Childhood Obesity最新文献

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.

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.

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: 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.

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: 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.