Psychological consequences of childhood obesity: psychiatric comorbidity and prevention

Family-based intervention to prevent childhood obesity among school-age children of low socioeconomic status: study protocol of the FIVALIN project

Background

Childhood obesity represents a global public health crisis: the number of obese children and adolescents (aged 519years) worldwide has risen tenfold in the past four decades. The vast majority of overweight and obese children live in high-income countries, and low socio-economic status (SES) is a significant risk factor. Family Based Interventions (FBI) have demonstrated positive results in preventing obesity, although these results are strongly influenced by SES. Moreover, we still poorly understand how FBI can determine a positive trend in weight status in low-income communities. Therefore, there is an urgent need to define and evaluate innovative and multi-target projects to reduce obesity risk behaviors and health inequalities and the present study aims to present the study protocol of FIVALIN a FBI that pretends to achieve this goal.

Methods

We will conduct a quasi-experimental design within 60 Community Child Centers (CCC) in Barcelona metropolitan area. Each cluster (CCC) will be assigned by convenience to the intervention and control groups. For the whole study, a total of 810 children aged 812years and 600 parents will be recruited during 3 consecutive editions (1st 2019/2020; 2nd 2020/2021; 3rd 2021/2022) of 10months each. The action is a regular multicomponent health-promotion intervention targeting children, families, and CCC. All activities are based on the Motivational Interviewing (MI) approach and will focus on promoting good dietary habits, physical activity, appropriate screen time and sleep duration, and psychological well-being. The control group participate in a unique workshop on general awareness of healthy lifestyles for families. We will perform a comparative analysis of the evolution of weight status, healthy lifestyles, and socioeconomic variables, between the intervention and control groups.

Discussion

There is a need for more evidence on how to target and evaluate holistic interventions in low SES families. Our multi-targeting intervention for obesity prevention tackles risky behaviors that go beyond diet and physical activity (PA). Therefore, future interventions can effectively promote all the behavioral domains that determine trends in the weight status.

Trial registration

ISRCTN Registry: ISRCRN12682870. Registered 9 July 2020. Retrospectively registered.

Protocol version: 30 April 2021, version 5.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02697-x.

Childhood Obesity in Serbia on the Rise

The aim of the study was to examine changes in obesity prevalence among primary school children in Serbia between 2015 and 2019 rounds of the national WHO European Childhood Obesity Surveillance Initiative (COSI-Serbia). Cross-sectional studies were conducted in 2015 and 2019. The nationally representative samples of primary school children were measured for body height and weight, following the COSI protocol. Body Mass Index was calculated, and the IOTF and WHO definitions were used to classify children as overweight or obese. Participants were children of both sexes aged 7.00–8.99 years (n = 6105). Significant differences in overweight (obesity included) prevalence between two COSI rounds were identified regardless of definitions applied. According to the WHO definitions, prevalence of overweight and obesity combined increased in 7–9-year-old children in Serbia from 30.7% in 2015 to 34.8% in 2019 (z = −3.309, p < 0.05), and according to the IOTF standards, the increase from 22.8% to 30% was registered (z = −6.08, p = 0.00). The childhood overweight/obesity rate is increasing in Serbia, which places monitoring and surveillance of children’s nutritional status high on the public health agenda.

Weight status in the 6 to 9 year-old school population in Spain: Results of the ALADINO 2015 study

INTRODUCTION

Overweight and obesity in childhood and adolescence has grown alarmingly in the last twenty years or so in many countries of Europe, including Spain. This study presents the prevalences of overweight and obesity in 6-9 year-old schoolchildren in 2015, and their associated characteristics.

METHODOLOGY

ALADINO (Its initials in Spanish for Diet, physical activity, child development and obesity) is a cross-sectional study of a representative sample of 6-9 year-old schoolchildren in Spain, in line with the Childhood Obesity Surveillance Initiative (COSI) of the World Health Organisation (WHO). The height and weight of the participants, defining the weight status according to WHO standards, and a questionnaire was given to the parents on lifestyle and sociodemographic characteristics.

RESULTS

Anthropometric measurements were taken on 10,899 schoolchildren for 168 primary education centres. Excess weight was observed in 41.3% (95% CI: 40.0-42.6), overweight in 23.2% (95% CI: 22.1-24.3) and obesity in 18.1% (95% CI: 17.2-19.1), with obesity being more prevalent in boys, overweight in girls. The prevalence of abdominal obesity was 23.2% (95% CI: 21.8-24.6). The prevalence of overweight and obesity increased with age. Excess weight decreased by 3.2% compared to 2011, mainly due to the decrease in overweight in boys, while that of obesity remained stable. Excess weight was more prevalent in schoolchildren from families with a lower socioeconomic level.

CONCLUSIONS

The prevalence of excess weight in 6-9 year-old schoolchildren in Spain has decreased by 3.2% since 2011, due to the decrease in overweight, whilst obesity remained stable. Action must be taken in the obesogenic environment, by promoting healthy eating habits and physical activity, bearing in mind the inequalities in health.

Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

Despite worldwide public attention and intense medical efforts, the prevalence of severe morbid obesity in children and adolescents is still rising. Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways leading to serious co-morbidities such as impaired glucose tolerance or even type 2 diabetes (T2D), dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, and hyperuricemia. The management of severe childhood obesity requires a life-long multidisciplinary approach with a combination of lifestyle changes, nutrition, and medications. Standardized life-style intervention programs remain the first-line treatment for morbid obese children and adolescents, but unfortunately reveal limited long-term success. In such cases, metabolic bariatric surgery (MBS) has evolved from being a controversial issue to being included in distinct recommendations. According to the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee, indications for bariatric surgery in adolescence must follow very strict criteria. Adolescents with class II obesity (BMI > 120% of the 95th percentile) and a diagnosed co-morbidity or with class III obesity (BMI ≥ 140% of the 95th percentile) should be considered for MBS. These interventions represent high-risk operations, and adolescents should be treated in specialized, multidisciplinary high-volume obesity centers with long-term follow-up programs. The Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), which the authors pioneered as a stand-alone procedure in morbidly obese adolescents in 2008, has become the most commonly performed operation in morbidly obese adolescents at present. Recent literature proves that MBS is safe and effective in morbidly obese adolescents. Mid-term data have revealed significant improvement or even resolution of major co-morbidities. Thus, MBS for the treatment of morbidly obese adolescents has evolved from being a controversial issue to being included in distinct recommendations by several medical societies as a therapeutic strategy to reduce severe co-morbidities potentially causing end-organ damage in adulthood.

Understanding children and young people's experiences pursuing weight loss maintenance using the Socio-ecological Model: A qualitative systematic literature review

Developing a broader understanding of children and young people's experiences of long-term attempts of weight management may provide insight into both enablers and barriers to successful weight loss maintenance. This review aims to explore children and young people's perceptions of long-term attempts of weight management. Six databases were searched for qualitative studies describing young participants (<25 years, previously or currently above a healthy weight) experiences of weight management for >6 months following intentional weight loss. A thematic synthesis was undertaken. Themes were interpreted using the Socio-ecological Model. Factors supporting attempts to maintain weight loss included having clear motivation for change; developing personal skills to manage the challenges of change; family support/dynamics that encourage healthy lifestyles; and health-promoting cultures in schools/workplaces, communities, and the broader living environment. Conversely, ambivalence, difficulty coping with changes, peer pressure, challenging family dynamics, limited professional support, and unhealthy living environments were barriers to maintaining behavior change. These facilitators and barriers at each level of the Socio-ecological Model informed a model of weight loss maintenance for children and young people. Supporting children, young people, and families to develop the skills to manage the individual, social, and environmental challenges that shape attempts of long-term weight management will help to support their ability to manage their weight long term.

Association between child/adolescent overweight/obesity and conduct disorder: A systematic review and meta-analysis

BACKGROUND

Research findings of the association and its pattern between obesity and psychiatric/psychological comorbidities are not consistent across the types of comorbidities or the study subgroups.

OBJECTIVES

We aimed to perform meta-analysis of cross-sectional studies and longitudinal studies analysing obesity as a risk factor for conduct disorder in order to assess the association between child/adolescent overweight/obesity and conduct disorder.

METHODS

Systematic literature search, study selection and data extraction were performed independently by the two authors. Data were analysed by Comprehensive Meta-analysis software.

RESULTS

Analysis of 13 high-quality cross-sectional studies including 79 027 children and adolescents indicated a significant association between overweight/obesity and conduct disorder among children and adolescents (OR 1.32 [95% CI, 1.18-1.49], I² = 86.68), with no publication bias. Subgroup analyses yielded a significant difference (P < .01) between boys and girls. Analysis of four low- to moderate-quality longitudinal studies (OR 1.11 [95% CI, 0.89-1.38], I² = 57.69) showed no prospective association between overweight/obesity and conduct disorder. Subgroup analysis according to gender revealed a significant positive association for boys and negative association for girls.

CONCLUSIONS

Based on the high-quality cross-sectional data, overweight and obesity are associated with conduct disorder among children and adolescents, affecting boys more frequently than girls. Results of the longitudinal analysis indicated possible association in boys, while girls seem to be protected from conduct disorder. However, these results are very unreliable, indicating the need of well-designed longitudinal studies to elucidate the pattern of association between these disorders.

Testing a multicomponent lifestyle intervention for combatting childhood obesity

BACKGROUND

Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity.

METHODS

Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8-14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in.

RESULTS

Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively).

CONCLUSIONS

Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02972164 , November 23, 2016.

Weight Stigma Model on Quality of Life Among Children in Hong Kong: A Cross-Sectional Modeling Study

We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life (QoL). We recruited 430 dyads of elementary school children [mean age = 10.07 years; n_boy = 241 (56.0%); n_overweight = 138 (32.1%)] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, weight-related self-stigma, and perceived weight stigma. Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations.

The delivery of obesity interventions to children and adolescents with physical disabilities: a systematic review

BACKGROUND

To examine the process and mechanisms of delivering obesity interventions to physically disabled children/adolescents.

METHODS

PubMed, Medline, CINAHL Plus, Embase, Cochrane Library, Google Scholar, ClinicalTrials.gov, Science Direct were systematically and manually searched for studies conducted in physically disabled children/adolescents (0-18 years). Included interventions were physical activity, diet and obesity prevention education. Included outcomes were body mass index (BMI)/weight and obesity prevention knowledge. The Mixed Methods Appraisal Tool aided methodological quality assessments. Data were extracted and delivery models were synthesized and narratively summarized using the social ecological model.

RESULTS

Seven studies of low (n = 4) and moderate (n = 3) scoring on methodological quality were eligible for inclusion. Study duration was 5 months or less (n = 5), 8 months (n = 1) and 2 years (n = 1). Interventions were delivered at home, school, hospital and rehabilitation centre through the internet, face-to-face and parents. No intervention was delivered at three or more levels of individual, interpersonal, institutional or community levels. No study reported significant outcomes on reduction in BMI/weight, or increase in obesity prevention knowledge.

CONCLUSIONS

Evidence reviewed in this study shows that obesity interventions for physically disabled children/adolescents lack both in delivery and design. Gaps revealed should be considered when developing interventions for this special population.

Psychopathology and Adolescent Bariatric Surgery: A Topical Review to Support Psychologists in Assessment and Treatment Considerations

The rising rates of severe obesity among adolescents in the United States indicate a dire need for more intensive weight management strategies. While current evidence suggests that bariatric surgery is a safe and efficacious intervention for adolescents, the linkages with psychopathology before and after surgery are not well understood. Psychologists are an integral part of the interdisciplinary surgery team and play an important role in preparing youth for bariatric surgery as well as supporting adolescents post-surgery. The present manuscript reviews the literature on psychopathology in the context of adolescent bariatric surgery, discusses consideration of psychopathology as a contraindication for surgery, and provides recommendations on how psychologist members of the bariatric surgery team may balance attention to motivation and adherence to medical recommendations with assessment and treatment of psychopathology. Finally, the importance of continued research to confirm clinical consensus regarding decision-making and expansion of psychological resources within adolescent bariatric surgery programs are discussed.

Children, Media and Food. A New Paradigm in Food Advertising, Social Marketing and Happiness Management

The growing number of children who are obese or overweight in certain countries or geographical areas is a fact, as evidenced by the continuous studies and reports on the subject, endorsed or carried out by the World Health Organisation and independent research. In this context, food and beverage advertising can contribute to this. The main objective of this research is to evaluate compliance with the Food and Drink Advertising Code for Children (PAOS Code) in Spain and its relationship with nutritional habits on television, specifically on channels aimed at children. The methodology is therefore mixed: on the one hand, a qualitative technique based on discourse analysis and, on the other, a quantitative technique based on the content analysis of the advertising broadcast for seven consecutive days on three specialised channels and two generalist channels on Spanish television. The results reveal a systematic noncompliance with this code, which translates into inadequate eating habits among children. The immediate conclusion is that 9 out of 10 parts of food and drink advertising do not comply with any of the rules of the PAOS Code and that self-regulation by the advertising companies is negligible and insufficient.

A community perspective of COVID-19 and obesity in children: Causes and consequences

The pandemic of childhood obesity that has been increasing over the last decade has collided with the current pandemic of COVID-19. Enforced behavioural changes have resulted in a myriad of problems for children particularly in weight management. Restricted activity is the most obvious but many other aspects of life have exacerbated biological, psychosocial, and behavioral factors identified as risks for childhood obesity. Significant effort is required to turn around the prevailing tide of weight gain necessitating changes in personal and family behavior and diet, as well as high-level governmental and educational policy. Evidence-based, focused, long-term interventions which are adequately funded are required. Enthusiasm and optimism for change coupled with public engagement by utilization of new technology as well as traditional methods offers hope for change. Public health interventions in isolation are inadequate and bolder changes to central policies and social structure are needed for sustained change. This will allow some mitigation of the affects of COVID-19 but also reduce negative outcomes in future comparable situations.

Parents' perception of their children's weight status in an urban area of Western Greece

Context:

A lot of parents whose children are overweight or even obese are in no position to accurately acknowledge the real weight of their children. Parents' perception of their children's weight plays a significant role in the prevention and treatment of childhood obesity.

Aims:

This paper describes parents' opinions on the real weight status of their children and the sufficiency of quality nutrients in their diet.

Settings and Design:

The research methodology used in the particular study was based on survey research in preschool settings in West Greece.

Methods and Material:

The research methodology used in the particular study was based on survey research. Data were collected through questionnaires answered by parents of children attending preschool settings aged between two and five. One hundred and seventy-eight children and their parents participated. All parents had been informed of the aim of the study beforehand and gave their consent on condition that they could withdraw at any stage they wished.

Statistical Analysis Used:

Data were analyzed using SPSS (Statistical Package for the Social Sciences).

Results:

Comparing the Body Mass Index of children with the parents' opinion of their children's weight, we noticed 85,71% and 78,13% of the parents whose children were obese and overweight respectively, regarded their weight as normal. The majority of the overweight and obese children's parents were of the opinion that their children's diet was proper and healthy.

Conclusions:

Most parents whose children were obese or overweight underestimated the real weight of their children and considered their nutrition healthy.

Altered patterns of brain dynamics linked with body mass index in youth with autism

Children with autism spectrum disorder (ASD) have higher rates of overweight and obesity (OWOB) compared with typically developing (TD) children. Brain functional connectivity differences have been shown in both ASD and OWOB. However, only one study to date has examined ASD and OWOB concurrently, so little is known regarding the neural mechanisms associated with the higher prevalence of OWOB and its behavioral impacts in ASD. We investigated co-activation patterns (CAPs) of brain regions identified by independent component analysis in 129 children and adolescents between 6 and 18 years of age (n = 68 ASD). We examined the interaction between body mass index (BMI) and diagnosis in predicting dynamic brain metrics (dwell time, DT; frequency of occurrence, and transitions between states) as well as dimensional brain-behavior relationships. The relationship between BMI and brain dynamics was moderated by diagnosis (ASD, TD), particularly among the frequency of CAP 4, characterized by co-activation of lateral frontoparietal, temporal, and frontal networks. This pattern was negatively associated with parent-reported inhibition skills. Children with ASD had shorter CAP 1, characterized by co-activation of the subcortical, temporal, sensorimotor, and frontal networks, and CAP 4 DTs compared with TD children. CAP 1 DT was negatively associated with cognitive flexibility, inhibition, social functioning, and BMI. Cognitive flexibility moderated the relationship between BMI and brain dynamics in the visual network. Our findings provide novel evidence of neural mechanisms associated with OWOB in children with ASD. Further, poorer cognitive flexibility may result in increased vulnerability for children with ASD and co-occurring OWOB. LAY SUMMARY: Obesity is a societal epidemic and is common in autism, however, little is known about the neural mechanisms associated with the higher rates of obesity in autism. Here, we find unique patterns of brain dynamics associated with obesity in autism that were not observed in typically developing children. Further, the relationship between body mass index and brain dynamics depended on cognitive flexibility. These findings suggest that individuals with autism may be more vulnerable to the effects of obesity on brain function. Autism Res 2021, 14: 873-886. © 2021 International Society for Autism Research, Wiley Periodicals LLC.

Clinical strategies for addressing obesity in infants and toddlers

ABSTRACT

Babies' earliest food experiences have a lifelong impact on eating preferences and dietary habits, laying the foundation for obesity risk. NPs have the opportunity to provide education about healthy infant feeding practices before the growth trajectory becomes abnormal and focus intensive education on at-risk families.

Pharmacotherapy in pediatric obesity: current evidence and landscape

PURPOSE OF REVIEW

Childhood obesity is escalating globally. Lifestyle and behavioral changes, which are the frequently used interventions in clinical practice, lead to only modest improvements in children with established obesity. Bariatric surgery is currently the most effective obesity treatment but has very limited utilization in pediatric obesity and is preferentially used for children with worsening comorbidities. There exists a massive treatment gap for children suffering with obesity especially after the failure of lifestyle modifications. Pharmacotherapy that is an established management tool in adults is very infrequently used in children. Only two medications, Phentermine and Orlistat are approved by the Food and Drug Administration (FDA) for use in adolescent obesity. Herein, we discuss the current landscape and available literature on the use of antiobesity pharmacotherapy in children.

RECENT FINDINGS

There are emerging pediatric data about the efficacy of the many weight loss medications that are FDA approved in adults. Moreover, more clinical trials are underway on the rarer, intractable forms of obesity such as monogenic, syndromic, and hypothalamic obesity.

SUMMARY

Weight loss medications in children, like adults, have variable efficacy and similar side effect profiles. Rigorous research and improved education of providers about weight loss medications may address the huge treatment gap in severe pediatric obesity.

Anthropometric indices and cardiometabolic risk factors in a Ghanaian adolescent population

OBJECTIVES

Adolescent overweight and obesity is a public health concern globally, especially in lower- and middle- income countries where there is an additional burden of undernutrition. The prevalence of adolescent overweight/2obesity has increased markedly over the past three decades. The transition in dietary habits coupled with reduced physical activity has been blamed for the increasing trend. Overweight/obesity in adolescence is complicated by cardiometabolic, respiratory, musculoskeletal and psychosocial disorders. Additionally, adolescent obesity is a predictor of future development of type 2 diabetes, cardiovascular diseases and metabolic disorders. The burden of cardiometabolic risk factors associated with adolescent overweight/obesity in Ghana is lacking, the project, therefore, was undertaken to add to the existing knowledge.

METHODS

The study was undertaken in adolescent students of a tertiary institution in Ghana. Two hundred and one students consented to participate in the study. Questionnaires on sociodemographic characteristics, dietary and substance abuse habits were self-administered. Blood pressure, height, weight and waist circumference measures were performed and venous blood drawn for the determination of fasting serum total/LDL/HDL cholesterol and triglycerides. Body mass indices were determined as the weight per square of their heights.

RESULTS

The prevalence of obesity was determined to be 15.81% generally, 27.71% in the females and 7.08% in the males. Diastolic blood pressure was the only cardiometabolic risk factor significantly associated with obesity in our study.

CONCLUSION

Overweight/obesity is common in Ghanaian adolescents, with the prevalence highest in the female population.

Effectiveness of different types of mental simulation in the weight loss process based on a perseverance study among people with different BMI

Background

Most of the world’s population lives in countries in which overweight and obesity kill more people than does underweight. The weight loss process can be supported by mental simulations, which are used to help individuals to effectively strive towards various goals. The aim of this study was to determine the impact of different types of mental simulations on perseverance, resistance to distractors and the ability to inhibit irrelevant thoughts or memories in people with different body mass indexes (BMI).

Methods

The study included 252 participants. They performed process simulations and outcome simulations, using instructions presented to them during the experiment. Perseverance and resistance to distractors were determined using a computer maze-solving task. Two indicators of perseverance were analysed: number of maze tasks solved and total time spent on solving the test. Mean time spent on a single task was used as a measure of resistance to distractors and the ability to inhibit irrelevant thoughts and memories.

Results

The results of the analyses showed that the type of mental simulation used had an effect on the indicators of perseverance. Process simulation subjects completed more tasks and spent more time solving the test than outcome simulation subjects. A relationship was found between the subjects’ BMI and the investigated indicators. Individuals who were underweight, overweight or obese scored lower on all three indicators compared to subjects with normal BMI. In people with a BMI above normal, mental simulations increased resistance to distractors and the ability to inhibit thoughts sidetracking them from the task at hand. It is possible that increasing the resistance to distractors is responsible for the effectiveness of mental simulations in the weight loss process.

Conclusion

Our results can be applied in developing interventions for people who suffer from overweight and obesity. Psychological interventions based on mental simulations can be used to assist individuals in physical activity, leading to an improvement in health, but it has to be underlined that the mechanism of their action may vary from person to person.

Social Ecological Barriers for Healthy Eating of Obese Children and Their Caregivers in Low-income Families in South Korea

In this qualitative study, the focus is on healthy eating in children from low-income families who visit a Community Child Care center (CCC) in South Korea. Barriers for healthy eating were identified using focus group interviews with low-income overweight and obese children and their caregivers and applying a social ecological model as well as the framework analysis for qualitative data. The need for theory- and evidence-based health promotion interventions is indicated, at the level of the family, but also at the level of collaboration among all stakeholders, as well as multi-level policy changes.

Inverse Association Between Health Literacy and Obesity Among Children in Greece: A School-Based, Cross-Sectional Epidemiological Study

Children's health literacy is a crucial pillar of health. This study is aimed to examine the association between health literacy and weight status among Greek schoolchildren aged 10 to 12 years old. A population-based, cross-sectional observational study enrolling 1,728 students (795 boys), aged 10 to 12 years old, was conducted during school years 2014-2016. A health literacy index (range 0-100) was created through an item response theory hybrid model, by combining a variety of beliefs and perceptions of children about health. The mean health literacy score was 70.4 (±18.7). The majority of children (63.8%) had a "high" level (i.e., >67/100) of health literacy, 30.5% had a "medium" level (i.e., 34-66/100) of health literacy, while a small proportion of children (5.7%) had a "low" level (i.e., <33/100). Girls exhibited a higher level of health literacy than boys (71.7 ± 18.3 vs. 68.8 ± 19.1, p < .01). Regarding body weight status, 21.7% of children was overweight and 5.0% was obese. Linear regression models showed that the health literacy score was inversely associated with children's body mass index (regression coefficient [95% CI]: -0.010 [-0.018, -0.001]), after adjusting for dietary habits, physical activity levels, and other potential confounders. Health literacy seems to be a dominant characteristic of children's weight status; therefore, school planning, as well as public health policy actions should emphasize on the ability of children's capacity to obtain, process, and understand basic health information.

Neural Mechanisms of Food Decision-Making in Children

PURPOSE OF REVIEW

The goal of the current paper is to review the literature on the neural and behavioral factors involved in food decision-making in youth.

RECENT FINDINGS

Recent neuroimaging studies that employ passive viewing paradigms have found that exposure to food-related cues activate reward, motor planning, and attentional salience signals in children. Greater activations of reward signals and/or lower activations of control signals are associated with overeating and weight gain. Neuroimaging studies with decision-making paradigms have found the reward network in the brain activates during food choices, while control network activates less strongly. Findings suggest that exposure to food cues activates reward/valuation network, but activation of control network tends to be relatively weaker in children. Hedonic aspects of foods are predominantly considered in children's food choices, and their dietary self-control is not matured yet. The increased activation in reward network and the decreased activation in control network are associated with risk of developing obesity.

Psychological health in preschool children with underweight, overweight or obesity: a regional cohort study

OBJECTIVE

To examine if underweight (UW), overweight (OW) or obesity (OB), or body mass index (BMI) expressed as its SD score (BMI SDS), were associated with psychological difficulties in preschool children.

DESIGN

Regional cohort study.

SETTING

Oppland County, Norway.

METHODS

At the routine school entry health assessment at 5-6 years of age, parents were invited to participate by local public health nurses. The parents completed questionnaires on sociodemographic, health and lifestyle factors of the child and the family, and on the child's neurocognitive development. They assessed psychological health with the Strengths and Difficulties Questionnaire (SDQ). Public health nurses measured weight and height on all eligible children and reported age, sex, height and weight anonymously for the children who declined to participate.

PARTICIPANTS

We obtained information on 1088 of 1895 (57%) eligible children. The proportion of UW, OW and OB was slightly higher among the children who declined.

MAIN OUTCOME MEASURES

SDQ subscale and Total Difficulties Scores.

RESULTS

The mean SDQ scores and proportion of scores ≥the 90th percentile had a curvilinear pattern from UW through normal weight (NW), OW and OB with NW as nadir, but the pattern was only significant for the mean Emotional problems, Peer problems and Total SDQ Scales, and for the Total SDQ Score ≥the 90th percentile (TDS90). After adjusting for relevant social, developmental, health and behavioural characteristics, TDS90 was only significantly associated with UW in multiple logistic regression analyses, and only with the lowest quartile of BMI SDS in a linear spline regression analysis.

CONCLUSIONS

The study suggests that UW and low BMI, but not OW, OB or higher BMI, are independent risk factors for having psychological symptoms in preschool children.

Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines

This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first-line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low-energy diet (n = 4), protein-sparing modified fast (n = 2), and very low-carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.

Beyond sleep duration: Sleep timing as a risk factor for childhood obesity

BACKGROUND

Ample evidence attests to the relationship between short sleep duration, sleep problems and childhood obesity. However, few studies have examined the association between sleep timing and obesity in children.

OBJECTIVES

To investigate how sleep duration, problems and timing relate to obesity and obesogenic behaviours in children.

METHODS

Eighty-five children (58.8% girls) with severe obesity and mean (SD) age of 12.1 (2.9) years, were matched by age and sex with peers with normal weight (n = 85,12.0 [2.8] years). Sleep and moderate-to-vigorous physical activity (MVPA) were measured via accelerometer for seven consecutive days. Children self-reported emotional eating on the Dutch eating behavior questionnaire. Parents reported children's screen time and sleep problems.

RESULTS

Children with severe obesity had significantly later mean mid-sleep time, overall (36 minutes later, P < .001), on school nights (36 minutes later, P < .001) and weekend nights (39 minutes later, P = .002) compared to children with normal weight. Children with obesity had more sleep problems (P = .030), but no differences emerged in sleep duration or social jetlag. After adjusting for demographic factors, mid-sleep time was positively related to screen time (P = .030). Mid-sleep time and sleep duration were inversely related to time in MVPA (Ps ≤ .041). There were no other significant associations between the sleep variables and the obesogenic behaviours.

CONCLUSIONS

Later sleep timing was related to obesogenic behaviours in children and may represent an obesity risk factor.

Temperament, socioeconomic adversity, and perinatal risk as related to preschoolers' BMI

OBJECTIVE

Disparities in childhood obesity necessitate identification of risk-protective and risk- augmenting factors for young children experiencing socioeconomic adversity born with perinatal risk. Temperamental reactivity is a biological marker of susceptibility to environmental characteristics. This study tested whether temperamental reactivity moderated the relation between socioeconomic risk and children's body mass index (BMI).

METHOD

This study examined 100 Head Start preschoolers (Mage = 4.07 years, SD = 0.56) with perinatal risk, defined as preterm birth (PT, <37 weeks gestation) or low birth weight (LBW, <2500g). Anthropometric measurements were collected from children and parents. Parents completed questionnaires on family level demographics and household food insecurity to create a cumulative socioeconomic risk variable. Parents also completed the Children's Behavior Questionnaire to assess preschoolers' temperamental reactivity.

RESULTS

Results supported a differential susceptibility hypothesis such that preschoolers' temperamental reactivity significantly moderated the relation between socioeconomic risk and child BMI z-score (BMIz). Higher BMIz was observed in highly reactive children exposed to higher socioeconomic risk. Alternatively, lower exposure to socioeconomic risk was related to lower BMIz for highly reactive children.

CONCLUSIONS

Findings suggest that highly reactive PT/LBW preschoolers are differentially susceptible to early socioeconomic adversity in a for better or for worse manner regarding BMIz. Thus, consideration of temperament as a marker of biological sensitivity to context may be necessary to inform obesity prevention for PT/LBW preschoolers from low-income families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychotherapie bei juveniler Adipositas: gerechtfertigt und sinnvoll?

Hintergrund

Adipositas ist im Kindes- und Jugendalter stark verbreitet. Medizinische Rehabilitationsmaßnahmen mit ihrem umfassenden Behandlungsangebot stellen eine wesentliche Säule der Versorgung dar. Da Adipositas mit vielfältigen psychosozialen Belastungen verbunden ist, stellt sich die Frage, ob psychotherapeutische Angebote noch stärker berücksichtigt werden sollten.

Fragestellung

Untersucht wurde, wie verbreitet psychische Auffälligkeiten bei Kindern und Jugendlichen mit Adipositas sind und in welchem Zusammenhang sie zum Gewichtsverlauf stehen.

Material und Methoden

Die Stichprobe bestand aus 220 Kindern und Jugendlichen mit Adipositas (8 bis 16 Jahre, M = 13,11 Jahre; SD ± 1,88 Jahre; 54,5 % weiblich), die an einer stationären Rehabilitationsmaßnahme teilnahmen. Emotionale- und Verhaltensauffälligkeiten (Strengths and Difficulties Questionnaire, SDQ) wurden zu Rehabilitationsbeginn sowie 6 und 12 Monate nach Rehabilitationsende im Elternbericht erfasst. Zudem wurden Daten zur Bestimmung des Gewichtstatus durch das medizinische Personal der Kliniken bzw. in der Katamnese von Hausärzten erhoben.

Ergebnisse

Fast die Hälfte der Kinder und Jugendlichen (48,6 %) wies auffällige Werte auf; v. a. Mädchen waren signifikant häufiger betroffen. Die deskriptive Betrachtung nach Rehabilitationsende zeigte einen vergleichbar hohen Anteil. Zudem wirkte sich das Vorliegen psychosozialer Auffälligkeiten signifikant negativ auf den Gewichtsverlauf aus.

Schlussfolgerung

Psychische Probleme sollten im Rahmen der Adipositastherapie stärker berücksichtigt werden. Zum einen sollten evtl. belastete Kinder durch Screenings identifiziert werden, zum anderen psychotherapeutische Maßnahmen zur Reduktion psychosozialer Belastungen integraler Bestandteil der Behandlung sein.

A comparison of emotional eating, social anxiety and parental attitude among adolescents with obesity and healthy: A case-control study

This case-controlled study was conducted to determine and compare the emotional eating, social anxiety and parental attitude in those adolescents with obesity and healthy counterparts. The sample of the study consist of obese adolescents in 14-18 aged (n = 150) followed up in the pediatric endocrinology outpatient clinic of a tertiary hospital and healthy adolescents in 14-18 aged (n = 150) who were studying in high schools. The data were collected using a questionnaire form, Emotional Eating Scale Adapted to Use in Children and Adolescents (EES-C), Social Anxiety Scale for Children-Revised (SASC-R) and Parenting Style Scale (PSS). The SASC-R and EES-C mean scores of obese adolescents were 39.03 ± 13.09 (p ≤ 0.001) and 76.66 ± 16.30 (p ≤ 0.001), respectively. The mean scores of PSS-AI, PSS-SS and PSS-PA subscales in obese adolescents were 26.80 ± 4.42 (p ≤ 0.001), 28.14 ± 4.06 (p ≤ 0.001) and 22.32 ± 4.63 (p = 0.037), respectively. There was a low-level correlation between the EES-C and SASC-R mean scores of obese adolescents (p < 0.05). The mean scores of PSS-AI, PSS-SS and PSS-PA subscales of PSS with EES-C and SASC-R of obese adolescents were no correlated (p > 0.05). In this study, the mean scores of the emotional eating and social anxiety of obese adolescents were higher than healthy ones. There was a low level of positive correlation between emotional eating and social anxiety mean scores of obese adolescents.

Health-related quality of life in children and adolescents with overweight and obesity: results from the German KIGGS survey

BACKGROUND

The well-being of persons with overweight and obesity, in particular of children and adolescents, may be impaired. The present study investigates the health-related quality of life (HRQoL) of girls and boys with overweight and obesity living in Germany as compared to those of normal-weight, while taking a selection of relevant determinants of HRQoL into account.

METHODS

The sample comprises 1771 children and adolescents aged 11 to 17 years that took part in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KIGGS Wave 2, 2014-2017). Sex-and age-specific BMI (kg/m2) percentiles were utilized to classify overweight and obesity. HRQoL was measured with the KIDSCREEN-27 questionnaire, which gathers detailed information about the five dimensions physical and psychological well-being, well-being regarding peers (i.e., social acceptance), parents (i.e., autonomy) and within the school environment. Multiple regression analyses were performed with HRQoL dimensions as outcomes to test for differences between children and adolescents with normal-weight vs. those with overweight and vs. those with obesity, separately for girls and boys. In a next step, age, physical activity, media consumption, social support and self-efficacy were considered as potential confounders in the analyses.

RESULTS

18.7% of the children and adolescents under study were affected by overweight and among them 8.0% by obesity. After adjusting for potential confounders, overweight and obesity were associated with lower physical well-being as compared to normal weight in both sexes (boys with overweight: standardized beta [β] = -.14, standard error [SE] = .03, p < .001, and obesity: β = -.16, SE = .03, p < .001; girls with overweight: β = -.09, SE = .04, p = .011, and obesity: β = -.11, SE = .03, p = .003). Results moreover suggest lower levels of psychological (β = -.10, SE = .04, p = .002) and parent-related well-being (β = -.08, SE = .04, p = .036) of boys with obesity as compared to normal-weight peers.

CONCLUSION

HRQoL of German children and adolescents with overweight and obesity is impaired according to physical well-being in general, while psychological and parent-related well-being is particularly affected in boys. Public health approaches should therefore promote children and adolescents with overweight and obesity by improving diverse facets of HRQoL as well as relevant associated factors (i.e., media consumption, self-efficacy) in general and in boys in particular.

Exergaming and Aquatic Exercises Affect Lung Function and Weight Loss in Obese Children

We investigated the effect of exergames and aquatic exercises on lung function and weight loss in obese children. Sixty-one obese male primary-school children were randomly allocated to video game, aquatic exercise, and control groups. Lung functions and anthropometric variables were measured before and after the intervention and after one month (follow-up). In the video game group, an Xbox Kinect game was played for 60 min during three sessions a week. The aquatic aerobic exercise was performed three times per week and consisted of a warm-up, main exercises, and a cool down phase. For the video game group, there was a significant reduction in body weight between (i) pre- and (ii) post-intervention and follow-up. In the aquatic exercise group, there was a significant reduction in body weight between pre- and post-intervention and between pre-intervention and follow-up. Both exercise groups improved the waist/hip ratio index compared to the control group. Forced vital capacity was significantly improved in the follow-up of the video game group and the aquatic exercise group compared to the control group. A significant improvement was found in forced expiratory volume in the first second at post-intervention and follow-up in the video game and the aquatic exercise groups. Exergames and aquatic exercises improved weight loss and lung function in obese children.

Various causative factors and associated complications of childhood obesity in Jeddah, western region, Saudi Arabia

OBJECTIVE

to investigate the causative factors and complications attributable to obesity in children living in jeddah, saudi arabia.

METHODS

this is a retrospective study encompassing a sample size of 151 children and adolescents between the ages of 4 and 20 years. data was collectived through revieweing medical records, medical files on the hospital electironic system and clinical interviews conducted with legal guardians. date of study was from january to june 2018, and was carried in jeddah, western region, saudi arabia.

RESULTS

data was entered, coded, cleaned and analysed using statistical package for social science (IBM SPSS), version 22. the analysis was done by assessing the significance of various risk factors ands equalae in their contribution to paediatric obesity by one way ANOVA for nominal variables of more than two categories and independent sample t-test for the nominal variables with two categories. the sample was 47% of the male gender whereas females made for the remaining 53%. the causation of obesity was distributed among the following factors: an unhealthy diet, a sedentary lifestyle, medications such as glucocorticoids, and complications attributed to obesity included gastro-oesophageal reflux, hypertension, precocious puberty, sleep apnoea, psychological disturbances and fatty liver diseases.

CONCLUSION

environmental factors were found to be the most predominant cause, where the majority of children were found to be leading a sedentary lifestyle, following an unhealthy diet, and skipping meals. the msot recurring complications involved psychosocial and behavioural abnormalities, and among the medical consequences, gastro-oesophageal reflux and obstructive sleep apnoea were the most prevalent.

Influence of dietary and activity patterns on weight status of Ukrainian school aged children

Objectives Dietary patterns and physical activity have significant influence on weight status. Despite numerous studies related to this topic, there is no existing research which provides complete population-based studies that identify the most significant predictors of pediatric obesity. Therefore, it has become the major goal of our study. Subjects and methods Three hundred school students between 10 and 17 years of age were participating in our study. All of them are currently attending various schools in city of Ternopil, Ukraine. Anthropometric measurements were performed for all participants. Information about food consumption and physical activity was obtained from distributed questionnaire. Logistic regression was used to identify the significant predictors of obesity. Results Lack of physical activity during week (OR=2.59 [95% CI 1.10-6.08]), long screen time in weekdays (OR=2.94 [95% CI 1.13-7.69]) and weekends (OR=3.63 [95% CI 1.55-8.50]), frequent consumption (OR=2.60 [95% CI 1.30-5.19]) and high amounts (OR=2.52 [95% CI 1.26-5.05]) of sweet beverages, fast-food consumption (OR=30.97 [95% CI 1.46-657.60]) and overeating (OR=3.99 [95% CI 1.26-5.05]) have increased chance to be overweight in children 10-17 years of age (p<0.05). Conclusion Decreased frequency in moderate physical activity per week, increased amount of sugar-sweetened beverages, fast-food consumption per day and food consumption without hunger, appear to be the most significant predictors of overweight and obesity among Ukrainian school-aged children.

Prevalence of Obesity and Overweight among School-Aged Children in Saudi Arabia and Its Association with Vitamin D Status

BACKGROUND

Childhood obesity is a significant global public health problem. Worldwide data showed an increasing trend over the years. We aimed to explore the prevalence of obesity, and its association with vitamin D status.

METHODS

This cross-sectional study was conducted during the period from 2016 to 2017. The study included 3613 schoolchildren aged 6-19 years in the western, central, and eastern regions in Saudi Arabia. Anthropometric data including age, sex and body mass index (BMI) was collected and the serum 25OH- vitamin D (25OHD) was measured. Age-sex standardized BMI Z-scores using the 2007 World Health Organization growth standards were applied.

RESULTS

Data from 3613 school-aged children (females = 51.8%), with equal percentage of participants from each region were analyzed. Prevalence of obesity and overweight was estimated at 7.1% and 14.4% respectively. An increasing trend was detected with age (p: 0.006). Obesity started to increase at the age of 10 years and continued to increase until 19 years. Most of the obese children (64.2%) had deficient vitamin D levels, compared to 33.7% of them with suboptimal levels and only 2.0% with optimal levels (p: <0.001).

CONCLUSIONS

This large cohort study revealed a high prevalence (21.5%) of obesity and overweight in school children aged between 6-19 years with increasing trend with age.  Children with high BMI showed extremely high prevalence of VDD and VDI. These findings are alarming and point to the need for effective national interventions that include improving and encouraging access to physical activity and exposure to sunlight, educational activities for students, parents, and schoolteachers and possible enrichment of staple food with vitamin D.

Is the Perceived Fruit Accessibility Related to Fruit Intakes and Prevalence of Overweight in Disadvantaged Youth: A Cross-Sectional Study

Background: Few investigations have studied the relationship between home and school food environments, fruit intakes, and prevalence of overweight in children and adolescents from disadvantaged backgrounds. This study aimed to determine whether food environments for fruit intake at household and school levels affect fruit intakes and risk of overweight among children and adolescents with low household income. Methods: Students (n = 3148) in Seoul, Korea completed questionnaires pertaining to select aspects of their food environments, frequency of fruit intakes, and weight status. Chi-square tests and logistic regressions evaluated associations between the aforementioned variables. Results: Participants consumed fruit an average of 0.77 times per day, though its frequency increased when fruit accessibility was perceived positively. The percentage of overweight participants was 23.5% for boys and 22.8% for girls. Generally, fruit intake frequency was linked to a lower prevalence of overweight. Regular provision of fruit in school lunches was associated with a reduced risk of overweight among elementary school girls (odds ratio (OR): 0.52, 95% confidence interval (CI): 0.30–0.92), and having someone at home to prepare fruit was associated with a reduced risk of overweight in elementary school boys (OR: 0.64, 95% CI: 0.43–0.94) and girls (OR: 0.63, 95% CI: 0.43–0.93). Conclusions: The frequency of fruit intake was low among disadvantaged youth. Increasing access to fruit in their food environments appears to enhance consumption and lower the risk of overweight, especially for elementary school girls.

Obesity in children and adolescents: An overview

Childhood obesity is an epidemic in the US. This article discusses the evolution, prevention, and associated physical and psychosocial consequences of and interventions for obesity in the pediatric population.

The potential health impact of restricting less-healthy food and beverage advertising on UK television between 05.30 and 21.00 hours: A modelling study

BACKGROUND

Restrictions on the advertising of less-healthy foods and beverages is seen as one measure to tackle childhood obesity and is under active consideration by the UK government. Whilst evidence increasingly links this advertising to excess calorie intake, understanding of the potential impact of advertising restrictions on population health is limited.

METHODS AND FINDINGS

We used a proportional multi-state life table model to estimate the health impact of prohibiting the advertising of food and beverages high in fat, sugar, and salt (HFSS) from 05.30 hours to 21.00 hours (5:30 AM to 9:00 PM) on television in the UK. We used the following data to parameterise the model: children's exposure to HFSS advertising from AC Nielsen and Broadcasters' Audience Research Board (2015); effect of less-healthy food advertising on acute caloric intake in children from a published meta-analysis; population numbers and all-cause mortality rates from the Human Mortality Database for the UK (2015); body mass index distribution from the Health Survey for England (2016); disability weights for estimating disability-adjusted life years (DALYs) from the Global Burden of Disease Study; and healthcare costs from NHS England programme budgeting data. The main outcome measures were change in the percentage of the children (aged 5-17 years) with obesity defined using the International Obesity Task Force cut-points, and change in health status (DALYs). Monte Carlo analyses was used to estimate 95% uncertainty intervals (UIs). We estimate that if all HFSS advertising between 05.30 hours and 21.00 hours was withdrawn, UK children (n = 13,729,000), would see on average 1.5 fewer HFSS adverts per day and decrease caloric intake by 9.1 kcal (95% UI 0.5-17.7 kcal), which would reduce the number of children (aged 5-17 years) with obesity by 4.6% (95% UI 1.4%-9.5%) and with overweight (including obesity) by 3.6% (95% UI 1.1%-7.4%) This is equivalent to 40,000 (95% UI 12,000-81,000) fewer UK children with obesity, and 120,000 (95% UI 34,000-240,000) fewer with overweight. For children alive in 2015 (n = 13,729,000), this would avert 240,000 (95% UI 65,000-530,000) DALYs across their lifetime (i.e., followed from 2015 through to death), and result in a health-related net monetary benefit of £7.4 billion (95% UI £2.0 billion-£16 billion) to society. Under a scenario where all HFSS advertising is displaced to after 21.00 hours, rather than withdrawn, we estimate that the benefits would be reduced by around two-thirds. This is a modelling study and subject to uncertainty; we cannot fully and accurately account for all of the factors that would affect the impact of this policy if implemented. Whilst randomised trials show that children exposed to less-healthy food advertising consume more calories, there is uncertainty about the nature of the dose-response relationship between HFSS advertising and calorie intake.

CONCLUSIONS

Our results show that HFSS television advertising restrictions between 05.30 hours and 21.00 hours in the UK could make a meaningful contribution to reducing childhood obesity. We estimate that the impact on childhood obesity of this policy may be reduced by around two-thirds if adverts are displaced to after 21.00 hours rather than being withdrawn.

Higher Child Body Mass Index Is Associated with Greater School-Based Health Center Utilization

Background: Children with overweight status and obesity seek care for acute illnesses more often than normal weight peers. School-based health centers (SBHCs) have a role in acute and chronic disease management; however, little is known about SBHC use by children with overweight status and obesity. This study compared SBHC utilization by student body mass index (BMI) category and investigated whether SBHC visit diagnoses varied by BMI category. Methods: We performed a retrospective analysis of students (n = 1161) in grades K-8 enrolled in a large SBHC for 2 years. Negative binomial regression models were used to test the independent association between BMI category as defined by BMI percentile [normal/underweight (BMI percentile <85%) and overweight/obesity (BMI percentile ≥85%), either overweight (85% ≤BMI percentile <95%) or obesity (BMI percentile ≥95%)], and the number of SBHC visits (nurse, clinician, and total visits) for the 2-year interval. Top five diagnoses based on ICD-10 visit codes were compared. Results: Students in the overweight/obesity category (BMI percentile ≥85%) had higher visit rates than normal/underweight peers after adjusting for age and gender, but only total visits were statistically significant [nurse: incident rate ratio (IRR) 1.42 (95% CI 0.94-2.15); clinician: 1.27 (95% CI 0.93-1.75); total: 1.45 (95% CI 1.02-2.07)]. Visit diagnoses were similar by BMI category. Conclusions: Students with higher BMI percentiles, categorized as overweight/obesity, had higher SBHC utilization than normal/underweight peers, but visit diagnoses were similar. This higher utilization may provide an as-yet untapped opportunity to expand school-based obesity prevention and management.

Psychische Auffälligkeiten von Jugendlichen mit Adipositas in der stationären Rehabilitation

Zusammenfassung. Es wurden die Geschlechts- und Altersunterschiede in den selbst- und fremdbeurteilten psychischen Auffälligkeiten bei N = 142 Jugendlichen mit Adipositas in der stationären Rehabilitation untersucht. Mädchen wiesen im Selbsturteil höhere Ausprägungen in der Ängstlichkeit/Depressivität sowie den emotionalen und Verhaltensproblemen auf. Die Eltern gaben eine höhere Hyperaktivität ihrer Söhne an. Jüngere schätzten ihre Verhaltensprobleme höher ein als Ältere. Zudem wurde die klinische Stichprobe mit geschlechts- und altersgematchten Kontrollen aus der Normierungsstudie des Screenings psychischer Störungen im Jugendalter (SPS-J-II; Hampel & Petermann, 2012a ) verglichen ( N = 254). Es ergab sich ein 2.43-fach erhöhtes Risiko für auffällige Werte in der Ängstlichkeit/Depressivität bei den Jugendlichen mit Adipositas und ein signifikanter Mittelwertunterschied. Die Befunde sprechen für eine frühzeitige Diagnostik psychischer Auffälligkeiten und bedarfsgerechte Interventionen, um der Entwicklung komorbider psychischer Auffälligkeiten vorzubeugen.

Obesity and Hair Cortisol: Relationships Varied Between Low-Income Preschoolers and Mothers

PURPOSE

Literature on the relationship between hair cortisol concentration (HCC) and body mass index (BMI) is scarce and inconsistent in both preschoolers and parents. Thus, the study aimed to examine the relationships among HCC, perceived distress, coping, and BMI among low-income Head Start preschoolers and mothers.

METHODS

A cross-sectional, correlational study was conducted with a non-random sample of 35 mother-preschooler dyads. Height and weight were measured using a ShorrBoard Stadiometer and a Seca portable electronic scale, respectively. HCC was extracted using the enzyme immunoassay approach. Mothers' perceived distress and coping were assessed by Cohen's Perceived Stress Scale.

RESULTS

Mothers' mean age was 29.74 years, and preschoolers' mean age was 4.69 years. The sample included 17% Hispanic, 54% Black, and 60% single mothers; and 23% Hispanic and 60% Black preschoolers. Compared to mothers in low HCC group (< 4.1 pg/mg), mothers in high HCC group (≥ 4.1 pg/mg) had lower BMI (B =  - 4.62, p = .049). The indirect effects of mothers' HCC on BMI via perceived distress and coping was 15% of the total effects. Preschoolers with mothers in high HCC group had significantly lower BMI z-score than those with mothers in low HCC group (B =  - 0.94, p = .043). Preschoolers' HCC had a small positive correlation with their BMI z-score (B = 0.01, p = .112).

CONCLUSIONS

Relationships between HCC and BMI varied between low-income mothers and preschoolers. A stress management component may need to be integrated into future obesity interventions. Given the limitation of small sample size and cross-sectional study design, the findings need to be interpreted with caution, and further investigation is warranted.

Contribution of Home and School Environment in Children's Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment

This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children’s food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and “grey” literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from <5% to >40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children’s food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.

[Psychological Parameters of Adolescent Patients Prior to Obesity Treatment]

Overweight and obesity in children and adolescents are highly prevalent and persistent. Current weight loss treatments are rarely individualized and show only small to moderate efficacy. Only rarely, psychopathological parameters are considered. The present study evaluated the psychopathology of adolescents with overweight and obesity (N=201, ages 12-17 years) prior to obesity treatment. The data were analyzed for age and sex effects. Self-report questionnaires assessed general symptom burden, eating disorder and general psychopathology, weight-related self-stigmatization, and physical and mental quality of life. Girls showed higher rates of weight-related self-stigmatization and higher disordered eating behavior compared to boys. Older adolescents reported a lower quality of life compared to younger adolescents. In normative comparisons with population-based samples and norms, adolescents with overweight and obesity showed significantly adverse outcomes in all parameters. Thus, this study identified psychopathology as an important factor in adolescents with high weight status that may affect obesity treatment. Future studies should examine psychopathology more differentially and determine therapeutic resources in adolescent overweight and obesity.

Adolescent obesity: Confessions of the young mind

Background

Obesity represents a worldwide leading health problem. Although the proportion of adolescent obesity is continuously rising, yet little is known considering adolescent's opinions regarding this condition.

Aim

To investigate adolescent's perceptions in relation to various aspects of obesity in a prospective cohort study.

Subjects and methods

The study population included primary school adolescents, 11-12 years of age. Anthropometric measurements of participants included height and weight. Overweight and obese participants were classified using the International Obesity Task Force criteria. A structured questionnaire assessing physical activity, dietary habits, parental guidance regarding dietary intake and psychological aspects in relation to social functioning, body weight and image was completed by each adolescent.

Results

Three hundred and thirty-five adolescents (181 boys) formed the study group. Obese participants were found to have significantly fewer friends (p = .050) and preferred indoor sedentary activities (p = .041). No differences were observed within the groups when questioned about their eating habits in terms of appetite and hunger. The majority of participants reported frequent consumption of homemade snacks in school resulting in no significant difference within the groups. Finally, body weight satisfaction was recorded for only 5.66% of the obese children, 25.66% and 68.64% of overweight and normal-weight participants respectively.

Conclusions

Our findings support the notion that adolescents are perfectly capable of expressing their opinions. When planning interventional programs for the management of adolescent obesity their views should be strongly considered.

Dietary Adequacy among Multi-Ethnic Urban Youth in Edmonton: Findings from the Wellness and Health in Youth - Aboriginal and All Communities in Transition NOW (WHY ACT NOW) Project

OBJECTIVE

The development of obesity and chronic diseases in adulthood often results from a childhood pattern of dietary excesses. This study aimed to identify dietary inadequacies and excesses of multiethnic youth in Edmonton.

METHODS

A cross-sectional survey of a convenience sample of 473 multiethnic youth between 11 and 18 years was conducted in 12 schools in Edmonton between October 2013 and March 2014. Data were analyzed to determine for each participant mean daily energy and nutrient intakes, dietary adequacy, and nutrient densities. Participants were divided by self-identified ethnicity (Indigenous, European, African and Middle Eastern, and Asian).

RESULTS

For all nutrients examined, the mean percentage of calories from fat was higher among European (31.7%) and Indigenous youth (31.8%) compared to African and Middle Eastern (28.3%) and Asian youth (29.0%), while Asian youth had the highest percentage of calories from protein (17.7%) compared to other ethnic groups (Indigenous = 15.5%; African & Middle Eastern = 16.5%; European = 16.2%). The majority of youth fell below the recommended values for dietary fiber (83.3-92.0%), vitamins D (84.4-90.2%), and E (89.5-92.0%). More than 50% fell below the dietary reference intakes (DRIs) for vitamin A, vitamin B5, calcium, and magnesium; >30% were below the DRI for folate, zinc, and vitamins B6, and C. The diet of girls contained a greater density of fiber compared to boys (9.3 vs. 8.0 g/1000 kcal; p-value = 0.002).

CONCLUSIONS

Inadequate dietary intake is evident among the majority of multiethnic youth in Edmonton. There is a need to develop strategies to reduce the burden of poor nutrition status for youth.

Machine Learning Models to Predict Childhood and Adolescent Obesity: A Review

The prevalence of childhood and adolescence overweight an obesity is raising at an alarming rate in many countries. This poses a serious threat to the current and near-future health systems, given the association of these conditions with different comorbidities (cardiovascular diseases, type II diabetes, and metabolic syndrome) and even death. In order to design appropriate strategies for its prevention, as well as understand its origins, the development of predictive models for childhood/adolescent overweight/obesity and related outcomes is of extreme value. Obesity has a complex etiology, and in the case of childhood and adolescence obesity, this etiology includes also specific factors like (pre)-gestational ones; weaning; and the huge anthropometric, metabolic, and hormonal changes that during this period the body suffers. In this way, Machine Learning models are becoming extremely useful tools in this area, given their excellent predictive power; ability to model complex, nonlinear relationships between variables; and capacity to deal with high-dimensional data typical in this area. This is especially important given the recent appearance of large repositories of Electronic Health Records (EHR) that allow the development of models using datasets with many instances and predictor variables, from which Deep Learning variants can generate extremely accurate predictions. In the current work, the area of Machine Learning models to predict childhood and adolescent obesity and related outcomes is comprehensively and critically reviewed, including the latest ones using Deep Learning with EHR. These models are compared with the traditional statistical ones that used mainly logistic regression. The main features and applications appearing from these models are described, and the future opportunities are discussed.

Adverse labour market impacts of childhood and adolescence overweight and obesity in Western societies-A literature review

Overweight and obesity among children and adolescents are major health issues of today with both somatic and psychosocial consequences in childhood, adolescence and adulthood and potentially adverse effects for adult social life. We conducted a narrative review of the literature about the association of overweight and obesity in childhood and adolescence with possible adverse impact on labour market in adulthood. By PubMed and Google Scholar searches, we identified 12 original, prospective studies from Western countries and extracted data from these studies. We discuss the possible explanations of the associations and the conceptual and methodological challenges in these studies. Despite inherent difficulties in interpreting results, partly due to differences in outcome definitions, ages at exposure, measurements of overweight and obesity, confounder control and societal differences, the studies indicate adverse labour market impacts on adult wage and employment. Furthermore, penalties seemed present even if the excessive weight was lost before adulthood, and women seemed more affected than men, especially when weight persisted into adulthood. While both health and lower education might contribute to explain the adverse labour market outcomes, also discrimination, stigmatization and the development of cognitive and noncognitive skills seemed to influence the outcomes. Prevention of these adverse labour market impacts likely requires multilevel efforts.

Predicting the development of overweight and obesity in children between 2.5 and 8 years of age: The prospective ABIS study

BACKGROUND

A relationship between overweight and obesity early in life and adolescence has been reported. The aim of this study was to track changes in overweight/obesity in children and to assess risk factors related to the persistence of overweight/obesity between 2.5 and 8 years.

STUDY DESIGN

Children who participated in all three follow-ups at 2.5, 5 and 8 years in the prospective cohort All Children in Southeast Sweden (ABIS) (N = 2245, 52.1% boys and 47.9% girls) were classified as underweight, normal, overweight or with obesity, and changes within categories with age were related to risk factors for development of obesity in a multivariate analysis.

RESULTS

The prevalence of overweight and obesity between 2.5 and 8 years was 11%-12% and 2%-3%, respectively. Children with normal weight remained in the same category over the years, 86% between 2.5 to 5 years and 87% between 5 and 8 years. Overweight and obesity at 5 and 8 years were positively related to each other (p < 0.0001 for both). High level of TV watching at 8 years and high maternal body mass index (BMI) when the child was 5 years were related to lower probability to a normalized ISO-BMI between 5 and 8 years of age (p < 0.05 for both).

CONCLUSION

Children with ISO-BMI 18.5 to 24.9 remain in that range during the first 8 years of life. Children with overweight early in life gain weight and develop obesity, and children with obesity tend to remain with obesity up to 8 years of age. TV watching and high maternal BMI were related to lower probability to weight normalization between 5 and 8 years of age. A multidisciplinary approach to promote dietary and physical activity changes in the entire family should be used for the treatment and prevention of overweight and obesity in early childhood.

Distinguishing factors that influence attendance and behaviour change in family-based treatment of childhood obesity: A qualitative study

OBJECTIVES

For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family-based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)).

DESIGN

Focus groups with children and parents/carers as part of a broader mixed-methods evaluation.

METHODS

Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change.

RESULTS

Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non-judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non-attending significant others.

CONCLUSIONS

Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family's change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention.

Thirty-Day Outcomes of Bariatric Surgery in Adolescents: a First Look at the MBSAQIP Database

INTRODUCTION

Bariatric surgery is the only effective treatment of severe obesity. The number of adolescents undergoing bariatric surgery is increasing. However, bariatric surgery in adolescents is controversial.

OBJECTIVE

The purpose of this study is to evaluate the outcomes of bariatric surgery in adolescents based on the MBSAQIP database (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project).

METHODS

We analyzed the 2015-2017 MBSAQIP database; patients ≤ 19 years of age were included in our analysis. Primary outcomes were 30-day serious adverse events (SAEs), organ space infection (OSI), re-intervention, and re-operation rates. Secondary outcomes included operation length, hospital stay, and re-admission rates. We conducted separate Mann-Whitney rank sums tests, chi-square, or Fisher's exact tests as appropriate, with p < .05 denoting statistical significance.

RESULTS

A total of 1983 adolescent patients were included in our analysis. The average age and BMI were 18.1 and 47.5, respectively. Of adolescent patients, 21.7% underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and 78.3% underwent laparoscopic sleeve gastrectomy (LSG). The 30-day SAE and readmission rates were significantly lower for LSG compared with LRYGB (2.9% and 2.6% vs 6.5% and 5.6%, respectively; p < 0.05). The 30-day reoperation rate was also lower for LSG compared with LRYGB albeit not significant (1.1% and vs 2.3%; p = 0.05). The 30-day intervention rate for LSG was significantly lower, however, compared with LRYGB (1.2% vs 3%; p < 0.05). Compared with adult patients, > 19 years old (n = 353,726), we found no difference in our outcomes. However, adolescents had significantly shorter operation length.

CONCLUSION

In adolescents, LSG had fewer SAE, re-intervention, and readmission rates compared with LRYGB. There was no difference in outcomes between adolescents and adults.

Behavioral comorbidity, overweight, and obesity in children with incontinence: An analysis of 1638 cases

AIMS

Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence.

METHODS

A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations.

RESULTS

The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters.

CONCLUSIONS

Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.

Cross-lagged associations between behaviour problems and obesity in head start preschoolers

BACKGROUND

Behaviour problems and obesity are related but research findings have been inconclusive regarding the direction of effects.

OBJECTIVES

This study examined the cross-lagged associations between behaviour problems, body mass index (BMI) and obesity in preschoolers, and whether sex modified these associations.

METHODS

Repeated measures of teacher-reported externalizing (EXT) and internalizing behaviour problems (clinically significant T scores were >90th percentile), BMI z-scores (BMI-Z) and obesity status (BMI ≥95th for age and sex) were assessed in the fall (T1) and spring (T2) of the school year in Head Start preschoolers (N = 423). Associations were examined with cross-lagged modelling.

RESULTS

Prospective paths from T1 clinically significant EXT to both T2 BMI-Z (β = .05) and obesity (β = .18) were significant. There was no evidence that T1 BMI-Z or obesity preceded T2 behaviour problems. However, sex-specific models indicated that T1 BMI-Z was prospectively associated with higher T2 EXT for boys (β = .13), but not girls. T1 EXT was predictive of subsequent BMI-Z (β = .09) and obesity (β = .33) at T2 for girls only.

CONCLUSION

Findings suggest that behaviour problems, particularly externalizing behaviours, are prospectively related to childhood obesity, and early prevention methods should reflect sex-specific modifications.