Strategies for Addressing Childhood Obesity in Canadian Children

This content delves into the prevalence of overweight and obesity in Canadian children, comorbidities associated with these conditions, impacts in adulthood, and challenges in adherence to care standards. It also discusses practical intervention guidelines focused on lifestyle modifications and motivational interviewing techniques in the primary care setting to address childhood obesity effectively.

• Childhood obesity
• Canadian children
• Intervention strategies
• Lifestyle modifications
• Motivational interviewing.

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1. Jrmie Marcoux Vendredi 2 juin 2017

2. % enfants canadiens atteints de surpoid ou dobsit ? (stat can 2011, Rodd CMAJ 2016) Comorbidit s (Lambert 2008; Fennoy 2010) R percussions l ge adulte (Reilly 2011) Faible adh rence aux standards de soins (Mabry 2005, Cook 2005, Hillman 2009, Kuhle 2011;)

3. Guide de pratique (INESS 2012) Intervention ax e sur le mode de vie Pas de recommandation quant au type d entrevue pour y parvenir Revue syst matique 0-6 ans (Colquitt, Loveman et al. 2016)

4. P: 6-18 ans, embonpoint ou obsit primaire I: Entrevue visant la modification des habitudes de vie C: soins usuels, liste d attente O: mesures anthropom triques diverses (IMC, IMC-z, % adiposit ) (Millstein 2014)

6. Revue de la littrature sur PubMed Mai 2011-janvier 2017 Strat gie de recherche Compl t e avec d autres mots cl s de revues syst matiques (Martin, Chater et al. 2013, Colquitt, Loveman et al. 2016)

7. MESH utiliss Overweight, obesity, abdominal obesity, pediatric obesity, child, adolescent Population Intervention Motivational interviewing, therapy, therapeutics, interview, psychological, counseling, directive counselling, patient education as topic, health education, health behavior, health promotion, life style, healthy lifestyle, psychotherapy, psychotherapy, group psychotherapy, psychodynamic, psychotherapy, rational-emotive, psychotherapy, multiple psychotherapy, brief, cognitive therapy, behavior therapy, behavior control, social support, family therapy, acceptance and commitment therapy, reality therapy Body weight, ideal body weight, weight loss, body weight changes, body weight maintenance, waist-height-ratio, body mass index, waist circumference Issue primaire

8. Critres inclusion 6 18 ans Crit res exclusion tudes qui ciblent sp cifiquement les IMC>99,9ep ou IMC-z >3 Comorbidit s pouvant interf rer avec le traitement Prise de m dicaments potentiellement confondant Interventions ne pouvant tre administr es dans un contexte de soins de premi re ligne Intervention n incluant pas d entrevue en face face Intervention d velopp sp cifiquement pour un groupe culturel autre que Nord-Am ricain D finition reconnue de l embonpoint ou de l ob sit Essai clinique randomis Essai clinique contr l Essai clinique pragmatique Fran ais, anglais Mai 2011 7 janvier 2017 Pas assez d information dans l article, les annexes et le protocole pour statuer sur le respect des crit res d inclusion et d exclusion.

10. 4 articles identifis par la recherche manuelle 2235 articles identifi s par la recherche de litt rature 2233 articles apr s retrait des duplicats et protocoles 2173 exclus par application des crit res d inclusion et d exclusion 52 exclus 2233 valu s par le titre et le r sum ge = 13 Participants de poids normal = 3 60 articles valu s par lecture du manuscrit complet Ob sit non d finie = 1 Entrevue n est pas l l ment principal de l intervention = 2 8 inclus Intervention sans entrevue individuelle en face face = 5 Intervention de groupe seulement = 6 Intervention en contexte d hospitalisation = 2 Intervention inclue AP supervis e = 2 M thode d entrevue non d finie = 3 Groupe contr le inexistant ou inad quat= 7 Autre issu primaire = 7 Pas assez d information pour statuer sur l ligibilit =1

11. tude (Brennan, Walkley et ge 11-19 Pays Australie Inclusion Embonpoint ou ob sit (IOTB) IMC > 85e p (OMS) Intervention individuelle al. 2013) (Cohen 2016) 6-8.5 Canada (Danielsen, Nordhus et al. 2013) 7-13 Norv ge Ob sit (IOTB) (Kong, Sussman et al. 2013) 15 ans (9-11e ann e) USA (hispanique 75%) IMC >85e p (Norman, Huang et al. 2016) 11-13 USA (83% hispanique) IMC >95e p (CDC)

12. tude Intervention Intensit Professionne l Psychologue Suivi Contr le n (Brennan, Walkley et al. 2013) EM 1h x1, puis TCC 16h45 17 visites 6 mois 9h00 6 visites 12 mois 9h45 13 visites 3 mois Step up/step down 8 visites 6 mois 19h 12 visites 12 mois 6 mois Liste d attente 63 (Cohen 2016) EM + TCP Nutritionniste 0 Visite initiale PRN 78 (Danielsen, Nordhus et al. 2013) (Kong, Sussman et al. 2013) FBBT Psychologue 12 mois Liste d attente 49 EM + 8 appels aux parents, mat riel crit Infirmi re M decin de famille 0 Visite initiale + Liste d attente 60 (Norman, Huang et al. 2016) SCT M decin ducateur 0 Visite initiale Visite avec ducateur Mat riel crit 106 TCC: th rapie cognitivo-comportementale. EM: entrevue motivationnelle. TCP: th rapie bas e sur la th orie du comportement planifi . FBBT: family-based behavioral therapy SCT: th rapie bas e sur la th orie socio-comportementale

13. Dveloppe dans les annes 80 Approche la plus tudi e (Coppock, Ridolfi et al. 2014), (Kendall 2012) 8 tudes, 437 enfants, 14-18 s ances, IMC-z 12 mois de 0,86 (Epstein, Paluch et al. 2007) Cible changement dans l alimentation et l AP des enfants et parents Habilet s comportementales

14. tude Interv ention EM 1h x1, puis TCC Intensit Professionnel Suivi R sultats Taillet d effet (Brennan, Walkley et al. 2013) 16h45 17 visites 6 mois Psychologue 6 mois -1,17 % pourcentage adiposit p=0.004 Petit (Cohen s d = 0.18) (Cohen 2016) EM + TCP 9h00 6 visites 12 mois Nutritionniste 0 IMC-z = non chiffr (p <0.001 12 mois) % gras = non chiffr (p=0.032 12 mois) IMC-Z = -0,16 (p=0,001) Inconnu (Danielsen, Nordhus et al. 2013) (Kong, Sussman et al. 2013) FBBT 9h45 Psychologue 12 mois Petit 13 visites 3 mois 8 visites 6 mois EM Infirmi re M decin de famille M decin ducateur 0 1. IMC perc= 0,6 (p=0,04) 2. tour de taille =-1,7 cm (p=0,04) IMC = -0.7 chez les H (p=0,003) Moyen (Cohen s d = 0,55) Moyen (Cohen s d =0,7) (Norman, Huang et al. 2016) SCT 19h 12 visites 12 mois 0

15. tude ge Pays Inclusion (Croker, Viner et al. 2012) 8-12 Grande - Bretagne (Blanc 57% Noir 19%) USA (Caucasien 85%) Embonpoint ou ob sit (IOTB ) (Saelens, Lozano et al. 2013) 7-11 IMC >85e p (CDC) 1 parent IMC >25 Ob sit (IOTB) (Vos, Huisman et al. 2012) 8-17 Pays-Bas

16. tude Intervention Intensit Professionnel Suivi Contr le n (Croker, Viner et al. 2012) FBBT 22h30 15 visites 6 mois Nutritionniste Psychologue Th rapeute familial 6 mois N=35 Liste d attente 72 (Saelens, Lozano et al. 2013) FBBT + EM 11h00 Intervenant familial 2 ans FBBT 89 20 visites 5 mois (Vos, Huisman et al. 2012) TCC 22h30 8 visites 3 mois Nutritionniste Physioth rapeute Psychologue Travailleur social 9 mois N=40 Conseils sur AP et alimentation 81

17. tude Intervention Intensit Suivi R sultats Taillet d effet (Croker, Viner et al. 2012) FBBT 22h30 15 visites 6 mois 6 mois IMC = -0.46 (p=0.17) 0 IMC en excluant 1 valeur aberrante = - 0.63 (p=0,03) IMC = - 0,34 (p=0,9) (Saelens, Lozano et al. 2013) FBBT + EM 11h00 20 visites 5 mois 2 ans 0 (Vos, Huisman et al. 2012) TCC 22h30 8 visites 3 mois 9 mois 3 mois IMC-z =-0.2 (p=0,05) Moyen (Cohen s d =0.59) 12 mois IMC-z -0.4 (p=0.01)

19. Cochrane collaboration risk of bias tool (Higgins, Altman et al. 2011) Biais de s lection Biais de performance G n ration de la s quence de randomisation personnel (Brennan, 2013) Faible Faible Haut Biais de d tection Aveuglement la mesure de l issu Faible Biais d attrition Donn es manquantes sur les issus Haut Biais de report Report s lectif Impr visibilit de la r partition Aveuglement des participants et du Faible (Cohen, 2016) (Croker et al., 2012) (Danielsen, 2013) (Kong et al., 2013) (Norman et al., 2016) (Saelens, 2013) Faible Faible Faible Faible Haut Haut Faible Faible Faible Haut Haut Faible Haut Haut Haut Haut Haut Faible Incertain Incertain Haut Incertain Haut Faible Faible Faible Haut Incertain Haut Faible Incertain Faible Faible Faible Faible Faible (Vos, 2012) Faible Haut Haut Incertain Haut Faible

20. Cochrane collaboration risk of bias tool (Higgins, Altman et al. 2011) Biais de s lection Biais de performance G n ration de la s quence de randomisation personnel (Brennan, 2013) Faible Faible Haut Biais de d tection Aveuglement la mesure de l issu Faible Biais d attrition Donn es manquantes sur les issus Haut Biais de report Report s lectif Impr visibilit de la r partition Aveuglement des participants et du Faible (Cohen, 2016) (Croker et al., 2012) (Danielsen, 2013) (Kong et al., 2013) (Norman et al., 2016) (Saelens, 2013) Faible Faible Faible Faible Haut Haut Faible Faible Faible Haut Haut Faible Haut Haut Haut Haut Haut Faible Incertain Incertain Haut Incertain Haut Faible Faible Faible Haut Incertain Haut Faible Incertain Faible Faible Faible Faible Faible (Vos, 2012) Faible Haut Haut Incertain Haut Faible

21. Cochrane collaboration risk of bias tool (Higgins, Altman et al. 2011) Biais de s lection Biais de performance G n ration de la s quence de randomisation personnel (Brennan, 2013) Faible Faible Haut Biais de d tection Aveuglement la mesure de l issu Faible Biais d attrition Donn es manquantes sur les issus Haut Biais de report Report s lectif Impr visibilit de la r partition Aveuglement des participants et du Faible (Cohen, 2016) (Croker et al., 2012) (Danielsen, 2013) (Kong et al., 2013) (Norman et al., 2016) (Saelens, 2013) Faible Faible Faible Faible Haut Haut Faible Faible Faible Haut Haut Faible Haut Haut Haut Haut Haut Faible Incertain Incertain Haut Incertain Haut Faible Faible Faible Haut Incertain Haut Faible Incertain Faible Faible Faible Faible Faible (Vos, 2012) Faible Haut Haut Incertain Haut Faible

22. Interventions individuelles semblent plus efficaces TCC 2 tudes/2 positives, 1 bonne qualit FBBT et EM 1 tude/2 positive chacune, faible qualit (Saelens, Lozano et al. 2013) (Croker, Viner et al. 2012) SCT, TCP 1 tude/1 positive, bonne qualit Efficacit > ?

23. Signification clinique Taille d effet Sans Tx, embonpoint et ob sit progressent (Cunningham, Kramer et al. 2014) Maintien Vs r duction de l embonpoint/ob sit Interpr tation des 2 r sultats n gatifs Effets ind sirables

24. Implication clinique Existence d interventions efficaces Intensit de Tx > offre Organisation des soins Qui peut potentiellement le plus en b n ficier ?

25. Prvalence de lembonpoint et de lobsit Interventions tudi es et efficaces Agir t t Organisation des soins

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