| 1. |
- Nowicka, Paulina, 1974-, et al.
(författare)
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Utility of Hemoglobin A1c for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents
- 2011
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 34:6, s. 1306-1311
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE—Hemoglobin A1c (A1C) has emerged as a recommended diagnostic tool for identifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1C with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.RESEARCH DESIGN AND METHODS—We studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1C measurement. These tests were repeated after a follow-up time of ;2 years in 218 subjects.RESULTS—At baseline, subjects were stratified according to A1C categories: 77% with normal glucose tolerance (A1C,5.7%), 21% at risk for diabetes (A1C 5.7–6.4%), and 1% with diabetes (A1C .6.5%). In the at risk for diabetes category, 47% were classified with prediabetes or diabetes, and in the diabetes category, 62% were classified with type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1C was 0.81 (95%CI 0.70–0.92). The threshold for identifying type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1C and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.CONCLUSIONS—The American Diabetes Association suggested that an A1C of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1C by itself represents a poor diagnostic tool for prediabetes and type 2 diabetes in obese children and adolescents.
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| 2. |
- Bergman, Karolin, 1979-, et al.
(författare)
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‘A holistic approach’ : incorporating sustainability into biopedagogies of healthy eating in Sweden’s dietary guidelines
- 2020
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Ingår i: Sociology of Health and Illness. - : Wiley. - 0141-9889 .- 1467-9566. ; 42:8, s. 1785-1800
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Tidskriftsartikel (refereegranskat)abstract
- Dietary guidelines can be considered a pedagogical tool, designed to promotehealthy eating at the population level. In this study, we critically examine thebiopedagogies implicated in Sweden’s official dietary guidelines. Published in2015, these guidelines take a potentially innovative ‘holistic approach’ to food andeating, addressing the challenge of formulating dietary advice that considers bothhuman health and environmental concerns. Applying Bacchi´s ‘What’s theproblem represented to be?’ approach, we interrogate how the guidelines frame theinterplay of public health concerns and environmental concerns in making foodchoices. We find that the biopedagogies of sustainable eating, as presented in theseguidelines, implicate the subject position of the ideal eater. The ideal eater valuessustainability, has high cultural capital, and draws on both taste and nutritionalknowledge to make good food choices. However, while the ideal eater is expectedto be aware of environmental issues, these are incorporated into the ideal eater’schoices only in addition to the primary concern of health. Thus, although theguidelines frame a ‘holistic approach’ as the solution to both health andenvironmental concerns, in cases where health and environmental prioritiesconflict, the guidelines’ biopedagogies of sustainable eating align with earlierbiopedagogies of healthy eating.
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| 3. |
- Bergman, Karolin, 1979-, et al.
(författare)
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Healthy eating as conceptualized in referral responses to Sweden’s updated dietary guidelines: excluding the complexity of everyday life
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- National Dietary Guidelines have been published in many countries to support healthier food habits among the public. In Sweden, the guidelines are produced in a process involving experts and stakeholders under the responsibility of the National Food Agency. Stakeholder perspectives on the concept of state dietary advice was explored in this study, by analyzing 40 referral responses on updated guidelines in Sweden 2015. The study focused on ideas about how state dietary advice should be framed and what it should be based on. Thematic analysis was used and resulted in two main themes. 'Securing scientifically proven advice' represented a perspective of the guidelines as to be scientifically correct and verified, and built upon an underlying assumption to present an objective and optimal composition of foods and nutrients that will fit all. Arguments based on nutritional reductionism could be seen, which gave a delimited idea of what healthy food is. 'Getting the message across' represented a perspective of the guidelines to be easily understood by and inclusive to the end user. Clarity in advice was seen to be reached by explaining difficult words, defining amounts and exact mechanisms of why something is a good choice. Also this perspective added to excluding other values of food, especially qualitative ones. The construction of a healthy diet in these remittance responses builds upon a notion of an ideal diet composed on the basis of the best scientific proof and clearly presented so as to be easily understood and practiced. It was clearly based on an individualistic behavioral view making the individual responsible to make informed and good choices for a healthy diet. This approach may be questioned, as it is too simplified to include the complex reality of everyday life.
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| 4. |
- Bergman, Karolin, 1979-
(författare)
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Negotiating healthy eating : Lay, stakeholder and government constructions of official dietary guidance in Sweden
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis approaches dietary guidance as socio-culturally produced and comprised in a specific historical context. The work is premised on the position that ideas and understandings of healthy eating are discursively constructed, and that we form our understandings of the world, ourselves and others through discourse. The theoretical approach builds on the Foucauldian notion of governing, which includes how the state governs people through strategic techniques and individuals’ self-governing in relation to discursive norms related to official institutions. The four studies included in the thesis therefore explore how healthy eating and official dietary guidance are negotiated and constructed from stakeholder, lay and policy perspectives. Paper I takes a stakeholder perspective on “appropriate” national dietary advice by exploring 40 written responses to updated official dietary guidelines. Paper II and III focus on lay people’s discourses on dietary guidance and healthy eating by examining their written correspondences (727 and 60 digital messages, respectively) with the Swedish Food Agency. Paper IV examines how the Swedish Food Agency’s official dietary guidelines frame the interplay of public health concerns and environmental concerns in making food choices.The findings demonstrate the dominance of a nutrient-centered and scientific discourse in communication (arguments, statements, instructions and questions) related to official dietary guidance in the Swedish context, even among non-professionals (in stakeholder responses, lay messages and the official dietary guidelines). In lay people´s communication with the Swedish Food Agency, both resistance to and internalization of official dietary advice are expressed within this dominating discourse. Resistance is additionally expressed through emotional language and by referring to alternative authorities, including personal experiences. The nutrient-centered and scientific discourse builds on the basic assumption of individual responsibility for health and the taken-for-granted nature of the primacy of physical health. Environmental perspectives come secondary to nutrition, which is demonstrated by their subordinate status in the official dietary guidelines and limited presence in lay people´s correspondences. Most socio-cultural, emotional and structural aspects on eating are made invisible by these discourses, in which food figures as scientifically quantifiable or functional in relation to physical health. However, in the official dietary guidelines from 2015, an additional discourse of cultivating certain tastes as a key to a sustainable diet constructs an ‘ideal eater’ with ‘middle-class’ aspirations.
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| 5. |
- Bergman, Karolin, 1979-, et al.
(författare)
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Public expressions of trust and distrust in governmental dietary advice in Sweden
- 2019
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 29:8, s. 1161-1173
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Tidskriftsartikel (refereegranskat)abstract
- We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice, or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice, or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and 'alternative' evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency’s advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.
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| 6. |
- Bergman, Karolin, 1979-, et al.
(författare)
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Stakeholder responses to governmental dietary guidelines : Challenging the status quo, or reinforcing it?
- 2018
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Ingår i: British Food Journal. - : Emerald Group Publishing Limited. - 0007-070X .- 1758-4108. ; 120:3, s. 613-624
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose of this paper is to explore how stakeholders in the food and nutrition field construct and conceptualise “appropriate” national dietary advice.Design/methodology/approachIn total, 40 voluntarily written stakeholder responses to updated official dietary guidelines in Sweden were analysed thematically. The analysis explored the logics and arguments employed by authorities, interest organisations, industry and private stakeholders in attempting to influence the formulation of dietary guidelines.FindingsTwo main themes were identified: the centrality of anchoring advice scientifically and modes of getting the message across to the public. Stakeholders expressed a view of effective health communication as that which is nutritionally and quantitatively oriented and which optimises individuals’ capacities to take action for their own health. Their responses did not offer alternative framings of how healthy eating could be practiced but rather conveyed an understanding of dietary guidelines as documents that provide simplified answers to complex questions.Practical implicationsPolicymakers should be aware of industrial actors’ potential vested interests and actively seek out other stakeholders representing communities and citizen interests. The next step should be to question the extent to which it is ethical to publish dietary advice that represents a simplified way of conceptualising behavioural change, and thereby places responsibility for health on the individual.Originality/valueThis research provides a stakeholder perspective on the concept of dietary advice and is among the first to investigate referral responses to dietary guidelines.
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| 7. |
- Bergman, Karolin, 1979-, et al.
(författare)
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'Writing nutritionistically' : A critical discourse analysis of lay people´s digital correspondence with the Swedish Food Agency
- 2022
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Ingår i: Health. - : Sage Publications. - 1363-4593 .- 1461-7196. ; 26:5, s. 554-570
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Tidskriftsartikel (refereegranskat)abstract
- This article analyzes lay people’s use of nutritionistic discourse in written correspondence with the Swedish Food Agency, an authority responsible for dietary advice. Examining 60 food related written digital messages, we apply a critical discourse analysis to parse the terms and grammar people use when constructing “food” in scientific terms. Findings show that message writers place nutrients at the discursive center and frequently use terms that indicate preciseness, such as numbers and amounts, reinforced by modality (auxiliary verbs) and transitivity (nominalizations). Messages therefore emphasize the what, but not the how, of eating, implying a focus on food as subject to regulation and control. As such, eating is discursively reduced to an act of ingesting nutrients that can be decontextualized and managed in isolation – as entities to increase or avoid separately. These discursive features preclude the conceptualization of food choice and eating as subjective experiences of feelings, taste, and tradition.
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| 8. |
- Braet, Caroline, et al.
(författare)
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The Assessment of Eating Behaviour in Children Who Are Obese: A Psychological Approach. A Position Paper from the European Childhood Obesity Group
- 2014
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Ingår i: Obesity Facts. - : S. Karger AG. - 1662-4025 .- 1662-4033. ; 7, s. 153-164
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice. Methods: Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors’ combined clinical experience, a three-staged approach to assessment was agreed by consensus. Results: Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three staged approach to assessing eating behaviours in the absence of hunger is described. Conclusions: This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.
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| 9. |
- Duncanson, K., et al.
(författare)
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Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity : a systematic review with meta-analysis
- 2021
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Ingår i: Journal of human nutrition and dietetics. - : Wiley. - 0952-3871 .- 1365-277X. ; 34:1, s. 147-177
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity.METHODS: Eligible randomised controlled trials (RCTs) published between 1975 and 2020 were identified by a systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Meta-analyses of eligible study outcomes were performed using statistical software. A multilevel random effects model was used with three significant random effects fitted using restricted maximum likelihood estimation.RESULTS: This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change and 14 reporting no significant dietary change. Results from the meta-analyses (n = 29 studies) indicated that, compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194 kcal day-1 , 95% confidence interval = -275.80 to -112.90 kcal day-1 , P < 0.001) and up to 12 months (-112 kcal day-1 95% confidence interval = -218.92 to -5.83 kcal day-1 ) P = 0.038), increases in fruit and/or vegetable intakes over 2-12 months (n = 34, range +0.6 to +1.5 servings day-1 ) and reductions in consumption of sugar-sweetened beverages (n = 28, range -0.25 to -1.5 servings day-1 ) at 4-24 months follow-up.CONCLUSIONS: Obesity interventions with a dietary component have a modest but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.
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| 10. |
- Eiffener, Elodie, et al.
(författare)
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The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes : Secondary findings from a randomized controlled trial
- 2019
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Ingår i: Pediatric Obesity. - : John Wiley & Sons. - 2047-6302 .- 2047-6310. ; 14:11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.Objectives: To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.Method: The study included 77 children (4‐6 years old, 53% girls, mean body mass index [BMI] z‐score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z‐score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.Results: Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z‐scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z‐scores.Conclusions: Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.
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