Mona Sharifi1, Gareth Marshall2, Roberta E Goldman3, Courtney Cunningham2, Richard Marshall4, Elsie M Taveras5. 1. Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: msharifi@mgh.harvard.edu. 2. Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA. 3. Warren Alpert Medical School, Brown University, Providence, RI, USA; Harvard School of Public Health, Boston, MA, USA. 4. Department of Social and Behavioral Sciences, Harvard Vanguard Medical Associates, Boston, MA, USA. 5. Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA; Harvard School of Public Health, Boston, MA, USA.
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.
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.
Authors: Jennifer S Li; Tracie A Barnett; Elizabeth Goodman; Richard C Wasserman; Alex R Kemper Journal: Circulation Date: 2012-12-03 Impact factor: 29.690
Authors: Elsie M Taveras; Steven L Gortmaker; Katherine H Hohman; Christine M Horan; Ken P Kleinman; Kathleen Mitchell; Sarah Price; Lisa A Prosser; Sheryl L Rifas-Shiman; Matthew W Gillman Journal: Arch Pediatr Adolesc Med Date: 2011-04-04
Authors: Mona Sharifi; Gareth Marshall; Richard Marshall; Clement Bottino; Roberta Goldman; Thomas Sequist; Elsie M Taveras Journal: J Health Care Poor Underserved Date: 2013
Authors: Erinn T Rhodes; Richard E Boles; Kimberly Chin; Amy Christison; Elizabeth Getzoff Testa; Kimberly Guion; Mary Jane Hawkins; Carter R Petty; Bethany Sallinen Gaffka; Melissa Santos; Laura Shaffer; Jared Tucker; Sarah E Hampl Journal: Child Obes Date: 2017-01-16 Impact factor: 2.992
Authors: Elsie M Taveras; Richard Marshall; Mona Sharifi; Earlene Avalon; Lauren Fiechtner; Christine Horan; John Orav; Sarah N Price; Thomas Sequist; Daniel Slater Journal: Contemp Clin Trials Date: 2015-09-30 Impact factor: 2.226
Authors: Elsie M Taveras; Richard Marshall; Mona Sharifi; Earlene Avalon; Lauren Fiechtner; Christine Horan; Monica W Gerber; E John Orav; Sarah N Price; Thomas Sequist; Daniel Slater Journal: JAMA Pediatr Date: 2017-08-07 Impact factor: 16.193
Authors: Lauren Fiechtner; Ines Castro; Erika R Cheng; Mona Sharifi; Monica W Gerber; Man Luo; Don Goldmann; Megan Sandel; Jason Block; E John Orav; Elsie M Taveras Journal: Pediatr Obes Date: 2021-03-18 Impact factor: 3.910