Publications by authors named "Maryam Kebbe"

21 Publications

  • Page 1 of 1

A Natural Experiment Comparing the Effectiveness of the "Healthy Eagles" Child Weight Management Intervention in School Versus Community Settings.

Nutrients 2021 Oct 31;13(11). Epub 2021 Oct 31.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.

Behavioural weight management interventions are recommended for the treatment of obesity in children. However, the evidence for these is limited and often generated under trial conditions with White, middle-class populations. Healthy Eagles is a behavioural weight management intervention designed to treat excess weight in children. It ran in the London Borough of Croydon from 2017 to 2020 and was delivered in both school and community settings, providing a natural experiment to compare outcomes. A total of 1560 participants started the Healthy Eagles programme; 347 were in the community setting and 703 in the school setting. Data were analysed for those who completed 70% of the programme. In the school setting, there was a small but significant reduction in BMI z-score (M = -0.04, 95% CI = -0.08, -0.01) for participants above a healthy weight, especially in those with severe obesity (M = -0.09, 95% CI = -0.15, -0.03); there was no significant change in any subgroup in the community setting. Linear regression analysis showed the school setting was associated with a 0.26 (95% CI = 0.13, 0.49) greater reduction in BMI z-score than the community setting after adjusting for ethnicity, deprivation, age and gender. Across both programmes, the effect was somewhat greater in participants from a Black (African/Caribbean/Other) ethnic background (M = -0.06, 95% CI = -0.09, -0.02) and from the two most deprived quintiles (M = -0.06, 95% CI = -0.11, -0.01). Data were limited, but minimal changes were measured in nutrition and physical activity behaviours regardless of setting. This evaluation provides indirect evidence of a small but significant benefit to running weight management interventions in a school versus community setting.
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http://dx.doi.org/10.3390/nu13113912DOI Listing
October 2021

Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017.

Obes Facts 2021 Nov 5:1-17. Epub 2021 Nov 5.

Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain.

Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions.

Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1.

Results: Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries.

Discussion/conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
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http://dx.doi.org/10.1159/000517586DOI Listing
November 2021

Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'.

Nutrients 2021 Sep 21;13(9). Epub 2021 Sep 21.

Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.

Understanding women's perceptions of eating behaviors and dietary patterns can inform the 'teachable moment' model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance < 0.05). Women ( = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet ( < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.
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http://dx.doi.org/10.3390/nu13093298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471126PMC
September 2021

Impact of COVID-19 Stay-at-Home Orders on Health Behaviors and Anxiety in Black and White Americans.

J Racial Ethn Health Disparities 2021 Aug 19. Epub 2021 Aug 19.

Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.

Background: In the United States (US), the incidence and severity of COVID-19 infections, hospitalizations, and deaths are higher in Black compared to White residents. Systemic inequities and differences in health behaviors may contribute to disparities in COVID-19 health outcomes. The aim of this study was to examine the impact of COVID-19 stay-at-home orders on changes in health behaviors and anxiety in Black and White adults residing in the US.

Methods: Beginning April 2020, the Pennington Biomedical Research Center COVID-19 Health Behaviors Study collected information on changes to employment, income, diet, physical activity, anxiety, and sleep patterns through a global online survey.

Results: Of 4542 survey respondents in the US, 7% identified as Black and 93% as White. Prior to the COVID-19 stay-at-home orders, a greater proportion of Blacks compared to Whites reported earning < US$50,000 per year (p < 0.0001). A greater proportion of Blacks reported being laid off, working fewer hours, and working from home following COVID-19 stay-at-home orders (p < 0.0001 for all). In the overall sample, eating behaviors improved, physical activity decreased, sleep time prolonged, and anxiety heightened following COVID-19 stay-at-home orders (p < 0.01 for all), which were universal between Black and White respondents (p ≥ 0.315 for all).

Conclusions: This study highlights the disproportionate changes to employment and income in Blacks, with no differential impact on health behaviors and anxiety compared to Whites due to COVID-19 stay-at-home orders. As the COVID-19 pandemic continues, disproportionate changes to employment and income status may widen among Blacks and Whites, which may influence health behaviors and anxiety.
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http://dx.doi.org/10.1007/s40615-021-01131-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375463PMC
August 2021

General practitioner views on addressing weight opportunistically in primary care: An embedded sequential mixed-methods study.

Patient Educ Couns 2021 Jun 29. Epub 2021 Jun 29.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Electronic address:

Objective: To assess GPs' thoughts, feelings, and practices on providing opportunistic weight loss interventions before and after educational training and application in practice.

Methods: In an embedded sequential mixed-methods design, 137 GPs delivered a 30-second brief opportunistic intervention to a mean of 14 patients with obesity. To assess GPs' experiences and views on the intervention, all were invited to complete pre- and post-trial questionnaires and 18 were purposively interviewed. Data were transcribed verbatim and analysed using inductive framework analysis.

Results: GPs' attitudes (importance, feasibility, appropriateness, helpfulness, and effectiveness), capacities (comfort, confidence, and knowledge), perceived subjective norms (role expectations), willingness, and intentions on providing weight loss interventions were predominantly improved post-trial. The research setting allowed GPs to depersonalise intervening on obesity and feel more comfortable discussing the topic. Beyond the trial, GPs reverted largely to not intervening, citing barriers that had reportedly been overcome during the trial.

Conclusion: GPs who delivered the intervention had positive experiences doing so, shifting their beliefs modestly that this intervention is important, feasible, and acceptable.

Practice Implications: Given that outside of the trial GPs were apprehensive about intervening without a prompt, developing systems to prompt patients may support implementation.
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http://dx.doi.org/10.1016/j.pec.2021.06.028DOI Listing
June 2021

Adherence to international dietary recommendations in association with all-cause mortality and fatal and non-fatal cardiovascular disease risk: a prospective analysis of UK Biobank participants.

BMC Med 2021 06 23;19(1):134. Epub 2021 Jun 23.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.

Background: International dietary guidelines aim to reduce risks of all-cause mortality, cardiovascular disease (CVD), and fatal CVD often associated with poor dietary habits. However, most studies have examined associations with individual nutrients, foods, or dietary patterns, as opposed to quantifying the pooled health effects of adherence to international dietary recommendations. We investigated associations between total adherence to the World Health Organization (WHO) dietary recommendations for saturated fats, free sugars, fibre, and fruits and vegetables and all-cause mortality and fatal and non-fatal CVD.

Methods: We included participants from the UK Biobank cohort recruited in 2006-2010, which provided at least two valid 24-h dietary assessments. We defined adherence to dietary recommendations as ≤ 10% saturated fats, ≤ 10% free sugars, ≥ 25 g/day fibre, and ≥ 5 servings of fruits and vegetables/day. Multivariable Cox-proportional hazards models were used to investigate prospective associations with all-cause mortality and fatal and non-fatal CVD. In cross-sectional analyses, multivariable linear regression was used to examine associations with cardiometabolic risk factors.

Results: Among 115,051 participants (39-72 years), only 29.7%, 38.5%, 22.3%, and 9.5% met 0, 1, 2, or 3-4 recommendations, respectively. There was a lower risk of all-cause mortality among participants meeting more dietary recommendations (P < 0.001), with a significantly lower risk among participants meeting 2: HR 0.91 (95% confidence interval [CI] 0.85-0.97) and 3-4: HR 0.79 (95% CI 0.71-0.88) recommendations. There was no trend with CVD risk, but a significantly lower risk of fatal CVD with 3-4 recommendations: HR 0.78 (95% CI 0.61-0.98). Meeting more recommendations resulted in significant cross-sectional trends (P < 0.001) towards lower body fat, waist circumference, LDL cholesterol, apolipoprotein B, triglycerides, alkaline phosphatase, gamma glutammyltransferase, and hs-CRP, but higher glucose and aspartate aminotransferase.

Conclusions: Meeting dietary recommendations is associated with additive reductions in premature mortality. Motivating and supporting people to adhere to dietary guidelines may help extend years of healthy life expectancy.
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http://dx.doi.org/10.1186/s12916-021-02011-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220774PMC
June 2021

Beyond weight loss: current perspectives on the impact of calorie restriction on healthspan and lifespan.

Expert Rev Endocrinol Metab 2021 May 7;16(3):95-108. Epub 2021 May 7.

Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States.

: Changes to mental, physical, and physiological functions drive the complex processes underlying the variable progression of human aging. Nutritional interventions are one of the most promising non-pharmacological therapeutics to attenuate aging in humans. This narrative review aims to describe the implications of moderate and prolonged calorie restriction (CR) in healthy adults without obesity that occur beyond weight loss.: Findings from CR studies, such as the CALERIE (Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy) trials, the most rigorous trials to date examining a prolonged 25% CR, are described. The main areas covered include; changes to anthropometrics, energy metabolism, cardiometabolic health, inflammation and immune function, physical fitness, health behaviors, and mental health in response to weight loss (1-year) and weight loss maintenance (2-year).: CR presents a novel and effective therapeutic approach for improving healthspan and biomarkers of lifespan. To date, scientific evidence suggests that continued CR, under medical supervision, is accompanied with persistent and beneficial effects on health outcomes independent of weight loss. Mechanisms are yet to be fully elucidated, and novel dietary approaches that may similarly attenuate aging-related conditions should be explored and compared to traditional CR.
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http://dx.doi.org/10.1080/17446651.2021.1922077DOI Listing
May 2021

Complexity and Stigma of Pediatric Obesity.

Child Obes 2021 06 29;17(4):229-240. Epub 2021 Mar 29.

Obesity Canada, University of Alberta, Edmonton, Alberta, Canada.

Weight stigma is rooted in a fundamental misunderstanding of the origins of obesity, wherein the interplay of behavioral, environmental, genetic, and metabolic factors is deemphasized. Instead, the widespread societal and cultural presence of weight stigma fosters misconceptions of obesity being solely a result of unhealthy personal choices. Weight stigma is pervasive in childhood and adolescence and can affect individuals throughout their life. Although the prevalence of pediatric obesity remains high throughout the world, it becomes increasingly important to understand how weight stigma affects weight and health outcomes in children and adolescents with overweight or obesity, including in those with rare genetic diseases of obesity. We identified and reviewed recent literature (primarily published since 2000) on weight stigma in the pediatric setting. Articles were identified with search terms including pediatric obesity, weight bias, weight stigma, weight-based teasing and bullying, and weight bias in health care. In this narrative review, we discuss the stigma of pediatric obesity as it relates to the complex etiology of obesity as well as describe best practices for avoiding bias and perpetuating stigma in the health care setting.
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http://dx.doi.org/10.1089/chi.2021.0003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147499PMC
June 2021

Physician-related predictors of referral for multidisciplinary paediatric obesity management: a population-based study.

Fam Pract 2021 09;38(5):576-581

Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.

Background: It is recommended that primary care-based physicians refer children with overweight and obesity to multidisciplinary paediatric obesity management, which can help to improve weight and health.

Objective: To determine predictors of referral to multidisciplinary paediatric obesity management.

Methods: This retrospective, population-level study included physicians who could refer 2-17 years old with a body mass index ≥85th percentile to one of three multidisciplinary paediatric obesity management clinics in Alberta, Canada. Physician demographic and procedural data were obtained from Practitioner Claims and Provider Registry maintained by Alberta Health from January 2014 to December 2017. Physician characteristics were compared based on whether they did or did not refer children for obesity management. Univariable and multivariable logistic regression models analysed associations between physician characteristics and referral making.

Results: Of the 3863 physicians (3468 family physicians, 395 paediatricians; 56% male; 49.3 ± 12.2 years old; 22.3 ± 12.6 years since graduation) practicing during the study period, 1358 (35.2%) referred at least one child for multidisciplinary paediatric obesity management. Multivariable regression revealed that female physicians (versus males) [odds ratio (OR): 1.68, 95% confidence interval (CI): 1.46-1.93; P < 0.0001], paediatricians (versus family physicians) (OR: 4.89, 95% CI: 3.85-6.21; P < 0.0001) and urban-based physicians (versus non-urban-based physicians) (OR: 2.17, 95% CI: 1.79-2.65; P < 0.0001) were more likely to refer children for multidisciplinary paediatric obesity management.

Conclusions: Approximately one-third of family physicians and paediatricians referred children for multidisciplinary paediatric obesity management. Strategies are needed to improve referral practices for managing paediatric obesity, especially among male physicians, family physicians and non-urban-based physicians as they were less likely to refer children.
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http://dx.doi.org/10.1093/fampra/cmab019DOI Listing
September 2021

Perceived Effectiveness and Applicability of Think-Pair-Share Including Storytelling (TPS-S) to Enhance Clinical Learning.

Teach Learn Med 2021 Apr-May;33(2):184-195. Epub 2020 Sep 2.

ERSU, School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Think-pair-share (TPS) is a teaching strategy that promotes active and collaborative learning; however, the effectiveness and applicability of this strategy in its original or altered form remain to be established, especially in health professions education. As a first step in this direction, the objective of our study was to examine the perceived effectiveness and applicability of TPS including storytelling (TPS-S) in an oral pathology seminar from the perspectives of students, seminar instructors, and peer instructors (experienced instructors who observed the seminar). Prompts for individual thinking (T), pair discussion (P), and class sharing (S) included clinical case-based questions related to diagnosis and management and wildcards with additional information about the cases. In addition to the traditional TPS phases, the experiences of the leading instructor in dealing with the cases discussed in the seminar were shared through storytelling to model good practices in clinical diagnosis and management. Our study was conducted in the School of Dentistry at the University of Alberta. Participants in this mixed-method study included third (Y3) and fourth (Y4) year dental students (n = 55) in their clinical training, seminar instructors (n = 2), and peer instructors (n = 3). Data from students, seminar instructors, and peer instructors were obtained through the Student Evaluation of Educational Quality (SEEQ) questionnaire, journaling, and interview, respectively. Descriptive statistics were performed to analyze SEEQ dimensions and statements (factors). MANOVA was used to determine significant differences between Y3 and Y4 students for SEEQ dimensions and ANOVA to identify the factors that accounted for significant differences. Qualitative data were analyzed using inductive content analysis. Participants positively valued the TPS-S seminar. Students rated all SEEQ dimensions between good and very good and regarded the seminar as superior to traditional lectures. Perceived conditions that facilitated the implementation of TPS-S included the use of real-life clinical cases, instructor facilitation skills, and the scaffolded structure of the seminar. Perceived conditions that hindered the implementation of TPS-S included unequal participation of Y3 and Y4 students, time constraints, and issues related to student pairing. TPS-S was perceived as effective to improve clinical learning and applicable to dental clinical education as long as its implementation matches the characteristics of the learning context. Further evidence is needed to empirically demonstrate the effectiveness and applicability of TPS-S.
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http://dx.doi.org/10.1080/10401334.2020.1811094DOI Listing
October 2021

Public health nurse referrals for paediatric weight management: A nested mixed-methods study.

J Clin Nurs 2020 Sep 25;29(17-18):3263-3271. Epub 2020 Jun 25.

Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.

Aims And Objectives: To (a) characterise and determine proportions of referred and enrolled children and (b) explore public health nurses' (PHNs) experiences, perspectives and recommendations regarding a new nurse-led referral pathway for paediatric weight management.

Background: Children with obesity and their families in Canada access specialised services for obesity management through physician referral. Since this requirement can prevent timely access to health services, we established and tested a referral pathway whereby PHNs directly refer children to specialised care for obesity management.

Design: Nested mixed-methods study reported using GRAMMS.

Method: Our research study included children (2-17 years of age; body mass index ≥85th percentile) referred by a PHN to the Pediatric Centre for Weight and Health (PCWH; Stollery Children's Hospital, Edmonton, Alberta, Canada) from April 2017-September 2018. We summarised referral and enrolment data using descriptive statistics and conducted one-on-one, semi-structured telephone interviews with PHNs; interviews were audio-recorded, transcribed verbatim, managed using NVivo 12 and analysed by two independent reviewers using content analysis.

Results: Our sample included 79 referred children (4.4 ± 1.8 years old; 3.4 ± 1.3 BMI z-score; 52.7% male), of which 47 (59.5%) enrolled in care. PHNs' (n = 11) experiences, perspectives and recommendations regarding the new referral pathway were grouped into four categories: (a) practicality of the referral pathway (e.g., simple and straightforward), (b) utility of the referral pathway (e.g., economic and timesaving), (c) uptake of the referral pathway (e.g., physician's influence) and (d) recommendations to improve the referral pathway (e.g., having electronic access to the referral form).

Conclusions: A PHN-specific referral pathway led most children and families to enrol in paediatric weight management and overall was perceived as acceptable and appropriate among PHNs.

Relevance To Clinical Practice: Our results highlight the valuable role that PHNs can play in directly referring children to specialised services for weight management. This pathway has the potential to reduce wait times and enhance treatment enrolment.
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http://dx.doi.org/10.1111/jocn.15350DOI Listing
September 2020

Correlates of nonmedical use of prescription opioids among a cohort of adolescents in Ontario, Canada.

J Psychiatr Res 2020 01 1;120:175-184. Epub 2019 Nov 1.

Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address:

Introduction: Mortality and morbidity rates related to prescription opioid analgesics have been rising in North America and may be a gateway to the nonmedical use of prescription opioids (NUPO). The purpose of this study was to explore correlates of NUPO in the adolescent population given the scarce literature in this area.

Methods: Cross-sectional data from 10,163 middle- and high-school students (15.1 ± 1.8 years old; 57.0% female; 55.6% White ethnic background) in Ontario were derived from the 2017 Ontario Student Drug Use and Health Survey. Potential correlates of NUPO in the past year included sociodemographic, behavioral, parental, and school characteristics.

Results: Overall prevalence of NUPO was 10.7%. In the final multivariable model, NUPO was significantly associated with 8 of the 21 correlates examined. Students who used prescription opioids nonmedically were of black, South Asian, and "other" ethnic backgrounds (OR 2.83, OR 1.77, and OR 1.67, respectively); reported a lower subjective socioeconomic status (OR 0.92), lower parental support (OR 0.90), and lower academic performance (OR 0.86); met physical activity recommendations (OR 1.48); consumed energy drinks (OR 1.42); smoked tobacco cigarettes (OR 2.33); and used cannabis (OR 1.84).

Conclusions: Findings from this study show a wide variety of correlates of NUPO among Canadian adolescents, and highlight the need for further research and the value in targeted prevention and multi-level intervention programs for NUPO in this population.
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http://dx.doi.org/10.1016/j.jpsychires.2019.10.021DOI Listing
January 2020

Adolescents' involvement in decision-making for pediatric weight management: A multi-centre, qualitative study on perspectives of adolescents and health care providers.

Patient Educ Couns 2019 06 10;102(6):1194-1202. Epub 2019 Feb 10.

Department of Pediatrics, University of Alberta, Edmonton, Canada. Electronic address:

Objective: To explore adolescents' and health care providers' (HCPs) perspectives on adolescents' involvement in decision-making within multidisciplinary clinical care for pediatric weight management.

Methods: In this multi-centre, qualitative description study, we purposefully recruited 13-17-year-olds with overweight or obesity and HCPs from two pediatric weight management clinics in Edmonton and Ottawa, Canada. Participants completed one-on-one, in-person, semi-structured interviews (adolescents) or focus groups (HCPs), which were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were analyzed by two independent researchers using inductive thematic analysis and the congruent methodological approach for group interactions.

Results: A total of 19 adolescents and 16 HCPs participated. Three themes were identified in relation to adolescents' decision-making for weight management, including (i) conditions for adolescent involvement, (ii) preferences for adolescent involvement, and (iii) extent of parental involvement.

Conclusions: Although adolescents and HCPs positively valued adolescents' involvement in making decisions regarding their weight and health, the extent to which adolescents wished to be involved in the decision-making process varied between individuals and families.

Practice Implications: HCPs are encouraged to include adolescents and families in their health services delivery, including consulting individually with adolescents and tailoring care to their expectations regarding decision-making.
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http://dx.doi.org/10.1016/j.pec.2019.01.017DOI Listing
June 2019

Barriers and enablers for adopting lifestyle behavior changes in adolescents with obesity: A multi-centre, qualitative study.

PLoS One 2018 18;13(12):e0209219. Epub 2018 Dec 18.

Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Background: Many adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management.

Objective: To explore barriers and enablers that influenced the adoption of lifestyle behavior changes among adolescents receiving multidisciplinary clinical care for pediatric weight management.

Methods: In this multi-centre, qualitative description study, we used purposeful sampling to recruit 13-17 year olds (body mass index ≥85th percentile) enrolled in one of two pediatric weight management clinics in Edmonton and Ottawa, Canada. Adolescents participated in one-on-one, in-person, semi-structured interviews in English or French. Interviews lasted 30-60 minutes, were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were triangulated using transcripts, field notes, and memos and analyzed by two independent researchers using inductive, semantic thematic analysis.

Results: In total, 19 adolescents (12 Anglophone and 7 Francophone; 15.1±1.7 years old; 3.5±0.6 BMI z-score; n = 11 female; n = 13 Caucasian) participated. Adolescents reported diverse barriers to and enablers of healthy nutrition, physical and sedentary activities, and sleep habits, which we organized into the following themes: physiological mechanisms and physical health status, self-regulation for behavior change, controllability and competence beliefs, social relationships and interactions, and accessibility to and availability of opportunities for lifestyle enhancement. Across these themes and lifestyle areas, we identified three shared barriers and/or enablers, including the degree of controllability, the impact of mental health, and social pressures related to weight management.

Conclusions: This research provides evidence that can be used to tailor interventions and health services delivery, including a focus on psychosocial well-being, to support adolescents with obesity in making and maintaining healthy lifestyle behavior changes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209219PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298663PMC
May 2019

Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management.

J Pediatr 2018 11 17;202:129-135. Epub 2018 Jul 17.

Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Objectives: To characterize the children who were referred, determine the proportion of referred children who enrolled, and examine factors associated with enrollment in multidisciplinary clinical care for pediatric weight management.

Study Design: This cross-sectional study included the population of children (2-17 years of age; body mass index of ≥85th percentile) referred to 1 of 3 hospital-based multidisciplinary weight management clinics in Alberta, Canada, from April 2013 to April 2016. Referral and enrollment data were obtained from Alberta Health Services databases. Bivariate and multivariable logistic regression models were used to determine the independent and combined effects of predictors of enrollment.

Results: Of the 2014 children (51.8% male; mean body mass index z-score: 3.42 ± 0.03) referred to multidisciplinary clinical care, 757 (37.6%) enrolled in care. Most referred children had severe obesity and were referred by physicians. Several factors independently predicted enrollment; however, in our most parsimonious multivariable model, only the time gap (OR, 0.94; 95% CI, 0.88-0.99; P = .03) between the attendance date of the orientation session and the booking date of initial appointment predicted enrollment for all children. Body mass index z-score (OR, 0.81; 95% CI, 0.67-0.98; P = .03) and time gap (OR, 0.92; 95% CI, 0.85-0.99; P = .02) predicted enrollment in children with severe obesity exclusively.

Conclusions: Fewer than 40% of referred children enrolled in multidisciplinary clinical care. Reducing the duration of enrollment and providing additional support for treatment initiation to children with severe obesity may enhance treatment uptake for pediatric weight management.
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http://dx.doi.org/10.1016/j.jpeds.2018.06.038DOI Listing
November 2018

A home for patient-oriented research.

CMAJ 2018 05;190(20):E607

Deputy editor (Patrick), CMAJ; Department of Pediatrics (Kebbe), Faculty of Medicine & Dentistry, University of Alberta; School of Public Health (Aubin), University of Alberta, Edmonton, Alta.

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http://dx.doi.org/10.1503/cmaj.180587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962390PMC
May 2018

Is there a role for shared decision-making in pediatric weight management?

Obes Res Clin Pract 2018 Mar - Apr;12(2):246-248. Epub 2018 Feb 1.

Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada. Electronic address:

Shared decision-making (SDM) is central to personalising health and medical decisions. This decisional model encourages patients to act as managers of their own care while maintaining a partnership with health professionals. Although applied to some conditions, SDM has been used infrequently in pediatric weight management (PWM). Herein, we highlight the applicability and usefulness of SDM in making several important decisions related to PWM, including referral-making to different levels of care and treatment initiation and implementation. We conclude by describing possible challenges that may arise when implementing this model and suggest strategies to optimise the use of SDM in PWM.
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http://dx.doi.org/10.1016/j.orcp.2018.01.004DOI Listing
April 2019

Parent Recommendations to Enhance Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management.

J Pediatr 2018 01;192:122-129

Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Objective: To explore parents' recommendations to enhance enrollment in multidisciplinary clinical care for managing pediatric obesity.

Study Design: Data for this interpretative description study were collected through individual, semistructured interviews that were audiorecorded, transcribed verbatim, and analyzed thematically. Parents (n = 79) were recruited from 4 multidisciplinary weight management clinics in Canada located in Edmonton, Hamilton, Montreal, and Vancouver.

Results: Most interviewed parents had children with obesity (body mass index ≥95th percentile; 84.2%), were female (87.3%), had postsecondary education (69.6%), and were white (75.9%). Parents' recommendations referred to enrollment opportunities, information about obesity services, motivation for treatment, and accessibility to obesity services. Specifically, parents recommended to increase referral options and follow-up contacts with families during the enrollment process, inform referring physicians and families about the availability and characteristics of obesity services, enhance families' motivation for treatment, prevent families from getting discouraged, make services more appealing to families, and address accessibility issues (eg, offering multiple options for appointment times, providing support for transportation).

Conclusions: Parents' recommendations support the need for family-centered approaches to enhance enrollment; however, their feasibility, acceptability, and effectiveness remain to be tested empirically.
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http://dx.doi.org/10.1016/j.jpeds.2017.09.025DOI Listing
January 2018

Following Suit: Using Conversation Cards for Priority Setting in Pediatric Weight Management.

J Nutr Educ Behav 2017 Jul - Aug;49(7):588-592.e1. Epub 2017 May 3.

Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. Electronic address:

Objective: To describe families' selections of Conversation Cards (CCs), a priority-setting tool in pediatric weight management, and examine CC-related differences based on families' anthropometric and sociodemographic characteristics.

Methods: A retrospective medical record review was conducted of 2- to 17-year-olds with obesity and their families who enrolled in a pediatric weight management clinic between January, 2012 and September, 2016.

Results: Medical records of 146 children were included. On average, families selected 10 ± 6 CCs (range, 3-32 CCs); only 50% of families (n = 73) indicated perceived readiness to make healthy changes. Adolescents (vs children) revealed less healthy eating behaviors (P = .001) and physical activity habits (P = .002). Goal setting was perceived to be a motivator across several sociodemographic characteristics (all P < .05).

Conclusions And Implications: The CCs were useful in describing families' priorities. The diversity of issues identified by families highlighted the importance of multidisciplinary expertise in pediatric weight management.
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http://dx.doi.org/10.1016/j.jneb.2017.03.020DOI Listing
April 2018

The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: study protocol.

BMC Health Serv Res 2017 04 11;17(1):261. Epub 2017 Apr 11.

Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.

Background: Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth.

Methods: From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13-17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children's hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined.

Discussion: As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families' needs.
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http://dx.doi.org/10.1186/s12913-017-2201-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387327PMC
April 2017
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