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Behavioural interventions for improving cognition and school achievement in children with O/O: What’s the Evidence?

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Health Evidence™ hosted a 90 minute webinar examining the effectiveness of physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Follow this link to access to the audio recording for this webinar: https://youtu.be/lzKV2Hg1J44

Dr. Anne Martin, Research Associate at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, and Dr. Josie Booth, Lecturer at the Institute for Education, Community and Society, The University of Edinburgh, presented an overview of findings from their latest systematic review and meta-analysis:

Martin A, Booth J, Laird Y, Sproule J, Reilly J, & Saunders D. (2018). Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database of Systematic Reviews, 2018(1), CD009728.

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. This systematic review assesses whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. Eighteen randomized and cluster-randomized controlled trials involving 2384 children were included in this review. Findings suggest that school and community‐based physical activity interventions provided within obesity prevention or treatment programmes can improve executive functions in children with obesity or overweight. Additionally, children with obesity may see improvements in general school achievement with school‐based dietary interventions.

Published in: Education
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Behavioural interventions for improving cognition and school achievement in children with O/O: What’s the Evidence?

  1. 1. Welcome! Behavioural interventions for improving cognition and school achievement in children with O/O: What's the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. Poll Questions: Consent • Participation in the webinar poll questions is voluntary • Names are not recorded and persons will not be identified in any way • Participation in the anonymous polling questions is accepted as an indication of your consent to participate Benefits: • Results inform improvement of the current and future webinars • Enable engagement; stimulate discussion. This session is intended for professional development. Some data may be used for program evaluation and research purposes (e.g., exploring opinion change) • Results may also be used to inform the production of systematic reviews and overviews Risks: None beyond day-to-day living
  3. 3. After Today • The PowerPoint presentation and audio recording will be made available • These resources are available at: – PowerPoint: http://www.slideshare.net/HealthEvidence – Audio Recording: https://www.youtube.com/user/healthevidence /videos 3
  4. 4. What’s the evidence? Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018). Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. The Cochrane database of systematic reviews, 3(3), CD009728. doi:10.1002/14651858.CD009728.pub4
  5. 5. • Use CHAT to post comments / questions during the webinar – ‘Send’ questions to All (not privately to ‘Host’) • Connection issues – Recommend using a wired Internet connection (vs. wireless) • WebEx 24/7 help line – 1-866-229-3239 Participant Side Panel in WebEx Housekeeping
  6. 6. Housekeeping (cont’d) • Audio – Listen through your speakers – Go to ‘Communicate > Audio Broadcast’ • WebEx 24/7 help line – 1-866-229-3239
  7. 7. Poll Question #1 How many people are watching today’s session with you? A. Just me B. 2-3 C. 4-5 D. 6-10 E. >10
  8. 8. Students: Sarah Neil-Sztramko (Postdoctoral fellow) Emily Belita (PhD candidate) Patricia Burnett (PhD candidate) Rawan Farran Research Coordinator Kristin Read Research Coordinator Heather Husson Administrative Director The Health Evidence™ Team Maureen Dobbins Scientific Director Maureen Dobbins Scientific Director Claire Howarth Research Coordinator Kate Turner Research Assistant Emily Sully Research Assistant
  9. 9. What is www.healthevidence.org? Evidence Decision Making inform
  10. 10. Why use www.healthevidence.org? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  11. 11. A Model for Evidence- Informed Decision Making National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [https://www.nccmt.ca/impact/publications/1]
  12. 12. Stages in the process of Evidence-Informed Public Health National Collaborating Centre for Methods and Tools. Evidence-Informed Public Health. [http://www.nccmt.ca/eiph]
  13. 13. Poll Question #2 Have you heard of PICO(S) before? A. Yes B. No
  14. 14. Searchable Questions Think “PICOS” 1.Population (situation) 2.Intervention (exposure) 3.Comparison (other group) 4.Outcomes 5.Setting
  15. 15. How often do you use systematic reviews to inform a program/services? A. Always B. Often C. Sometimes D. Never E. I don’t know what a systematic review is Poll Question #3
  16. 16. Dr. Anne Martin (PhD, MSc, BSc), Research Associate at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow Dr. Josie Booth (PhD), Lecturer (Assistant Professor) at the Institute for Education, Community and Society, The University of Edinburgh
  17. 17. Background (1) • 50 million girls and 74 million boys aged 5-19 years with obesity (NCD Risk Factor Collaboration, Lancet 2017) • Physical and mental health problems, and psychosocial consequences are common in young people with obesity (Grant-Guimaraes et al 2016; Rankin et al 2016) • Cognitive and academic consequences have also been observed in young people with obesity (Liang et al 2013, Martin et al 2016, Martin et al 2017, Pearce et al 2018)
  18. 18. Martin A., Booth JN., et al. (2017). Longitudinal associations between childhood obesity and academic achievement: systematic review with focus group data. Current obesity reports, 6(3), 297-313. https://link.springer.com/article/10.1007/s13679-017-0272-9
  19. 19. • Guidelines for prevention and treatment of childhood obesity recommend changes towards a healthy diet, increased physical activity, and reduced sedentary activities • Changing these health behaviours can benefit cognitive function and school achievement of young people in general (e.g. Berlot et al 2011, Vazou et al 2016) Background (2)
  20. 20. Cognitive function • Differences between school achievement, IQ, and executive function • Executive function = umbrella term, includes: – Attention – Working memory – Inhibition – Cognitive flexibility Can you solve the following just in your head: 43 x 81?
  21. 21. Thinking about your own practice… Poll Question #4 Have you noticed children with overweight or obesity having difficulties with attention, memory, problem solving, decision making and/or academic achievement? YES | NO
  22. 22. Potential causal links Martin et al (2018). The Cochrane database of systematic reviews, 3(3), CD009728
  23. 23. Bi-directionality: Obesity ↔ Cognition • Children with obesity show – higher impulsivity and inattention – lower reward sensitivity, self-regulation and cognitive flexibility compared with healthy-weight peers (Jansen et al 2015, Nederkoorn et al 2006) • Neurocognitive correlates were associated with uncontrolled food intake and physical activity behaviour, and thus are assumed to predict weight gain (Kulendran et al 2014) • Improved cognitive abilities were associated with reduction of weight status after an obesity treatment intervention (Delgado-Rico et al 2012, Naar-King et al 2016, Verbeken et al 2013)
  24. 24. Methods
  25. 25. Type of outcomes School achievement Cognitive function Average across subjects Composite executive function Mathematics Inhibition control Reading Attention Language Working/non-verbal/verbal memory Health class Visuo-spatial abilities - Cognitive flexibility - General intelligence
  26. 26. Physical activity vs standard practice • High quality evidence o Executive function: MD 5.00, 95%CI 0.68 - 9.32; scale mean=100, SD=15; n=116) o Memory: MD 3.00, 95% CI 0.51 to 5.49, scale mean=100, SD=15; n=116) Intervention: • Aerobic group exercise for 40 minutes 5 times/week, over a mean total of 13 weeks in an after-school setting • 5-minute warm-up phase consisted of brisk walking and static and dynamic stretching • Activities at a heart rate >150 beats/minute: running games, tag games, jump rope, modified basketball and football. • The intervention involved no competition or skill enhancement and was delivered (Davis et al 2011)
  27. 27. Physical activity vs standard practice • Moderate quality evidence (school-based intervention) o General intelligence: MD 17.14, 95%CI 7.24 - 27.04, scale range 0-108; n=37) o No statistically significant effect on mathematics, reading (n=155 – 308) Intervention (MOVI-Kids): • standardised extra-curricular non-competitive physical activity programme of 4½ hours/week • informative sessions to parents and teachers about how schoolchildren can become more active, • Changes to the playground (equipment, facilities, painting, etc.) aimed to promote physical activity during recess (Sánchez-López et al 2017)
  28. 28. Physical activity + health education • Low to very low quality of evidence o No statistically significant effect on o average achievement across subjects taught at school, mathematics or reading achievement o inhibition control, attention, visuo-spatial abilities and non-verbal memory
  29. 29. Dietary interventions vs standard practice • Low quality evidence 1. Improvement of the school food environment (2 studies) o Average achievement across subjects taught (SMD 0.46, 95%CI 0.25 to 0.66, n=382) Interventions 1. A whole-school lifestyle education programme involving curriculum material taught by trained teachers, school meal modification towards nutrient-dense food and nutrition counselling. (Johnston et al 2013) 2. Project breakFAST (Fuelling Academics and Strengthening Teens) aimed to improve students’ school breakfast programme (SBP) participation (Nanney et al 2016)
  30. 30. Effects on BMI z-scores
  31. 31. Results: Summary
  32. 32. Results in context (1) • Improving cognition is difficult o Small to moderate effects of interventions are common • Most effective interventions for improving cognition in the general population are o computer interventions (e.g. Cogmed) o mindfulness training, yoga, tae-kwon-do (Diamond & Ling, 2016, https://doi.org/10.1016/j.dcn.2015.11.005)
  33. 33. Results in context (2) • Yoga etc may be the “best bet” as get health benefit as well as cognitive benefit • Several studies have found yoga to have benefits. For example: o Hainsworth et al (2018): yoga improved gait and emotional function in children with obesity https://doi.org/10.3390/children5070092 o Watts et al (2018): yoga improved healthy eating and physical activity in general population https://doi.org/10.1186/s12966-018-0674-4 • More research in this area is needed but Yoga is not currently part of weight management in the UK
  34. 34. Summary: Implications for practice • Physical activity only & dietary interventions: – Some evidence that interventions may be effective in producing small improvements in average achievement across subjects taught at school, executive functions and memory in primary school-aged children with obesity – Findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools • Other interventions: Evidence does not allow us to draw definitive conclusions on their impact on cognitive and academic outcomes.
  35. 35. Conclusions
  36. 36. References (in order of appearance) NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet Online 10 October 2017;390(10113):2627–42. Grant-Guimaraes J, Feinstein R, Laber E, Kosoy J. Childhood overweight and obesity. Gastroenterology Clinics of North America 2016;45(4):715–28. Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolescent health, medicine and therapeutics. 2016;7:125. Liang J, Matheson BE, Kaye WH, Boutelle KN. Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents. International Journal of Obesity 2014; Vol. 38, issue 4:494–506. Pearce AL, Leonhardt CA, Vaidya CJ. Executive and Reward-Related Function in Pediatric Obesity: A Meta-Analysis. Childhood Obesity. 2018 Jul 1;14(5):265-79. Martin A, Booth JN, Young D, Revie M, Boyter AC, Johnston B, et al. Associations between obesity and cognition in the pre-school years. Obesity 2016;24(1): 207–14. Martin A, Booth JN, McGeown S, Niven A, Sproule J, Saunders DH, et al. Longitudinal associations between childhood obesity and academic achievement: systematic review with focus group data. Current Obesity Reports 2017; 10:1–7. [DOI: 10.1007/s13679-017-0272-9.
  37. 37. References (in order of appearance) Belot M, James J. Healthy school meals and educational outcomes. Journal of Health Economics 2011;30(3): 489–504. Vazou S, Pesce C, Lakes K, Smiley-Oyen A. More than one road leads to Rome: a narrative review and meta-analysis of physical activity intervention effects on cognition in youth. International Journal of Sport and Exercise Psychology 2016; 14:1–26. Jansen A, Houben K, Roefs A. A cognitive profile of obesity and its translation into new interventions. Frontiers in Psychology 2015;6:1807. Nederkoorn C, Braet C, Van Eijs Y, Tanghe A, Jansen A. Why obese children cannot resist food: the role of impulsivity. Eating Behaviors 2006;7(4):315–22. Kulendran M, Vlaev I, Sugden C, King D, Ashrafian H, Gately P, et al. Neuropsychological assessment as a predictor of weight loss in obese adolescents. International Journal of Obesity 2014;38(4):507 Delgado-Rico E, Rio-Valle JS, Albein-Urios N, Caracuel A, González-Jiménez E, Piqueras MJ, et al. Effects of a multicomponent behavioral intervention on impulsivity and cognitive deficits in adolescents with excess weight. Behavioural Pharmacology 2012;23(5-6):609–15. Naar-King S, Ellis DA, Idalski CA, Templin T, Jacques- Tiura AJ, Brogan Hartlieb K, et al. Sequential multiple assignment randomized trial (SMART) to construct weight loss interventions for African American adolescents. Journal of Clinical Child and Adolescent Psychology 2016; 45(4):428–41.
  38. 38. Verbeken S, Braet C, Goossens L, Van der Oord S. Executive function training with game elements for obese children: a novel treatment to enhance self-regulatory abilities for weight-control. Behaviour Research and Therapy 2013;51 (6):290–9. Diamond, A. and Ling, D.S., 2016. Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not. Developmental cognitive neuroscience, 18, pp.34-48. Hainsworth, K., Liu, X., Simpson, P., Swartz, A., Linneman, N., Tran, S., Medrano, G., Mascarenhas, B., Zhang, L. and Weisman, S., 2018. A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning. Children, 5(7), p.92. Watts, A.W., Rydell, S.A., Eisenberg, M.E., Laska, M.N. and Neumark-Sztainer, D., 2018. Yoga’s potential for promoting healthy eating and physical activity behaviors among young adults: a mixed-methods study. International Journal of Behavioral Nutrition and Physical Activity, 15(1), p.42 References (in order of appearance)
  39. 39. Poll Question #5 The information presented today was helpful A. Strongly agree B. Agree C. Neutral D. Disagree E. Strongly disagree
  40. 40. What can I do now? Visit the website; a repository of over 5,000+ quality-rated systematic reviews related to the effectiveness of public health interventions. Health Evidence™ is FREE to use. Register to receive monthly tailored registry updates AND monthly newsletter to keep you up to date on upcoming events and public health news. Tell your colleagues about Health Evidence™: helping you use best evidence to inform public health practice, program planning, and policy decisions! Follow us @HealthEvidence on Twitter and receive daily public health review- related Tweets, receive information about our monthly webinars, as well as announcements and events relevant to public health. Encourage your organization to use Health Evidence™ to search for and apply quality-rated review level evidence to inform program planning and policy decisions. Contact us to suggest topics or provide feedback. info@healthevidence.org
  41. 41. Poll Question #6 What are your next steps? [Check all that apply] A. Access the full text systematic review B. Access the quality assessment for the review on www.healthevidence.org C. Consider using the evidence D. Tell a colleague about the evidence
  42. 42. Your Feedback is Important Please take a few minutes to share your thoughts on today’s webinar. Your comments and suggestions help to improve the resources we offer and plan future webinars. The short survey is available at: https://surveys.mcmaster.ca/limesurvey/index.p hp/183927?lang=en
  43. 43. Thank you! Contact us: info@healthevidence.org For a copy of the presentation please visit: http://www.healthevidence.org/webinars.aspx

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