Psychological consequences of childhood obesity: psychiatric comorbidity and prevention

Psychological well-being and weight-related teasing in childhood obesity: a case-control study

PURPOSE

The prevalence of childhood obesity continues to increase worldwide. The aims of this study were to (1) assess the psychological well-being and rates of teasing of Spanish children with obesity (OG) and compare them with their non-overweight peers (NG), and (2) analyze the mediating role of weight-related teasing on the relation between children's BMI z score and psychological well-being.

METHODS

The cross-sectional study included 50 preadolescents with obesity, matched with non-overweight children according to age, sex, and socioeconomic status, who were assessed via self-report instruments measuring anxiety, depression, self-esteem, and teasing.

RESULTS

The OG reported higher anxiety, depression, and teasing, and lower self-esteem. SEM revealed that children who scored worse on instruments assessing psychological well-being had higher BMI z scores. Weight-related teasing predicted poor psychological well-being scores and weight-related teasing mediated the relation between BMI and psychological well-being.

CONCLUSIONS

The high rates of anxiety, depression, and weight-related teasing, as well as the low self-esteem, which was observed amongst the children with obesity, raise concerns about the quality of life of this population. Furthermore, the finding that weight-related teasing mediated the relationship between BMI and psychological well-being adds to a growing body of research, highlighting the harmful effects of weight-related stigma. Overall, these results highlight the importance of early intervention to assess for, and address, the presence of weight-related teasing and psychological well-being difficulties in preadolescents with obesity.

LEVEL OF EVIDENCE

Level III, case-control study.

The impact of obesity on self-esteem and academic achievement among university students

BACKGROUND

Previous studies showed that obesity was correlated with many negative social and health outcomes including poor academic achievement and low self-esteem.

PURPOSE

To determine the prevalence of obesity and to identify the impact of obesity on self-esteem and academic performance among university students.

METHOD

The study used a correlational design to achieve the study objectives. It was conducted at the University of Jordan (UJ). The study population was all university students in at UJ. A convenience sampling technique was conducted to select 419 students. A self-administered questionnaire was designed to collect data from the sample. The body of the questionnaire was divided into two sections: a demographic data section, and the second section aimed to measure the students' self-esteem using the Rosenberg Self-Esteem Scale (SES).

RESULTS

The response rate in this study was 91.1%. The results showed that 33 students were obese (7.88%), 116 students were overweight (27.68%), 266 students were normal weight (63.48%), and four students were underweight (0.95%). The results showed that there was a significant negative relationship between obesity and self-esteem (total item) (r = -0.231, 0.000*). The results showed that there was a significant negative relationship between obesity and academic achievement (r = -0.131, 0.002).

CONCLUSION

There was a significant impact of obesity on the self-esteem and academic performance among university students.

Weight misperception and psychological symptoms from adolescence to young adulthood: longitudinal study of an ethnically diverse UK cohort

BACKGROUND

To evaluate the association between weight misperception and psychological symptoms in the Determinants of young Adults Social well-being and Health (DASH) longitudinal study.

METHODS

A longitudinal sample of 3227 adolescents, in 49 secondary schools in London, aged 11-16 years participated in 2002/2003 and were followed up in 2005/2006. A sub-sample (N = 595) was followed up again at ages 21-23 years in 2012/2013. An index of weight misperception was derived from weight perception and measured weight. Psychological well- being was measured using the Strengths and Difficulties Questionnaire at 11-16 years and the General Health Questionnaire at 21-23 years. Associations with weight misperception was assessed using regression models, adjusted for socio-economic and lifestyle factors.

RESULTS

White British males and females were more likely than ethnic minority peers to report accurate perceptions of measured weight. At 11-13y, 46% females and 38% males did not have an accurate perception of their measured weight. The comparable figures at 14-16y were 42 and 40%. Compared with male adolescents, more females perceived themselves as overweight or were unsure of their weight but measured normal weight, and this was more pronounced among Indians, Pakistanis and Bangladeshis. At 14-16y, more males perceived themselves as underweight but measured normal weight, and this was more pronounced among Indians. Compared with those who had an accurate perception of their normal weight, a higher likelihood of probable clinically-relevant psychological symptoms was observed among those who measured normal weight but perceived themselves to be underweight (females Odds Ratio (OR) = 1.87 95% CI 1.03-3.40; males OR = 2.34 95% CI 1.47-3.71), overweight (females only OR = 2.06 95% CI 1.10-3.87), or unsure of their weight (males only OR = 1.61 95% CI 1.04-2.49). Among females, the association was driven by internalising rather than externalising symptoms. An accurate perception of overweight was associated with higher psychological symptoms in adolescence and early 20s. Ethnic specific effects were not evident.

CONCLUSION

Weight misperception may be an important determinant of psychological symptoms in young people, with an accurate perception of normal weight status being protective. Culturally targeted interventions should be considered to promote healthy perceptions of body image.

A multivariate multilevel analysis of the risk factors associated with anthropometric indices in Iranian mid-adolescents

BACKGROUND

The present study was conducted to jointly assess some specific factors related to body fat measures using a multivariate multilevel analysis in a representative sample of Iranian mid-adolescents.

METHODS

This study was conducted among 2538 students (1286 boys) aged 14-20 years old, who were randomly selected among 16 public high schools by multi-stage random sampling procedure from all education districts of Shiraz, Iran. Data on demographic characteristics, family history of obesity, physical activity, socio-economic (SES) variables and screen time were collected. Height, weight, triceps (TST), abdominal (AST), and subscapular (SST) skinfold thickness were measured and their body mass index (BMI) was calculated. A multivariate multilevel approach was used to analyze the factors associated with obesity measures of the TST, AST, SST at the child and district levels.

RESULTS

In this study, the prevalence of overweight and obesity was estimated to be 10.2 and 5.1%, respectively. Overall, the major portion of the total variance in TST (97.1%), AST (97.7%), and SST (97.5%) was found at the child level. The results of multivariate multilevel method revealed that being girls, having a family history of obesity, and SES were significantly associated with increasing of three body fat measures (all the p-values were less than 0.05). There were significant positive associations between moderate to vigorous physical activities with AST and SST (for AST: β =2.54, SE = 1.40, p = 0.05; for SST: β =2.24, SE = 1.20, p = 0.05). Compared to children in 14-16 age group, children in age group 16-18 years had less TST (β = - 0.67, SE = 0.34, p = 0.04). Furthermore, other age groups and screen time did not play an important role in three outcome variables.

CONCLUSIONS

The results showed some factors that contribute to three body fat measures. Therefore, it is necessary to develop effective interventions to prevent the effects of individual and environmental undesirable factors on childhood obesity in both family and community levels.

The Association between Parents and Children Meeting Physical Activity Guidelines

PURPOSE

To examine the association between parents and children meeting physical activity (PA) guidelines, by gender, among 8-12 year old children with BMI ≥75th percentile DESIGN AND METHODS: This was a secondary analysis of baseline data from a school-based healthy weight management intervention in Minnesota for 8-12 year old children. Survey data about PA participation were collected from 2014 through 2018. Analyses entailed descriptive statistics and multivariate logistic regression controlling for child age, race/ethnicity, BMIz, child's perception of parent support for activity, and number of sports played.

RESULTS

Children's (n = 132) mean age was 9.32 ± 0.89 years, 49% were female, 63% were members of racial/ethnic minority groups, and 33% met PA Guidelines (≥60 minutes daily). Parents' (n = 132) mean age was 39.11 ± 7.05 years, mean BMI of 30.90 ± 8.44, 94% were female, 42% were members of racial/ethnic minority groups, and 57% met PA Guidelines for Americans (≥150 minutes moderate or >75 minutes vigorous PA weekly). There was no association between parents and children meeting PA guidelines for the total sample (OR = 1.43, 95% CI = 0.63-3.24, p = 0.39) or girls (OR = 0.65, 95% CI = 0.18-2.33, p = 0.51). Boys whose parents met PA guidelines had 3.84 times greater odds of meeting PA guidelines (95% CI = 1.28-13.4, p = 0.04).

CONCLUSIONS

PA interventions for boys may benefit from focus on parents' PA. Further research should investigate correlates of girls' PA.

PRACTICE IMPLICATIONS

Pediatric nurses working with children to increase PA should encourage parents' PA. For parents of boys, this may increase the child's PA. Considered broadly, nurses should be aware of gender influences on children's engagement in PA.

The Effects of Interrupting Sitting Time on Affect and State Anxiety in Children of Healthy Weight and Overweight: A Randomized Crossover Trial

PURPOSE

Sedentary time relates to higher anxiety and more negative affect in children. This study assessed whether interrupting sitting over 3 hours is sufficient to influence state anxiety, positive affect, or negative affect, and tested weight status as a moderator.

METHODS

Analyses were the second (preplanned) purpose of a larger study. Children (N = 61; age: mean [SD] = 9.5 [1.3]; 43% healthy weight) completed 2 experimental conditions: continuous sitting for 3 hours and sitting for 3 hours interrupted with walking for 3 minutes in every 30 minutes. State anxiety, positive affect, and negative affect were reported at pretest and posttest. Multilevel models for repeated measures assessed whether experimental condition predicted posttest scores.

RESULTS

Experimental condition was unrelated to posttest state anxiety or positive affect. Weight status moderated how experimental condition influenced posttest negative affect (P = .003). Negative affect was lower in the children of healthy weight after interrupted sitting (vs continuous sitting; β = -0.8; 95% confidence interval, -1.5 to 0.0, P = .05), but it was higher in the children with overweight/obesity after interrupted sitting (vs continuous sitting; β = 0.6; 95% confidence interval, 0.0 to 1.2, P = .06).

CONCLUSIONS

Interrupting sitting acutely reduced negative affect in children of healthy weight, but not in children with overweight. Further research is needed to better understand the potential emotional benefits of sitting interruptions in youth.

The Kids Obesity Prevention Program: Cluster Randomized Controlled Trial to Evaluate a Serious Game for the Prevention and Treatment of Childhood Obesity

Background

Health games provide opportunities for the treatment and prevention of childhood obesity. We developed a motion-controlled serious game for children that addresses 3 core topics of nutrition, physical activity, and stress coping. It is the first serious game that extensively targets the dietary energy density principle (DED-P) in relation to nutrition. The game is intended to provide an additional educational component for the prevention and treatment of obesity in children.

Objective

The Kids Obesity Prevention study aimed to evaluate the newly developed game and to evaluate how well children are able to understand and apply the DED-P.

Methods

This cluster randomized controlled trial collected data from 82 primary school children aged 9 to 12 years and their parents at baseline (T0), at 2 weeks after study commencement (T1), and at the 4-week follow-up (T2). The dropout rate was 3.6%. The intervention group (IG) played the game within 2 weeks (2 sessions with different game modules). One part of the game involves selection of food with the lower energy density when presented with a pair of foods. This allows assessment of whether the children have understood the DED-P and whether they can apply it to unknown foods under time pressure. The control group (CG) received a brochure about the food pyramid concept and physical activity. The primary outcome was the gain in knowledge (nutrition and stress coping) and measured with a pretested questionnaire. The secondary outcomes were the maintenance of knowledge, application of the DED-P, feelings during game play, game acceptance, and behavioral measures (physical activity, media consumption, and dietary intake).

Results

The knowledge score ranging from 0 to 100 increased from T0 (IG: 53 [SD 10], CG: 50 [SD 11]) to T1 (IG: 69 [SD 11], CG: 52 [SD 12]) in IG versus CG (P<.001). At T2, the knowledge score of IG remained at the same level as that of T1. Game data showed that after DED-P education, the classification under time pressure of unknown versus known food pairs according to their DED category was similar (hit rate around 70%). Overall, 95% of the children liked the game very much or much. No group changes were observed at the behavioral level.

Conclusions

The Kids Obesity Prevention program sustainably increased knowledge in the areas of nutrition and stress coping, and children were able to apply the DED-P.

Trial Registration

ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978

Role of Parents in Body Mass Reduction in Children with Obesity-Adherence and Success of 1-Year Participation in an Intervention Program

Background and Objectives: Obesity in children and adolescents results in a number of serious health-related consequences necessitating early treatment. Support from family members and family-focused lifestyle interventions can improve effectiveness of the treatment. The aim of the study was to assess the effects of parental characteristics and family-based dietary habits on the adherence and success of a body mass reduction program in children with obesity included in a lifestyle intervention program after 1 year. Materials and Methods: The program included dietetic, psychosocial, and endocrine counseling given to individuals either alone or in groups and was conducted by a multidisciplinary team (consisting of endocrinologists, nurses, psychologists, social counselors, dietitians, and physiotherapists). A total of 113 children aged 10-17 years (mean age 12.9 ± 2.0; 60 girls, 53 boys) were included in the program. After 1 year of participation, the rate of adherence and success were assessed. The effect of the participants' general characteristics, including anthropometric data, as well as parental characteristics (marital status, employment, education, body mass index (BMI), duration of breastfeeding) and the circumstances of meal consumption (eating at home or outside, fast food consumption), was analyzed. Results: The most important factors predicting body mass reduction success were baseline BMI (p < 0.0001) and waist-hip ratio (WHR) (p = 0.04), but they did not predict body mass reduction adherence. Conclusions: The meal consumption habits and support from family members may be among the determinants of adherence to a body mass reduction program for preadolescents and adolescents with obesity. However, the results of the presented study suggested that baseline BMI and WHR are the most important determinants of the body mass reduction success.

Emotion Identification in Preschool and Early Adolescent Body Mass Index: Exploring the Roles of Depressive Symptoms and Peer Relations

The ability to identify and label emotions may represent an early-life risk factor that relates to excess weight gain during childhood. The current study investigates the relationships between preschool emotion identification and early adolescent body mass index (BMI), as well as the mediating role of two variables: depressive symptoms and peer relations. In a longitudinal study, preschoolers completed an emotion identification task, and parents completed psychiatric assessments and a peer-relations questionnaire about their child. BMI percentile was measured at later time points in early adolescence. Poor emotion identification during preschool predicted increases in BMI percentile over time, with greater deficits in emotion identification ability relating to steeper increases in BMI percentile across early adolescence. Peer relations in preschool partially mediated the relationship between preschool emotion identification ability and adolescent BMI. This study provides novel information about potential targets for early interventions in the service of obesity prevention.

Abnormal body weight and food-related behavior in school-aged children as measured by the Children's Binge Eating Disorder Scale

Obesity in children is becoming a global epidemic. Health and emotional consequences can threaten life and health both during childhood and adulthood. In this study, we aimed to assess the coexistence of overweight and obesity, binge eating disorder and detrimental attitudes toward nutrition among school-age children. We also aimed to determine the usefulness of the Children's Binge Eating Disorder Scale (C-BEDS) as a screening tool. We examined a group of over 550 healthy children aged 6-12. In all, 15% were overweight, and 6% were obese. A total of 12% of the children presented an increased risk of eating disorders. The examined group of children significantly differed in the number of positive C-BEDS responses compared with the authors of the test. Test reliability as measured by the Cronbach's alpha coefficient was .008. Preliminary results indicate that the problem of excessive body weight affects every fifth child, consistent with previous reports. The C-BEDS used in this study did not permit the identification of children, neither with the risk of Binge Eating Disorder (BED) nor subthreshold BED. This may be due to the relatively low internal consistency of the questions contained in the scale.

Physical Activity, Sleep, Body Mass Index, and Associated Risk of Behavioral and Emotional Problems in Childhood

OBJECTIVE

Cross-sectional data indicate that physical activity, longer sleep duration, and normal body weight are associated with better mental health in childhood. It is less clear whether these factors protect against future emotional and behavioral problems. We investigated whether physical activity, sleep duration, and body mass index (BMI) at the age of 7 years are associated with emotional and behavioral problems at the age of 11 years.

METHODS

Children born to European mothers enrolled in the prospective longitudinal Auckland Birthweight Collaborative Study (N = 871) were assessed at birth and ages 7 and 11 years. Physical activity and sleep duration were measured using accelerometer. BMI was calculated from height and weight measurement. Outcome variables assessed at the age of 11 years were parent and child self-report Strengths and Difficulties Questionnaire and parent and teacher Conners' Rating Scale scores.

RESULTS

Physical activity, sleep duration, and BMI at the age of 7 years were not significantly associated with emotional and behavioral problems at the age of 11 years. In cross-sectional analysis at the age of 11 years, there was no significant association between physical activity or sleep duration and emotional and behavioral problems. Children with a BMI in the overweight or obese range were significantly more likely to have teacher-rated behavior problems and parent-rated emotional or behavioral problems after adjustment for potential confounders.

CONCLUSION

Although physical activity and sleep have physical health benefits, they may not be protective against future emotional and behavioral problems in childhood in the general population. BMI in the obese or overweight range was significantly associated with current emotional and behavioral problems at the age of 11 years.

Community-level obesity prevention is not associated with dieting behaviours and weight dissatisfaction in children: The Healthy Communities Study

BACKGROUND

Within the context of high childhood obesity prevalence, there is a concern that community efforts intended to reduce childhood obesity may lead to unintended adverse outcomes.

OBJECTIVE

This analysis examined relationships between community programs, policies, and environmental changes (CPPs) for obesity prevention with unhealthy dieting behaviours and body weight satisfaction in children.

METHODS

Using the Healthy Communities Study 2013 to 2015 survey sample of 5138 US children aged 4 to 15 years old, multilevel models examined associations between standardized CPP intensity scores and child dieting behaviours and weight satisfaction, adjusting for community and child-level covariates and clustered study design.

RESULTS

In fully adjusted models, higher total, physical activity, and nutrition CPP intensity scores were associated with lower odds of dissatisfaction with weight (1 year total CPP odds ratio [OR]: 0.41, 95% confidence interval [CI], 0.22-0.73; 6 year total CPP OR: 0.48, 0.29-0.80). Higher physical activity CPP intensity over the past year was associated with greater odds of weight satisfaction (OR: 1.77, 95% CI, 1.10-2.84). No associations were observed with dieting behaviours.

CONCLUSIONS

Results suggest that community efforts focusing on nutrition and physical activity to prevent childhood obesity may be associated with weight satisfaction and not with unhealthy dieting behaviours.

Psychosocial Functioning After One Year of Interdisciplinary Pediatric Weight Management

Youth with obesity are more likely than normal-weight peers to experience psychosocial problems. Empirically-based recommendations for addressing pediatric obesity include intensive interdisciplinary weight management comprising medical, behavioral health, nutrition, and exercise components. The present study examined changes in psychosocial functioning associated with frequency of participation in an interdisciplinary pediatric weight management program. Participants were 86 patients (55.8% females; median age = 11.5 years; 67.4% Non-Hispanic Black; median BMI percentile = 99.5) enrolled in an interdisciplinary pediatric weight management program for at least one year. Psychosocial functioning was measured with the Pediatric Symptom Checklist (PSC-17), a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention difficulties as well as global functioning. The PSC-17 was completed at the initial clinic visit (baseline) and repeated one-year later (annual). The Wilcoxon Signed Rank test indicated that annual PSC-17 scores were significantly lower than baseline scores across all domains. Spearman correlation coefficients revealed no significant association between total number of clinic visits and PSC-17 global or subscale scores. However, the number of visits for exercise-only sessions was significantly correlated with caregiver-reported improvement in internalizing behaviors. Findings suggest that participation in interdisciplinary pediatric weight management may improve psychosocial functioning in youth with obesity and that attending supervised exercise sessions may be especially beneficial for improving internalizing behavior symptoms.

Fast food intake and excess weight gain over a 1-year period among preschool-age children

BACKGROUND

Fast food is cross-sectionally associated with having overweight and obesity in young children.

OBJECTIVES

To examine whether fast food intake independently contributes to the development of overweight and obesity among preschool-age children.

METHODS

Prospective cohort of 3- to 5-year-old children (n = 541) followed for 1 year. Children's height and weight were objectively measured at baseline and study end. Parents reported their child's fast food intake frequency in the past week from 11 chain fast food restaurants in six online follow-up surveys, completed approximately 8 weeks apart. Poisson regression with robust standard errors modelled the risk of a child increasing in weight status (ie, transitioning from a having a healthy weight to having overweight or from having overweight to having obesity) over the study period in relation to their average weekly fast food intake, adjusted for sociodemographics, child obesogenic behaviours, and parent weight status.

RESULTS

At baseline, 18.1% of children had overweight and 9.8% had obesity; 8.1% of children transitioned to a greater weight status over the 1-year period. Mean fast food intake frequency among consumers was 2.1 (SD: 1.4) times per week. The risk of increasing in weight status increased linearly with each additional time fast food was consumed in an average week over the study year (RR: 1.38; 95% CI, 1.13-1.67; P < .01).

CONCLUSIONS

Greater fast food intake over 1 year was associated with increasing weight status during that time in this preschool-age cohort.

APOLO-Teens, a web-based intervention for treatment-seeking adolescents with overweight or obesity: study protocol and baseline characterization of a Portuguese sample

PURPOSE

APOLO-Teens is an ongoing web-based program combining a manualized intervention delivered by Facebook^®, a self-monitoring web application and monthly chat sessions to optimize treatment as usual for adolescents with overweight and obesity. The aims of this paper are twofold: (1) to describe the study protocol of the APOLO-Teens randomized controlled effectiveness trial and (2) to present baseline descriptive information of the Portuguese sample.

METHODS

APOLO-Teens includes adolescents aged between 13 and 18 years with BMI percentile ≥ 85 (N = 210; 60.00% girls, BMI z-score 2.40 ± 0.75) undergoing hospital ambulatory treatment for overweight/obesity. Participants completed a set of self-report measures regarding eating behaviors and habits, psychological functioning (depression, anxiety, stress, and impulsivity), physical activity, and quality of life.

RESULTS

Depression, anxiety, stress, impulsivity, and percentage body fat were inversely associated with health-related quality of life (r_s = - 0.39 to - 0.62), while physical activity out-of-school was positively correlated with health-related quality of life (r_s = 0.22). When compared to boys, girls demonstrated statistically significant higher scores on psychological distress, disturbed eating behaviors, impulsivity, were less active at school and had lower scores on the health-related quality of life (p < 0.05).

CONCLUSION

The results showed that there were gender differences in key psychological constructs that are likely to determine success with the treatment and that, therefore, need to be considered in future interventions. The results of APOLO-Teens randomized controlled trial will determine the impact of these constructs on the efficacy and adherence to a web-based intervention for weight loss in the Portuguese population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Various causative factors and associated complications of childhood obesity in Jeddah, Western Region, Saudi Arabia

Objective:

The objective of the study was 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 were collected through reviewing medical records, medical files on the hospital electronic system, and clinical interviews conducted with legal guardians. The date of the study was from January to June 2018, and the study was carried out in Jeddah, Western Region, Saudi Arabia.

Results:

Data were entered, coded, cleaned, and analyzed using the Statistical Package for the Social Sciences (IBM SPSS), version 22. The analysis was done by assessing the significance of various risk factors and sequelae in their contribution to pediatric obesity by one-way ANOVA for nominal variables of more than two categories and independent-samples 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 including gastroesophageal reflux, hypertension, precocious puberty, sleep apnea, 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 most recurring complications involved psychosocial and behavioral abnormalities, and among the medical consequences, gastroesophageal reflux and obstructive sleep apnea were the most prevalent.

Lipid disorders in children living with overweight and obesity- large cohort study from Poland

Background

While in the general paediatric population the presence of abnormal lipid values is estimated at 8–20%, depending on the population, accepted norms and age, it was shown that in the population of lean children the prevalence of dyslipidemia is lower than in obese children, in whom it ranges from 20 to over 40%. Until now, however, no results of similar studies on a large sample of children form a Central or Eastern European country have been published. The aim of this study was to evaluate the prevalence of lipid disorders in overweight and obese children and adolescents participating in an integrated weight reduction programme.

Methods

According to the “6-10-14 for Health” programme implementation schedule, the programme accepted patients living in Gdańsk, aged 6, 9–11 and 14 years old, with BMI above the 85th percentile for age and sex, according to the Polish percentile charts. During the first visit, each of the participants underwent basic anthropometric examinations - body weight, body height, waist and hip circumference, blood pressure and body composition by bioelectrical impedance were measured. Blood samples were taken to assess lipid, glucose and insulin levels as well as alanine transaminase (ALT) and thyroid stimulating hormone (TSH) activity.

Results

1948 patients underwent full anthropomethric and blood work measurements. At least one of the lipid disorders occurred in 38.23% of girls and 40.51% of boys with overweight and obesity. The most common lipid disorderswere decreased high-density lipoprotein cholesterol (HDL-C) levels (present in 20.55% of the girls and 23.79% of the boys) and elevated low-density lipoprotein cholesterol (LDL-C) (present in 15.31% of the girls and 14.25% of the boys). There was no strong association between lipid disorders and age, sex, birth weight, gestational age at birth or body composition.

Conclusions

Such a frequent occurrence of lipid disorders in the population of children and adolescents should be an important warning signal both at the individual and population level. Not only effective screening methods for overweight and obese children should be implemented from an early age but also therapeutic measures are required.

Trial registration

The trial is registered under the Local Ethics Committee at Medical University of Gdańsk, decision No. NKBBN/228/2012 from 25 June 2012.

Association between high pre-pregnancy body mass index, excess gestational weight gain, and poor breastfeeding with overweight in 3-4-year-old Chilean children

OBJECTIVE

The aim of this study was to determine the association between prepregnancy body mass, gestational weight gain, and inadequate breastfeeding (BF) with overweight in Chilean children ages 3 to 4 y.

METHODS

This was an analytical and cross-sectional study with 560 participants. Age, residence, BF, and weight gain information were collected from child care records. The children's nutritional status (NS) was determined according to the weight-for-height z-score for sex. Bivariate relationships were evaluated by the χ² test, and a multivariate logistic regression model was applied with the Stata version 15 software at α < 0.05.

RESULTS

Prepregnancy NS values were 37% normal and 63% overweight. Excess weight gain occurred in 75% of the mothers. The children's NS was related to the duration of BF (P = 0.002), prepregnancy NS (P = 0.002), and weight gain (P = 0.004). When adjusting the logistic regression model for sex and maternal age, the overweight prepregnancy NS increased up to twice the risk for OW in children (odds ratio [OR], 2; 95% confidence interval [CI], 1.3-4.1), as well as excess weight gain (OR, 2.3; 95% CI, 1.5-5.9), and non-exclusive BF (OR, 2.4; 95% CI, 1.3-4.4).

CONCLUSION

Children showing risk factors such as non-exclusive BF, prepregnancy NS with overweight, and excess gestational weight gain faced between 2 and 2.4 times more risk for overweight than children without these factors.

Maternal attachment style, sensitivity, and infant obesity risk in low-income, Latino families

Disparities in childhood obesity highlight the need for research to identify its early predictors in high-risk populations, such as low-income, Latino families. In the current study, the first of its kind in a low-income Latino sample (N = 55; M _{child age} = 12.74 months, SD = 3.96), we investigated whether mothers' self-reported attachment style predicted their infants' weight-for-length (WFL; an early indicator of childhood obesity). We also explored whether observed maternal sensitivity, coded from a video-recorded semi-structured play assessment, mediated this association. We found a significant direct effect of maternal attachment style on infants' WFL z-scores (c' = -0.68, SE = 0.22, p = .004). Infants of mothers who classified themselves as secure had lower WFL z-scores than infants of insecure mothers (avoidant or anxious). Maternal sensitivity did not mediate this association, but was positively associated with infant WFL z-scores. We discuss implications of these findings for future research.

Fitness as a Mediator of the Enhancement of Quality of Life after a 6-Months Exercise Program

Purpose: The study aimed to test whether improvement in fitness components, mediates the changes in Health-related Quality of Life (HRQoL) after exercise intervention in overweight and obese children. Methods and design: 170 obese and overweight children (121 exercise group and 49 control group) participated in a public exercise program based on sports practice for 6 months, 2 h per week. Anthropometry, physical fitness, and HRQoL were measured. Magnitude-based inferences and Cohen's effect size were performed to analyze the program effect. To know which physical fitness components mediated the improvement on children's HRQoL, multiple mediation analyses were performed. Results: the analysis showed a moderate effect on some fitness components and a moderate and small effect on HRQoL. The improvement of agility or cardiorespiratory fitness showed a significant indirect effect on the enhancements in some HRQoL dimensions. Conclusion: after a 6-months exercise program in overweight and obese children, all physical fitness components improved, being responsible for the improvement of the HRQoL, agility and cardiorespiratory fitness.

Childhood obesity and the associated rise in cardiometabolic complications

Childhood obesity is one of the most serious global public-health challenges of the twenty-first century. Over the past four decades, the number of children and adolescents with obesity has risen more than tenfold. Worldwide, an increasing number of youth are facing greater exposure to obesity throughout their lives, and this increase will contribute to the early development of type 2 diabetes, fatty liver and cardiovascular complications. Herein, we provide a brief overview of trends in the global shifts in, and environmental and genetic determinants of, childhood obesity. We then discuss recent progress in the elucidation of the central role of insulin resistance, the key element linking obesity and cardiovascular-risk-factor clustering, and the potential mechanisms through which ectopic lipid accumulation leads to insulin resistance and its associated cardiometabolic complications in obese adolescents. In the absence of effective prevention and intervention programs, childhood obesity will have severe public-health consequences for decades to come.

Proportion of kindergarten children meeting the WHO guidelines on physical activity, sedentary behaviour and sleep and associations with adiposity in urban Beijing

Background

World Health Organisation (WHO) Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children under 5 Years of Age were released in 2019. The aim of this study was to examine the proportion of Chinese kindergarten children who met each individual guideline and each combination of the guidelines and the associations with adiposity.

Methods

Participants were 254 kindergarten children aged 4.1–6.3 years recruited from three kindergartens in urban area of Beijing. Physical activity, sedentary behaviour and sleep duration were assessed using 24-h accelerometry over three consecutive days. Screen time was reported by parents. Weight and height were measured; and children were categorised into normal weight and overweight/obese groups according to the WHO age- and sex- specific criteria. Frequency analyses were performed to examine the proportion of children meeting individual and combination of these guidelines. Logistics regression analyses were conducted to examine the associations between guideline compliance and adiposity.

Results

The proportion of children who met the physical activity (≥ 3 h daily physical activity, including ≥1 h daily moderate- to vigorous-intensity physical activity (MVPA)), sedentary screen time (< 1 h/day), and sleep guidelines (10-13 h/day) were 65.4, 88.2 and 29.5%, respectively; only 15.0% met all three guidelines and 2.7% did not meet any of the guidelines. Not meeting the physical activity guideline, sleep guideline, or combination of any two guidelines, or all three guidelines was not associated with overweight or obesity; however, children who did not meet the sedentary screen time guidelines were at higher risk for overweight and obesity (odds ratio = 3.76, 95% CI: 1.50–9.45).

Conclusions

In our study, only a small proportion of children met all three guidelines. Most Chinese kindergarten children met physical activity guidelines or screen time guidelines, whereas fewer children met sleep guideline. Not meeting sedentary screen time guidelines was associated with adiposity, which warrant further interventions for limiting screen time in young children.

The Psychological Effects of Exergames for Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis

The systematic review and meta-analysis were conducted to analyze the psychological effects of exergames for children and adolescents with overweight or obesity. In August 2018, the electronic databases searched were PubMed, Scopus, Web of Science, SPORTDiscus, Science Direct, CINAHL, and PsycINFO. The eligibility criteria were defined according to the population, intervention, comparison, outcome, and study design. In relation to the population, only studies with children or adolescents with overweight or obesity and without any other comorbidities were analyzed. Only publications in English were considered. Nine studies were selected. The comparisons identified were in relation to weight, type of activity, and play style versus control and preintervention. The magnitude of effect size suggests that the practice of exergaming has a small effect on psychological outcomes. Furthermore, cooperative games produced greater attraction to the game (g = 4.71, 95% confidence interval [CI] = 3.23-6.19) and greater intrinsic motivation (g = 5.29; 95% CI = 3.68-6.90). It was verified that self-esteem (standard mean difference [SMD] = 0.37; 95% CI = 0.09-0.66), and self-efficacy (SMD = 0.42; 95% CI = 0.06-0.79) improved after playing an exergame. This systematic review and meta-analysis suggest that exergames may be effective in improving psychological aspects of children and adolescents with overweight or obesity. Given the limited number of studies, it is essential to increase scientific research in this area.

Aim2Be mHealth intervention for children with overweight and obesity: study protocol for a randomized controlled trial

Background

The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has been presented as a viable alternative to in-person interventions for behavior change, especially with teens.

Purpose

The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching to improve weight outcomes (i.e., decrease in standardized body mass index (zBMI)) and lifestyle behaviors (i.e., improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among children 10- to 17-years old with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to 1) test whether supplementing the Aim2Be program with health coaching increases adherence and 2) examine the mediators and moderators of adherence to the Aim2Be intervention.

Methods

We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019–2020). Participants will be recruited from Canadian pediatric weight management clinics and through online advertisements. Child participants must be between the ages of 10 and 17 years, have overweight or obesity, be able to read English at least at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. After having their data collected for 3 months, the control group will gain access to Aim2Be, with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy.

Discussion

Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviors and guide future mHealth interventions for pediatric weight management.

Trial registration

ClinicalTrials.gov, NCT03651284. Registered 29 August 2018.

Are Movement Behaviors and Fundamental Motor Skills Associated With Fitness and Fatness in Early Childhood? Findings From the 2012 NHANES National Youth Fitness Survey

PURPOSE

Using 2012 National Health and Nutrition Examination Survey (NHANES) National Youth Fitness Survey data, the authors conducted a cross-sectional secondary analysis to examine the associations of movement behaviors (ie, physical activity [PA] and screen-based sedentary behaviors) and fundamental motor skills (FMS) with fitness (ie, muscular fitness) and fatness (ie, body mass index and waist circumference) in 3- to 5-year-old children. The effect of ethnicity (Hispanic vs non-Hispanic) on these associations was also examined.

METHODS

A total of 352 children (173 girls; mean age = 4.02 y) from the 2012 NHANES data set were included. Parents reported their child's PA and screen-based sedentary behaviors. FMS (ie, locomotor and object control) were assessed with the Test of Gross Motor Development, 2nd edition. Other variables used were body mass index, waist circumference, and plank.

RESULTS

Hispanic children demonstrated lower levels of PA than non-Hispanic children (P < .05). Children's FMS emerged as significant predictors of muscular fitness and waist circumference, but not for body mass index in the Hispanic group. In the non-Hispanic group, FMS (ie, object control skills) and PA accounted for significant variances of muscular fitness and waist circumference, respectively.

CONCLUSION

The associations of movement behaviors and FMS with fitness and fatness are different between Hispanic and non-Hispanic young children. Changes in policy or early childhood curriculum may be tailed to promote FMS for an impact on fitness and fatness in both Hispanic and non-Hispanic children.

Physical and Psychological Effects of Bariatric Surgery on Obese Adolescents: A Review

The worldwide obesity crisis is not isolated to adults; rather, obesity in adolescents has reached epidemic levels as well. Bariatric surgery continues to be one of the most effective treatments for obesity, both in adults and adolescents, with new evidence continually emerging; however, research surrounding outcomes of these procedures in younger patients is limited in comparison with data available for adults. Further, it is important to examine psychological aspects of obesity in adolescents, as well as effects of surgery on mental health endpoints. Conditions such as anxiety, depression, anger, and disruptive behavior show increased prevalence among obese adolescents, but minimal research exists to examine changes in such conditions following bariatric surgery. Additionally, there is growing evidence of a bidirectional relationship between sleep (quality; disorders) and the development of obesity, and the effects of this relationship are particularly pronounced in the vulnerable adolescent population. This review aims to compile and discuss the results of literature within the last 5 years with regard to overall efficacy of bariatric surgery specifically in adolescent patients in terms of weight and body mass index (BMI) reduction, hormonal changes, and co-morbidity resolution, as well as data surrounding sleep and psychological outcomes. Race, ethnicity, and socioeconomic status were also examined. From this review, we conclude that current research supports bariatric surgery in adolescents as an effective method of treatment for obesity and related co-morbidities; however, minimal long-term data exists to adequately assess efficacy and trends into adulthood. These areas are ripe for future study.

Childhood and Adolescent Obesity: A Review

Obesity is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors; it is a significant public health problem. The most common cause of obesity throughout childhood and adolescence is an inequity in energy balance; that is, excess caloric intake without appropriate caloric expenditure. Adiposity rebound (AR) in early childhood is a risk factor for obesity in adolescence and adulthood. The increasing prevalence of childhood and adolescent obesity is associated with a rise in comorbidities previously identified in the adult population, such as Type 2 Diabetes Mellitus, Hypertension, Non-alcoholic Fatty Liver disease (NAFLD), Obstructive Sleep Apnea (OSA), and Dyslipidemia. Due to the lack of a single treatment option to address obesity, clinicians have generally relied on counseling dietary changes and exercise. Due to psychosocial issues that may accompany adolescence regarding body habitus, this approach can have negative results. Teens can develop unhealthy eating habits that result in Bulimia Nervosa (BN), Binge- Eating Disorder (BED), or Night eating syndrome (NES). Others can develop Anorexia Nervosa (AN) as they attempt to restrict their diet and overshoot their goal of "being healthy." To date, lifestyle interventions have shown only modest effects on weight loss. Emerging findings from basic science as well as interventional drug trials utilizing GLP-1 agonists have demonstrated success in effective weight loss in obese adults, adolescents, and pediatric patients. However, there is limited data on the efficacy and safety of other weight-loss medications in children and adolescents. Nearly 6% of adolescents in the United States are severely obese and bariatric surgery as a treatment consideration will be discussed. In summary, this paper will overview the pathophysiology, clinical, and psychological implications, and treatment options available for obese pediatric and adolescent patients.

Breakfast consumption and obesity among preadolescents: An epidemiological study

BACKGROUND

This study aimed to examine the association between breakfast consumption and childhood weight status, in relation to various socioeconomic and lifestyle factors.

METHODS

A cross-sectional survey was conducted including 1,728 children aged 10-12 years and their parents, during the school years 2014-2016. Primary schools from five Greek counties (including the Athens metropolitan area) were randomly selected. Parental and child data were collected through self-administered, anonymous questionnaires. Children's weight status was based on gender- and age-specific tables derived from the International Obesity Task Force body mass index cutoffs. Logistic regression was used to determine the association between frequency and type of breakfast consumption and children's weight status.

RESULTS

The frequency of breakfast consumption was not associated with childhood overweight or obesity, even when other factors were included in the analysis like sex, age, physical activity, meals / day, family annual income, parental weight status, parental physical activity level, parental educational level and parental employment status. From the nine foods that were included only the consumption of bread or rusks and chocolate milk were found to have a negative association with childhood overweight or obesity (odds ratio: 0.51; 95% CI: 0.34, 0.79 and OR: 0.50; 95% CI: 0.28, 0.87, respectively).

CONCLUSIONS

The result that frequency of breakfast consumption was not associated with children's overweight / obesity may lead to a deeper investigation of the foods consumed during breakfast. Bread or rusks and chocolate milk seemed to have a protective effect; further nutritional analysis is needed to explore the potential mechanisms of this observation.

Double Burden of Malnutrition: Examining the Growth Profile and Coexistence of Undernutrition, Overweight, and Obesity among School-Aged Children and Adolescents in Urban and Rural Counties in Henan Province, China

OBJECTIVE

To examine the gender, age, and region of residence in the anthropometric and nutritional profiles of children and adolescents aged 6-18 in Henan Province, China's third most populous province.

DESIGN

This cross-sectional study of the China National Nutrition and Health survey (2010-2013) used a multistage cluster sampling technique. The sample included Chinese schoolchildren and adolescents aged 6 to 18 years (1,660 boys and 1,561 girls). Multiple logistic regression models were used to estimate the associations between sociodemographic correlates and overweight or obesity and stunting. Setting. Nine districts/counties in Henan Province. Participants. 3,221 subjects completed the questionnaire. Sociodemographic information was obtained. Body weight and height were measured.

RESULTS

There were statistically significant regional differences in average height and weight for boys in all age groups. Girls followed the same trends except for height when 15-18 years old. The urban-rural residence differences were found in relation to prevalence of stunting and weight status. Subjects in poor rural areas (15.43%) and ordinary rural areas (15.34%) had higher rates of stunting compared to their urban counterparts. Prevalence of overweight or obesity was highest in big city areas (15.71%) and lowest in ordinary rural areas (6.37%). Being a boy (OR = 1.69, 95% CI = 1.314-2.143), living in a big city (OR = 2.10, 95% CI = 1.431-3.073), or in a small-medium city (OR = 2.28, CI = 1.606-3.247), or being in a younger age group was associated with being overweight or obese. In addition, being a boy, living in a big city, or in a small-medium city, or being younger in age meant they were less likely to be stunted.

CONCLUSIONS

A substantial dual burden of malnutrition among children and adolescents in Henan Province was revealed. The urban-rural differences in nutritional status were found. Stunting was more prevalent in rural areas than in urban. In contrast, while the rising problem of childhood and adolescent obesity still exists in the big city, we also found a great spike in obesity in small-medium cities. Evidence also indicated that boys were more likely to be overweight or obese. Our findings suggest that nutrition education, as well as environmental and policy interventions, is needed to target specific geographic regions.

The placebo effect on aerobic fitness test results is preserved following a multidisciplinary intervention program for treating childhood obesity

BACKGROUND

The aim of the study was to examine the placebo effect on fitness test results in trained and untrained overweight and obese children.

METHODS

Twenty pre-pubertal overweight children performed two pairs of progressive treadmill exercise tests before and 12 weeks into a multidisciplinary program for the treatment of childhood obesity. In each test pair, at random order, participants received different types of information regarding a water drink consumed prior to testing-standard information (water) vs deliberate positive information (presumed energy drink, placebo).

RESULTS

The intervention led to a significant change (P < .05) in BMI%ile (95.6 ± 4.4 vs 93.6 ± 6.9), % fat (35.4 ± 6.0 vs 31.6 ± 5.8), baseline heart rate (104.2 ± 11.6 vs 94.0 ± 7.0 bpm), total leisure activity score-Godin (9.3 ± 8.8 vs 41.5 ± 15.2), total screen time (6.9 ± 5.8 vs 3.1 ± 1.4 h/d), and a significant improvement in fitness. Following the placebo drink, both groups achieved a significantly higher peak heart rate (untrained: 176.1 ± 13.7 vs 167.5 ± 16.8; trained: 170.7 ± 11.6 vs 166.2 ± 11.4 bpm) and longer running time (untrained: 559.9 ± 151.0 vs 434.4 ± 140.3 seconds; trained: 728.3 ± 177.3 vs 667.1 ± 176.1 seconds). Despite longer exercise duration and higher peak exercise heart rate, average, and peak RPE were lower after the placebo drink (untrained: 12.1 ± 2.3 vs 13.6 ± 2.1; trained:10.0 ± 1.8 vs 11.6 ± 2.1), recovery time was shorter (untrained: 119.2 ± 25.3 vs 133.2 ± 23.7 seconds; trained: 92.6 ± 18.9 vs 102.7 ± 18.3 seconds). The placebo-induced change in running time and peak RPE were significantly greater prior to training.

CONCLUSION

The significant information placebo effect is preserved in trained overweight children. Information, as well as other motivating aids and fatigue distractors may be useful in enhancing physical performance in obese children.

The feasibility and acceptability of a primary school-based programme targeting diet and physical activity: the PhunkyFoods Programme

Background

This study aims to evaluate the feasibility and acceptability of the PhunkyFoods Programme, a primary school-based intervention to promote healthy nutrition and physical activity knowledge and behaviours to assess outcomes to inform a phase 3 trial.

Methods

The cluster randomised feasibility trial recruited eight primary schools from the North of England. Elibility criteria included all primary schools in one town, excluding independent and special schools and schools that comprised of only key stage 2 pupils (years 3–6). Eight schools agreed to participate. Randomisation to intervention or control arms was in a 1:1 ratio. Intervention schools received PhunkyFoods over 17 months. Control schools continued with usual curriculum. Assessors were blinded to group assignment. Measures comprised of a Healthy Lifestyle Knowledge Questionnaire and Synchronised Nutrition and Activity Program to assess diet and physical activity, height, weight, and psychological wellbeing. Feasibility outcomes were recruitment, attrition rates, interviews with teaching staff, focus groups with pupils to explore the acceptability of outcome measures, implementation, intervention content, and programme fidelity.

Results

Three hundred fifty-eight pupils, aged 6–9 years from eight schools were recruited at baseline (control n = 170, intervention n = 188); 337 (94.1%) at 6 months (control n = 163, intervention n = 181); and 331 (92.5%) at 18 months (control n = 152, intervention n = 179), and 6 pupils opted out. Trends in increased knowledge of healthy lifestyle behaviours, healthier eating, and liking of fruit and vegetables were reported in the intervention compared to the control group. Year 4 intervention pupils had significantly higher healthy balanced diet knowledge scores compared to control pupils, mean difference 5.1 (95% CI 0.1 to 10.1, p=0.05). At 18 months, the mean percentage of vegetables liked was higher (intervention 53.9% vs. 43.0% control). Similarly, percentage of fruits liked was also higher (intervention 76.9% vs. 67.2% control). Qualitative data showed that delivery of the intervention was feasible and acceptable to teachers and pupils. Lessons were learned to inform the phase 3 trial around the dietary assessment measure and timing of recruitment.

Conclusions

Whilst the study was not powered to detect a definitive effect, results suggest a potential to increase knowledge of healthy lifestyle behaviours and dietary behaviours, suggesting that with minor changes, a phase 3 trial is likely to be deliverable.

Trial registration

ISRCTN, ISRCTN15641330. Registered 8 May 2015—retrospectively registered, 10.1186/ISRCTN15641330

Association of urinary polycyclic aromatic hydrocarbons and obesity in children aged 3-18: Canadian Health Measures Survey 2009-2015

Polycyclic aromatic hydrocarbons (PAHs) may contribute to obesity. Childhood obesity is a strong predictor of adult obesity and morbidity; however, the relationship between PAHs and obesity in young children (e.g., aged 3-5) has not been studied. We examined the association between urinary PAH metabolites and measures of obesity in children. We analyzed data from 3667 children aged 3-18 years who participated in the Canadian Health Measures Survey (CHMS, 2009-2015). We ran separate multivariable linear models to estimate the association between quartiles of PAH metabolites and each of body mass index (BMI) percentile, waist circumference (WC), and waist-to-height ratio (WHtR) in the total population, as well as in the age subgroups 3-5, 6-11, and 12-18, adjusting for age, sex, ethnicity, education, income quintile, diet, creatinine, and exposure to environmental tobacco smoke. A multinomial logistic regression model estimated adjusted odds ratios for risk of central obesity. BMI, WC, and WHtR were positively associated with total PAH and naphthalene metabolites in the total population aged 3-18 and in age groups 6-11 and 12-18. In 3-5 year olds, WHtR, but not BMI, was significantly associated with total PAH, naphthalene, and phenanthrene metabolites. Overall, those in the highest quartile for naphthalene or total PAH metabolites had three times greater odds of having central obesity compared with those in the lowest quartile. Urinary PAH metabolites are associated with WHtR, an indicator of central obesity and predictor of health risks associated with obesity, in children as young as 3-5.

Identifying the relationship between biological, psychosocial and family markers associated with childhood obesity: Case-control "ANOBAS" study

The recent increase in childhood obesity prevalence rates illustrates the extreme relevance of biological, psychosocial and familial factors implicated in body weight status, which at the moment remain unclear. The study aims to compare biological, psychosocial and familial markers between preadolescents with obesity and their non-overweight peers, and explore the relationship with psychiatric diagnosis on these markers. Both groups were composed of 40% of males with a mean age of 10 years, and no differences in socio-demographic variables were found between groups. No sex differences were found on bio/psycho/family markers. While 48% (n = 24) of the preadolescents with obesity presented a DSM-IV diagnosis (OGD), only 2% (n = 1) of the non-overweight peers (NG) met diagnostic criteria. Significant differences were found for all bio/psycho/family markers among obese preadolescents with the exceptions of cortisol, peptide YY and maternal state-anxiety and depression. The preadolescents with obesity without a diagnosis (OGND) presented greater levels of leptin than NG (p = 0.01). For psychosocial markers, statistically significant differences were found between groups in the majority of the variables (p <  0.01), with the exception of trait anxiety where a tendency towards significance was revealed (p = 0.06). For family markers, we found statistically significant differences in emotional over-involvement (p = 0.01), with NG mothers presenting lower scores than OGD and OGND. Include psychosocial and family factors in obesity intervention programs is necessary. Also, health professionals working with children with obesity must take care to assess the presence of a psychiatric diagnosis amongst this population.

Correlates of psychiatric inpatient readmissions of children and adolescents with mental disorders

To identify correlates of psychiatric readmission of youth, we conducted a consecutive, retrospective 1-year cohort study (07.01.2014-06.30.2015) of youth (age = 5-17.9) admitted to psychiatric inpatient facility. Stepwise elimination, multivariable logistic regression analyses were conducted to identify independent correlates of 1-year and 30-day psychiatric readmissions. The Family/Caregiver Interview Tool (FCIT) was given to caregivers of 30-day readmitted youth and analyzed using generalized linear model to predict time to readmission. Altogether, 1231 youth experienced 1534 hospitalizations. The 1-year readmission rate was 32.4%; 30-day readmission rate was 10.2%. Significant independent correlates of readmissions were longer length of stay, higher antipsychotic treatment rates, living closer to the hospital, and comorbid obesity, all accounting for 12.2% of variance. FCIT revealed that caregiver's ability to fill prescription after discharge delayed readmission, while shorter time to follow-up appointment hastened it. Illness exacerbation was responsible for 73% of 30-day readmissions; system of care factors accounted for 13%. Compared to clinicians, caregivers significantly underestimated environment of care factors (including caregiver's mental health) as the primary cause for readmission. Readmissions are common and correlate with illness severity and systems of care factors. Family support services may help reduce readmissions. Hospital-specific qualitative investigation may help identify intervention targets to reduce readmissions.

The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action

BACKGROUND

In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025.

MAIN BODY

Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children's Fund (UNICEF), WHO and the World Bank. The Institute for Health Metrics and Evaluation (IHME) has published country-level estimates of obesity in children aged 2-4 years. For children aged 5-19 years, obesity estimates are available from the NCD Risk Factor Collaboration. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2-4 years has increased moderately. In 1975, obesity in children aged 5-19 years was relatively rare, but was much more common in 2016.

CONCLUSIONS

It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity. Although cost-effective interventions such as WHO 'best buys' have been identified, political will and implementation have so far been limited. There is therefore a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity. To be successful, the obesity epidemic must be a political priority, with these issues addressed both locally and globally. Work by governments, civil society, private corporations and other key stakeholders must be coordinated.

The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial

BACKGROUND

Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.

OBJECTIVES

To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.

METHOD

The study included 77 children (4-6 years old, 53% girls, mean body mass index [BMI] z-score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z-score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.

RESULTS

Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z-scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z-scores.

CONCLUSIONS

Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.

Is body image associated with perseverance? A study among people with normal and increased body weight

Background

The extreme lack of perseverance in obese and overweight people is mainly associated with difficulties in holding back irrelevant thoughts or memories. The aim of this study was to analyze the relationship between body image and perseverance.

Methods

The research was carried out amongst a cohort of 135 people with normal and overweight/obese body weight. The criterion determining body image in the study participants was an index in the form of a subjective assessment of body weight (too low/correct/too high). Perseverance was determined using a website with simple maze tasks. For the assessment of one’s nutritional status, the applied body mass index (BMI) was utilized. For the statistical analysis, the Student’s t-test and the r-Pearson correlation were used.

Results

Respondents with a normal BMI were more persistent in performing the tasks, in comparison with those who possessed a BMI above the normal range. There was a positive correlation between the average time spent on one task and the BMI. People in either group of normal BMI or with an overweight BMI, who assessed their body weight as too high, had lower results of analyzed perseverance indicators than those who assessed their body weight as normal.

Conclusion

This is the first study analyzing the relationship between body image with perseverance. Our results showed that perseverance is associated with body image. There was a correlation between the distractor resistance index and BMI. Lower results of analyzed perseverance indexes were observed in people perceiving their body weight as too high and not necessarily overweight.

The relationship between risk of obstructive sleep apnea and other sleep problems, depression, and anxiety in adolescents from a community sample

Obstructive sleep apnea (OSA) is highly related to mental health problems, such as depression and anxiety. However, previous studies on OSA and depression and anxiety have mostly been conducted in the adult population. We aimed to (1) screen for risk of OSA in a sample of adolescents from the general population using self-report questionnaires and (2) examine whether there are differences between the high- and low-risk groups for OSA in depressive and anxiety symptoms, self-esteem, and sleep-related variables. The data of 793 students (age range: 12-17 years old) were analyzed. The participants were assigned to the high-risk (n = 202, 25.5%) or the low-risk group (n = 591, 74.5%) of OSA. The participants in the high-risk group had more severe anxiety symptoms, lower self-esteem, insomnia, excessive daytime sleepiness, and higher BMI compared those in the low-risk group. This study shows that it is possible to efficiently screen for risks of various problems associated with OSA in adolescents using an easy and simple screening tool.

Body Mass Index Status across Different Psychiatric Disorders in a National Survey amongst Children and Adolescents: To Identify the Role of Gender

Objective: Body mass index undergoes a substantial change in some psychiatric disorders. This study aimed to explore the status of body mass index (BMI) in different psychiatric disorders in a national survey among children and adolescents and to identify the role of gender in this regard. Method : A total of 30 532 children and adolescents were randomly selected using cluster sampling method with equal blocks of three age groups and two genders. Psychiatric disorders were assessed using a standardized face-to-face diagnostic interview of Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (KSADS-PL), and Body Mass Index (BMI) was measured for each participant. Results: In this study, 22 730 children and adolescents (109 46 boys and 11784 girls), with valid data of BMI, completed the KSADS-PL interview. The prevalence of psychiatric disorders was 21.2% among underweight participants, 22.8% among overweight participants, and 22.2% among obese participants, which was significantly higher than normal weight participants with 19.6% (X2 = 17.55; p = 0.001). In boys' subgroup, depression and separation anxiety were mostly seen among the underweight category, while tic disorder was mostly seen in the obese category. In girls' subgroup, on the other hand, generalized anxiety was mostly observed in the underweight category, while oppositional defiant disorder (ODD), depression, and mental retardation were mostly observed in the obese category. In total, the highest mean BMI rates were among the children and adolescents with alcohol abuse disorder, mania, and panic disorder. However, the lowest BMI rates were among those with attention deficit hyperactivity disorder (ADHD), separation anxiety disorder (SAD), and enuresis. Conclusion: This study gives an overall picture of BMI status in different psychiatric disorders according to gender. Furthermore, in a multidisciplinary approach, the results of this study drew the attention of child psychiatrists to the status of BMI in their clients.

Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies

Objectives:

To assess the impact of increased body mass index (BMI) on orthodontic tooth movement (OTM) and related parameters in children and adolescents.

Search sources:

A search of six electronic databases and manual searching were performed up to June 2019 without language and time restrictions.

Data selection:

Eligibility criteria were as follows: (1) longitudinal controlled clinical studies; (2) children and adolescents undergoing orthodontic therapy (OT); (3) no systemic diseases; (4) experimental group: patients with increased BMI; and (5) control group: patients with normal BMI.

Data extraction:

Screening, study selection and data extraction were performed; bias within studies was assessed using the Risk of Bias In Non-randomised Studies (ROBINS-I) tool.

Results:

Seven studies were included. One study showed that an increased BMI is associated with less wear-time of removable orthodontic appliances and one study found no significant association. One study showed that an increased BMI is associated with less cooperation during OT; however, not with the treatment results. One study reported higher pain experience during OT in adolescents with than without increased BMI. Two studies showed that increased BMI in adolescents is related to OTM, one with increased and one with decreased rates of OTM, respectively. One study reported an association between increased BMI and incidence of white spot lesions and gingivitis during OT. The ROBINS-I tool showed low to moderate risk of bias within studies.

Conclusions:

The influence of BMI on OTM and related parameters in children and adolescents remains debatable.

Foundational knowledge regarding childhood obesity: a cross-sectional study of medical students

Background

Documentation and diagnosis of childhood obesity in primary care is poor and providers are often unfamiliar with guidelines. This lack of knowledge may be attributed to insufficient training in medical school and residency; however, no studies have evaluated medical students’ knowledge of recommendations.

Methods

We distributed a modified version of the Physician Survey of Practice on Diet, Physical Activity, and Weight Control to medical students at a single university. Descriptive analyses assessed knowledge and attitudes of childhood obesity and diabetes.

Results

Of the 213 participating students, 74% indicated being unfamiliar with obesity screening recommendations. Few correctly identified BMI percentile cut-points for child overweight (21.2%), obesity (23.7%), and normal weight (29.4%). They reported screening glucose 4.5 years earlier in patients with risk factors compared to those without (p < 0.001).

Conclusions

Although students recognized the need for earlier diabetes screening in children with risk factors, we determined that overall, student knowledge of obesity-related preventative care was inadequate.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7499-1) contains supplementary material, which is available to authorized users.

Prediction Models for Early Childhood Obesity: Applicability and Existing Issues

Statistical models have been developed for the prediction or diagnosis of a wide range of outcomes. However, to our knowledge, only 7 published studies have reported models to specifically predict overweight and/or obesity in early childhood. These models were developed using known risk factors and vary greatly in terms of their discrimination and predictive capacities. There are currently no established guidelines on what constitutes an acceptable level of risk (i.e., risk threshold) for childhood obesity prediction models, but these should be set following consideration of the consequences of false-positive and false-negative predictions, as well as any relevant clinical guidelines. To date, no studies have examined the impact of using early childhood obesity prediction models as intervention tools. While these are potentially valuable to inform targeted interventions, the heterogeneity of the existing models and the lack of consensus on adequate thresholds limit their usefulness in practice.

Association of Daily Rest-Activity Patterns With Adiposity and Cardiometabolic Risk Measures in Teens

PURPOSE

Emerging data indicate that the timing and rhythms of energetic behaviors may influence metabolism and obesity risk. Our aim was to derive diurnal rest-activity patterns from actigraphy in adolescents and analyze associations with adiposity measures and cardiometabolic risk factors.

METHODS

Adolescents in the Project Viva cohort wore a wrist actigraph over 7 days. We derived markers of daily rest-activity patterns from actigraphy using nonparametric models, generating measurements of relative amplitude (RA). RA reflects the normalized difference in activity measured during the most active 10-hour period and the least active 5-hour period, averaged over multiple 24-hour periods. Using multivariable-adjusted linear regression models, we estimated associations of RA and its components with markers of adiposity (body mass index, waist circumference, skinfolds, dual-energy X-ray absorptiometry fat mass) and cardiometabolic health (cardiometabolic risk score, derived as the mean of five sex-specific internal z-scores for waist circumference, systolic blood pressure, high-density lipoprotein cholesterol scaled inversely, and log-transformed triglycerides and homeostatic model assessment of insulin resistance).

RESULTS

A total of 778 adolescents provided at least 5 days of valid actigraphy data. The average age was 13.2 (±.9) years, 52% were female, and the average RA was .9 (±.1). A higher RA reflecting higher activity during wakefulness and lower activity during the night was associated with more favorable indices of adiposity (e.g., -.35 kg/m² lower body mass index per each .04 units increment of RA; 95% confidence interval: -.60 to -.09).

CONCLUSIONS

In this large sample of adolescents, a higher RA emerged as a novel biomarker, associated with more favorable cardiometabolic profiles.

Short-term and long-term positive outcomes of the multidisciplinary care implemented by the French health networks for the prevention and care of paediatric overweight and obesity

BACKGROUND

The nine French regional health networks for the prevention and care of paediatric obesity offer a 2-year program of multidisciplinary primary care (medical, dietetical, psychological, adapted physical activity) based on multicomponent lifestyle interventions.

OBJECTIVES

To assess the short-term and long-term impact of care management.

METHODS

The impact of the multidisciplinary care was assessed by changes in the body mass index (BMI) Z score during the period of the care, and at least 2 years after the end. Anthropometric data were collected at baseline and at the end of the care either through a digital medical file or through direct phone contacts with the referring. Long-term outcomes were assessed through studies relative to post follow-up evaluation.

RESULTS

At the end of the period of the care in a network, 72.9% of 6947 children had decreased their BMI Z score from 3.6 ± 1.0 DS at baseline to 3.3 ± 1.1 DS at the end. The four studies relative to long-term evaluation showed a pursuit of the decrease of BMI Z score during the 5.1 years after the beginning of the care.

CONCLUSIONS

The care provided by regional French networks for prevention and care of paediatric obesity induce a reduction of BMI that continues afterwards.

Multisector Approach to Improve Healthy Eating and Physical Activity Policies and Practices in Early Care and Education Programs: The National Early Care and Education Learning Collaboratives Project, 2013-2017

Purpose and Objectives

Embedding healthy eating and physical activity best practices in early care and education settings is important for instilling healthy behaviors early in life. A collaborative partnership between Nemours Children’s Health System and the Centers for Disease Control and Prevention was created to implement the National Early Care and Education Learning Collaboratives Project (ECELC) in childcare settings in 10 states. We measured improvement at the program level by the self-reported number of best practices implemented related to healthy eating and physical activity.

Intervention Approach

The ECELC implemented a collaborative model with state-level partners (eg, child care resource and referral networks) and early care and education programs. Intervention components received by program directors and lead teachers included 1) self-assessment, 2) in-person learning and training sessions, 3) action planning and implementation, 4) technical assistance, and 5) post-reassessment.

Evaluation Methods

A pre–post design assessed self-reported policies and practices related to breastfeeding and infant feeding, child nutrition, infant and child physical activity, screen time, and outdoor play and learning as measured by the validated Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) best practices instrument. The sample included 1,173 early care and education programs.

Results

The number of best practices met for each of the 5 NAP SACC areas increased from pre-assessment to post-assessment approximately 6 months later and ranged from 1.5 to 4.7 best practices (P < .001). Almost all increases occurred regardless of participation in the Child and Adult Care Food Program, Quality Rating Improvement System, Head Start/Early Head Start, and/or accreditation status.

Implications for Public Health

The innovative and collaborative partnerships led to broad implementation of healthy eating and physical activity–based practices in early care and education settings. Development, implementation, and evaluation of policy and practice-based partnerships to promote healthy eating and physical activity among children attending early care and education programs may contribute to obesity prevention in the United States.

Time spent looking at food during a delay of gratification task is positively associated with children's consumption at ad libitum laboratory meals

Greater ability to delay gratification for an immediate food reward may protect against the development of obesity. However, it is not known if the behaviors children exhibit during a delay of gratification task are related to overeating in other contexts. The purpose of this analysis was to assess the relationship between observed child coping strategies during a delay of gratification task and laboratory intake from ad libitum test-meals. The sample consisted of 40, 7-9 year old children (40% (N = 16 with overweight/obesity). Across 5 laboratory visits, children consumed 3 identical test-meals presented after varying exposure conditions (i.e., no exposure, exposure to food commercials, exposure to toy commercials). On the first visit, children were recorded during a delay of gratification task which was coded for three behavioral themes: looking at vs. away from food, talking vs. staying silent, and fidgeting vs. sitting still. Pearson correlations and multiple regressions were run to look at the relationships between coping strategies and test-meal intake. Time spent looking away from food was negatively associated with ad libitum food consumption at the meals. Conversely, greater time spent looking at food was positively associated with ad libitum food consumption. These relationships were independent of covariates likely to influence intake (e.g., sex, age, weight status, parent income) and were more robust following food rather than toy commercial exposure. Children who spent more time looking at food and less time looking away during a delay of gratification task may be vulnerable to overeating in other contexts. Upon replication in larger samples, these behaviors could serve as modifiable targets in the development of childhood obesity prevention programs.

Associations between father availability, mealtime distractions and routines, and maternal feeding responsiveness: An observational study

Responsive feeding and frequency of family mealtimes are related to healthier eating behaviors and weight outcomes in children and adolescents. Distractions at mealtimes are related to greater intake of unhealthy food and a less positive mealtime emotional climate. However, there is little understanding of the effects of routines and father availability on distractions at family meals, and there is limited research investigating the effects of distractions among all family members on maternal feeding practices in toddlerhood. This study aims to characterize distractions at family mealtimes and examine associations between father availability, distractions, and observed responsive feeding. Descriptive analyses, nonlinear mixed models, and path analyses were conducted using observational (home-based family mealtimes) and self-report data collected from a subsample of families (n = 109) of 18- to 24-month-old children in the larger STRONG Kids 2 Study (N = 468). Between fathers, mothers, and children, families spent almost half of the mealtime distracted. Fathers and mothers engaged in about equal amounts of distractions, and children engaged in more technology-related distractions than parents. Fathers' absence at the mealtime was associated with more child distractions and less maternal feeding responsiveness. Lower paternal total distractions, maternal non-technology-object-related distractions, and higher household income were significantly associated with more observed maternal feeding responsiveness. Future research should investigate how father availability and family mealtime distractions may be associated directly and indirectly with children's eating behaviors and weight outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).