Childhood Obesity最新文献

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: 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.

Purpose: Cost is a critical consideration when implementing evidence-based family healthy weight programs (FHWPs). However, real-world implementation cost data are often underreported, and standardized methods for accurate cost collection are lacking. This article synthesizes the implementation costing approaches used across five FHWPs to inform future adopters and implementers by illustrating context-appropriate costing methods and identifying practical considerations for cost data collection and reporting. Methods: We descriptively report and compare the implementation strategies and associated cost assessment methods across five projects funded by the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration (CORD 3.0) program. CORD 3.0 aimed to package FHWPs for implementation in health care, community, or public health settings. Costing approach information was organized and abstracted using a published checklist. Findings: Despite variation in program models and settings, several common costing approaches emerged. All projects used direct measurement methods (e.g., activity-based or micro-costing) and categorized costs consistently (e.g., labor, supplies, space, information technology) to support decision-making and improve comparability. Several projects applied structured frameworks to guide costing efforts and distinguished between fixed, one-time costs (e.g., training development) and variable, recurring costs (e.g., session delivery, supervision). These patterns highlight a balance of methodological consistency and adaptability across diverse contexts. Conclusions: This study provides an overview of approaches to assessing FHWP implementation costs within the CDC's CORD 3.0 initiative. Applying structured frameworks and practical tools, these projects demonstrate how cost assessments can guide strategic planning, reimbursement, and sustainability-laying groundwork for improved cost reporting and integration in future FHWP dissemination and implementation.

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: Despite previous studies showing that acculturation in Hispanic mothers is associated with less frequent use of highly controlling feeding practices, our understanding of acculturation and feeding is still limited. Little attention has been given to positive feeding practices, researchers have focused on acculturation as a unidimensional construct, and few studies have compared Hispanic to non-Hispanic parents. Methods: In this study, 750 mothers (596 Hispanic) completed questionnaires assessing feeding practices/styles; Hispanic mothers completed a bidimensional, language-based acculturation questionnaire. Acculturation was analyzed both as a continuous variable and by assigning Hispanic mothers into acculturation groups based on their language competency, usage, and media preferences (separation, assimilation, integration, and marginalization). Results: Highly controlling feeding practices were associated with Spanish orientation scores, whereas mealtime/snack-time structure, responsiveness to children's fullness cues, child involvement in food preparation, and feeding efficacy were associated with English orientation scores. Acculturation group comparisons showed that mothers in the separation group differed the most from non-Hispanic mothers and that mothers in the assimilation group did not significantly differ from non-Hispanic mothers on any feeding practices. Mothers in the integration group were more restrictive than non-Hispanic mothers. The indulgent feeding style was most common among mothers in the assimilation group. Conclusions: These findings extend the results of previous research by: (1) identifying positive feeding strategies associated with acculturation, (2) demonstrating the value of studying acculturation as a multidimensional process, and (3) showing how feeding practices and styles show different patterns of association with acculturation in Hispanic mothers.

Background: Glucagon-like peptide-1 receptor agonists, such as liraglutide, have been approved for the management of pediatric obesity. However, real-world evidence remains limited. We aimed to evaluate real-world adherence to and effectiveness of liraglutide among adolescents with obesity. Methods: In this retrospective observational study, we included adolescents aged 12-18 years with obesity who were dispensed liraglutide through Clalit Health Services between January 28, 2022 and July 1, 2024. Adherence was defined as the number of monthly prescriptions dispensed over 12 months. Effectiveness was assessed by percent change in BMI. Multivariate logistic regression was used to evaluate factors associated with adherence (defined as ≥7 dispensed prescriptions). Linear regression was used to assess the association between the number of prescriptions dispensed and the percent change in BMI, adjusting for sociodemographic and clinical variables. Results: Of 966 adolescents (median baseline BMI 38.2), 172 (18%) were dispensed ≥7 monthly prescriptions. A total of 542 participants had follow-up BMI data. Mean BMI change for the entire cohort was -2%. Among those dispensed ≥7 prescriptions, BMI reduction was -10%. Each additional dispensed prescription was associated with a 1.1% (95% CI: -1.4% to -0.83%) reduction in BMI. In adolescents with ADHD, adherence to liraglutide was higher in those medically treated for ADHD (p < 0.001). Conclusions: Meaningful BMI reduction was observed only in adolescents dispensed ≥7 liraglutide prescriptions. However, only 18% achieved this level of adherence, underscoring the gap between randomized controlled trial efficacy and real-world outcomes, as well as the need for strategies to improve adherence.

Background: Children with severe early-onset obesity (defined as a body mass index >120% of the 95th percentile before age 5) are a high-risk population often displaying disruptive food-related behaviors. This study assessed: (i) caregivers' confidence addressing obesity-related behaviors in children with severe early-onset obesity and (ii) differences in behavior perceptions between children with and without impaired satiety. Methods: Caregivers from a specialized pediatric obesity clinic completed the Lifestyle Behavior Checklist (LBC), a 25-question tool, evaluating their perceptions and confidence managing obesity-related behaviors. Impaired satiety diagnoses were based on clinical ascertainment of at least three abnormal eating behaviors across multiple settings. Data were analyzed using appropriate statistical tests. Results: A total of 89 caregivers completed the LBC. Parents felt least confident managing four of the top five perceived most problematic behaviors: excessive eating, requesting extra portions, unhealthy snacking, and eating too quickly. Parents of children with impaired satiety rated 16 behaviors as significantly more problematic (Q-value <0.05) and reported lower overall confidence in managing these behaviors compared with parents of children without impaired satiety (Q-value = 0.04). Despite these differences, both groups identified excessive eating as the most problematic behavior and the one they were least confident in managing. Conclusion: Parents of children with severe, early-onset obesity, reported difficulty managing food-related behaviors. Children with severe, early-onset obesity and impaired satiety displayed similar, but more pronounced, problematic lifestyle-related behaviors compared with those without satiety impairments. Future research should determine if behavior-specific counseling would be helpful to parents of children with severe, early-onset obesity.

Introduction: Growth charts were not designed to monitor children and adolescents with severe obesity. We evaluate three commonly used international references and their implications for children with severe obesity and develop a BMI growth chart for children with severe obesity, which we call "Reference-point BMI from adjusted World Health Organization (WHO) population" (R-BMI). Method: Growth charts from the WHO, International Obesity Task Force, and CDC were reviewed regarding population, statistical method, and cut-offs. We created the R-BMI chart from the WHO population, with adapted adjustment and reference-point cut-offs, and the layout was updated for better readability. Moreover, an interactive web app was developed for this project at the following link https://child-bmi.serve.scilifelab.se/ with the purpose of visually comparing different BMI references for children with obesity. Results: Three different references for children with severe obesity, with corresponding adjustments, are presented to illustrate implications for researchers and clinicians. Furthermore, R-BMI is presented as a method attempting to address chart challenges related to the extreme BMI. The result is reference curves which share desirable features with established references, while avoiding undesirable curve behavior. Conclusions: Growth charts present challenges for children living with severe obesity, leading to varying approaches and implications of international references. The proposed R-BMI offers monitoring of children with severe obesity that can be used from birth to adulthood. It relates to adult BMI cut-offs and allows for a terminology, and it has a layout with the potential of highlighting changes which may otherwise go unnoticed.

Background: African American (AA) and Hispanic children are at high risk of developing obesity. Social networks are powerful drivers of health behaviors and outcomes. Parent social network characteristics may influence child health behaviors and obesity risk. Methods: This is a cross-sectional, observational study of parents of AA and Hispanic children 2-4 years. The social network survey was adapted from The Important and Health Matters Social Network Battery (PhenX Toolkit). Child health behavior questions were from the National Health and Nutrition Examination Survey. Child body mass index z-score (BMIz) was calculated based on measured height and weight at the child's most recent well-child visit. Linear regression models identified associations between parent network characteristics, BMIz, and child health behaviors. Participants included 44 parents of Hispanic children and 74 parents of AA children. Results: Parents of Hispanic children named fewer supportive alters (network members) than parents of AA children (3.7 vs. 5.0, p < 0.1). A higher number of stressful parent relationships was associated with higher child BMIz (β = 0.2, p < 0.05). For parents of AA children, a higher number of supportive alters was associated with more hours of child weekday (β = 0.2) and weekend sleep (β = 0.2) and less child weekday screen time (β = -0.2) (all p < 0.05). For parents of Hispanic children, a higher number of alters with whom the parent discusses important matters was associated with more hours of child weekday sleep (β = 0.3, p < 0.05). Conclusions: Parent social network characteristics are population-specific and associated with child health behaviors and BMIz. Augmenting supportive parent relationships and stress coping may reduce child obesity risk.

Background: We examined the independent and joint prospective associations of screen time, sleep disturbance, and sleep duration with body mass index (BMI) and waist circumference (WC) stratified by sex. Methods: Data are from 7445 participants (47.3% females) aged 9-10 years at baseline (2016-2018) in the Adolescent Brain Cognitive Development Study. Missing data were imputed, and weighted multivariable linear regression models estimated the independent and joint effects of screen time and sleep disturbance or sleep duration on BMI and WC after 2 years. Joint associations grouped participants by combinations of screen time and sleep, with low screen time and sufficient sleep or no sleep disturbance as the reference groups. Results: Screen time was significantly associated with higher BMI (B = 0.32; 95% CI: 0.19, 0.45; p < 0.001) and WC (B = 0.40; 95% CI: 0.23, 0.56; p < 0.001). Sleep disturbance was associated with higher BMI (B = 1.23; 95% CI: 0.14, 2.33; p 0.026) in males. Insufficient sleep (<9 hours) (B = 1.30; 95% CI: 0.53, 2.07; p < 0.001) was associated with higher BMI. Medium screen time without sleep disturbance or insufficient sleep, and medium and high screen time with either sleep problem were associated with higher BMI and WC. Low screen time with insufficient sleep and high screen time with sufficient sleep were associated with higher BMI. Associations were generally stronger among males, particularly with high screen time. Conclusion: Screen time and insufficient sleep were independently and jointly associated with higher BMI and WC 2 years later, especially when both were present.