Engaging children in the development of obesity interventions: Exploring outcomes that matter most among obesity positive outliers

Abstract

Objective To explore outcomes and measures of success that matter most to 'positive outlier' children who improved their body mass index (BMI) despite living in obesogenic neighborhoods. Methods We collected residential address and longitudinal height/weight data from electronic health records of 22,657 children ages 6–12 years in Massachusetts. We defined obesity “hotspots” as zip codes where >15% of children had a BMI ≥95th percentile. Using linear mixed effects models, we generated a BMI z-score slope for each child with a history of obesity. We recruited 10–12 year-olds with negative slopes living in hotspots for focus groups. We analyzed group transcripts and discussed emerging themes in iterative meetings using an immersion/crystallization approach. Results We reached thematic saturation after 4 focus groups with 21 children. Children identified bullying and negative peer comparisons related to physical appearance, clothing size, and athletic ability as motivating them to achieve a healthier weight, and they measured success as improvement in these domains. Positive relationships with friends and family facilitated both behavior change initiation and maintenance. Conclusions The perspectives of positive outlier children can provide insight into children’s motivations leading to successful obesity management. Practice implications: Child/family engagement should guide the development of patient-centered obesity interventions.

Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions

“…The intervention was built upon practices of positive outlier families as well as strategies recommended by a diverse group of stakeholders representing parents, children, pediatricians, and community members. 13,14 In this report, we summarize the main outcomes of Connect for Health .…”

Connect for Health : Design of a clinical-community childhood obesity intervention testing best practices of positive outliers

“…12,13 Several children and parents from these focus groups now participate as ongoing members of our parent and youth advisory board. Leaders and staff of youth-serving community-based organizations, including the YMCA, provided critical input on the ideas and activities we ultimately implemented.…”

“…We have previously published the methods and results of this formative work. 12,13 Parents reported several practices that facilitated their ability to help their child improve their BMI. Among them were: 1) making changes as a family rather than solely for the child; 2) implementing limits and rules around snacking, screen time and activity, and maintaining consistency around those rules; 3) being involved in the decision-making with their health care provider about their child's weight management; 4) using more immediate rather than long-term outcomes of weight management to motivate change, and 5) maximally leveraging community resources to support behavior change.…”

“…The intervention was built upon practices of positive outlier families as well as strategies recommended by a diverse group of stakeholders representing parents, children, pediatric clinicians, and community/public health providers. 12,13 In this paper we summarize the development and methods of Connect for Health .…”

The “pumpgate” incident: Stigma against lactating mothers in the U.S. workplace

“…Coders used the immersion crystallization content analysis procedure (Sharifi et al, 2015) to identify emergent themes about breastfeeding in general, public breastfeeding, and pumping breastmilk in the workplace. These data were initially analyzed for whether the respondent was in favor of pumping breastmilk in the workplace.…”