Childhood Obesity最新文献

Background: Pediatricians support families in establishing healthy behaviors, yet there is limited information on valid and pragmatic questionnaires for assessing weight-related health behaviors in early childhood (≤24 months). The objective of this review is to summarize the evidence on parent-reported measures of weight-related health behaviors and/or parenting practices (e.g., feeding practices, dietary intake, sleep duration/routine, physical activity/sedentary behavior, and screen time) in early childhood. Methods: We conducted a scoping review by searching MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane from inception to May 2025 (Open Science Framework Protocol https://doi.org/10.17605/OSF.IO/ME5KW). Articles included were peer reviewed, original research, published in English, and parent-reported measures of weight-related health behaviors in early childhood that reported psychometric results and/or were used in primary care. Trained reviewers systematically extracted details on the setting, questionnaire, and psychometrics. Findings were summarized using descriptive analysis. Results: Our search yielded 26,642 articles with a final data set of 223 articles. Of the 100 unique questionnaires identified, most (90%) assessed parents' feeding practices and/or children's dietary intake; few assessed sleep duration/routine (13%), screen time (13%), and/or physical activity/sedentary behavior (12%). Of the 52 articles describing questionnaires used in primary care, 35% reported psychometric analyses. Conclusions: Most questionnaires measuring weight-related health behaviors in early childhood assessed parent feeding practices and/or children's dietary intake. Few questionnaires used in primary care reported psychometric results. Comprehensive, valid, reliable, and pragmatic questionnaires of health behaviors in early childhood are needed in the primary care settings to standardize screening for obesity risk in early childhood.

Background: Pharmacological options for severe obesity in early childhood are limited. While lisdexamfetamine is approved for attention-deficit/hyperactivity disorder (ADHD) and binge eating disorder, its role in managing obesity in children without these conditions has not been well studied. This case series assessed the effect of lisdexamfetamine on weight in young children with severe obesity but without ADHD or binge eating disorder. Methods: We conducted a retrospective chart review of six children with severe obesity treated with lisdexamfetamine for weight management. Demographic, anthropometric, and metabolic data were collected. One patient had Prader-Willi syndrome (PWS); the others had no known syndromic obesity. Results: Median age at treatment initiation was 6.5 years (range: 4.5-14), with equal male and female distribution. Median treatment duration was 12 months (range: 12-24), and mean maximum tolerated lisdexamfetamine dose was 35 mg (range: 10-60). In patients without syndromic obesity (n = 5) including one child with hypothalamic obesity, lisdexamfetamine significantly reduced body mass index (BMI) percent of the 95th percentile at 12 months (median change -24%, range: -18 to -28, p = 0.031), equating to a 13.8% reduction in BMI. Height percentile remained unchanged (p = 0.59). The patient with PWS did not achieve lasting weight loss. Three children reported decreased appetite. Conclusions: Lisdexamfetamine was associated with weight loss in young children with severe obesity without genetic syndromes. Further studies are warranted to assess the long-term efficacy and safety of lisdexamfetamine in the management of pediatric obesity.

Background: During the early COVID-19 pandemic, many US youths experience rapid excess weight gain and increase in BMI and obesity prevalence. We leveraged longitudinal electronic health records from three health care organizations in metropolitan Denver, Colorado, to assess COVID-19 pandemic effects on BMI and obesity prevalence. Methods: Using a retrospective cohort of 55,429 children aged 2-19 years, each with ≥3 BMI measurements during 2019-2022, we used mixed-effects regression models to estimate rates of change in BMI and obesity prevalence during prepandemic, early pandemic (March-December 2020), and two later pandemic periods (2021, 2022). Results: The average rate of BMI gain was nearly 70% higher during early pandemic compared to prepandemic [rate ratio (RR): 1.68 (95% confidence interval {CI}: 1.60-1.76)] but attenuated substantially as the pandemic continued [RR: 0.37 (95% CI: 0.34-0.40) for 2021 vs. early pandemic]. This coincided with changes in estimated obesity prevalence from 16% to 17% prepandemic to 21% by December 2020% to 20% by December 2022. School-aged children 6-13 years, those with prepandemic healthy weight, and Hispanic and non-Hispanic Black children had the most pronounced BMI increases in early pandemic. Conclusions: Although rates of BMI gain leveled out from early pandemic increases, obesity prevalence in health care-seeking youths in metropolitan Denver remained substantially higher in 2022 than prepandemic, particularly in certain subgroups. Opportunities exist to strengthen institutions and programs that support healthy eating, physical activity, and maintenance of a healthy weight. This work underscores the value of regional surveillance systems to monitor disease trends and inform local efforts to support children's health.

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.