7/2/2020 COPE Webinar Series for Health Professionals July 8, 2020 - - PDF document

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COPE Webinar Series for Health Professionals

July 8, 2020

Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder

Moderator Lisa K. Diewald MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education

• M. Louise Fitzpatrick College of Nursing

Finding Slides for Today’s Webinar

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Today’s Webinar Objectives

• 1. Describe pregnancy-related risk factors for child obesity in children

with ASD.

• 2. Highlight possible dietary and early life risk factors that may be

underlying the increased obesity risk in children with ASD.

• 3. Address feeding and weight-related concerns in children with ASD

and directions for future research.

Continuing Education Credit Details

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration

Continuing Education Credit Details

This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians Suggested CDR Learning Need Codes: 5070, 5180, 5370, 9020 Level 2 CDR Performance Indicators: 6.2.5, 6.3.7, 6.3.8

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Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder Tanja Kral, PhD Professor

School of Nursing & Perelman School

• f Medicine

University of Pennsylvania

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Disclosures

The planners and presenter of this program have no conflicts of interest to disclose. Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity.

Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder

Tanja Kral, PhD

School of Nursing & Perelman School of Medicine University of Pennsylvania

McDonald Center for Obesity Prevention and Education (COPE) Webinar Series July 8, 2020

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My Research Interests Outline of Talk:

1. Obesity in children with Autism Spectrum Disorder (ASD) 2. Pregnancy-related risk factors for childhood obesity in children with ASD 3. ASD symptoms and co-occurring conditions related to obesity risk 4. Feeding difficulties in children with ASD

Obesity Risk in Children with ASD

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Obesity Risk

• In some studies, children with ASD show a 4-fold

increased risk for overweight and obesity than typically developing children (TDC).

• Prevalence rates across studies:
• Overweight/Obesity: 34 - 53%
• Obesity: 10 - 43%
• Children with ASD are also over 3 times more likely

to develop the metabolic syndrome.

Child Characteristic ASD (N = 25)

[mea mean ± SD SD or

• r N (%

(%)] )]

TDC (N = 30)

[mean ± SD or N (%)]

P-value Height (cm) 109.4 ± 6.5 112.6 ± 7.2 0.10 Weight (kg) 19.9 ± 3.7 20.1 ± 3.6 0.79 BMI z-score 0.75 ± 1.39 0.17 ± 1.07 0.088 BMI-for-age percentile 66.1 ± 29.9 55.6 ± 30.2 0.20 Waist circumference (cm) 56.2 ± 7.5 51.9 ± 4.0 0.01 Waist-to-height ratio 0.51 ± 0.06 0.46 ± 0.03 < 0.001 Weight status

Underweight / normal-weight Overweight / obese

14 (56%) 11 (44%) 24 (80%) 6 (20%) 0.055

Kral et al. (2015). Public Health Nursing, 32(5): 488-497

Cardiovascular Risk

• Kral et al. (2014) showed that children with ASD, ages 4-6,

showed significantly greater abdominal waist circumference and waist-to-height ratio.

• Mean waist-to-height ratio for children with ASD: 0.51 ± 0.06
• Castro et al. (2017) reported that nearly 50% of children with

ASD, ages 4-16, showed high central adiposity (waist circumference >80th percentile) and total adiposity (body fat curves >95th centile).

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Early Life Risk Factors for Obesity

• 1. Maternal pre-pregnancy obesity
• 2. Excess gestational weight gain
• 3. Rapid weight gain during infancy

Early Life Risk Factors

Weight Trajectories of Children Born at Low- or High-Risk for Obesity

0.3 1 2 3 4 5 6 7 8 10 12 13 14

• 0.5

0.0 0.5 1.0 1.5

Low-Risk High-Risk

* * * * * * * * *

Child Age (yrs) BMI z-score

Stunkard et al., 2004

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 Exceeding the IOM gestational weight gain recommendations was

associated with a 46% increase in the odds of having a child with

• verweight or obesity at ages 2-5 years (Sridhar et al., 2014).

Institute of Medicine (IOM) Pregnancy Weight Gain Recommendations

Pre-pregnancy weight status Recommended weight gain during pregnancy Underweight (BMI < 18.5 kg/m2) 28 – 40 pounds Normal-weight (BMI 18.5 – 24.9 kg/m2) 25 – 35 pounds Overweight (BMI 25.0 – 29.9 kg/m2) 15 – 25 pounds Obese (BMI > 30 kg/m2) 11 – 20 pounds

 Rapid weight gain during the first year of life conferred a 2-fold higher risk of childhood

• besity and a 23%

higher risk of adult

• besity (Druet et al., 2012).

Rapid Weight Gain During Infancy and Obesity Risk

Study to Explore Early Development (SEED)

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7/2/2020 8 Study to Explore Early Development (SEED)

Group Classification

ASD

(Autism Spectrum Disorder)

DD

(Developmental Delays / Disorders)

POP

(General Population Controls)

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Sample

 Maternal pre-pregnancy BMI  Maternal gestational weight gain:

• Compared to IOM guidelines
• Recommended weight gain met (yes / no)
• Gestational weight gain (< / = / > than

recommendations)

Maternal Weight-Related Variables

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• Child heights/lengths and weights:
• Birth to 6 months: Neonatal and pediatric medical records
• Ages 2-5: In-person clinic visit
• Child age- and sex-specific weight-for-age or BMI z-

scores and percentiles were calculated from:

• WHO Growth Charts (birth to 24 months)
• CDC Growth Charts (>24 months)
• Rapid weight gain: Change in weight-for-age z-scores

from birth to 6 months >0.67 SD (Monteiro and Victora, 2005)

Child Weight-Related Variables

Demographic, Maternal, and Birth Variables

Demographic Maternal Birth

Child age Diabetes Birth weight Child sex High blood pressure (BP) Prematurity status Maternal education Pregnancy-related high BP (eclampsia, pregnancy- induced hypertension, HELLP syndrome) Gestational age Maternal race Eating disorders (bulimia nervosa, anorexia nervosa, dieting during pregnancy) Duration of breastfeeding Poverty status Intrauterine growth restriction (IUGR) Smoking during pregnancy

Co-Occurring Medical, Behavioral, and Psychiatric Conditions

Medical Conditions or Symptoms Behavioral, Developmental or Psychiatric Conditions or Symptoms Asthma ADHD Birth defects Behavioral problems Cardiac diseases / disorders Cognitive delay Endocrine diseases / disorders Feeding difficulties Gastrointestinal diseases / disorders Motor delay Genetic disorders Psychiatric disorders Immune disorders Sensory disorders Metabolic disorders Sleep problems Neurological abnormalities / symptoms Speech delay Renal diseases / disorders Respiratory diseases / disorders Seizure disorders

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Autism Severity

• Ohio State University Autism Rating Scale (OARS)
• Scores 2-3: Mild range of severity (21%)
• Scores 4-5: Moderate range of severity (49%)
• Scores 6-7: Severe range (22%)
• Autism Calibrated Severity Score (ACSS)

OARS ACSS

• Measures severity of global

functioning

• Most impacted by adaptive abilities

and expressive language skills

• Measures severity of ASD

symptoms, independent of developmental factors

• May not take into account overall

degree of impairment

Results: Descriptive Characteristics

Child Demographic and Anthropometric Characteristics

Characteristic ASD Mean  SD

• r N (%)

DD Mean  SD

• r N (%)

POP Mean  SD

• r N (%)

P-Value Age (months) 59.3  6.6 59.2  7.2 59.2  7.4 0.99 Sex (male/female) 82% / 18% 66% / 34% 52% / 48% <.001 Prematurity status Very preterm (< 32 weeks) Moderate to late preterm (32 to < 37 weeks) Term (37 to < or equal 41 weeks) Post-term (> 41 weeks) 39 (7.2%) 74 (13.6%) 411 (75.4%) 21 (3.8%) 64 (8.6%) 136 (18.3%) 513 (69.1%) 30 (4.5%) 25 (3.5%) 76 (10.5%) 591 (81.5%) 33 (4.5%) <.001 BMI z-score 0.35  1.16 0.26  1.20 0.14  1.12 0.001 Weight status Underweight (BMI-for-age <5th percentile) Normal-weight (BMI-for-age 5-84th percentile) Overweight (BMI-for-age 85-94th percentile) Obese (BMI-for-age > or equal 95th percentile) 30 (4.5%) 454 (68.0%) 101 (15.1%) 83 (12.4%) 44 (4.8) 642 (70.2%) 125 (13.7%) 103 (11.3%) 56 (6.3%) 656 (74.2%) 103 (11.7%) 69 (7.8%) 0.007

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Maternal Demographic and Weight Characteristics

Characteristic ASD Mean  SD

• r N (%)

DD Mean  SD

• r N (%)

POP Mean  SD

• r N (%)

P-Value Race / ethnicity White African American Asian American Indian or Pacific Islander Multiracial Hispanic 408 (61.1%) 123 (18.4%) 58 (8.7%) 5 (0.8%) 27 (4.0%) 21 (3.1%) 583 (63.8%) 154 (16.9%) 42 (4.6%) 7 (0.1%) 43 (4.7%) 43 (4.7%) 646 (73.1%) 94 (10.6%) 39 (4.4%) 5 (0.6%) 36 (4.1%) 19 (2.2%) <.001 Education Less than high school High school Some college or more 43 (6.6%) 92 (14.2%) 515 (79.2%) 81 (9.1%) 130 (14.7%) 676 (76.2%) 26 (3.1%) 73 (8.6%) 751 (88.4%) <.001 Below federal poverty level (% yes) 68 (10.7%) 93 (4.0%) 47 (5.7%) 0.001 Pre-pregnancy weight status Underweight / normal-weight Overweight / obese 363 (57.2%) 272 (42.8%) 470 (54.2%) 397 (45.8%) 545 (64.9%) 295 (35.1%) <.001 IOM GWG recommendations Above Met Below 312 (50.7%) 215 (34.9%) 89 (14.5%) 393 (46.4%) 295 (34.8%) 159 (18.8%) 375 (45.5%) 336 (40.8%) 113 (13.7%) 0.005

Maternal Medical and Other Characteristics

Characteristic ASD Mean  SD

• r N (%)

DD Mean  SD

• r N (%)

POP Mean  SD

• r N (%)

P-Value Diabetes Pre-pregnancy diabetes Gestational diabetes 9 (1.4%) 47 (7.0%) 25 (2.7%) 99 (10.8%) 11 (11.2%) 50 (5.7%) 0.03 <.001 Blood pressure conditions Hypertension Eclampsia Pregnancy-induced hypertension HELLP syndrome 71 (10.6%) 2 (0.3%) 110 (16.5%) 6 (0.9%) 92 (10.1%) 13 (1.4%) 147 (16.1%) 16 (1.8%) 52 (5.9%) 7 (0.8%) 104 (11.8%) 7 (0.8%) 0.001 0.06 0.01 0.12 Eating disorder 25 (3.7%) 40 (4.4%) 29 (3.3%) 0.48 IUGR 19 (2.8%) 36 (3.9%) 19 (2.2%) 0.08 Smoking during pregnancy 76 (11.4%) 84 (9.2%) 45 (5.1%) <.01 Duration of breastfeeding Never < 3 months 3-6 months > 6 months 111 (16.6%) 167 (25.0%) 108 (16.2%) 282 (42.2%) 151 (16.5%) 228 (25.0%) 116 (12.7%) 419 (45.8%) 97 (11.0%) 159 (18.0%) 119 (13.5%) 509 (57.6%) <.01

Frequency of Child Medical Conditions

Characteristic ASD N (%) DD N (%) POP N (%) P-value Asthma 40 (6.0%) 41 (4.5%) 52 (5.9%) .308 Birth defects 37 (5.5%) 68 (7.4%) 20 (2.3%) <.001 Cardiac diseases 26 (3.9%) 42 (4.6%) 11 (1.2%) <.001 Endocrine diseases 10 (1.5%) 20 (2.2%) 4 (0.5%) .007 Gastrointestinal diseases 161 (24.1%) 165 (18.1%) 154 (17.4%) .002 Genetic disorders 24 (3.6%) 51 (5.6%) 9 (1.0%) <.001 Immune disorders 0 (0%) 4 (0.4%) 5 (0.6%) .169 Metabolic disorders 2 (0.3%) 3 (0.3%) 2 (0.2%) .917 Neurological abnormalities 47 (7.0%) 47 (5.1%) 10 (1.1%) <.001 Renal diseases 6 (0.9%) 9 (1.0%) 14 (1.6%) .369 Respiratory diseases 3 (0.5%) 1 (0.1%) 1 (0.1%) .253 Seizure disorders 24 (3.6%) 26 (2.8%) 1 (0.1%) <.001

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Frequency of Child Behavioral, Developmental or Psychiatric Conditions

Characteristic ASD N (%) DD N (%) POP N (%) P-value ADHD 52 (7.8%) 65 (7.1%) 5 (0.6%) <.001 Behavioral problems 104 (15.6%) 81 (8.9%) 18 (2.0%) <.001 Cognitive delay 5 (0.8%) 2 (0.2%) 2 (0.2%) .157 Feeding difficulties 48 (7.2%) 34 (3.7%) 22 (2.5%) <.001 Motor delay 127 (19.0%) 138 (15.1%) 11 (1.2%) <.001 Psychiatric disorders 25 (3.7%) 20 (2.2%) 4 (0.5%) <.001 Sensory disorders 188 (28.1%) 99 (10.8%) 9 (1.0%) <.001 Sleep problems 43 (6.4%) 24 (2.6%) 5 (0.6%) <.001 Speech delay 426 (63.8%) 525 (57.4%) 76 (8.6%) <.001

Levy et al., The Journal of Pediatrics, 205: 202-209, 2019

Results: Weight-Related Associations

Association between Maternal Pre-Pregnancy Weight Status and Child Weight Status

Kral et al., Autism, 2019 Maternal prepregn. weight status Unadjusted

• Adj. for case

status

• Adj. for case status,

demographic covariates

• Adj. for case status,

maternal covariates

• Adj. for case

status, demographic, maternal covariates

• Adj. for case

status, demographic, maternal, birth covariates OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OW/OB vs. UW/NW 2.43 (2.00, 2.96) <.001 2.38 (1.96, 2.90) <.001 2.40 (1.95, 2.95) <.001 2.32 (1.88, 2.87) <.001 2.33 (1.89, 2.87) <.001 2.00 (1.57, 2.53) <.001

After controlling for all covariates, mothers with pre-pregnancy obesity were 2 times more likely to have a child with obesity.

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Association between Maternal Gestational Weight Gain (GWG) and Child Weight Status

GWG Unadjusted

• Adj. for case status
• Adj. for case status

& demographic covariates

• Adj. for case status

& maternal covariates

• Adj. for case

status, demographic & maternal covariates

• Adj. for case

status, demographic, maternal, & birth covariates OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P < IOM vs. > IOM 0.77 (0.56, 1.05) .095 0.75 (0.55, 1.03) .075 0.66 (0.47, 0.92) .016 0.78 (0.57, 1.07) .118 0.69 (0.49, 0.96) .029 0.77 (0.54, 1.09) .144 < IOM vs. = IOM 1.15 (0.83, 1.60) .393 1.11 (0.80, 1.55) .522 0.96 (0.67, 1.36) .799 1.14 (0.82, 1.58) .452 0.98 (0.69, 1.40) .928 1.01 (0.70, 1.46) .958 > IOM vs. = IOM 1.51 (1.19, 1.90) .001 1.48 (1.17, 1.87) .001 1.45 (1.14, 1.84) .003 1.46 (1.15, 1.85) .002 1.43 (1.13, 1.83) .004 1.32 (1.02, 1.69) .033

When controlling for case status, mothers who exceeded the GWG recommendations were 1.5 times more likely to have a child with obesity.

Kral et al., Autism, 2019

Frequency of Rapid Weight Gain Across Groups

ASD DD POP 10 20 30 40 50

44% 36% 33% P = 0.004

Rapid Weight Gain (% yes) Change in weight-for-age z-scores from birth to 6 months > 0.67 SD

Kral et al., Autism, 2019

Association between Rapid Weight Gain and Child Weight Status

Rapid weight gain Unadjusted

• Adj. for

demographic covariates

• Adj. for maternal

covariates

• Adj. for

demographic & maternal covariates

• Adj. for

demographic, maternal, birth covariates OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P ASD: Yes vs. no 2.56 (1.60, 4.08) <0.001 2.60 (1.58, 4.27) <0.001 2.54 (1.58, 4.09) <0.001 2.65 (1.60, 4.41) <0.001 3.47 (1.85, 6.51) <0.001 DD: Yes vs. no 1.24 (0.83, 1.85) 0.302 1.30 (0.84, 2.00) 0.232 1.25 (0.83, 1.88) 0.286 1.32 (0.85, 2.05) 0.209 1.53 (0.92, 2.55) 0.098 POP: Yes vs. no 1.38 (0.88, 2.17) 0.158 1.44 (0.88, 2.35) 0.146 1.24 (0.78, 1.98) 0.363 1.26 (0.76, 2.09) 0.376 2.85 (1.44, 5.64) 0.003

Children w/ASD and rapid weight gain had 3.5 times greater odds of developing

• besity after controlling for all covariates.

Kral et al., Autism, 2019

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Association between Child Weight Status and Co-Occurring Conditions

Child Classification Unadjusted

• Adj. for demographic

covariates

• Adj. for medical, behavioral,

and/or developmental / psychiatric covariates OR (95% CI) P OR (95% CI) P OR (95% CI) P ASD vs. DD 1.14 (0.91, 1.43) .245 1.18 (0.93, 1.50) .181 1.25 (0.99, 1.59) .063 ASD vs. POP 1.57 (1.24, 2.00) <.001 1.50 (1.16, 1.94) .002 1.51 (1.14, 2.00) .004 DD vs. POP 1.38 (1.10, 1.72) .005 1.27 (1.00, 1.62) .047 1.20 (0.93, 1.56) .157 Levy et al., The Journal of Pediatrics, 205: 202-209, 2019

Prevalence of Overweight and Obesity by ASD Severity Status (OARS)

Mild Moderate Severe 10 20 30 40

23% 27% 34%

b a, b a

ASD Severity

Overweight and Obesity Prevalence (%)

Discussion and Implications

• Children with ASD showed the highest frequency of rapid

weight gain and those with rapid weight gain were 3.5 times as likely to develop obesity during childhood.

• Helping mothers achieve a healthy pre-pregnancy weight

and adequate GWG and fostering healthy growth during infancy represent important targets for all children.

• Healthy growth patterns during infancy may carry special

importance for children at increased risk for ASD.

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7/2/2020 16 Discussion and Implications

• Developmental disabilities, such as ASD, confer an

independent risk of overweight and obesity in children.

• Children with ASD with a higher degree of impairment

and more severe symptoms found to be at even great risk

• f developing overweight or obesity.
• Children who receive diagnosis of ASD or DD may benefit

from enhanced monitoring of their weight development and anticipatory guidance for their parents.

Feeding Difficulties in Children with ASD

Feeding Difficulties

• Feeding difficulties reported in as many as 89% of

children (Ledford and Gast, 2006; Ahearn et al., 2001; DeMeyer, 1979).

• Arise as early as during infancy (late acceptance of solid

foods; described as ‘slow eaters’) (Emond et al., 2010).

• Potential for short- and long-term health risks.
• Source of significant caregiver stress and concern

during mealtimes (Marshall et al., 2014).

• Importance of providing guidelines for clinicians for

management strategies (Marshall, Hill & Dodrill, 2011).

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Picky Eating

• ~80% of children with ASD, compared to 20% of

typically developing children (TDC), shown moderate to severe levels of picky eating (Williams et al.,

2000; Whiteley et al., 2000; Zucker et al., 2015).

“[My child] is very picky. He has good appetite but his choices are very limited. Pancakes with chocolate chips, pizza, McDonald’s chicken nuggets, some fruits, yogurt, applesauce, juices.”

• Quote from parent of 5 year-old child with ASD -

Food Neophobia and Rituals

• ~69% of children with ASD show (chronic) food

neophobia (Lockner, Crowe & Skipper, 2008; Martins, Young &

Robson, 2008).

• 46% of children with ASD showed rituals and

rigid routines during mealtimes (Williams et al., 2000;

Schreck & Williams, 2006).

Food Refusal Based on Food Characteristics

Food characteristic Children w/ASD (%) TDC (%) P-value Consistency / texture 77.4 36.2 < .0001 Food mixed together 45.3 25.9 0.03 Temperature 30.2 24.1 0.47 Food touching other foods 20.8 17.2 0.64 Color 15.1 12.1 0.64 Brand 15.1 1.7 0.01 Shape 11.3 1.7 0.05

Adapted from Hubbard et al., J Acad Nutr Diet, 114: 1981-87, 2014

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Sensory Processing Difficulties

• Sensory processing and food acceptance are

related (Blissett and Fogel, 2013).

• Sensory processing difficulties may lead children

with ASD to restrict their intake to foods with preferred and tolerable sensory properties (e.g.,

Legge et al., 2002; Field et al., 2003).

40% 44% 16%

Oral Sensory Sensitivity in Children with ASD

Typical Atypical Kral et al., 2015

Quote from Parent

“Since 15 months of age [my child] has had a limited diet. He has sensory issues as far as texture and smell. [My child] can become repetitive with certain foods and he will eat that food for months at a time. Ex: He used to only eat yogurt for lunch, nothing else. Now he only wants peanut butter sandwiches.”

Eating Behaviors of Children with ASD by Sensory Sensitivity Status

Kral et al., Public Health Nursing,32(5): 488-497, 2015

Food Neophobia

1 2 3 4 Typical Oral Sensory Sensitivity Difference in Oral Sensory Sensitivity P = 0.004

*

Score Food Fussiness 1 2 3 4 5 Typical Oral Sensory Sensitivity Difference in Oral Sensory Sensitivity P = 0.03

*

Score Emotional Overeating 1 2 3 4 5 Typical Oral Sensory Sensitivity Difference in Oral Sensory Sensitivity P = 0.07 Score Emotional Undereating 1 2 3 4 5 Typical Oral Sensory Sensitivity Difference in Oral Sensory Sensitivity P = 0.02

*

Score

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7/2/2020 19 Consequences of Feeding Difficulties in Children with ASD

• Food selectivity (Bandini et al., 2010):
• Food refusal
• Limited food repertoire
• High frequency of single food intake

Adapted from Bandini et al., J Pediatr, 157(2): 259-64, 2010

Domains Children w/ASD TD children P-value Food refusal # foods will not eat % foods will not eat of those offered 45 41.7% 21 18.9% < .0001 < .0001 Limited repertoire (# unique foods) 19.0 22.5 0.0003 Single food intake 4 1 0.19

Limited Dietary Variety

• Progressively less varied

diet from 15 months of age compared to children with typical development.

• No differences in energy

and macronutrient intake.

Emond et al., Pediatrics; 126(2): e337-342, 2010

Caregiver Feeding Practices

• Little is known about feeding practices that

caregivers of children with ASD use to address feeding difficulties in their children.

• Restrictive feeding practices as well as emotional

and instrumental feeding, associated prospectively with obesogenic eating behaviors and increased BMI z-scores in TDC (e.g., Rodgers et al., 2013; Birch et al.

2011).

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Caregiver Feeding Practices

Kral et al., Public Health Nursing,32(5): 488-497, 2015

• Caregivers of children

w/ASD reported to engage in higher levels of prompting and encouragement to eat (P = .002).

• There was a non-significant

trend for increased use of instrumental feeding and restriction (P < .08).

Emotional Feeding

1 2 3 4 5 Typical Oral Sensory Sensitivity Atypical Oral Sensory Sensitivity

P = 0.02

*

Score

Summary

• Children with ASD at higher risk for developing
• besity and perhaps cardiovascular disease. Risk

factors start early, before children are born.

• Despite more limited dietary variety, many children

with ASD meet recommended intake for many nutrients.

• Children on restricted diets may be at higher risk

for nutrient deficiencies and should be monitored closely.

Research Opportunities

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Opportunities for Interdisciplinary Collaboration

• In Science:
• Nutrition
• Nursing
• Family studies
• Pediatrics
• Psychology
• Public Health
• Epidemiology
• In Practice:
• Dietitians
• Nurses
• Occupational therapists
• Behavioral

psychologists

Technology-Based Intervention

• Develop and test

feasibility of an interactive mobile health nutrition intervention for children with ASD who are picky eaters.

• Test in 3-month RCT

efficacy of intervention on changing consumption of targeted foods and beverages.

NIH / NICHD: R21 HD091330‐01A1 Collaborators: Drs. Susan Levy, Emily Kuschner, Jennifer Pinto-Martin, Graham Thomas

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To Receive Your CE Certificate

• Look for an email containing a link to an evaluation.

The email will be sent to the email address that you used to register for the webinar.

• Complete the evaluation soon after receiving it.

It will expire after 3 weeks.

• You will be emailed a certificate within 5 business days.

Check out the COPE Fall Webinar Series

• 9/16/20 Katelyn Carr, PhD

Choice is relative: Reinforcing value of food and activity in obesity treatment

• 10/14/20 Abby Braden, PhD

Dialectical behavior therapy and behavioral weight loss for emotional eating and obesity

• 11/11/20 Lauren Sastre, PhD, RD, LDN

Sharing the “weight” of obesity management in primary care: Integration of RDs/RDNs

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Moderator: Lisa Diewald MS, RD, LDN cope@villanova.edu www.villanova.edu/cope

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