Childhood Obesity最新文献

Objective: The American Academy of Pediatrics recommends all children receive care in a patient-centered medical home. With weight stigma potentially hampering family-centered communication in the care of children with overweight or obesity, we aimed to determine how children's weight status was associated with access to a medical home and its components. Methods: We analyzed 2016-2021 data on children age 10-17 years in the National Survey of Children's Health. Children's weight status was classified as underweight/normal weight, overweight, or obese, based on caregiver-reported height and weight. Outcomes included receiving care in a medical home and each category of the medical home definition (personal health care provider, usual source of health care, family/patient-centered care, care coordination, and assistance with referrals). Results: Based on the study sample (n = 105,111), we estimated that 16% of children were overweight and 16% were obese, while 42% had access to a patient-centered medical home. On multivariable analysis, obesity compared to normal weight was associated with lower access to a medical home (odds ratio: 0.87; 95% confidence intervals: 0.80, 0.95; p = 0.003) and, specifically, with lower access to family-centered care and assistance with care coordination. Conclusions: Children with obesity encounter barriers to accessing care meeting medical home criteria, with one plausible mechanism being that weight stigma disrupts family-centered communication. Lower access to care coordination among children with obesity may also indicate a need to improve the integration of obesity-related specialty care with pediatric primary care services.

Equitable access to affordable, effective, and safe obesity prevention and treatment remains a problem for many children and families in the U.S. In 2023, the American Academy of Pediatrics (AAP) published its first Clinical Practice Guideline (CPG) for pediatric obesity evaluation and treatment, aiding the field's awareness of effective approaches. CDC has supported the adapting and packaging of existing, effective Family Healthy Weight Programs that deliver CPG-recommended intensive behavioral treatment for kids. Currently, at least six family-centered programs are recognized by CDC and can be implemented in clinical and community settings to support child health. CDC and other national partners are coordinating the movement of these research-tested FHWPs into public health practice. This work includes implementing FHWPs in over 60 US communities and supporting national-level infrastructure improvements. CDC is committed to engaging with stakeholders to help scale proven strategies that ensure all children receive the care they need to thrive.

Background: The BMI z-score is a standardized measure of weight status and weight change in children and adolescents. BMI z-scores from various growth references are often considered comparable, and differences among them are underappreciated. Methods: This study reanalyzed data from a weight management clinical study of liraglutide in pubertal adolescents with obesity using growth references from CDC 2000, CDC Extended, World Health Organization (WHO), and International Obesity Task Force. Results: BMI z-score treatment differences varied 2-fold from -0.13 (CDC 2000) to -0.26 (WHO) overall and varied almost 4-fold from -0.05 (CDC 2000) to -0.19 (WHO) among adolescents with high baseline BMI z-score. Conclusions: Depending upon the growth reference used, BMI z-score endpoints can produce highly variable treatment estimates and alter interpretations of clinical meaningfulness. BMI z-scores cited without the associated growth reference cannot be accurately interpreted.

Background: Families with children who have or are at risk for obesity have differing needs and a one-size-fits-all approach can negatively impact program retention, engagement, and outcomes. Individually tailored interventions could engage families and children through identifying and prioritizing desired areas of focus. Despite literature defining tailoring as individualized treatment informed by assessment of behaviors, intervention application varies. This review aims to exhibit the use of the term "tailor" in pediatric obesity interventions and propose a uniform definition. Methods: We conducted a scoping review following PRISMA-ScR guidelines among peer-reviewed pediatric obesity prevention and management interventions published between 1995 and 2021. We categorized 69 studies into 6 groups: (1) individually tailored interventions, (2) computer-tailored interventions/tailored health messaging, (3) a protocolized group intervention with a tailored component, (4) only using the term tailor in the title, abstract, introduction, or discussion, e) using the term tailor to describe another term, and (5) interventions described as culturally tailored. Results: The scoping review exhibited a range of uses and lack of explicit definitions of tailoring in pediatric obesity interventions including some that deviate from individualized designs. Effective tailored interventions incorporated validated assessments for behaviors and multilevel determinants, and recipient-informed choice of target behavior(s) and programming. Conclusions: We urge interventionists to use tailoring to describe individualized, assessment-driven interventions and to clearly define how an intervention is tailored. This can elucidate the role of tailoring and its potential for addressing the heterogeneity of behavioral and social determinants for the prevention and management of pediatric obesity.

Background: The purpose of this study was to determine the reliability of anthropometric measurements between two trained anthropometrists working in a team and one trained anthropometrist working with a child's parent/caregiver in a primary health care setting. Study Design: An observational study to determine measurement reliability was conducted in a primary care child research network in Canada. In total, 120 children 0-5 years old had their anthropometric measurement taken twice by two trained anthropometrists working in a team and twice by one trained anthropometrist working with a child's parent/caregiver. Inter- and intra-observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM), and the coefficient of reliability (R). Results: The %TEM values for length/height and weight were <2%, and the R coefficient values were >0.99, indicating a high degree of inter- and intra-observer reliability. The TEM values demonstrated a high degree of reliability for inter- and intra-observer measurement of length/height in comparison with other anthropometric measurement parameters. However, there was greater variation seen in the length measurement for children 0 to <2 years of age and in arm circumference measurement across both age-groups. Conclusion(s): This study suggests that anthropometric measurement taken by one trained anthropometrist with the assistance of a parent/caregiver is reliable. These findings provide evidence to support inclusion of a child's parent/caregiver with anthropometric measurement collection in clinical setting(s) to enhance feasibility and efficiency and reduce the research costs of including a second trained anthropometrist.

Factors associated with change in percent body fat (%BF) of children in pediatric weight management (PWM) care may differ from those associated with change in weight status. Objective: To describe %BF and weight status at initial visits to 14 PWM sites, identify differences by sex, and evaluate factors associated with change over 6 months. Methods: Initial visits of 2496 males and 2821 females aged 5-18 years were evaluated. %BF was measured using bioelectrical impedance analysis. Results: Sex-specific logistic regressions [806 males (32.3%), 837 females (29.7%)] identified associations with primary outcomes: lower %BF and metabolically impactful ≥5-point drop in percent of the 95th BMI percentile (%BMIp95) over 6 months. At the initial visit, males had lower %BF and higher %BMIp95 than females. Over 6 months, males had significantly (p < 0.001) greater median drop in %BF (-1.4% vs. -0.4%) and %BMIp95 (-3.0% vs. -1.9%) and a higher frequency of decreased %BF (68.9% vs. 57.8%), but similar percentage with ≥5-point %BMIp95 drop (36.5% vs. 32.4%; p = 0.080). For males, factors significantly associated with decreased %BF (older age, ≥6 visits, lack of developmental or depression/anxiety concerns) were not related to having a ≥5-point %BMIp95 drop. For females, lack of depression/anxiety concern was significantly associated with decreased %BF but was not associated with ≥5-point %BMIp95 drop. Conclusions: There are differences by sex in initial visit %BF and %BMIp95 and in characteristics associated with changes in these measures. PWM interventions should consider evaluating body composition and sex-stratifying outcomes.

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children's health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n = 429; 1.16%), overweight most of the time (n = 15,006; 40.65%), increasing BMI percentile (n = 9,060; 24.54%), decreasing BMI percentile (n = 5,058; 13.70%), and always normal weight (n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Interventions in community settings, where children spend substantial out of school time, may enhance access to evidence-based lifestyle interventions. The Boys and Girls Club of Lawrence (BGCL) and New Balance Foundation Obesity Prevention Center at Boston Children's Hospital partnered to revise, enact, and evaluate BGCL's existing Healthy Living Club and then flexibly expand the program to increase access. The BGCL is within walking distance of three public housing communities and easily accessible to members, of whom 90% identify as Hispanic. The interventions comprised nutrition sessions and either fitness activity sessions (N+FA Cycle 1, n = 63, 26 hours; N+FA Cycle 2, n = 94, 27 hours) or academic basketball practices (N+AB Cycle 2, n = 99, 72-80 hours), leveraging time already in the schedule where fitness could be intentionally promoted by coaches. Among children aged 8-15 years, mean [95% confidence interval (CI)] changes (beginning to end) in percentage above the BMI median were significant [N+FA Cycle 1: -2.4 (-4.1, -0.8); N+FA Cycle 2: -4.3 (-5.4, -3.1); N+AB Cycle 2: -5.5 (-6.9, -4.1)]. Lifestyle interventions, implemented with flexibility in existing programs, had beneficial impact, indicating potential of community-academic partnerships.

Background: To examine longitudinal associations of early neighborhood Child Opportunity Index 2.0 (COI) with children's BMI trajectories and identify whether household economic resources moderate relations of COI in infancy/toddlerhood and the preschool years to longitudinal BMI growth between 2 and 12 years. Methods: Family data (n = 1091) were drawn from the Family Life Project, a longitudinal study of families residing in rural high-poverty areas. Neighborhood COI was obtained for each developmental period: infancy/toddlerhood (2-15 months) and the preschool years (2-5 years). BMIs were created from anthropometrics collected at six time points. Results: Higher neighborhood COIs during the infancy/toddlerhood (β = -0.0130, p < 0.01) and preschool years (β = -0.0093, p < 0.05) were associated with lower BMI at 5 years of age; although the latter became nonsignificant after adjusting for infancy/toddlerhood COI. Both household income and time spent in poverty moderated associations of infancy/toddlerhood exposure to neighborhood COI with BMI change. Among children residing in not poor households, higher neighborhood level child opportunity was associated with a slower increase in BMI from 2 to 12 years (β = -0.0369, p < 0.05), and a lower BMI at 12 years (β = -0.0395, p < 0.05). Conclusions: Neighborhood COI during the infant and toddler years is longitudinally associated with child growth, and long-term associations are evident among children residing in not poor households. Future work is needed to better understand how family and neighborhood-level resources interact to influence obesity risk, particularly for those at high risk.