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Whitlock EP, O'Connor EA, Williams SB, et al. Effectiveness of Weight Management Programs in Children and Adolescents. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Sep. (Evidence Reports/Technology Assessments, No. 170.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Effectiveness of Weight Management Programs in Children and Adolescents.

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Appendix K. Glossary

Adipose Tissue: Fat tissue in the body

Bariatric Surgery: Surgery on the stomach and/or intestines to help patients with extreme obesity to lose weight. Bariatric surgery is a weight-loss method used for people who have a body mass index (BMI) above 40. Surgery may also be an option for people with BMI between 35 and 40 who have health problems like heart disease or type 2 diabetes.

Behavioral Treatment: Behavioral treatment (or behavior therapy) draws on the principles of learning theory (stimulus-behavior contingencies or behavior-reward contingencies). Consists of assessment (identifying and specifying problem behaviors and the circumstances in which they are elicited), treatment (including setting specific, measurable and modest goals that are continually revised) and monitoring. Behavior change processes include stimulus control, graded exposure, extinction and reward

Behavioral Counseling Interventions: Brief counseling in which the primary goal is usually to provide information and make recommendations, with minimal discussion of behavioral management principles. May be delivered in primary care or other settings and primarily involve office staff. Is analogous to the Prevention Plus activities recommended as the first step for those that are overweight in the Expert Panel.

Behavioral Management Interventions: Interventions that include at least some behavioral management principles, such as those used in behavioral treatment. May be less intensive than behavioral treatment.

Behavioral Interventions: A generic term encompassing behavioral counseling, behavioral management interventions, and behavioral treatment.

Bio-electrical Impendence (BIA): A way to estimate the amount of body weight that is fat and nonfat. Nonfat weight comes from bone, muscle, body water, organs and other tissues. BIA works by measuring how difficult it is for a harmless electrical current to move through the body. The more fat a person has the harder it is for electricity to flow through the body. The less fat a person has, the easier it is for electricity to flow through the body. By measuring the flow of electricity, one can estimate body fat percent.

Body Mass Index (BMI): A measure of body weight relative to height. BMI is a tool that is often used to determine if a person is at a healthy weight, overweight, or obese, and whether a persons' health is at risk due to his or her weight. To calculate BMI, use the following formula: weight in kilograms/ height in meters2

Body Mass Index Standard Deviation Score (BMI SDS): This is also known as a BMI z-score. A standard deviation score quanitifies the distance of a BMI from the average BMI of a population or sample. In a normally distributed population, 84% of the population have a BMI SDS at or below 1.0 and 97.5% of the population have a BMI SDS at or below 2.0. The Center for Disease Control and Prevention provides a computer program that converts BMI scores (combined with age and sex of the child) to BMI SDSs. They also provide tables for select BMI scores.

Body Mass Index Z-score (BMI z-score): See Body Mass Index Standard Deviation Score.

Dual Energy X-ray Absorptiometry (DEXA): is an enhanced form of x-ray technology that is used to measure bone loss. DEXA is today's established standard for measuring bone mineral density (BMD).An x-ray (radiograph) is a painless medical test that helps physicians diagnose and treat medical conditions. Radiography involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging. DEXA is most often performed on the lower spine and hips. Portable DEXA devices, including some that use ultrasound waves rather than x-rays, measure the wrist, fingers or heel and are sometimes used for screening purposes.

Dyslipidemia: An abnormal profile of blood lipids. The characteristic dyslipidemia associated with insulin resistance and poorly controlled diabetes includes high levels of triglycerides, low levels of HDL-C, and partitioning of LDL-C into relatively small and dense particles.

Glucose: A building block for most carbohydrates. Digestion causes some carbohydrates to break down into glucose. After digestion, glucose is carried in the blood and goes to the body cells where it is used for energy or stored.

High-density Lipoprotein (HDL): A unit made up of proteins and fats that carry cholesterol to the liver. The liver removes cholesterol from the body. HDL is commonly called “good” cholesterol. High levels of HDL cholesterol lower the risk of heart disease. An HDL level of 60 mg/dl or greater is considered high and is protective against heart disease. An HDL level less than 40 mg/dl is considered low and increases the risk for developing heart disease.

Homeostasis Model Assessment of Insulin Resistance (HOMA): An empirical mathematical formula based on fasting plasma glucose and fasting plasma insulin levels that was developed as a surrogate measurement of in vivo insulin sensitivity

HOMA-IR = fasting plasma insulin (μIU/mL) × fasting plasma glucose (mmol/L) 22.5

Hypertension/High Blood Pressure: Blood pressure rises and falls throughout the day. An optimal blood pressure is less than 120/80 mmHg. When blood pressure stays high—greater than or equal to 140/90 mmHg—you have high blood pressure. With high blood pressure, the heart works harder, your arteries take a beating, and your chances of a stroke, heart attack and kidney problems are greater.

Insulin Resistance: Reduced effectiveness of insulin to mediate its metabolic effects. Insulin resistance generally refers to glucose metabolism, but can be used to describe reductions in other aspects of insulin action. Insulin resistance is a primary abnormality that places people at risk for type 2 diabetes. Additional conditions may be associated with insulin resistance, including cardiovascular disease, hyperinsulinemia, dyslipidemia, hypertension, abdominal obesity, and clotting abnormalities, among others

Insulin: A hormone made by the pancreas that helps moves glucose (sugar) from the blood to muscles and other tissues. Insulin controls blood sugar levels.

Intention-to-Treat: A strategy for analyzing data from a randomized controlled trial. All participants are included in the arm to which they were allocated, whether or not they received (or completed) the intervention given to that arm. Intention-to-treat analysis prevents bias caused by the loss of participants, which may disrupt the baseline equivalence established by randomization and which may reflect non-adherence to the protocol. The term is often misused in trial publications when some participants were excluded.3

LOCF (Last observation carried forward): An imputation that substitutes the last data collected for a time point with missing data.

Laparoscopic Surgery: Surgical approach using a laparoscope and limited incisions to indirectly visualize and perform surgery.

Laparotomy: Surgical incision of the abdomen to allow direct visualization during surgery.

Least Squares Mean (LSM): The method of least squares is a criterion for fitting a specified model to observed data. The LSM is the estimated mean after controlling for potentially confounding variables using the least squares method.

Low-density Lipoprotein (LDL): A unit made up of proteins and fats that carry cholesterol in the body. High levels of LDL cholesterol cause a buildup of cholesterol in the arteries. Commonly called “bad” cholesterol High levels of LDL increase the risk of heart disease. An LDL level less than 100 mg/dl is considered optimal, 100 to 129 mg/dl is considered near or above optimal, 130 to 159 mg/dl is considered borderline high, 160 to 189 mg/dl is considered high, and 190 mg/dl or greater is considered very high.

Metformin: is an oral anti-diabetic drug from the biguanide class.

Obesity: In children aged 2–17, overweight is defined as having a BMI at or above the 95th percentile, compared with other children of the same age and sex, or having a BMI of 30 or more, whichever is lower.

Overweight: In children aged 2–17, overweight is defined as having a BMI in the 85th to 94th percentile, compared with other children of the same age and sex.

Percentile: The percentile indicates the relative position of the child's BMI among children of the same sex and age. Specifically, a percentile tells the proportion of a population or sample that are at or below a given percentile value. For example, 95% of the population are at or below the 95th percentile. To determine a child's BMI percentile score, his or her BMI is compared with published BMI percentile scores based on large, representative samples of children. In the U.S., norms developed by the Center for Disease Control and Prevention are most widely use. Several other countries have developed their own BMI norms.

Physical Activity: Any form of exercise or movement. Physical activity may include planned activities such as walking, running, strength training, basketball, or other sports. Physical activity may also include daily activities such as household chores, yard work, walking the dog, etc. It is recommended that adults get at least 30 minutes of moderate-intensity physical activity for general health benefits. Adults who wish to lose weight may need 60 minutes of physical activity on most days and adults who wish to maintain lost weight may require 60 to 90 minutes of physical activity. Children should get at least 60 minutes of moderate-intensity physical activity most days of the week. Moderate-intensity physical activity is any activity that requires about as much energy as walking 2 miles in 30 minutes.

Skinfold Thickness: A measure of the amount of fat under the skin; the measurement is made with a calliper. Measurements at several sites are normally required as the per cent of fat at each site varies with age, sex and ethnicity. Skinfold measurements are usually taken at the triceps, subscapular and supra-iliac sites

Triglycerides: Triglycerides are the chemical form in which most fat exists in food as well as in the body. They're also present in blood plasma and, in association with cholesterol, form the plasma lipids

Type 2 Diabetes: Diabetes that results from insulin resistance and inadequate insulin secretion (Formerly known as non-insulin-dependent diabetes mellitus or NIDDM). Insulin resistance is generally present before diabetes develops and insulin secretion declines progressively, leading to progressive hyperglycemia. Patients require treatments to reduce insulin resistance and/or increase insulin levels to regulate blood glucose levels. Type 2 diabetes accounts for ~90% of all diabetes cases

Waist Circumference: A measurement of the waist. Fat around the waist increases the risk of obesity related health problems. Women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches have a higher risk of developing obesityrelated health problems, such as diabetes, high blood pressure, and heart disease.

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