Childhood Obesity最新文献

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: 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.

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: National guidelines support adjunct anti-obesity medications to treat adolescent obesity. The combination of phentermine and topiramate is accessible and efficacious in controlled trials, but very little clinic-based data exist. We sought to describe prescribing characteristics, effectiveness, and safety of phentermine and/or topiramate in a clinical setting. Methods: A retrospective chart review was conducted among patients prescribed phentermine and/or topiramate for obesity in a pediatric obesity management program between 2019 and 2021. Patient and provider characteristics, percent BMI change, vital signs, laboratory tests, and discontinuation data were assessed. Results: Patients (n = 126) with mean age of 15.5 years, 50% Hispanic, 66% with public insurance, were included, of whom 83% had severe obesity and 51% had ≥3 comorbidities. Discontinuation at 12 months was observed in 58% of the sample, driven primarily by loss to follow-up. Patients who continued medication had significant BMI reductions at 3 (-3.1%), 6 (-4.7%), 9 (-5.2%), and 12 (-7.5%) months. Heart rate increased on phentermine by 5-10 beats per minute at 9 and 12 months only. Adverse effects were experienced by 25.8% at 3 months and most commonly included mood changes, fatigue, and paresthesias. Side effects and side effect-related discontinuation were most common with topiramate monotherapy. Conclusions: Phentermine and/or topiramate resulted in BMI reduction in most patients exposed for 3-12 months. Safety data support individualized monitoring of heart rate and neuropsychiatric side effects. High attrition and variables associated with differential BMI response require further study. Most patients had severe, complicated obesity at medication initiation and may benefit from earlier intervention.

Background: This study aimed to compare recess physical activity, social behaviors, and social/school perceptions among children with obesity and severe obesity and those without obesity. Methods: Recess observations were done using the System of Observing Children's Activity and Relationships during Play. School climate surveys and anthropometric measurements were also completed. A total of 414 observations from 160 (52% female) children were collected at four schools in Little Rock, AR, during three semesters from 2023 to 2024. Children were in kindergarten through 5th grade. Linear mixed-effects models were used to estimate adjusted associations. Results: Thirteen percent of observations reflected children with severe obesity, 21% were from children with obesity, and 66% were from children with a BMI below the 95th percentile on the age- and gender-specific reference growth charts. Overall, children were engaged in moderate-vigorous physical activity 64% of the time and played alone 22% of the time. Positive play was observed 50% of the time. Children with severe obesity played alone 8% (p < 0.05) more than the reference group without obesity. There was no evidence of an inverse association between obesity and physical activity. Surveys from upper elementary children showed no differences in self-reports of being happy, having friends, or enjoying recess by weight status. Conclusions: While we observed more alone play at recess among children with severe obesity, we did not observe less physical activity or more negative play experiences among children with obesity or severe obesity. Recess appears to be beneficial regardless of weight status, both socially and for physical activity.

Background: Treatment-seeking adolescents with obesity may have diverse dietetic, psychological, or medical needs that require support during obesity treatment. Objectives: To characterize initial referral reasons, content, and outcome of support visits provided in addition to protocolized visits during an obesity treatment trial. Methods: The Fast Track to Health trial was a 52-week multi-site randomized trial conducted between 2018 and 2023 in Australia, comparing intermittent and continuous energy restricted dietary interventions delivered as part of an intensive behavioral intervention in adolescents with obesity and ≥1 obesity-related complications. Alongside protocolized mental health screening and medical and dietetic reviews, additional support was provided by the study dietitian, pediatrician or psychologist if needed or requested by families. Two reviewers independently coded deidentified clinical notes for each additional support visit to identify referral reasons, content and outcome of each visit. Results: Of 141 adolescents enrolled, 51 (36.2%) attended at least one additional support session, with most (n = 31) having one visit. Most referrals were initiated by a clinician (n = 34) and included requests for dietetic review (n = 16), motivation and/or support during COVID-19 lockdowns (n = 15), general psychological review (n = 14) and anxiety (n = 11). Conclusions: Understanding the diverse needs of adolescents with obesity is essential to inform obesity treatment interventions.

Background: Maternal consumption of fruits and vegetables can reduce future childhood obesity risk. Health Bucks, a fruit and vegetable voucher program redeemable at New York City (NYC) farmers' markets, supports access to fresh produce. Methods: In a cross-sectional analysis within a cohort study, we evaluated the integration of Health Bucks into the prenatal expansion of a primary care-based obesity prevention program. We analyzed data from 176 pregnant Latina participants at a NYC public hospital, with vouchers given to 114 (64.8%) participants. Later in infancy, we measured maternal outcomes (fruit and vegetable intake, stress) and food access (food environment, household food insecurity). We performed adjusted regression analyses to evaluate outcome differences between those who received vouchers and those who did not. Secondary analyses assessed whether voucher redemption or first-trimester timing of distribution were associated with outcomes. Results: Receipt of vouchers was associated with higher daily fruit and vegetable intake (incident rate ratio [IRR] = 1.3 [95% confidence interval [CI]: 1.1, 1.6]), and lower stress (B = -1.9 [95% CI: -3.7, -0.1]). Voucher redemption was associated with higher daily fruit and vegetable intake (IRR = 1.3 [95% CI: 1.04, 1.6]). First trimester receipt was associated with a favorable view of the neighborhood food environment (adjusted odds ratio = 5.5 [95% CI: 1.04, 28.6]) and lower stress (B = -3.8 [95% CI: -7.5, -0.1). We did not detect associations with food insecurity. Conclusion: Integrating Health Bucks into a prenatal obesity prevention program was associated with favorable outcomes. Subgroup analyses showed that voucher redemption and first-trimester receipt were associated with positive outcomes, guiding strategies for fruit and vegetable voucher distribution.