Childhood Obesity最新文献

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: Our aim was to examine if a prepregnancy lifestyle intervention impacted early childhood weight gain.

Methods: A 5-year longitudinal observational follow-up of children born to women aged 18-40 years with body mass index (BMI) ≥27 kg/m² who participated in Prepare, a randomized clinical trial testing a prepregnancy lifestyle intervention vs. usual care control. Data were collected from birth through ages 36-60 months using electronic medical record (EMR) chart abstraction, a single in-person or virtual visit, and surveys.

Results: Of the 165 children born to Prepare participants, 133 (70 in intervention and 63 in usual care) contributed BMI data to the PrepareD observational follow-up study. Longitudinal BMI trajectories from birth to age 5 demonstrated no significant differences between study arms (p = 0.06). There were no significant differences in mean BMI (17.0 ± 1.7 vs. 16.7 ± 1.7; p = 0.44), BMI z-score (0.30 ± 1.12 vs. 0.02 ± 1.19; p = 0.40), BMI percentile (56.2 ± 29.8 vs. 50.2 ± 31.4; p = 0.56), or conditional weight gain (0.10 ± 1.07 vs. -0.17 ± 0.95; p = 0.19) between intervention and control arms, respectively, at age 12 months. There were also no significant differences in mean BMI (16.4 ± 1.7 vs. 16.2 ± 1.6; p = 0.61), BMI z-score (0.43 ± 1.07 vs. 0.23 ± 1.17; p = 0.44), BMI percentile (56.2 ± 29.8 vs. 57.1 ± 32.5; p = 0.39), or conditional weight gain (0.01 ± 1.08 vs. -0.09 ± 0.95; p = 0.51) at 36-60 months.

Conclusions: A prepregnancy lifestyle intervention did not influence childhood weight trajectory. Focusing lifestyle interventions solely on prepregnancy maternal obesity may not be sufficient to influence childhood growth. Trials that examine lifestyle interventions that offer support before, during, and after pregnancy are needed to determine if intervening before conception can interrupt the intergenerational cycle of obesity.

Background: While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) lower body mass index (BMI) in youths with obesity, less is known about their effect on metabolic parameters such as alanine aminotransferase (ALT), high-density lipoprotein, low-density lipoprotein, and hemoglobin A1c levels. We conducted a systematic review of the existing literature and a meta-analysis to determine the effect of GLP-1 RAs on metabolic parameters.

Methods: A search of the PubMed, Scopus, and Embase databases was conducted with variations of the terms GLP-1, obesity, semaglutide, exenatide, liraglutide, randomized clinical trial, adolescent, youth, and children.

Results: A total of 197 studies were identified, of which 6 satisfied the inclusion criteria. Four studies focused on exenatide, one on semaglutide, and one on liraglutide, with participant numbers ranging from 11 to 201 and study lengths of 12 to 68 weeks. Only BMI (-1.7, p = 0.02) and ALT (-3.0, p = 0.01) showed a significant treatment effect.

Conclusions: Our meta-analysis suggests GLP-1 RAs improve BMI and show a modest decrease in ALT levels in youths with obesity. The clinical significance of the ALT decreases remains uncertain and warrants further examination in future trials.

Introduction: Metabolic and bariatric surgery (MBS) is an evidence-based intervention for adolescents with severe obesity, yet uptake remains low, especially among historically underrepresented populations. This study examined perceptions of MBS among youth and their caregivers referred to a tertiary care obesity center within a large urban safety-net hospital.

Methods: Youth aged 12-18 years and their primary caregivers at a comprehensive obesity clinic completed a 22-item survey via REDCap assessing awareness, safety, perceptions, and willingness to consider surgery. Demographic and clinical data were extracted from electronic health records. Descriptive statistics, group comparisons, and multivariable regression identified factors linked to favorable MBS attitudes. Open-ended responses were analyzed using content analysis.

Results: A total of 109 youth (median age 15.2 years [IQR: 14.3-17.2]; 62.4% female; 89.9% Hispanic; median body mass index [BMI] 37.5 kg/m² [IQR: 33.2-41.6]; median %BMI_p95 127% [IQR:112-141%]) and 95 caregivers (median age 43.7 years [IQR: 41.2-55.3]; 93.7% female; 86.3% Hispanic; median BMI 32 kg/m² [IQR: 28.2-42.2]) participated; 91 dyads completed all data. While 71% of caregivers and 56% of youth had heard of MBS as a treatment for obesity in adults, only 24% of caregivers and 15% of youth were aware of MBS as a treatment option for pediatric patients. Perceptions of safety were limited, with more than half of both caregivers and youth reporting uncertainty about the safety of MBS in children. Despite this, support for its availability was high: 79% of caregivers and 90% of youth believed that MBS should be an option for children with severe obesity when lifestyle interventions are unsuccessful. In adjusted models, caregiver history of MBS was associated with more favorable impressions of pediatric MBS among caregivers (OR = 2.86, 95% CI: 1.02-7.91, p = 0.01) and youth (OR = 2.43, 95% CI: 1.00-5.94, p < 0.05); youth impressions were also predicted by caregiver impressions (OR = 1.26, 95% CI: 1.03-1.54, p < 0.05).

Conclusions: Among predominantly Hispanic, publicly insured families, awareness and safety perceptions of pediatric MBS were low despite high support. Caregiver MBS experience strongly influenced attitudes, highlighting the need for culturally informed, family-centered education to improve equitable access.

Most research studies enrolling adolescent metabolic and bariatric surgery patients rely on in-clinic recruitment methods, subsequently limiting participant diversity. Emerging literature indicates that community-partnered recruitment strategies may increase representation. The current study evaluated recruitment efficiency by comparing a community-partnered approach to additional recruitment channels. Preoperative and postoperative adolescents, and parents/guardians, were invited to participate in qualitative interviews and recruited through either (1) OCEANS (a community program) or (2) additional recruitment channels. Group differences in recruitment outcomes (eligibility, consent, and study completion) were assessed using Fisher's exact test. During recruitment, it was suspected that mischievous responses may be present in the dataset. Mischievous responses were systematically removed using a rubric. Compared to the additional channels group (n = 52), the community-partnered approach (n = 19) resulted in a statistically significantly higher percentage of individuals who were eligible and completed study requirements (p < 0.001). Community-partnered recruitment demonstrates potential for effectively enrolling eligible adolescents and parents/guardians in research.

Background: There is a pressing need to provide evidence-based treatment for obesity to millions of children. We sought to implement and evaluate the packaged Healthy Weight Clinic (HWC), a primary care-based Family Healthy Weight Program (FHWP) delivering Intensive Health Behavior and Lifestyle Treatment.Methods: We conducted a Type III hybrid effectiveness-implementation study in four health care organizations affiliated with eight primary care clinics. Sites received provider training, technical assistance, and participated in a virtual learning community with quality improvement. Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) implementation frameworks were used to evaluate implementation via quantitative and qualitative methods. Children with a BMI ≥85th percentile were eligible to participate in the effectiveness trial. A group of 5990 children with a BMI ≥ 95th percentile receiving care at the eight health centers but not participating in the HWC served as the comparison group.Results: The packaged HWC reached 191 children. The HWC was effective in reducing BMI -0.26 (95% confidence interval [CI]: -0.47, -0.04), percentage of the median -1.87 (95% CI: -3.09, -0.64), and %BMIp95 -1.05 (95% CI: -1.97, -0.13) compared with comparisons. Seven of the eight sites were able to adopt all the components of the program except the texting campaign and sustain the program 18 months after training. Qualitative themes contextualized implementation findings, highlighting barriers and facilitators.Conclusions: The HWC is a promising FHWP that can improve health for children with overweight and obesity. The implementation package can facilitate the adoption across diverse primary care settings in the United States.

Background: Dissemination of evidence-based intensive health behavior and lifestyle treatments (IHBLTs) to families from low-income communities was the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) 3.0 projects. The goal of RI CORD 3.0 was to adapt and test the effectiveness and context for remote implementation of an IHBLT, JOIN for ME.

Methods: Children aged 6-12 years with body mass index (BMI) >85th percentile and a caregiver (N = 111) were recruited through a federally qualified health center (FQHC) or community setting and participated in an immediate or 4-month delay condition. Child and caregiver weight status, Family Nutrition and Physical Activity (FNPA), and child weight-related quality of life were assessed at baseline, 4 months, and at the end of the 10-month remotely delivered intervention. Program acceptability and intervention fidelity were assessed to inform subsequent implementation.

Results: Analyses comparing active and delayed treatment groups at 4 months showed significant improvements in FNPA for the active treatment group compared with delayed group. Groups did not differ significantly on child or caregiver weight status. Ten-month treatment effects in the combined sample showed significant effects of time on child relative weight status, with children who initiated the program demonstrating decreases of 2.90% median BMI, 3.89%BMIp95, and 0.16 zBMI units. Session attendance and food security at baseline were related to greater changes in weight status.

Conclusions: The adapted version of the JOIN for ME was successfully implemented and shown to be associated with significant, modest changes in child weight status.

Background: Building Healthy Families (BHF) is an adapted family healthy weight program (FHWP) designed for and implemented in rural areas. To increase the likelihood of the broad dissemination and implementation of BHF to other rural communities, the Nebraska Childhood Obesity Research Demonstration 3.0 project developed the BHF Online Training Resources and Program Package (BHF Program Resources). The BHF Program Resources is a "turn-key" online platform that includes a train-the-trainer system, program materials, and a data portal for use by community-based implementation teams.

Methods: A community-randomized type 3 hybrid effectiveness-implementation pilot study tested the BHF Program Package only (BHF-PO) with and without an action learning collaborative (BHF-LC) to determine relative implementation fidelity and effectiveness among community-based implementation teams. RE-AIM was used for planning and reporting outcomes.

Results: The BHF-LC communities demonstrated higher implementation fidelity during the core sessions (90.6% vs. 75.8%, p = 0.076), with greater contact hours (17.8 vs. 14.8, p = 0.096). Adoption and Maintenance were successfully achieved but did not differ by the study condition. Children in the BHF-LC communities attended significantly more sessions (79% vs. 69%, p < 0.05, Reach) and showed a greater change in the BMI z-score (-0.15 ± 0.14 vs. -0.08 ± 0.16, p < 0.05, Effectiveness) by 3 months.

Conclusions: Rural communities can implement the BHF program with fidelity using online resources; however, adding a learning collaborative may improve early implementation quality and child engagement. These findings warrant further testing in a larger trial.

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.