Childhood Obesity最新文献

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.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to end-stage liver disease and hepatocellular carcinoma (HCC), albeit infrequently in childhood. Our objectives were to (1) investigate the prevalence of elevated alpha-fetoprotein (AFP) in children with advanced, MASLD-related, fibrosis (bridging fibrosis or cirrhosis) and (2) ascertain whether pediatric MASLD is associated with AFP elevations regardless of fibrosis severity. Methods: Retrospective cohort study of patients aged 6-18 years seen at a single center between 2000 and 2024. Demographics, anthropometrics, blood work, histological data, and relevant imaging studies were collected. Descriptive statistics were used. Results: Out of a cohort of 483 pediatric patients followed for MASLD with available AFP data, 161 had undergone liver biopsy, and of those, 22 had advanced fibrosis. Children with advanced fibrosis were predominantly male (82%) and non-Hispanic (55%), with a median age of 11 years (interquartile range [IQR] = 10-18) and severe obesity (median [IQR] body mass index z-score 2.56 [2.33-2.75]). No patients with advanced fibrosis had elevated AFP levels. Of the entire MASLD cohort, however, nine had elevated AFP levels. None were diagnosed with HCC or other tumors. Conclusions: In a pediatric cohort with MASLD, severe fibrosis was not associated with elevated AFP levels. AFP elevations were seen however in some patients with MASLD but were not associated with malignancies.

Introduction: Prescribing glucagon-like peptide receptor agonists (GLP1-RA) for pediatric patients with obesity is increasing. There are concerns that cost, insurance coverage, and/or provider prescribing practices will lead to inequities with GLP-1-RA use. Objective: Describing the GPL1-RA prescribing practices in a pediatric weight management program. Methods: We retrospectively reviewed charts of patients treated from 7/1/2021 to 6/30/2023. The following was extracted from the medical record: demographic data, anthropometrics (percent of 95^th percentile body mass index [BMI] for age/sex [p95%BMI] and BMI class), laboratory measures (hemoglobin A1C [HbA1c] and alanine aminotransferase [ALT]), and whether patients were prescribed a GLP1-RA and/or metformin. Results: A total of 2,563 patients were seen in 2 years. Patients prescribed GLP1-RAs had higher HbA1c, 6.5% vs. 5.6% (p < 0.001); ALT, 79 IU vs. 37 IU (p < 0.001); and p95%BMI, 169 vs. 141 (p < 0.001), than others. There were no differences between the groups regarding race, sex, ethnicity, or insurance status. Conclusions: GLP1-RA prescribing was associated only with disease burden.

Background: Obesity is a prevalent medical condition among the pediatric population. Metabolic and bariatric surgery is recommended to treat severe obesity. Resting energy expenditure (REE) plays a vital role in weight homeostasis. This study aims to assess the impact of sleeve gastrectomy (SG) on REE in pediatric patients with severe obesity while comparing REE values with body composition. Methods: Participants were recruited from the Pediatric Weight Management Clinic and Bariatric Surgery Clinic at Lucile Packard Children's Hospital. REE was measured using indirect calorimetry. Body composition was assessed using dual energy X-ray absorptiometry scans. Data were collected prospectively and analyzed using a generalized linear model and correlation analyses. Results: Thirty-six participants with severe obesity were included. Correlation analyses showed significant differences in baseline REE/kg between age groups, with higher REE/kg in participants <16 years. No significant correlations were observed between pre-SG REE/kg and degree of weight loss post-SG. Pre-SG %lean body mass positively correlated with REE/kg. There was no significant change in REE/kg following SG with weight loss. Conclusions: SG remains an effective intervention for managing severe obesity. This study found no significant changes in REE after SG. Future research should focus on larger longitudinal studies to enhance understanding of the metabolic effects of SG in pediatric patients while optimizing strategies for improved health outcomes.

Objective: This study examined the association between neighborhood food swamp environments and sugar-sweetened beverage (SSB) consumption in quick-service restaurants (QSRs) and whether ethnicity and race moderated this association. Methods: Observational data were collected from parent-child dyads patronizing four QSRs in Massachusetts (n = 82 dyads) and New Hampshire (n = 67 dyads), including children's SSB consumption (measured by plate waste) categorized as high (>25 g) versus lower sugar. The neighborhood food environment of each QSR was categorized as food swamp versus nonfood swamp based on the ratio of unhealthy to total food outlets in the neighborhood. Logistic regression analysis was used to test the relationship between food swamps, ethnicity/race, and SSB consumption. Results: Of the 149 children (49% Latinx, 58% between the ages of 7 and 12), most visited QSRs located in food swamps (63%). All children consumed a beverage in QSRs, and 83% consumed high-sugar SSBs. Children patronizing QSRs in food swamps did not differ significantly in the likelihood of consuming high SSBs relative to children in QSRs in nonfood swamps [82% vs. 83%, adjusted odds ratio (aOR) = 0.8, 95% confidence interval (CI): 0.3-2.2]. However, Latinx children were more likely than non-Latinx children to consume high-sugar SSBs in QSRs (93% vs. 72%, aOR = 3.4, 95% CI: 1.1-10.5). SSB consumption did not differ significantly between racial minority and White children. SSB consumption in food swamps did not differ by ethnicity/race. Conclusions: Regardless of the neighborhood food environment, children consume high-sugar SSBs in QSRs. Latinx children had higher odds of consuming high-sugar SSBs in QSRs. These findings support incentives promoting healthier beverage options for children across all food outlets.

Background: Despite the rapid increase in glucagon-like peptide-1 receptor agonist (GLP-1) use for management of weight among adolescents (ages 12-18 years), there is limited guidance on associated behavioral health considerations. Adolescents on GLP-1 therapy represent a potentially vulnerable population at risk of experiencing medical and psychosocial effects of obesity and comorbidities, as well as side effects and behavioral implications of the medications. Method: This perspective discusses behavioral and psychosocial considerations for adolescents seeking GLP-1s. The limited and developing literature on the use of GLP-1s for pediatric obesity treatment was reviewed to evaluate key aspects of psychosocial functioning and health behavior engagement and to stimulate discussion, research, clinical innovation, and advocacy to support best practices for youth seeking GLP-1s to address weight concerns. Results: There is currently sparse research on the effects of GLP-1s on adolescents' psychosocial functioning. In the context of clinical practice, it may be important to assess for symptoms of eating disorders/disordered eating behaviors, mood instability, and general psychosocial functioning as well as quality of life, social support, health behaviors, and readiness to change prior to the initiation of and throughout the course of GLP-1 treatment. Conclusions: This perspective serves as a call to action for research and clinical innovation to address the psychosocial effects of GLP-1s on adolescents. Screening, monitoring, and future research will be key to ensuring safe and effective use of GLP-1 therapy as well as optimal psychosocial outcomes for youth utilizing GLP-1 medications for obesity treatment.

Background: This study explored whether baseline body esteem predicted changes in eating behaviors, physical activity (PA), and health-related quality of life (QoL) over a 24-month period among youth with obesity enrolled in weight management programs. Methods: Utilizing data from the CANadian Pediatric Weight Management Registry, the study included 415 participants (n = 221 girls, n = 194 boys) aged 10-17 years (mean = 13.2, standard deviation = 2.2). Baseline assessments included a measure of body esteem, while QoL, eating behaviors, and PA were reported at baseline, 12 months, and 24 months. Multilevel modeling was applied to examine the relationships between baseline body esteem and changes in outcomes over time. Results: Higher baseline body esteem was associated with higher initial QoL scores (β = 0.70, p < 0.001) and healthier eating behavior scores (β = -0.57, p < 0.001). Individuals with lower baseline body esteem exhibited greater improvements in QoL (β = -0.12, p = 0.010) and eating behaviors (β = 0.12, p = 0.004) over time. However, baseline body esteem did not significantly predict changes in PA. Conclusions: These findings highlight the prospective relationship of body esteem with future health behaviors and outcomes, providing evidence for weight management programs to consider addressing body esteem within pediatric obesity research and treatment.