Browsing by Author "Fiechtner, Lauren"

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    Characteristics of achieving clinically important weight loss in two paediatric weight management interventions
    (Wiley, 2021) Fiechtner, Lauren; Castro, Ines; Cheng, Erika R.; Sharifi, Mona; Gerber, Monica W.; Luo, Man; Goldmann, Don; Sandel, Megan; Block, Jason; Orav, E. John; Taveras, Elsie M.; Pediatrics, School of Medicine
    Objective: To examine characteristics and lifestyle behaviours associated with achieving clinically important weight loss (CIWL) in two paediatric weight management interventions (PWMIs). Methods: We examined 1010 children enrolled in the STAR and Connect for Health trials. We defined achieving CIWL as any participant who had decreased their BMI z-score by ≥0.2 units over 1 year. Using log-binomial regression we examined associations of child and household characteristics and lifestyle behaviours with achieving CIWL. Results: In multivariable analyses, children with severe obesity had a lower likelihood of achieving CIWL compared to children without severe obesity (RR: 0.68 [95% CI: 0.49, 0.95]). Children who were ≥10 years were less likely to achieve CIWL (RR: 0.56 [95% CI: 0.42, 0.74]) vs those 2-6 years of age. Children who consumed <1 sugary beverage per day at the end of the intervention were more likely to achieve CIWL vs those who did not meet the goal (RR: 1.36 [95% CI 1.09-1.70]). Conclusion: In this analysis of children enrolled in PWMIs, achieving CIWL was associated with younger age, not having severe obesity and consuming fewer sugary beverages at the end of the intervention. Focusing on intervening earlier in life, when a child is at a lower BMI, and reducing sugary beverages could allow for more effective PWMI's.
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    Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity
    (American Public Health Association, 2016-03) Fiechtner, Lauren; Kleinman, Ken; Melly, Steven J.; Sharifi, Mona; Marshall, Richard; Block, Jason; Cheng, Erika R.; Taveras, Elsie M.; Department of Pediatrics, IU School of Medicine
    OBJECTIVES: To determine whether proximity to a supermarket modified the effects of an obesity intervention. METHODS: We examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included computerized clinician decision support plus family self-guided behavior change or health coaching. Outcomes were 1-year change in BMI z-score, sugar-sweetened beverage intake, and fruit and vegetable intake. We examined distance to the closest supermarket as an effect modifier. RESULTS: Distance to supermarkets was an effect modifier of 1-year change in BMI z-score and fruit and vegetable intake but not sugar-sweetened beverage intake. With each 1-mile shorter distance to a supermarket, intervention participants increased their fruit and vegetable intake by 0.29 servings per day and decreased their BMI z-score by -0.04 units relative to controls. CONCLUSIONS: Living closer to a supermarket is associated with greater improvements in fruit and vegetable intake and weight status in an obesity intervention.
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    Multilevel Correlates of Healthy BMI Maintenance and Return to a Healthy BMI among Children in Massachusetts
    (Mary Ann Liebert, 2017-04) Fiechtner, Lauren; Cheng, Erika R.; Lopez, Gabriel; Sharifi, Mona; Taveras, Elsie M.; Pediatrics, School of Medicine
    OBJECTIVES: To examine predictors of healthy BMI maintenance (HBM) or return to a healthy BMI (RHB) among children. METHODS: We studied 33,272 children in Massachusetts between 2008 and 2012. We used multinomial logistic regression to examine associations of individual- and neighborhood-level factors with the odds of: (1) HBM: maintenance of a healthy BMI ≥5th to <85th percentile and (2) RHB: transition to a healthy BMI range from an initial BMI ≥85th percentile between two clinic visits spanning an average of 3.5 years. RESULTS: Racial/ethnic minorities had lower odds of HBM and RHB than non-Hispanic white children. Higher neighborhood educational attainment was associated with an increased odds of HBM and RHB. Higher neighborhood median household income, proximity to a supermarket, and access to more open recreational space were associated with a higher odds of HBM. Children of ages 2-5 years at baseline had higher odds of RHB and HBM than children 13 years and older. CONCLUSIONS: Early childhood interventions and efforts to create health-promoting neighborhoods including improving access to supermarkets and open recreational space could have important effects on obesity prevention and management.
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    The Association of Food Insecurity on Body Mass Index Change in a Pediatric Weight Management Intervention
    (Wiley, 2023) Persaud, Alicia; Evans, E. Whitney; Perkins, Meghan; Simione, Meg; Cheng, Erika R.; Luo, Mandy; Burgun, Rachel; Taveras, Elsie M.; Fiechtner, Lauren; Pediatrics, School of Medicine
    Background: Childhood obesity is a critical public health concern. One potential determinant to obesity that is less understood is food insecurity. Objective: To examine the association of food security status on body mass index (BMI) change in a Pediatric Weight Management Intervention (PWMI) consistent with national treatment recommendations. Methods: This analysis included 201 participants from the Healthy Weight Clinic (HWC). Using linear mixed models, we compared BMI and %BMIp95 change per year between the food insecure group and food secure group, adjusting for baseline BMI, age and sex, and SNAP enrolment. Results: In fully adjusted models, children in households with food insecurity had a 0.50 (0.26-0.74) kg/m2 BMI increase per year and a 2.10 (1.02-3.19) %BMIp95 increase per year compared to households that were food secure. Conclusions: When comparing the BMI effect of the HWC between the food insecure group and food secure group, those experiencing food insecurity in the HWC had an increase in BMI compared to those with food security. These findings suggest that food insecurity may reduce the effectiveness of PWMIs consistent with national recommendations; however, more studies should be conducted to better understand this relationship.