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Barnfetma - föräldrarna till skolbänken

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https://sverigesradio.se/sida/artikel.aspx?programid=406&artikel=7415599

En svensk föräldrakurs för att stoppa barnfetma som visat sig vara effektivast i världen, ska nu testas i fler EU-länder.Forskare följer familjer med överviktiga tvååringar i Rumänien, på Mallorca och i Stockholm för att se effekten.– Vi var jättenöjda när vi kom därifrån, säger en mamma.– Och visst har det gett resultat kring viktkurvan, helt klart, tillägger pappan i samma familj.De här föräldrarna som vill vara anonyma, gick kursen "Mer och mindre", efter att barnavårdscentralen påpekat att den då fyraåriga dottern var överviktig.De var först tveksamma, med en oro för kaloriräkning och ätstörningar. Men kursen på 10 tillfällen och boosteruppföljning, innehöll bara positiva tips och knep från ledare och medföräldrar kring vardagsutmaningar i föräldraskapet.Vad är lagom portioner, gränser för skärmtid, hur får man släkten med sig på att servera nyttig mat och barnen att röra på sig mer? En vetenskaplig studie publicerad förra året på barn mellan 4-6 år visade att metoden i snitt minskade barnens fetma med 0,54 i BMI, vilket är världsrekord.

Läs mer om studiedesignen här. Ganska intressant. 

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7161-y

According to the World Health Organization childhood obesity is one of the gravest public health challenges of today’s society [1], with approximately 108 million 2- to 19-year-old children being classified as having obesity [2]. More specifically, in children less than 5 years, there has been a swift increase in childhood overweight and obesity and if these trends continue it is predicted that 70 million children will be overweight or obese by 2025 [3]. These statistics are concerning as Geserick et al. [4] found that 90% of 3 year olds with obesity still had overweight or obesity in adolescence. Furthermore, for those adolescents with overweight or obesity, the majority of weight gain happened between two and 6 years of age [4]. Thus, this demonstrates the need for evidence-based treatment programs in the pre-school years in order to attempt to rectify the increased prevalence of childhood overweight and obesity.

According to Colquitt et al. [5] for children under 6 years of age multicomponent interventions (i.e., diet, physical activity, and behavioral interventions) seem to be effective at treating overweight and obesity. However, the authors did state that evidence is limited [5]. To date, the majority of the treatment interventions for overweight and obesity use face-to-face delivery methods [6]. A recent meta-analysis by Ling et al. [6] found small effect sizes on treatment interventions for preschool-aged children for body mass index (BMI) (− 0.28 kg/m2, p < 0.001) using various in person delivery methods. Furthermore, the More and Less (ML) study found that at the 12-month follow-up, a 10-week group treatment program focusing on parenting practices had a greater reduction in BMI z-scores than standard treatment in health care (− 0.30 vs. -0.07, p < 0.05). An even greater reduction was observed in the intervention group who received booster sessions (a 30-min phone call every 4 to 6 weeks over a 9-month period) [7]. These results are promising; however, sustained contacts with families after treatment programs are burdensome on both health care providers and participants, which makes it difficult to scale-up. Therefore, different types of boosters need to be used in order to reduce the burden on both health care and participants.

The universal use of smartphones makes the use of mobile health (mHealth) an option for boosting the effects of treatment programs. mHealth is increasingly being used for promoting healthy habits and as treatment of many types of health conditions and diseases. In adults, two meta-analyses have found that mHealth interventions focusing on weight loss significantly decreased participants’ weight in the intervention groups compared to the control groups [8, 9]. In children and adolescents few studies have utilized mHealth in the prevention or treatment of obesity [10,11,12,13,14] and hardly any have been conducted in the preschool-age group [15, 16]. The Mobile-based Intervention Intended to Stop Obesity in Preschoolers (MINISTOP) trial was a mHealth obesity prevention intervention that was developed and led by Marie Löf and her team to improve 4-year-old children’s body composition, dietary, physical activity, and sedentary behaviors [17, 18]. The MINISTOP intervention had a significant effect on a composite score composed of body composition, diet, and physical activity variables, with this effect being more evident among children with a higher fat mass index [18]. There are numerous advantages of mHealth over conventional intervention approaches such as: the programs can be delivered any time and place; are interactive; can be tailored to different groups (e.g., translated into multiple languages); and reduces burden on health care professionals and participants. These advantages further motivates the use of mHealth in families with young children with overweight and obesity.

The mechanisms that drive weight gain such as epigenetics and gut hormones are still unclear [19, 20]. Epigenetics has received attention during the recent years for the putative involvement in transmitting obesity risk to offspring and in the heritable regulation of gene expression without altering their coding sequence [21]. The most relevant epigenetic mechanisms involved in gene activity control are histone modifications, non-coding RNAs (ncRNA) and DNA methylation [20]. Further, obesity has been associated with the epigenetic modulation of several genes. For example, a relationship has been reported between increased BMI and adiposity as well as higher DNA methylation levels at the hypoxia-inducible transcription factor 3A (HIF3A) gene [22]. Moreover, an increased methylation in the gene RXRA measured at birth has been associated with greater adiposity in later childhood [23]. Two other investigations identified a strong correlation between obesity and serum levels of micro RNA (miR)-122 and miR-519d [24] and found DNA methylation to be related to insulin resistance [25]. However, these findings need to be confirmed and further explored in young children.

Another field of interest for obesity is the gastrointestinal tract (GIT) [26]. The GIT plays an important role in acute appetite regulation through a number of mechanisms: (1) the release of hormones that play a role in appetite regulation such as anorectic hormones (Peptide YY, PYY, and glucagon-like peptide, GLP-1) and orexogenic gut hormones (e.g., ghrelin), (2) the enteric nervous system and signals through the vagus to the brain to influence appetite and (3) secondary to stimulating signals from other organs such as liver adipose. Previous research in adults has demonstrated that the infusion of the GIT anorectic hormones PYY and GLP-1 at physiological doses has profound effects to suppress appetite [26]. Also weight loss appears to lead to a suppression of PYY and GLP-1 suggesting a role in the feelings of hunger during weight reduction. However, evidence of the role of GIT hormones in overweight and obesity among young children is sparse.

A major challenge in the management of obesity in both adults and children is understanding what people eat. Most dietary assessment methodologies use methods of self-reported food intake which is a subject to large misreporting error [27, 28]. It is therefore impossible to understand what children eat. Garcia et al. has developed a new metabolomic methodology of dietary assessment using urine, which is not subject to the same misreporting errors [29]. This method has been validated in adults. Our aim is to do this is children.

To the best of our knowledge there is no study to date that has the ambition to assess a broad array of key biological and social determinants of obesity in young children. This study protocol outlines the design of a multi-country study that incorporates both a parent support program and mHealth in an overweight and obesity intervention in 2- to 6-year-old children with overweight and obesity.

 

 
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"En vetenskaplig studie publicerad förra året på barn mellan 4-6 år visade att metoden i snitt minskade barnens fetma med 0,54 i BMI, vilket är världsrekord."

Var det inte en ganska blygsam genomsnittlig minskning? Om man klassas som överviktig, så borde det inte vara så svårt att se en större minskning i BMI, med några kilos nedgång.
Tänker att jag själv lätt kan förändra BMI-värdet med 0,1-0,2 på bara någon vecka. Men jag är å andra sidan inte överviktig och barn.

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