title: Engaging children in the development of obesity interventions: Exploring outcomes that matter most among obesity positive outliers.
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.
  
  
  CONCLUSIONS
  Child/family engagement should guide the development of patient-centered obesity interventions.
authors.affiliation: Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: msharifi@mgh.harvard.edu.
authors.forename: Mona
authors.initials: M
authors.lastname: Sharifi
authors.affiliation: Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
authors.forename: Gareth
authors.initials: G
authors.lastname: Marshall
authors.affiliation: Warren Alpert Medical School, Brown University, Providence, RI, USA; Harvard School of Public Health, Boston, MA, USA.
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Goldman
authors.affiliation: Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Social and Behavioral Sciences, Harvard Vanguard Medical Associates, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Marshall
authors.affiliation: Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA; Harvard School of Public Health, Boston, MA, USA.
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
mesh_terms: D001519:Behavior; D001835:Body Weight; D002648:Child; D006801:Humans; D009042:Motivation; D063766:Pediatric Obesity / Q000503:physiopathology / Q000523:psychology*; D012015:Reference Standards; D012307:Risk Factors; D057566:Self Report
keywords: Attitude to health; Children; Obesity; Overweight; Positive deviance; Qualitative