Childhood Obesity最新文献

Background: Previous research has not examined whether youth with obesity class I, II, or III differ in adherence to health behavior recommendations.

Objective: To examine differences in meeting recommendations for physical activity (PA), screen time (ST), fruit/vegetable (F/V), dairy, and water consumption by obesity class.

Methods: Data were from primary care visits from 2013 to 2019 among youth ages 2-17 years with obesity. A brief survey was used to capture adherence to five different health behaviors. Logistic regression compared odds of adherence across obesity classes (I vs. II/III; II vs. III).

Results: Among 11,525 youth with obesity, rates of meeting recommendations were 78.6% (PA), 55.0% (ST), 8.1% (F/V), 29.6% (dairy), and 54.7% (water). In adjusted models, compared with youth with obesity class I, youth with obesity class II and class III had lower odds of meeting PA (odds ratio [OR_CII] = 0.63, 95%CI = 0.56, 0.72; OR_CIII = 0.60, 95%CI = 0.49, 0.72), and ST recommendations (OR_CII = 0.83, 95%CI = 0.74, 0.92; OR_CIII = 0.78, 95%CI = 0.65, 0.94). No differences were observed between obesity class II and class III.

Conclusions: Youth with different classes of obesity demonstrate different adherence to ST and PA recommendations. Pediatric primary care providers can utilize these findings to determine adherence barriers and tailor their counseling for patients with severe obesity.

Background: Obesity is a multifactorial condition and represents a major public health issue. In 5% of cases, obesity is monogenic, secondary to an abnormality in a gene of the leptin-melanocortin signaling pathway.

Objectives: The aim of our retro-prospective descriptive study is to reclassify heterozygous variants of unknown significance (VUS) and to describe the clinical and biological phenotypes of the patients carrying these variants.

Methods: Our study population included adult and pediatric patients followed in the Hospices Civils de Lyon for severe obesity, with a heterozygous probably pathogenic variant or a variant of unknown significance on a specific gene of interest identified by genetic analysis between January 2018 and December 2022. Reclassification of variants was based on family segregation and the recent literature data. The data concerning medical history, phenotypic characteristics, and biological results were extracted from medical files.

Results: Twenty-six patients underwent family segregation analysis: 10 patients were identified as carriers of a heterozygous probably pathogenic variant or VUS with a positive segregation. All patients had early-onset obesity at a mean age of 2.8 years.

Conclusions: Our study highlights the clinical relevance of family segregation in reclassifying VUS within the leptin-melanocortin pathway and underscores the diagnostic value of early obesity onset in identifying potential monogenic forms.

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: 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.

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.