OBJECTIVE Self-efficacy is a crucial factor in enabling pediatric primary care providers (PCPs) to deliver recommended care to children with overweight and obesity. This study, conducted with a large, national sample of PCPs, aimed to... more
OBJECTIVE Self-efficacy is a crucial factor in enabling pediatric primary care providers (PCPs) to deliver recommended care to children with overweight and obesity. This study, conducted with a large, national sample of PCPs, aimed to identify key factors which may contribute to PCP self-efficacy for obesity-related care, from a list of previously reported barriers and facilitators. METHODS A national random sample of American Academy of Pediatrics members were surveyed in 2017 (analytic n=704). Factor analysis was used to identify self-efficacy variables from relevant indicators and assess fit. Multivariable linear regression analyses were conducted to identify key predictors of PCP self-efficacy from reported facilitators or barriers to care, including characteristics of the PCP, practice, community, and payment systems. RESULTS Two PCP self-efficacy variables were identified: health risk assessment and patient-centered counseling. Both were positively predicted by relevant training, the belief that pediatricians play an important role in obesity, and awareness of barriers to payment for dietitians or weight management programs. Both were negatively predicted by a perceived lack of available PCP time for counseling and inadequacy of available referral resources to assist with treatment. Additional predictors of counseling self-efficacy included PCP beliefs that they are paid for treatment (+) and that patients/families lack time for healthy behaviors (-). Electronic health record clinical decision supports or registries and patient social disadvantage were not predictive. CONCLUSIONS Results suggest multiple potential roles and strategies for local and national organizations seeking to facilitate improvements to PCP self-efficacy in caring for children with overweight and obesity.
Research Interests:
The prevalence of obesity in the pediatric population has risen more than 20% in 25 years. Accordingly, surgical procedures on obese children have become more common. Adenotonsillectomy (AT) remains among the most frequently performed... more
The prevalence of obesity in the pediatric population has risen more than 20% in 25 years. Accordingly, surgical procedures on obese children have become more common. Adenotonsillectomy (AT) remains among the most frequently performed pediatric surgical procedures in the United States. Our objective was to determine if there is an increased complication rate in morbidly obese (MO) children undergoing AT and if elective pediatric intensive care unit (PICU) admission for observation is warranted. This retrospective study includes postoperative admissions to the PICU over a 4-year period at one hospital. Out of 957 adenotonsillectomies performed by one surgeon, 543 were admitted to the hospital. Fourteen MO children were identified. Using body mass index (BMI; weight in kg/m(2)), as calculated for age appropriate categories, postoperative outcomes of AT in MO children (>95th percentile BMI) were determined. These 14 were electively admitted to the PICU for airway observation. The indication for surgery in these 14 children was obstructive sleep apnea. Ages ranged from 4 to 15 years. There were 11 males and 3 females. Two patients required overnight bi-level positive airway pressure (BiPAP) for oxygen desaturation. One patient remained intubated for 10 days. Three patients required supplemental oxygen. Four of these admissions had preoperative polysomnograms (PSGs). Our study concluded that routine PICU admission was not warranted for most MO patients although several required supplemental oxygen, BiPAP, and one required intubation. These interventions can easily be administered in a surgical floor bed. In fact, these results imply that performing this surgical procedure in obese children is not as risky as many believe. Trends were noted for an increased need of airway interventions in children requiring preoperative BiPAP and in those with comorbidities. In this small population, sample AT was performed on the basis of history. This is to serve as a pilot review for a prospective study in which preoperative PSGs would be used to determine potential indicators for elective PICU admission.
Research Interests: Pediatrics, Adolescent, Medicine, Humans, Child, and 15 moreObstructive sleep apnea, Female, Male, Body Mass Index, Adenoidectomy, Clinical Sciences, Retrospective Studies, Airway Obstruction, Pilot Projects, Retrospective Study, Prospective Study, Cohort Studies, Postoperative Complications, Child preschool, and Paediatrics and reproductive medicine
ObjectiveTo compare primary care pediatricians’ practices and attitudes regarding obesity assessment, prevention, and treatment in children 2 years and older in 2006 and 2017.Study designNational, random samples of American Academy of... more
ObjectiveTo compare primary care pediatricians’ practices and attitudes regarding obesity assessment, prevention, and treatment in children 2 years and older in 2006 and 2017.Study designNational, random samples of American Academy of Pediatrics members were surveyed in 2006, 2010, and 2017 on practices and attitudes regarding overweight and obesity (analytic n = 655, 592, and 558, respectively). Using logistic regression models (controlling for pediatrician and practice characteristics), we examined survey year with predicted values (PVs), including body mass index (BMI) assessment across 2006, 2010, and 2017 and practices and attitudes in 2006 and 2017.ResultsPediatrician respondents in 2017 were significantly more likely than in 2006 and 2010 to report calculating and plotting BMI at every well-child visit, with 96% of 2017 pediatricians reporting they do this. Compared with 2006, in 2017 pediatricians were more likely to discuss family behaviors related to screen time, sugar-sweetened beverages, and eating meals together, P < .001 for all. There were no observed differences in frequency of discussions on parental role modeling of nutrition and activity-related behaviors, roles in food selection, and frequency of eating fast foods or eating out. Pediatricians in 2017 were more likely to agree BMI adds new information relevant to medical care (PV = 69.8% and 78.1%), they have support staff for screening (PV = 45.3% and 60.5%), and there are effective means of treating obesity (PV = 36.3% and 56.2%), P < .001 for all.ConclusionsResults from cross-sectional surveys in 2006 and 2017 suggest nationwide, practicing pediatricians have increased discussions with families on several behaviors and their awareness and practices around obesity care.
Research Interests:
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will... more
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are clinically based, effective treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori key questions.
Research Interests:
Research Interests:
Research Interests:
The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice... more
The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are effective clinically based treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori Key Questions.
Research Interests:
Purpose: Expert guidelines recommend primary care pediatricians identify obesity in children and provide patient-centered counseling around lifestyle risk behaviors. We compared the effect of delivering lifestyle risk behaviors counseling... more
Purpose: Expert guidelines recommend primary care pediatricians identify obesity in children and provide patient-centered counseling around lifestyle risk behaviors. We compared the effect of delivering lifestyle risk behaviors counseling by primary care providers with and without a health coach reinforcing this messaging via telemedicine on patients’ reported behaviors, risk category and weight status. Methods A prospective, randomized, open-label intervention study was conducted over 12 months. Participants were assigned to one of two groups 1) telemedicine lifestyle risk behavior counseling (Telehealth) with CCDSS-supported primary care and 2) CCDSS-supported primary care (PC) …
Research Interests:
Research Interests:
Research Interests:
Background The objective of this study is to describe the weight trajectory of refugee children after resettlement in the US. Methods A pilot study was conducted, utilizing longitudinal data obtained from the electronic health record of... more
Background The objective of this study is to describe the weight trajectory of refugee children after resettlement in the US. Methods A pilot study was conducted, utilizing longitudinal data obtained from the electronic health record of 129 children between 2 and 18 years of age (54% female, mean age 10 years) from the 3 primary countries of origin presenting to a refugee clinic (Bhutan, N = 71; Burma, N = 36, and Iraq, N = 22).. Mixed effects model analyses were utilized to characterize weight trajectory with calculation of a per year change in BMI-z score, adjusting for baseline BMI-z score, age, and time. Results There was a significant increase in BMI-z (mean 0.15 units/year, p=0.04) among refugee children during their initial period after resettlement. Female children from Bhutan demonstrated the most rapid increase in weight, with a mean BMI-z gain of 1.00 units/year. Conclusion Female children from Bhutan demonstrated rapid weight gain after resettlement in the US. Further st...
Research Interests:
Background: Evidence increasingly supports the importance of the first 1000 days of development for obesity prevention and overall child health. However, recent national studies highlight many relevant gaps in early child nutrition. Only... more
Background: Evidence increasingly supports the importance of the first 1000 days of development for obesity prevention and overall child health. However, recent national studies highlight many relevant gaps in early child nutrition. Only 36% of children are breastfed for the recommended duration (≥12 months). In addition, 55% of infants are introduced to complementary foods before ≅6 months, and 16% before 4 months. On a given day about a quarter of children ages 6-12 months reportedly eat no fruits or vegetables, but about a third consume sugary beverages/snacks, a value that more than doubles before age two. Resources are now available to …
Research Interests:
Research Interests:
Severe obesity defined as an age- and gender-specific body mass index ≥120% of the 95th percentile in children younger than 5 years is well recognized as a significant challenge for prevention and treatment. This article provides an... more
Severe obesity defined as an age- and gender-specific body mass index ≥120% of the 95th percentile in children younger than 5 years is well recognized as a significant challenge for prevention and treatment. This article provides an overview of the prevalence, classification of obesity severity, patterns of weight gain trajectory, medical and genetic risk factors, and comorbid disorders among young children with an emphasis on severe obesity. Studies suggest rapid weight gain trajectory in infancy, maternal smoking, maternal gestational diabetes, and genetic conditions are associated with an increased risk for severe obesity in early childhood. Among populations of young children with severe obesity seeking care, co-morbid conditions such as dyslipidemia and fatty liver disease are present and families report behavioral concerns and developmental delays. Children with severe obesity by age 5 represent a vulnerable population of children at high medical risk and need to be identified...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Background. The identification of the ob gene and its adipocyte-specific protein leptin has provided the first physiologic links to the regulatory system controlling body weight. In adults, elevations of serum leptin concentrations were... more
Background. The identification of the ob gene and its adipocyte-specific protein leptin has provided the first physiologic links to the regulatory system controlling body weight. In adults, elevations of serum leptin concentrations were closely correlated with the percentage of body fat. This study investigated whether leptin concentrations were elevated in obese children and the relationship between leptin concentrations and gender, pubertal stage, and race. Methods. Seventy-seven children (44 girls and 33 boys), mean age, 11.3 years, with a body mass indices (BMIs) greater than 95% for age, race, and gender (mean BMI, 34.4) constituted the obese group. Thirty children (20 girls and 10 boys), mean age, 13.3 years, with BMIs less than 85% for age, race, and sex formed the control group. Radioimmunoassay for serum leptin was performed on a blood sample collected from each child after an overnight fast. Results. The mean serum concentration of leptin in the obese group was 38.6 (SD, 2...
Research Interests:
Advanced Health Information Technologies to Engage Parents, Clinicians, and Community Nutritionists in Coordinating Responsive Parenting Care: Descriptive Case Series of the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care Randomized Controlled Trialmore
Background Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in... more
Background Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in conflicting messages. Stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs. Objective This analysis describes the usability of advanced health information technologies aiming to engage parents in self-reporting parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC nutritionists. Methods Parents and newborns (dyads) who were eligible for WIC care and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the 6-month interven...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Pediatrics, Obesity, Family Medicine, Medicine, Logistic Regression, and 15 moreMultivariate Analysis, Motivational Interviewing, Overweight, Humans, Female, Male, Preparedness, Adult, Odds ratio, Post graduate medical education, Pediatric Obesity, Clinical Competence, Logistic Models, Confidence Interval, and Paediatrics and reproductive medicine
Research Interests:
ABSTRACT Objective: Our purpose in this paper is to describe parental perceptions of weight-related behaviors in young children with obesity. Methods: Fifty-nine parents of children with obesity aged 4 to 7 completed the Lifestyle... more
ABSTRACT Objective: Our purpose in this paper is to describe parental perceptions of weight-related behaviors in young children with obesity. Methods: Fifty-nine parents of children with obesity aged 4 to 7 completed the Lifestyle Behaviour Checklist (LBC), assessing how problematic they perceived their child&#39;s weight-related behaviors to be. Scores were compared among subgroups based on demographics, psychosocial factors, and weight status. Results: Half of children were Hispanic and 76% had severe obesity. Sixty percent had clinically significant LBC scores. Non-Hispanic children, children with severe obesity, and children of families reporting food insecurity were reported to have more problematic behaviors (p Conclusions: Weight-related behaviors identified by parents of children with obesity as problematic may be an important target of intervention to reduce the burden of childhood obesity.
Research Interests:
In 2005, an expert committee was convened on behalf of the American Medical Association, the Health Resources and Service Administration, and the Centers for Disease Control and Prevention to update the previous recommendations on the... more
In 2005, an expert committee was convened on behalf of the American Medical Association, the Health Resources and Service Administration, and the Centers for Disease Control and Prevention to update the previous recommendations on the evaluation and treatment of childhood obesity. Fifteen national health care organizations, which served children, participated in writing these recommendations. This article reviews recommendations on assessment of BMI, nutrition and activity, and obesity-related comorbidities. Principles of obesity prevention and treatment are discussed and high-risk eating and activity behaviors are addressed. Prevention and treatment of obesity are reviewed as set in the context of the Medical Home using the principles of the chronic disease model. The stepwise approach to obesity treatment and prevention is reviewed along with specific evidence-based/informed strategies. The skills needed to implement the recommendations, such as integration of the care team, roles...
Research Interests:
This article briefly describes the Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity and explains how the Delaware Primary Care Initiative on Childhood... more
This article briefly describes the Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity and explains how the Delaware Primary Care Initiative on Childhood Overweight, a quality improvement initiative, trains primary care practices to implement them. It includes a Delaware pediatrician's first-hand description of how she incorporates the recommendations into her daily practice using motivational interviewing and the 5-2-1-Almost None healthy lifestyle message.
Research Interests:
Research Interests:
Research networks assemble interdisciplinary researchers and practitioners to conduct, support, promote, and disseminate research on complex topics that require an interdisciplinary approach to ensure forward progress. The problem of... more
Research networks assemble interdisciplinary researchers and practitioners to conduct, support, promote, and disseminate research on complex topics that require an interdisciplinary approach to ensure forward progress. The problem of childhood obesity in children with ASD/DD is a topic well-suited to such an approach. As part of its foundational work, the Healthy Weight Research Network for Children with ASD/DD (HWRN), funded by HRSA’s Maternal and Child Health Bureau, undertook an agenda-setting process using a modified Delphi method. Twenty-three members and advisors representing the disciplines of epidemiology, exercise science, family studies, nutrition, pediatrics, psychiatry, psychology, public health, and self-advocacy provided initial topic ideas via an open-ended survey. Topics were grouped into 19 areas and expanded further at a kick-off meeting. Topics were then condensed into 9 themes and accompanied by exemplar research questions, and the group was re-surveyed. Themes i...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The obesity epidemic has been part of the pediatric landscape since the 1980s and is now one of the most common issues that pediatricians confront in their day-to-day practice. From the first National Health and Nutrition... more
The obesity epidemic has been part of the pediatric landscape since the 1980s and is now one of the most common issues that pediatricians confront in their day-to-day practice. From the first National Health and Nutrition ExaminationSurvey (NHANES) (1971–1974) toNHANES2003–2006, obesity (BMI 95th percentile for age and gender) increased from 5.0% to 12.4% in children aged 2 to 5 years, from 4.0% to 17.0% in children aged 6 to 11 years, and from 6.1% to 17.6% in adolescents (aged 12–19 years).1–4 Although there is evidence that these rates have begun to stabilize,4 this leaves us with 16.3% of 2to 19-year-olds with BMI values above the 95th percentile and 31.9% above the 85th percentile.5
Research Interests:
Research Interests:
Research Interests:
Testosterone and luteinizing hormone secretion is reportedly impaired in infants born with cryptorchidism. To better characterize this phenomenon, we studied a range of hormones that normally increase in boys during the first few months... more
Testosterone and luteinizing hormone secretion is reportedly impaired in infants born with cryptorchidism. To better characterize this phenomenon, we studied a range of hormones that normally increase in boys during the first few months of life. A case-control study was conducted of boys with nonsyndromic cryptorchidism identified at birth (cases) and boys with descended testes presenting to the urology clinic without endocrine related concerns (controls). Blood was obtained at approximately 2 months of age and up to 3 urine samples were obtained at monthly intervals until age 120 days. Testosterone, estradiol, luteinizing hormone and follicle-stimulating hormone were measured in plasma and urine, and inhibin B, sex hormone-binding globulin (SHBG) and leptin were measured in plasma using standard assays. Data were analyzed using t tests with and without log transformation. Of 20 cases 15 were unilaterally cryptorchid. Although 7 testes descended spontaneously, 2 became cryptorchid again during followup and, therefore, 15 boys required orchiopexy. Diagnoses of 26 controls included foreskin problems (15), prenatal hydronephrosis (4), penile torsion (2), ectopic kidney (1) and hydrocele (1). None of the plasma or urinary hormone measurements was significantly different between boys requiring orchiopexy and controls. Plasma SHBG and testosterone, SHBG, estradiol and leptin, and body mass index positively correlated, while testosterone and body mass index negatively correlated. We failed to identify any significant differences in hormone levels between controls and boys with cryptorchidism during activation of the pituitary-testicular axis in early infancy. These data suggest that impairment of this process may be uncommon in boys with nonsyndromic cryptorchidism.
Research Interests: Endocrinology, Urology, Medicine, Prospective studies, Humans, and 14 moreInternal Medicine, Testosterone, Male, Infant, tESTIS, Cryptorchidism, Clinical Sciences, Pituitary Gland, Hormone, Sex hormone-binding globulin, Luteinizing Hormone, Estradiol, Follicle stimulating hormone, and Case Control Studies
Research Interests:
Research Interests: Obesity, Adolescent, Medicine, Humans, Child, and 13 moreTibia, Femur, Female, Male, Pediatric, Body Mass Index, Slipped capital femoral epiphysis, Phenotype, Pediatric Orthopaedics, Polycystic ovarian disease, Type 2 Diabetes Mellitus, Pediatric Orthopedics, and Paediatrics and reproductive medicine
... DOI: 10.1080/02739615.2011.590386 Danielle L. Rosnov a , Michael C. Roberts a , Emily D. Kessler a , Jennifer Shroff ... [CrossRef], [Web of Science ®] View all references), others have shown modest, unsustainable improvements... more
... DOI: 10.1080/02739615.2011.590386 Danielle L. Rosnov a , Michael C. Roberts a , Emily D. Kessler a , Jennifer Shroff ... [CrossRef], [Web of Science ®] View all references), others have shown modest, unsustainable improvements (Berkowitz, Wadden, Tershakovec, &amp; Cronquist ...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have... more
Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP’s 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be not...
Research Interests: Neurology, Pediatrics, Primary Care, Autism, Disability Studies, and 15 morePrimary Health Care, Health Services Research, Medicine, Overweight, Humans, Child, Autism Spectrum Disorder, Clinical Nutrition and Dietetics, Weight Management, Health Services Administration, Pediatric Obesity, Nutritional and Metabolic Diseases, Psychiatry and Psychology, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
New care delivery models call for integrating health services to coordinate care and improve patient-centeredness. Such models have been embraced to coordinate care with evidence-based strategies to prevent obesity. Both the Special... more
New care delivery models call for integrating health services to coordinate care and improve patient-centeredness. Such models have been embraced to coordinate care with evidence-based strategies to prevent obesity. Both the Special Supplemental Program for Women, Infants and Children (WIC) Program and pediatricians are considered credible sources of preventive guidance, and coordinating these independent siloes would benefit a vulnerable population. Using semistructured focus groups and interviews, we evaluated practices, messaging, and the prospect of integrating and coordinating care. Across Pennsylvania, WIC nutritionists (n = 35), pediatricians (n = 15), and parents (N = 28) of an infant or toddler participated in 2016. Three themes were identified: health assessment data sharing (e.g., iron, growth measures), benefits and barriers to integrated health services, and coordinating care to reduce conflicting educational messages (e.g., breastfeeding, juice, introduction of solids)...