and better results for the subjects, who are presumably trying to accomplish something, like an improved state of health.

Compliance rates are influenced by comfort and familiarity with the technology. Most kids are adept at using technological devices like cell phones and activity monitors.

When the patients are children and teens, EMA is attractive for very good reasons. It can stand alone as a treatment modality, without bringing pharmaceuticals into the picture. Also, it is not surgery.

EMA’s Adaptability

All studies have different needs and constraints, so a dozen researchers might design a dozen different protocols to come at the same problem from different directions. EMA’s advantage is that it can cover a lot of angles, and is almost infinitely adaptable.

A Children’s Hospital of Pittsburgh research team discovered that most attempts to quell pediatric obesity have disappointingly unspectacular results. According to the research team:

EMA methodology may assist weight-loss efforts by clarifying the antecedents of participants’ eating behavior, by improving accuracy of self-monitoring and by specifying the temporal relationships of the target behaviors. A second, equally important value of the EMA approach is its ecological validity, that is, that its results can be generalized by its ability to perform measurements in the real world: the authentic surroundings of the respondents.

Carried out by the Weight Management Center, a 2009 study with 20 subjects hoped to assess the possibility of using EMA to “examine important domains relevant to interregulatory health processes in overweight adolescent females.” Each participant wore an activity monitor, which senses motion and other physical states, and also transmits and records information about physical activity (PA), sleep cycles, and other variables.

The device can be worn on the wrist, waist, ankle or thigh. The authors say:

The intervention consisted of four weekly, four bi-weekly, and three monthly individual sessions. Information focusing on nutrition, PA, and behavior change was presented in ~45-min sessions using cognitive–behavioral therapy and motivational interviewing followed by ~30 min of PA.

Participants received calls from a trained staff member for three extended weekends across the intervention. Participants were called twice on weekdays and four times on weekends for a total of 14 calls between 4 PM Thursday and 9 PM Monday. Each call consisted of a brief structured interview to evaluate current eating, PA, affect, and social context and lasted between 5 and 10 min.

Medicine and health promotion are related fields, of course. It makes sense that the technologies of information and communications are important to both of them, especially when it comes to data collection. As we have seen, EMA takes snapshots of a person’s daily life, randomly, or at crucial times (like deciding to go off the rails and eat everything that doesn’t eat you first), and ties them to other contemporaneous phenomena.

EMA tracks several factors at once, and every scrap of data can be marshaled into an algorithm. There are physical measurements like heart rate, and mental/emotional events are documented the moment they bubble up in the brain. Also, the subject does not have to remember past events. The immediacy, or “momentary” nature of the reportage, is a feature.

Your responses and feedback are welcome!

Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,” NIH.gov, December 2009
Photo via Visualhunt

What Is Ecological Momentary Assessment For?

cookie-on-keyboard

Childhood Obesity News is looking at Ecological Momentary Assessment (EMA).
Part data-collection technique and part therapeutic modality, EMA is, consequently, adaptable to many situations.

These meaningful words are from a 2010 study:

EMA methods are particularly well-suited to studying drug use. Drug use itself is a discrete, episodic behavior that lends itself to event-oriented recording…

Moreover, many theories of drug use emphasize the role of the immediate situation in drug use, with emphasis on immediate internal experience (e.g., the user’s mood, craving, or withdrawal state) and external situational factors (e.g., the presence of the target substance, substance-related cues, social pressures to use)…

Theory has similarly emphasized the role of the acute effects of drugs (i.e., reinforcement, euphoria, relief of stress), which also lend themselves to momentary assessment.

Episodic; role of the immediate situation; mood, craving or withdrawal state; presence of the substance; triggering cues; social pressure; stress; the desire for euphoria… This all sounds very familiar. Everything the authors say about drug use is also true of eating disorders.

In 2006, Debbie S. Moskowitz and Simon N. Young wrote:

A review of the use of EMA methods in eating disorders concluded that patients are willing and able to engage in EMA studies, and the method makes it possible to collect data that could not be obtained with other study designs.

The authors noted that EMA methods had been used to help depressed adolescents and children, and they themselves studied patients with bulimia who “recorded their perceptions of social interactions, concurrent self-perceptions and moods, and eating behaviors after each social interaction for up to 22 days.”

A 2014 study declared in its Objective that the context of eating episodes in obesity is not well understood. The researchers went on to examine “emotional, physiological, and environmental correlates of pathological and nonpathological eating episodes.” Fifty adult subjects, mostly women, documented every episode of eating, along with the associated emotional, physiological and environmental conditions, for two weeks.

They were asked to distinguish between loss of control, binge eating, and nonpathological overeating. It turns out that loss of control and binge eating are more likely to be associated with emotional and physiological cues. The study authors wrote:

Results support distinctions among the different constructs characterizing aberrant eating and may be used to inform interventions for obesity and related eating pathology.

Many obesity professionals have made the comparison between hard drugs and food. While there may be debate over whether compulsive overeating is a substance addiction or a behavioral addiction, the important thing is, it behaves like an addiction and is shown to be responsive to methods that address addiction.

Your responses and feedback are welcome!

Source: “Ecological Momentary Assessment (EMA) in Studies of Substance Use,” NIH.gov, December 2010
Source: “Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology,” NIH.gov, January 2006
Source: “Ecological momentary assessment of eating episodes in obese adults,” NIH.gov, November 2014
Photo credit: Theo Crazzolara via Visualhunt/CC BY

What Is Ecological Momentary Assessment?

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Anyone familiar with the culture of the “Sixties” knows the influence of ancient philosophies. Traditions from places like India emphasized the importance of checking in with yourself in real time, and experiencing the present fully conscious — “Be here now.” This is why Ecological Momentary Assessment (EMA) sounds familiar. It is a form of data collection, and also of cultivating self-awareness.

The technique behind Ecological Momentary Assessment is to describe what is going on at certain moments of the day. The moments may be scheduled, or random, or dependent on a certain behavior, like drug use or an eating binge. Or any combination of those. The person pauses to take stock of, and document, current thoughts, feelings, and behaviors.

Why do researchers like this? Because self-reporting is dicey at best, and “retrospective recall” makes it worse. Even studies that require subjects to make a diary or journal entry at the end of the day are not satisfactory. The farther away events are in time, the less reliable the memory becomes. There is a concern that sources of bias may intervene.

When the objective is to learn about something as complicated as, for instance, obesity, the tools need to competently handle many complex factors all at once. For these reasons, researchers call the data derived from EMA “ecologically valid,” or at least more valid than some other kinds.

It is ecological because the subjects are in their natural environments and doing what they normally do. One source describes EMA as…

[…] a group of methods, developed by personality/social psychologists […] which permit the research participant to report on symptoms, affect and behavior close in time to experience and which sample many events or time periods.

In other words, it provides the scope to include several dimensions of behavior in the one study, including social interactions and mood, and the interactions between those factors. A potential difficulty has been spotlighted, in that the procedures required by EMA are more demanding than “more global types of assessment.” But Debbie S. Moskowitz and Simon N. Young found that…

[…] impulsivity does not seem to prevent the use of EMA methods, because they have been applied successfully to patients with borderline personality disorder, bulimia, attention-deficit hyperactivity disorder (ADHD) and violent patients.

The EMA tool can be used for many purposes. A 2006 study sought to determine whether there might be a better way to assess social functioning in the particular context of clinical psychopharmacology. In this field, it can takes months or years to discover what medication works for each particular patient, and in what amounts. To really fine-tune the dosage of these powerful drugs the practitioner needs “wide-ranging and detailed measurements of mood and behavior.”

Many vital quality-of-life issues are concerned here. The symptoms of any disorder can throw a monkey wrench into social interactions, ranging from the mundane to the crucial. The ability to connect either a failed or a successful social interaction with other factors in real time (or almost) provides important clues in the pursuit of more successful encounters with others in the world.

Moskowitz and Young wrote:

In summary, measures that can be classified under the rubric of EMA methodology have been shown to be reliable and valid, can show excellent matching between the measure and the theoretical definition of the outcome, reduce reliance on retrospective memory and reduce the need to rely on the integrative judgements of either the clinician or the respondent.

Your responses and feedback are welcome!

Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,” NIH.gov, December 2009
Source: “Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology,” NIH.gov, January 2006
Images: @JesseFernandez (top), @thatcarlygirl (bottom)

The Continued “Quality of Life” Roundup

sunset-rock-man

Quality of life comes in several varieties, and none of them can perform its magic if the person is depressed. Britain’s National Obesity Observatory (NOO) discovered that when an obese child is depressed that depression seems to increase as time goes on. If the family lives at or near poverty level, the effect is even worse. Their work resulted in a 28-page report titled “Obesity and mental health,” which Childhood Obesity News had talked about. (The same post mentioned a few other interesting studies, too.)

One of the Observatory’s conclusions about obese young people was that weight management programs can help, even though the benefit may not show up right away in the form of immediate weight loss.

This seems to reflect a profound truth. To experience an epiphany, followed by an instantaneous change in behavior, is not the human way. People mull things over. Ideas take a while to sink in. A person might hear the same idea from multiple sources for years, and it doesn’t make a dent. Then one day someone frames it in exactly the right words, and everything clicks.

For scientists to serve up immediate and exquisitely quantifiable results, seems hubristic, but they can’t be blamed for what might seem like unearned omniscience. The system they must operate in wants to see graphs and charts with crisp delineations. This is, after all, how funding is obtained.

For the clinician, interventions that challenge family tradition and wider culture may not resolve anything in the short term. It’s not exactly like waving a magic wand, and no primary care physician or therapist should ever feel inadequate if results are not immediately apparent. Who knows what might happen 10 years from now? It’s always “better late than never.”

The NOO report also confirmed that obesity can aggravate mental/emotional health that is already impaired, and vice versa. It goes both ways, and a vicious cycle can develop quickly. When two or more problems continually exacerbate each other, it’s called “spiraling out,” and it needs to be stopped.

An audacious experiment

In one post, Childhood Obesity News explored the official one-child policy that China pursued for some years. An awful lot of boys became obese, partly because parents and grandparents who enjoyed spoiling kids with junk food had fewer targets to concentrate their energies on. The Chinese childhood obesity epidemic led to brutal “fat camps” and deprogramming centers designed to cure internet addiction.

Peripherally related

In another post, Childhood Obesity News looked at the multi-generational, epidemiologically-oriented Framingham Heart Study. Data from this longitudinal study has been utilized in many different ways by numerous research teams. It was noticed that if a subject became obese during the study, their spouse or a sibling would become obese also, but the reasons are not clear and could be quite mundane.

It turns out that researchers used the Framingham Heart Study subjects’ information to zero in on the “quality of life” question, with a study called “Dynamic spread of happiness in a large social network.” They were interested in the idea of emotional contagion, how it works, and how far its reach extends. In defining nodes, ties, components, and clusters, they used the same kind of analysis that Facebook uses when deciding who is shown which advertisements.

These authors were not concentrating on weight an ingredient of happiness, but they did mention a couple of things known from previous studies:

Happiness spreads significantly more through same sex relationships than opposite sex relationships… This result also accords with previous evidence on sex effects in the spread of obesity and suggests that people might be more likely to take emotional cues from members of the same sex. The spread of happiness seems to reach up to three degrees of separation, just like the spread of obesity…

Your responses and feedback are welcome!

Source: “Obesity and mental health,” Khub.net, March 2011
Source: “Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study,” BMJ.com, 12/05/08
Photo via Visualhunt

Roundup: Quality of Life

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Last month, Childhood Obesity News posted a guide to some of the archived posts concerning quality of life. There are more! Today, we look back over some interesting angles on the quality of life experienced by obese children and teenagers, and how that quality can be improved.

For instance, one group of researchers determined that a school-based weight management program could work, if correctly implemented. That means an intensive, instructor-led course; none of this self-taught or parent-taught stuff. In addition, one-year and two-year followups showed that the good results from the intensive, instructor-led type of program tended to stick.

In testing the W8Loss2Go smartphone app, Dr. Pretlow noticed resistance among some of the young participants. Talks revealed that a kid might have been overweight for so long she or he just got used to it, and even developed a fatalistic attitude that disallows the possibility for change.

We asked why obese young folks will pour their hearts out via anonymous forums, surveys, etc., and yet “take the 5th” in a person-to-person setting. Sometimes, a person will grow up and talk later, when school is a distant memory of “merciless cruelty.”

Quality of Life Studies” and its sequel discuss some of the original research projects that have formed current opinion about quality of life among the young and obese. A classic study compared obese kids to young cancer patients undergoing chemotherapy treatment, and the observations included an interesting sidebar about the parents of obese kids: They rate their children as even more unhappy than the children rate themselves.

Is it possible that parents overreact to a situation in which they themselves would be miserable, but where some kids seem comfortable? Perhaps mobs of overweight and obese children and teens will rebel against the the adults, chanting “We’re okay, go away!” Do we have that science fiction movie to look forward to?

Scientists are trying to get a handle on the whole cause-and-effect thing. Does the physical condition of being overweight or obese make a child’s quality of life decline? Or does the messed-up life come first, so the child eats and puts on weight in reaction? As so often happens, the answer is both. Some kids never have a chance; they are born overweight and it only gets worse. The younger it starts and the longer a young person stays overweight, the less chance there is to ever reverse it.

Of course, the other scenario happens too. A normal-weight child winds up in the wrong circumstances and, suddenly, food is their only friend. A vicious cycle can start with fatness and then become emotional distress, expressed by eating to “stuff” the feelings, but naturally that leads to more flab, and so on.

Or emotional disturbance can turn people fat who never were before, and then they are even more upset, so a sturdy and resilient vicious cycle is constructed. Either way, it is a disastrous whirlpool to be caught in.

Your responses and feedback are welcome!

Photo credit: VFS Digital Design via Visualhunt/CC BY

Why Measuring Matters

escali-food-scale-and-wahoo-body-weight-scale

As we have seen, for the W8Loss2Go program, Dr. Pretlow initially tried a “cutting in half” method in which the participant would first take what for her or him would be a typical serving, then put back half, or even a quarter. The fraction was irrelevant because just “eyeballing” the portions didn’t work anyway. The mind is a trickster, especially when rewards are involved, and food is very rewarding.

As a 10-year-old boy in the study noted, “Tt lets you get away with more than you’re actually supposed to have.” It became evident that some sort of measuring would have to be implemented, and there was an intermediary try-out stage, which Dr. Pretlow describes thusly:

We had participants measure out their amounts at meals with measuring spoons, cups, and rulers. Then, they would remove 1/2 inch, 1/2 tablespoon, 1/4 cup, etc. from whatever portion they were serving themselves. That procedure also didn’t work very well, because their starting amounts were too indefinite and attempting to progressively reduce amounts was too inaccurate.

Then the process was further refined:

Finally, we had participants weigh their typical portions with a food scale. Then, they would remove an ounce, etc., and put it back. That procedure was an order of magnitude improvement in the amounts reduction process, because it turned the amounts they were eating into a number, which the app could then progressively reduce in small increments. And, participants were amazed that they didn’t miss the subtracted amounts.

In an audio clip, we hear one of the participants express that very thought. Another, a young woman of 17, reported, “It works because it’s an ‘exact number, ‘ I can’t add more or less, there’s no decision.” Just as with anything worth doing, the setup involves a bit of focus. The person needs to choose a baseline group of frequently-eaten foods and enter some information and so on. Then,

Participant will eat only those progressively reduced amounts from his/her logged foods list, and no other foods, until his/her weight starts dropping. If his/her weight drops and continues dropping, the food amounts are kept at that percent cut level. If his/her weight stops dropping, amounts are reduced by further percent cuts of all the foods logged, until the weight resumes dropping.

Makes sense, right? There are a few other things to know, for instance:

The “Tare” function of the scale allows zeroing out the weight of the plate and each food in turn, when the foods are added one at a time to the plate for the meal. Thus, there is no mess, and the meal is ready to eat.

For younger kids, it’s really great when a parent or older sibling is on hand to help out. Hopefully, older kids will find a source of accomplishment and pride as they master the learning curve and become expert in helping the program to calibrate their servings. Some, like the young lady heard in this audio excerpt, will really get into it.

Once again, we recommend the very thorough documentation of how the W8Loss2Go smartphone app can help to change a life. In particular, for a serious hardcore information-acquisition session, turn to these pages that explain the application’s rationale, methods, and instructions.

Your responses and feedback are welcome!

Image source: W8Loss2Go

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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