Childhood Obesity最新文献

Objective: To assess the longitudinal associations between maternal diet during pregnancy and child adiposity between ages 2 and 12 years.

Methods: Repeated measures linear regression models with autoregressive covariance were used to assess the association between maternal diet and child body mass index (BMI) trajectories between ages 2 and 12 years. Logistic regression models were used to assess the associations between maternal diet and likelihood of child BMI greater than the 85th percentile, as well as the association between age at adiposity rebound and the likelihood of subsequent overweight/obesity. Additionally, multiple linear regression was used to assess the association between maternal diet and child age at adiposity rebound. Interactions with race/ethnicity were explored.

Results: There was no association between maternal diet during pregnancy and child adiposity, but race-ethnic specific analyses revealed that compared to a high maternal adherence to a Mediterranean-style diet, a low adherence was associated with a higher BMI trajectory among White children (β = -0.67; p = 0.01).

Conclusions: Maternal diet during pregnancy may influence child BMI trajectories in race/ethnic-specific ways that likely stem from cultural and socioeconomic factors that should be considered when designing interventions.

Background: Many children and adolescents with overweight or obesity experience negative psychosocial health consequences. Systematic reviews show that behavioral interventions can help improve specific psychosocial outcomes. This scoping review aims to identify and map the different types of psychosocial outcomes measured and reported in randomized behavioral intervention trials for managing pediatric overweight and obesity.

Methods: A total of 11 databases were searched until February 2024. We included randomized behavioral intervention trials for children and adolescents (≤18 years) with overweight or obesity that report at least one psychosocial outcome.

Results: Overall, 197 articles reflecting 169 behavioral intervention trials were included. To assess the psychosocial outcomes captured, among 169 trials, 174 different measures were identified (e.g., self- and proxy-reported questionnaires). The psychosocial outcomes were organized into nine categories. The most frequently reported outcome categories were (1) emotional and behavioral functioning (n = 79 outcomes); (2) eating attitudes, behaviors, and body image (n = 72 outcomes); and (3) quality of life (n = 68 outcomes). Among all psychosocial outcomes captured, most outcomes were reported among older children and adolescents (78.4%) and for interventions with a duration of up to 26 weeks (75.1%).

Conclusions: This scoping review identified a variety of psychosocial outcomes across different behavioral intervention trials and a variety of measures used to assess them. Evidence among younger samples and regarding the long-term effects of behavioral intervention trials on psychosocial health is limited. Identifying the core outcomes as well as a psychometric evaluation of the measures identified is needed.

Background: Few childhood obesity interventions have been designed for Hispanic families including Spanish speakers. This pragmatic pilot study assessed the effectiveness of a whole-family obesity prevention and treatment program-the Healthy Living Program (HeLP).

Methods: HeLP is delivered at recreation centers by teams of health educators and fitness professionals. HeLP involves 12 group sessions, including parenting, child feeding, nutrition, cooking, meal planning/shopping, and fitness. Primary care providers referred families of children 2 years and older with obesity. This pragmatic longitudinal study collected data at the intervention and from electronic health records to compare child BMI trajectories from 12 months pre- to 12 months postintervention, in terms of the percentage of the 95th percentile BMI (BMI%95) using hierarchical mixed-effects models to account for clustering and to adjust for age, sex, weight status, and language.

Results: Median attendance was 8 of 12 sessions. Of 317 children who had BMI measured clinically 1 year prior to HeLP, 265 (84%) had BMI measured 1 year post-HeLP, including 210 with overweight or obesity and 55 healthy weight siblings. About 71% of parents spoke Spanish only. Changes in modeled BMI%95 trajectory for children with overweight or obesity were: -6.7% [95% CI -13.0%, -0.4%] (p = 0.04) for 2-6 years, -5.8% [-8.6%, -3.0%] (p < 0.0001) for 7-11 years, and -4.1% [-6.8%, -1.4%] (p = 0.003) for 12-18 years. Children with overweight decreased -4.6% [-8.4%, -0.9%] (p = 0.001).

Conclusions: These data suggest that HeLP, a whole-family intervention delivered by clinic-community partnership, may be effective at preventing and treating obesity in children from Hispanic families with low income and support an ongoing randomized controlled trial.

Background: There is a pressing need to understand developmental patterns of adiposity as well as factors that influence it. Group-based trajectories, usually based on body mass index (BMI), have been used in adults and children to investigate adiposity trajectories. The objectives of this study were to identify sex-specific groups with similar longitudinal trajectories for fat mass index (FMI) and to compare sex-specific longitudinal trajectory groups on demographic and behavioral characteristics. Methods: This study employed a longitudinal design to examine patterns of age-related change in FMI-assessed adiposity in children transitioning from elementary to high school. FMI, moderate-to-vigorous physical activity (MVPA), sedentary behavior, and diet quality were measured at 5^th, 6^th,7^th, 9^th, and 11^th grades when the children were 10-16 years of age. Sex-specific group-based trajectory analyses were conducted for FMI, and repeated ANOVAs were used to compare behaviors between trajectories. Results: Both boys' (n = 320) and girls' (n = 389) group-based trajectory analysis resulted in three groups, each with a low FMI and stable trajectory. In girls, two trajectories increased from 10 to 16 years of age, while in boys, one trajectory increased, and one decreased over time. In girls only, the groups differed by race and parent education. There were also group differences in MVPA for boys and in diet quality for girls. Conclusions: An accurate assessment of adiposity, FMI, was used to establish the trajectories in this study. The characteristics of the groups provide valuable information about when and for whom to target obesity prevention efforts.

Background: Produce Prescription Interventions (PRx) are designed to improve food insecurity and diet quality by offering greater access to healthy fruits and vegetables (FV) and nutrition and culinary education. This study evaluated the relationship between participation in a family-based PRx and child FV intake. Methods: Between November 2022 and December 2024, children (0-18 years) and caregiver dyads were recruited to participate in a 6-month PRx that provided 16 pounds of FV per month and virtual nutrition and culinary education sessions monthly. Adult-reported child FV intake data were collected at baseline and post-intervention. The effect of the intervention on child FV intake was evaluated by multiple mixed model regression analyses. Results: A total of 176 dyads completed an FV intake evaluation. Participation in the intervention was associated with a significant increase in fruit (R = 0.21, p = 0.004) and vegetable (R = 0.30, p < 0.0001) consumption. When adjusting for demographic and programmatic variables, the effect of time remained significant. Conclusions: These data support the hypothesis that PRx participation is associated with a modest improvement in FV intake, but barriers to FV intake remain. Further work is needed to understand the optimal PRx design to achieve healthy FV intake in children.

Introduction: Food Is Medicine (FIM) programs have demonstrated effectiveness in improving diet quality and food insecurity. There remains a lack of evidence of their impacts in pediatric populations. This pilot comparative effectiveness randomized control trial assessed two FIM strategies on implementation and health outcomes in Medicaid-eligible children aged 5-12 years with a BMI ≥85th percentile. Methods: Participants (n = 150) were enrolled for a 32-week intervention through recruitment at two urban pediatric primary care clinics in Houston, TX. Participants were randomized 1:1:1 into three arms: (1) biweekly $25 produce vouchers + nutrition education, (2) biweekly produce home delivery + nutrition education, or (3) wait-listed control (n = 50 per arm). Implementation outcomes included retention, redemption, dosage, reach, fidelity, and acceptability. Child outcome measures included diet, food security, BMI z-scores, hemoglobin A1c, liver panels, and lipid panels. Multilevel mixed-effects regression models were used to assess the effectiveness of the intervention on outcomes. Results: On average, voucher participants redeemed $353 out of $400 (88%) of their funds, and 100% of the home delivery group received ∼18 lb (52 servings) of produce per week. Parents found the program helpful in reducing grocery costs (voucher: 95%, delivery: 76%). Compared to the control group, voucher group participants had a significant decrease in aspartate aminotransferase (-5.50, 95% confidence interval: -9.43, -1.57, p = 0.006) from baseline to post-intervention. Conclusions: This pilot study found FIM programs are both feasible and well accepted among at-risk populations, with slightly higher acceptability of the voucher model. More adequately powered studies with a stringent design are needed to test their effectiveness.

Background: Transgender youth in the United States are at increased risk for obesity and type 2 diabetes compared with their cisgender peers due to diverse factors including minority stress, stigma, and limited knowledge regarding effective care. Given myriad factors limiting affirming weight-related care, research is needed on health behaviors of transgender youth to provide insight into their experiences and inform novel approaches to care. Methods: Data from the 2017 and 2019 Youth Risk Behavior Surveillance Survey were used to explore the health behaviors of transgender youth with obesity (TYO) and without obesity (TYNO) and cisgender youth with obesity (CYO) and without obesity. Differences by racial and ethnic identity were considered. The study sample included 2561 transgender youths and 21,146 cisgender youths with obesity from 15 US states. Results: Transgender youth had a higher rate of obesity than their cisgender peers. Few significant differences were observed when comparing health behaviors of TYO and TYNO and CYO. Describing self as overweight was the only variable that was consistently significant across comparisons. Transgender youth of all racial/ethnic identities except Other were significantly likely to endorse sleeping <6 hours a night. Health behaviors did not consistently explain obesity status. Race/ethnicity was not significant for any comparison. Conclusions: Results of this study indicated race, ethnicity, and health behaviors did not explain differences in obesity rates for transgender and cisgender youth. Future research is needed to understand factors contributing to the increased risk of obesity in transgender youth.

Weight stigma is a pervasive problem affecting children's mental and physical health. This unique pilot project sought to improve pediatric providers' attitudes and confidence in skills around weight stigma by combining education with practice changes. Educational interventions and practice changes around the weighing process were performed at a pediatric primary care clinic across 1 year. Providers at the practice took the same self-assessment survey at baseline, before and after each intervention, at project end, and 6 months post-project completion. Results showed statistically significant increases in confidence in skills related to identifying and addressing weight stigma in clinic, both at project end and in long-term follow-up. This project may represent a model that other practices could adapt to improve weight stigma in their own clinics.

Background: Although the effect of mindfulness on emotion regulation is known, the relationship between mindfulness and emotional eating has not been well-studied in adolescents to date. In this study, we investigated whether mindfulness has a direct effect on the level of emotional eating or whether this association is mediated by emotional dysregulation in a sample of adolescents with obesity. Methods: Our sample consisted of 80 adolescents with obesity. All participants were administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behavior Questionnaire (DEBQ-EE), and the Mindful Attention Awareness Scale (MAAS). Results: The mean age of the sample was 15.32 ± 1.07, the mean body weight was 93.33 ± 20.84 kg, and the BMI percentile was 98.33 ± 1.65. In total, 22.5% of mothers and 7.5% of fathers were obese. There were significant associations between high emotional eating and emotion dysregulation and low mindfulness. In two mediation models, the indirect effects obtained by using DERS-total and DERS-impulsivity as the mediators were statistically significant on the path between MAAS and DEBQ-emotion [b = -0.148, confidence interval (CI) = -0.318/-0.031; b = -0.114, CI = -0.233/-0.015, respectively], indicating a significant mediating effects of DERS-total and DERS-impulsivity. Conclusions: We suggest that emotional eating increases as mindfulness decreases, through emotional dysregulation, particularly difficulty in regulating impulsivity.

It is unknown how many children with obesity are offered treatments aligned with clinical practice guidelines. This study examined electronic medical record data from a Midwest, USA, health system to quantify referrals to obesity treatment among patients 2-17 years old with obesity presenting for well-child visits in 2022 and/or 2023. Mixed-effects logistic regression models tested associations of referral placement with child characteristics, the Area Deprivation Index, and distance to specialty care. Of 14,893 patients, 591 (4.0%) received a referral. Referrals were associated with severe obesity (p < 0.001), older age (p < 0.001), proximity to specialty care (p < 0.001), number of well-visits (p ≤ 0.001), and identification with a minoritized race or ethnicity (p < 0.05-0.001). Findings indicate a large gap from the current state of referrals to alignment with practice guidelines for pediatric obesity. Furthermore, research needs to explore and address barriers to referrals and treatment access.