Summary/ImplicationsSummarize your main findings and point out how your clinical question was answered or not answered; what were the gaps in the research; and possible new inquiryclinical question : How does participation in play impact obesity in children?I attach the 3 articles_______________________________________________________________
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1. Childhood obesity as an emerging area of practice for occupational therapists: A case report………………. 1
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Childhood obesity as an emerging area of practice for occupational therapists: A case report
Author: Pizzi, Michael; Orloff, Susan
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Full text: Headnote
The impact of childhood obesity on occupational performance has received little attention in the professional
literature, despite its impact on children’s participation in school. Childhood obesity has become a pandemic
and results in physical, psychosocial, emotional and academic challenges that the profession of occupational
therapy could meet. This descriptive case study addresses the challenges and occupational concerns related to
siblings who are overweight. The paper outlines the role of occupational therapy in childhood obesity,
occupational interventions that were implemented and, strategies for occupational therapists to incorporate into
client and family-centered care.
Key words
Family centred care, occupational therapy, quality of life
The Centres for Disease Control (CDC) cited that more than one-third of U.S. adults (35.7%) and approximately
17% (or 12.5 million) of children and adolescents aged 2-19 years are obese (CDC, 2013). The US centennial
vision for the profession of occupational therapy stated, “We envision that occupational therapy is a powerful,
widely recognized, science-driven, and evidence-based profession with a globally connected and diverse
workforce meeting society’s occupational needs” (AOTA, 2007). Childhood obesity is becoming a pandemic that
does and will impact all societies and all populations for decades unless preventive, proactive and innovative
approaches are taken (WFIO, 2014; Pizzi et al” 2014). These innovative approaches need to consider the
child’s occupational challenges in the context of multiple environments.
The most recent statistics from 2008 by the World Health Organization stated the following key facts:
* Worldwide obesity has nearly doubled since 1980.
* In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly
300 million women were obese.
* 35% of adults aged 20 and over were overweight in 2008, and 11 % were obese.
* 65% of the world’s population live in countries where overweight and obesity kills more people than
* More than 40 million children under the age of 5 were overweight or obese in 2012.
* Obesity is preventable (WHO, 2014).
Equally, the most recent statistics cited by the Health Ministry of New Zealand state that one in nine children
aged two to fourteen years were obese (11 %) and one in four children were overweight (22%) (New Zealand
Ministry of Health, 2014). The Ministry also defined obesity as “an excessively high amount of body fat (adipose
tissue) in relation to lean body mass. Obesity is associated with a substantially increased risk of a number of
health conditions” (New Zealand Ministry of Health: Obesity, 2014). This paper explores the role of occupational
therapy in helping to remediate some of the social, physical, mental/ emotional and learning challenges and
health conditions of sisters who present with learning challenges while being overweight.
Literature review
Children who are overweight, despite their race, colour and nation of origin, are all at risk of experiencing
multiple health issues as adults and must cope dally with mental, physical and social challenges associated with
obesity (Pizzi &Vroman, 2013). They are also prone to many health risks that include but are not limited to
elevated cholesterol levels, joint problems and musculoskeletal problems, high blood pressure, Increased risk
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for childhood diabetes, and mental and social health issues (CDC, 2013). While occupational therapists
consider these issues as client factors, we will argue that childhood obesity should be viewed relative to
impairment in occupational participation In the context of home, school and community.
The participation of families in helping children who are overweight or obese has been found to be very effective
(Epstein, et al., 1990; Golan et al., 1998). “An awareness of family influences and an appreciation of the
relationship between eating behaviours and social contexts can be Important in the development of early
healthy eating habits” (Kuczmarski, Reitz &Pizzi, 2010, p. 270). However, there is evidence that children who
come from families with at least one parent who is overweight or obese, despite parenting style or family
functioning will also be overweight or obese (Gibson, et al., 2007). Obese children under three years of age
whose parents are not obese are at low risk for obesity In adulthood. However obesity among older children Is
an increasingly important predictor of adult obesity, regardless of the parent’s size. Parental obesity more than
doubles the risk of adult obesity among both obese and non-obese children under ten years of age (Whitaker et
al., 1997). This is potentially problematic If occupational therapists simply focus on the child as the client, it is
imperative that childhood obesity Issues are addressed through family-centred care. Several authors have
noted that comprehensive programmes for successful weight management In childhood need to approach the
Issue of weight from multiple perspectives; social, physical, emotional and nutritional. These perspectives must
also include environmental supports and meaningful, health promoting activity within families
(Harbaugh,Jordan-Welch, Bounds, Blon, &Fisher, 2007; Hesketh, Waters, Green, Salmon &Williams, 2005;
Kuczmarski, Reitz &Pizzi., 2010; Pizzi &Vroman, 2013). Supportive and caring adults in a child’s life enable
positive development of self-efficacy that can, in turn, enable productive participation and enhanced quality of
The impact of childhood obesity on participation and quality of life
Wilcock and Townsend (2000) developed the concept of occupational justice, defined as “equitable opportunity
and resources to enable people’s engagement in meaningful occupations” (p. 85). Children who are overweight
or obese are often marginalized and deprived of opportunities to participate due to size and stigma.
Occupational alienation can be associated with “prolonged experiences of disconnectedness, isolation,
emptiness, lack of a sense of identity, a limited or confined expression or spirit, or a sense of meaninglessness”
(Townsend &Wilcock, 2004, p.80). It is unclear as to whether children who are overwelght/obese and
marginalized and isolated by their peers engage in more passive solitary activities, or if they have perceived
incompetency resulting in diminished physical activity participation. “An equal and perhaps cooccurring
explanation is that depression symptoms hinder their ability to initiate and enjoy physical activities” (Pizzi
&Vroman, 2013, p. 102). Furthermore, weight bias by others has been determined as a cause for occupational
deprivation and alienation (Vroman &Cote, 2011).
Children struggling to cope with being overweight or obese may have multiple health issues and are absent
from school more than their peers within typical weight ranges. The health Issues seen by occupational
therapists include cardiac, joint and other physical Issues as well as, the psychosocial consequences of obesity
such as being bullied and self-confidence (Pan et al.,
2013). Absence from school Impacts greatly on educational outcomes (Datar &Sturm, 2006) so it is essential
that teachers see obesity not just as a weight problem but as an Issue that impacts school attendance,
educational outcomes and social skills. Encouraging parents to maintain occupational routines is essential to
enable children to participate at school, to make friends and, to enhance educational outcomes (DeGrace,
Working with childhood obesity requires involvement of the whole family. In one study, a qualitative analysis of
parental interviews allowed the development of a conceptual framework to examine a child’s quality of life. The
framework highlighted three major interfacing areas that influence children’s quality of life and include the child,
the child’s family, and environmental influences such as the school and local neighborhood (Renwick &Fudge
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Schormans, 2004). These three areas are discussed in this paper, relative to occupational interventions that
enhance quality of life.
The occupational domains of being, belonging and becoming are dynamic aspects of quality of life that need to
be considered through a developmental lens when working with children. These domains are used in practice to
view the child’s life from a holistic perspective thus supporting childhood occupations (Pizzi &Renwick, 2010).
Yet children who are overweight or obese face challenges In each of these domains. Ultimately, obesity impacts
negatively on quality of life, health and wellness of children, families and communities because It Impacts
participation in favoured daily occupations. This case study will describe how two overweight sisters addressed
learning challenges using occupational adaptation both at home, and school, to promote health and well-being,
increased academic participation, social participation and self-esteem.
Description of the setting and programme
Molly, aged seven, and Jane, aged five, are sisters who until recently lived In an intact family with their mother
and father. Both parents have a history of weight issues, although Dad lost considerable weight and has
maintained that loss. Mother also lost some weight but remains in the obese range and has a diagnosis of Type
2 diabetes. The second author has known both children for three years, and her observations indicate that they
are overweight. Their parents recently got divorced and the subsequent shuttling between parents has
increased fast food dinners and led to emotional and psychosocial challenges related to the family disruption.
Both children have gained considerable weight since the divorce, a fact that is validated by the school nurse.
Molly has been receiving occupational therapy services for the past four years. She was initially referred by her
developmental pediatrician for motor delays, secondary to a bilateral hearing loss (she wears hearing aides)
and visual issues corrected with glasses. However, other occupational needs were noted when she entered
school. Balance and motor planning (in addition to vestibular issues) appeared to be negatively impacting
spontaneous playground participation. Molly is a friendly child, sweet and eager to please however,
social/emotional issues limit her ability to make friends and participate in school activities. Molly’s weight limits
her endurance during physical play. She gets out of breath easily and wants to stop often within the process of
the game instead of completing game sequences. Due to processing and motor planning issues, organized
sports are not a current option. Academic issues unrelated to obesity include auditory processing, dyslexia, and
motor based developmental delays.
Jane, Molly’s younger sister is also very overweight, but she does not share many of the physical issues
identified in Molly. Articulate and bright, Jane has issues with endurance and stamina. She participates in
occupational therapy for perceptual processing delays that impact her reading and writing.
Both children appear to have been stigmatized and marginalized as evident in teasing comments by other
children. The sisters prefer to play with each other rather than their peers and it would seem that obesity clearly
impacts on their social skills and self-esteem. This is evidenced in the fact that they do not engage in peer play
at recess. Since they are in different age groups they do not have each other to play with during recess times,
which further limits opportunities for occupational engagement and social participation. According to their
parents the girls play skills are all sedentary in nature, and include video games, computers and electronic toys
that require no physical movement.
Contextual challenges and related interventions
Throughout the occupational therapy process, the therapist faced many challenges, most notably from other
school personnel, primarily the teachers. Teachers would have preferred the therapist to work primarily on ‘the
actual occupational therapy interventions’, meaning handwriting and self-management. Despite ongoing
education by the occupational therapist, other therapists did not see the connection between working on the
sister’s mental health and obesity issues and their educational goals. In this case, the mental health challenges
included coping, self-esteem, body and self-image, and issues with social relationships. All of these issues were
impacted by the children’s weight.
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To make the links between mental health and obesity explicit, the occupational therapist took a client and
family-centred approach. She argued that the family issues needed to be incorporated into the occupational
therapy plan as they posed other challenges that impacted on the occupational therapy process. The following
is a description of the primary interventional strategies and challenges met while working with Molly and Jane.
Although the girls were receiving occupational therapy services for learning and motor impairments, the
therapist recognized the need to address the weight issues and so she included obesity interventions in their
occupational therapy plan of care.
Enhancing teacher awareness
Perhaps the most difficult part of the intervention process was increasing awareness of the teachers regarding
the impact of obesity on learning. While the teachers were readily aware of the academic issues impacting
learning, they had difficulty translating issues of obesity to learning and participation. This required detailed
explanations from the occupational therapist. An example was to educate the teachers about adapting
handwriting due to limed grasp secondary to larger fingers.
Obesity limits one’s choices for participation in community and school activities. In the community of school that
can mean extra-curricular activities such as sports and clubs. Joining various activities means being with others.
The impact of stigma and subsequent occupational alienation was also an area requiring extra attention and
education aimed towards the teachers to increase awareness of the impact of childhood obesity on
Academic choices can also be impacted by obesity. Obese people do not do as well on college and job
interviews, and research indicates that they may have lower grades than non-obese peers in middle school,
high school and college but are just as intelligent (McCann and Roberts, 2013). Often children who are
overweight or obese are reported to want to be “invisible”, hoping to get to school and get home without being
victimized and bullied. The American Psychological Association (APA) details how social isolation, behavioural
difficulties, negative self-view, and low self-esteem among others are directly related to the stigma of being
overweight or obese (APA, 2013). It was vital that the teachers understand the behaviours of Molly and Jane so
that there was no further stigmatization.
Extra weight is a whole body issue. For instance, D’Hondt et al., (2008) noted that excess body weight can
interfere with fine motor skills and grasp, and also impact postural control. In the case of Molly and Jane, they
had limited grasp and release hand skills inclusive of but not limited to writing, cutting, and in-hand manipulation
abilities. Proposed intervention strategies were explained to the family, teachers, and counselors (see Table 1 ).
Moreover, suggestions made to encourage the teachers to support the mental, physical and social health needs
of Molly and Jane included:
* Sharing thoughts about learning styles and students in general. This was key to facilitate a shift in perceptions
about obese children.
* Helping the teachers to understand compensatory behaviors. For example, the child with obesity being the
“class clown”, “the nerd”, or the “teacher’s pet”.
* Encouraging teachers see behaviours more in terms of meaning as opposed to actions, to attend more to
Molly and Jane’s behaviours, as well as the reactions of classmates.
* Including the entire class in stretching and movement activities for just a few minutes during classroom
Involving teachers and counselors in the therapy plan assisted the occupational therapist to implement
throughout the school. Simultaneously, they learned about the impact of obesity on participation. For several of
the teachers and counsellors, this was a catalyst for change in the perception about obesity as it influences
academic and social participation. The occupational therapist also worked closely with the adaptive physical
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education teacher, who confirmed the children’s weight issues affected their physical skills different than their
tone or visual-perceptual challenges.
Parent participation
Understanding family dynamics was essential to family participation. Occupational challenges encountered by
Molly and Jane were complicated by conflicting parenting styles.
The father was invested in the occupational therapy plan from the start. However, working with the mother
required an understanding of her busy lifestyle which included many fast food meals and little home cooking.
The occupational therapist developed an obesity prevention and reduction plan for Molly and Jane which was
incorporated into their educational plan for the school setting. This included nutrition, physical activity and
developing a sense of self-efficacy and self-esteem (improving their mental health). Their energy levels and
choices of activities within the therapy sessions appeared to be determined by how much movement would be
needed to do specific tasks, and, when given a choice, the girls consistently chose tasks that required limited
exertion and endurance. Through observation and comments from the girls, It appeared that their weight was a
major factor impacting occupational performance and participation.
Schooling was the most important thing to the father, so presenting the occupational therapy treatment
programme framed in traditional academic skill sets was very effective. The most difficult challenge was working
with the children’s mother, educating her about the benefits of limiting fast foods and the benefits of healthy food
choices. This was achieved by presenting the weight management programme as an expansion of the already
existing occupational therapy intervention. After several discussions, one of the interventions was to take the
sisters with their mother into the kitchen in their own home to demonstrate healthy and inexpensive meal
preparation alternatives. Once the ease with which this could be accomplished was recognized, along with the
positive reactions from Molly and Jane, she was much more cooperative with the intervention plan. The children
over time had become very close to the occupational therapist. They were accustomed to “silly homework” as
termed by the sisters. Asking them to play a “game” with food and activity was easily received along with some
friendly sibling competition.
New to single parenting, the father was eager to be the best parent possible. When concerns were (gently)
presented to him about the children’s weight, he was able to listen when presented in the context of academics.
He also became much more participatory and engaged when the interventions focused on reducing the sisters’
anxiety and stress with the recent life changes and improving their emotional and social health. Overtime, he
experienced occupational adaptation.
The occupational therapy home programme
The home programme created by the occupational therapist in collaboration with the family focused on
academics, physical activities and integrating current family routines. The intention was to create a healthy life
style without radically changing family dynamics. The occupational therapist, recognizing the need to work with
the parents separately, shared Information and programme planning via emails and in-person interventional
sessions. Before intervention planning, the occupational therapist interviewed the parents regarding activity,
nutrition, parent observations of the children and environmental issues (e.g. the children living between two
homes, school issues). The interventions created for this family included:
* Presenting and sharing of nutritional Information;
* Delineating the parents’ processing styles for tolerating change. Because the mother was more resistant,
suggesting ways that made her life “easier” was key while the father looked forward to having “gym buddies”;
* Creating (meals) a variety of foods for increased health and mobility, participation in sports, etc.;
* Using healthy ways of incorporating food for improved social skills to increase self-esteem /positive body
* Developing healthy habits for eating and for specific occupational role participation in the areas of student,
family member and friend;
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* Providing a ‘helpful hints’ handout related to basic strategies to help reduce weight (see Table 2).
Primarily this programme was for Molly but eventually included Jane. Unhealthy habits were in evidence which
contributed to weight gain. This was confirmed by the parents. The programme was designed to help the family,
and in particular the children, learn healthy habits that they can use throughout their lives. It was never intended
to be a weight loss programme. For a more detailed account about home and school interventions (see Table
After the programme was presented to the parents and the children, reactions to the proposed programme were
varied. The father was supportive of anything to help the children improve their health and increase their level of
He shared that he was an alumni of a specific weight loss programme, and was excited to see how homework
and healthy habits could be combined for his children. The mother was more defensive, and appeared
overwhelmed, citing multiple responsibilities while being a single parent and leading a busy lifestyle. She stated
that she was always “on the go” and felt the “need” to use fast food options. The occupational therapist tried to
discuss options for developing healthier habits and changes in occupational routines to best help the children,
however these suggestions were dismissed. However, over time, as the occupational therapist worked with the
children, the mother more slowly became involved as the children asked for healthier alternatives. Fast food
was still being purchased, but substituting the fruit for fries and mustard for mayonnaise was a change that was
well tolerated. An early study by Epstein et al (1994) demonstrated that children who receive support from the
family, including extensive participation and modelling, along with other sources of support, benefit most and
long term changes in behaviours and changes in obesity rate occur.
Weekend activities were suggested to encourage movement but took into consideration Molly’s hearing loss
and visual problems. Remedial horseback riding was an agreed upon activity because it was novel, exciting and
also worked on balance and core strengthening. Molly reported that weekend excursions to the park were
“more fun” now that she had learned how to “pump on the swing”. And she added that she did it a “long time
and didn’t get tired”. Other activities such as ice-skating lessons for the girls fed into their “girly” preferences for
glitter and ruffles and that served as a motivator for participation. School lunch choice was available at their
school so that children and parent could talk about healthy choices before even standing in the cafeteria line.
The occupational therapist developed a healthy choices chart for the children (See Table 4). The chart tied in
the children’s occupational therapy handwriting homework so that they got double credit for a good choice and
for legibly recording what they did. Wary at first, the children reacted well to charting and it became a friendly
competition between the children as to who got more ‘stars’ on their healthy habits chart which they brought to
occupational therapy each week. Molly previously reported that during recess, she would “mostly stay and talk
to her teacher”. As the programme unfolded, the children reported having more “fun” during recess. It was also
interesting to note that the children slowly began to choose outdoor occupational therapy activities where
previously they would choose more sedentary activities. Encouraging weekend outdoor activities with the
parents was also a long term goal of this programme.
The occupational therapist also followed up with the home programme, discussing the various suggested
activities with both parents. It was noted that the more structured environment of school with was more
impactful for the sister’s occupational participation on a daily basis. At home, there were numerous other
distractions (e.g. games, television, and visitors to the home) which often impeded follow through. These were
seen as making progress by both parents and both developed a commitment to improving the children’s health
and began to see health benefits for themselves.
The authors have presented this case report to contribute to the literature on childhood obesity. In evidence is
the efficacy of attending to the occupational needs of the sisters in this case and how innovative occupational
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interventions, interwoven with their academic and home life, helped remediate occupational challenges that
were a direct result of being overweight. Also demonstrated was the need to view the obesity epidemic through
a developmental and family-centred lens in order to positively impact on quality of life and enable social and
physical participation in school, at home and in the community.
Occupational concerns for any child in a school setting requires attention paid to a child’s weight as it impacts
on academic performance and social participation. Molly and Jane were referred for occupational therapy
services for developmental learning challenges. The occupational therapist, while working with those
challenges, also recognized the need to tailor intervention plans to also meet occupational challenges and
limited participation due to being overweight. A family centred approach was taken in this case, which included
both parents and Molly’s younger sibling Jane, who was also overweight. The following table illustrates some of
the concerns noted by the occupational therapist, the interventions used with the children or suggested to
teachers and counselors, and the resultant health outcomes.
The occupational therapy plan for the sisters was never intended to be a weight loss programme, rather it was
intended to help them develop social-emotional and physical skills and occupational habits that would impact on
managing their weight. The occupational therapist in the school focused on the academic and learning
challenges faced by the children, while simultaneously integrating activities focused on weight management. It
must also be noted that the impact of the parent’s health behaviours and habits were not previously considered.
With a family-centred focus, occupational therapists can and, in this case, did impact health on multiple levels.
While this programme has been implemented for only a few months, the outcomes so far have been very
positive and have been validated by the teachers, counselors and parents (see Table 1 ). It is projected that the
children, with familial and school personnel support, will continue to become increasingly active given their
current levels of participation and the familial and school support that has developed. As activity increases and
eating habits continue to change, it is the authors’ belief that the children will be increasingly more active,
academic and peer interactions will increase and that their lives will be filled with meaningful, productive
Future directions
The obesity epidemic impacts children on every level of occupational functioning and participation. Occupational
therapists can make major strides in changing the health behaviours of children and their families when working
with environmental barriers and supports to participation. It is imperative that, in order to transform the life of a
child who is overweight, occupational therapists employ efforts to work within the contexts of the child’s life to
best support the overweight child’s mental, physical and social health and wellbeing. Multiple strategies that
impact an overweight child’s occupational participation to meet their many occupational needs, including their
academic, developmental and health needs, is possible. This includes developing programmes using a public
health tiered approach (Bazyk &Winne, 2013; Pizzi, et al., 2014),
More occupational therapy evidence is needed in the area of childhood obesity that explores the impact of
occupation in various contexts. Research on, for example, the use of occupation with children who are
overweight at individual and population levels, at different developmental ages, and surveys of children and
parents/carers on activity and weight management would be useful for the profession. It would also be
interesting to study the impact of obesity on each specific occupation (e.g. education, sleep, self-care, leisure).
While this case explored sisters who were overweight with developmental issues, it would be helpful research to
explore the impact of occupational therapy on children who were overweight or obese without learning
There is also a need for more occupation and client centred assessments in the area of childhood obesity. A
recent development in this area includes the clinical utility and validation of the Pizzi Healthy Weight
Management Assessment (PHWMA). The assessment has been used with Burmese immigrants (youth version)
and with Jewish Orthodox mothers (parent version) (Kuo, Pizzi, Chang, Koning &Fredrick, unpublished
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manuscript; Pizzi, unpublished manuscript). Further research using this assessment is being implemented in
cross cultural studies.
Finally, it is important that the profession align itself with the important area of health and well-being as it relates
to occupational participation and engagement. Childhood obesity impacts participation and the health and wellbeing of children, as noted throughout this article, and the authors feel this type of research can contribute not
only to the evidence base of the profession, but also towards the betterment of all societies.
Key points
* Occupation has a powerful role in the lives of overweight/ obese children.
* Obesity challenges both individuals and families therefore a family-centred approach is essential to influence
health promoting behaviours.
* Including teachers and school personnel will support the children by providing consistent health promoting
messages across disciplines.
* Enabling active and positive participation in favoured occupations will facilitate improved quality of life.
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Corresponding author:
Michael A. Pizzi, PhD, OTR/L, FAOTA (Assistant Professor)
Health and Wellness Consultant
Department of Occupational Therapy
Long Island University-Brooklyn
Susan Orloff, MS, OTR/L, FAOTA
Children’s Special Services
Atlanta GA
Publication title: New Zealand Journal of Occupational Therapy
Volume: 62
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Issue: 1
Pages: 29-38
Number of pages: 10
Publication year: 2015
Publication date: Apr 2015
Year: 2015
Section: Feature Article
Publisher: New Zealand Association of Occupational Therapists
Place of publication: Wellington
Country of publication: New Zealand
Publication subject: Education–Special Education And Rehabilitation, Medical Sciences
ISSN: 11710462
Source type: Scholarly Journals
Language of publication: English
Document type: General Information
ProQuest document ID: 1718110894
Document URL:
Copyright: Copyright New Zealand Association of Occupational Therapists Apr 2015
Last updated: 2015-10-01
Database: Nursing & Allied Health Database,Health Management Database,Health & Medical Collection
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Table of contents
1. Social Anxiety in Obese Youth in Treatment Setting………………………………………………………………………… 1
28 July 2016
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Social Anxiety in Obese Youth in Treatment Setting
Author: Thompson, Julia E; Allyson Phillips, B; Mccracken, Andy; Thomas, Kenneth; Ward, Wendy L
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Abstract: The aim of this study was to determine the prevalence of social anxiety in obese children treated in a
weight management clinic. We hypothesized that social anxiety would positively correlate with obesity, and that
“extremely obese” patients would have significantly higher rates of social anxiety when compared to “obese”
patients. Information was collected at a multidisciplinary treatment clinic for obese youth during the first clinic
visit. The social anxiety scale was administered (including parent-report and self-report scales for both
elementary and adolescent versions) and demographic data was obtained. Social anxiety was found to be
significantly positively correlated with BMI percentile. In addition, “extremely obese” patients had significantly
higher social anxiety scores than “obese” youth at least for elementary-age youth. Trends in gender differences
and racial differences in this obese pediatric clinical sample were consistent with results found in community
samples. Social anxiety and obesity were found to be positively correlated in this pediatric clinic-based
population. For elementary-age patients, “extremely obese” patients were at greater risk than “obese patients”
for social anxiety and its various symptoms–fear of negative evaluation, social avoidance/distress in new
situations, and social avoidance/distress in general. Results for adolescents were less clear. Clinical
implications of these results were discussed. Limitations of this study, and directions for future research were
Subject: Children & youth; Obesity; Anxieties;
Publication title: Child & Adolescent Social Work Journal
Volume: 30
Issue: 1
Pages: 37-47
Publication year: 2013
Publication date: Feb 2013
Year: 2013
Publisher: Springer Science & Business Media
Place of publication: New York
Country of publication: Netherlands
Publication subject: Children And Youth – About, Psychology, Sociology
ISSN: 07380151
Source type: Scholarly Journals
Language of publication: English
Document type: Feature
28 July 2016
Page 1 of 2
ProQuest document ID: 1285065633
Document URL:
Copyright: Springer Science+Business Media New York 2013
Last updated: 2014-08-09
Database: Psychology Database,Research Library: Health & Medicine,Nursing & Allied Health Database,Health
& Medical Collection,Public Health Database
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Table of contents
1. Volumes and Bouts of Sedentary Behavior and Physical Activity: Associations with Cardiometabolic
Health in Obese Children………………………………………………………………………………………………………………..
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Volumes and Bouts of Sedentary Behavior and Physical Activity: Associations with Cardiometabolic
Health in Obese Children
Author: Cliff, Dylan P; Jones, Rachel A; Burrows, Tracy L; Morgan, Philip J; Collins, Clare E; Baur, Louise A;
Okely, Anthony D
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Abstract: To examine associations of volumes and bouts of sedentary behavior (SED) and moderate-tovigorous physical activity (MVPA) with individual and clustered cardio-metabolic outcomes in overweight/obese
children. Cross-sectional data from 120 overweight/obese children (8.3±1.1 years, 62% girls, 74% obese) with
SED and MVPA assessed using accelerometry. Children were categorized into quartiles of mean bouts per day
of SED (10, 20, and 30 min) and MVPA (5, 10, and 15 min). Associations with triglycerides, HDL cholesterol,
glucose, insulin, systolic/diastolic blood pressure, and clustered cardio-metabolic risk (cMet) were examined
using linear regression, adjusted for confounders. Independent of MVPA, SED volume was inversely associated
with HDL cholesterol (β [95% CI]=-0.29 [-0.52, -0.05]). MVPA volume was inversely associated with diastolic
blood pressure, independent of SED (β=-0.22 [-0.44, -0.001]), and cMet (β=-0.19 [-0.36, -0.01]) although not
after adjustment for SED (β=-0.14 [-0.33, 0.06]). Independent of MVPA and SED volumes, participants in the
highest quartile of 30 min bouts per day of SED had 12% lower HDL cholesterol than those in the lowest
quartile (d=0.53, P= 0.046, P^sub trend^=0.11). In addition to increasing MVPA, targeting reduced SED and
limiting bouts of SED to
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