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Cuda S. Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024. OBESITY PILLARS 2024; 11:100113. [PMID: 38953014 PMCID: PMC11216014 DOI: 10.1016/j.obpill.2024.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile. Methods The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child. Conclusions This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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Leerkes EM, Buehler C, Wideman L, Chen Y, Shriver LH. Biopsychosocial predictors of rapid weight gain from birth to 6 months. Pediatr Obes 2024:e13170. [PMID: 39209424 DOI: 10.1111/ijpo.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/16/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Childhood obesity remains a public health crisis and identification of unique prenatal and early infancy predictors of obesity risk are critically needed. OBJECTIVES We test a comprehensive biopsychosocial model of the predictors of rapid weight gain (RWG) in the first 6 months of life. METHODS Two hundred and ninety nine pregnant women and their infants participated. Maternal prenatal psychobiological risk (PPBR) was assessed during the third trimester via maternal anthropometrics, serum biomarkers (insulin, leptin, adiponectin), and maternal report of pregnancy complications, substance use, mental health and stress. Infant stress reactivity was measured at 2 months (cortisol output, resting RSA, observed irritability, negative emotionality). At 2 and 6 months, maternal self-report of obesogenic feeding practices and observed maternal sensitivity during three tasks were collected. RWG was classified based on change in weight-for-age z scores from birth to 6 months (>0.67 SD). RESULTS Obesogenic feeding practices predicted greater likelihood of RWG, β = 0.30, p = .0.01, independent of other predictors and covariates. Obesogenic feeding practices was the only proposed intervening mechanism that produced a significant indirect effect of PPBR on RWG, b = 0.05, S.E. = 0.04, 95% CI [0.002, 0.15], β = 0.06. CONCLUSION Identifying proclivity towards obesogenic feeding practices and providing support to reduce these behaviours may enhance childhood obesity prevention efforts.
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Affiliation(s)
- Esther M Leerkes
- Department of Human Development and Family Studies, UNC Greensboro, Greensboro, North Carolina, USA
| | - Cheryl Buehler
- Department of Human Development and Family Studies, UNC Greensboro, Greensboro, North Carolina, USA
| | - Laurie Wideman
- Department of Kinesiology, UNC Greensboro, Greensboro, North Carolina, USA
| | - Yu Chen
- Department of Human Development and Family Studies, UNC Greensboro, Greensboro, North Carolina, USA
| | - Lenka H Shriver
- Department of Nutrition, UNC Greensboro, Greensboro, North Carolina, USA
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Smith AR, Eiden RD, Shisler S, Paluch RA, Piazza J, Kong KL. The effects of a music enrichment program on parent-infant interactions during mealtime: A randomized controlled trial. Appetite 2023; 187:106590. [PMID: 37148975 PMCID: PMC10401892 DOI: 10.1016/j.appet.2023.106590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Parent-child interactions are linked to childhood obesity. Music enrichment programs enhance parent-child interactions and may be a strategy for early childhood obesity prevention. OBJECTIVE We implemented a 2-year randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) vs. active play date control (control, n = 45) on parent-child interactional quality and infant weight status. METHODS Typically developing infants aged 9-to 15-months were enrolled with a primary caregiver in the Music Together ® or a play date program. Participants attended once per week group meetings for 12 months and once per month group meetings for an additional 12 months. Parent-child interaction was measured using the Parent Child Early Relational Assessment (PCERA) at baseline, month 6, 12, and 24. We used a modified intent-to-treat mixed model regression to test group differences in parent-child interactions and Weight for length z-score (zWFL) growth trajectories were modeled. RESULTS There were significant differential group changes across time for negative affect during feeding (group*month; p = 0.02) in that those parents in the music group significantly decreased their negative affect score compared with the control group from baseline to month 12 (music change = -0.279 ± 0.129; control change = +0.254 ± 0.131.; p = 0.00). Additionally, we also observed significant differential group changes across time for parent intrusiveness during feeding (group*month; p = 0.04) in that those parents in the music group significantly decreased their intrusiveness score compared with the control group from month 6 to month 12 (music change = -0.209 ± 0.121; control change = 0.326 ± 0.141; p = 0.01). We did not find a significant association between any of the changes in parental negative affect and intrusiveness with child zWFL trajectories. CONCLUSION Participating in a music enrichment program from an early age may promote positive parent-child interactions during feeding, although this improvement in the quality of parent-child interactions during feeding was not associated with weight gain trajectories.
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Affiliation(s)
- Amy R Smith
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA; Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Rina D Eiden
- Department of Psychology, Department of Psychology and the Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
| | - Shannon Shisler
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jacqueline Piazza
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA; Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA; Department of Pediatrics, University of Missouri- Kansas City, Kansas City, MO, USA
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Kong KL, Eiden RD, Morris KS, Paluch RA, Carr KA, Epstein LH. Reducing relative food reinforcement of infants using a music enrichment program: a randomized, controlled trial. Am J Clin Nutr 2022; 116:1642-1653. [PMID: 36250608 PMCID: PMC9761746 DOI: 10.1093/ajcn/nqac209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/15/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Food reinforcement or one's motivation to eat may be established early in life; it might not be the food reinforcement per se that drives weight gain, but rather the imbalance between food and nonfood reinforcement. OBJECTIVES We implemented a 2-y randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) compared with an active play date control (control, n = 45) in 9- to 15-mo-old healthy infants who were strongly motivated to eat. METHODS The 12-mo intensive intervention phase included 4 semesters of Music Together® or a play date program (Winter, Spring, Summer, and Fall), comprised of once per week group meetings, followed by a 12-mo maintenance phase with monthly meetings. Parents were encouraged to listen to the Music Together® program CD or play with the play date group's toy with their infants at home, respectively. We performed a modified intention-to-treat analysis using all randomly assigned, non-excluded subjects for the outcome measures [relative reinforcing value of food (RRVfood), food reinforcement, music reinforcement, and weight-for-length z-score (WLZ)]. RESULTS There were significant differential group changes across time for RRVfood (group × month; P = 0.016; Cohen's f2 = 0.034). The music group had significantly greater RRVfood decreases than the control group from baseline to the end of the intensive intervention phase (music change = -0.211; control change = -0.015; P = 0.002; Cohen's D = 0.379). However, these differences were not maintained during months 12-24 (music change = -0.187; control change = -0.143; P = 0.448; D = 0.087). We observed an overall moderation effect by sex for food reinforcement and WLZ. Boys in the music group had a significant attenuation in food reinforcement and WLZ compared with boys in the control group. CONCLUSIONS This study extends our knowledge in infant eating behavior by providing insight into the role of nonfood alternatives in altering one's motivation to eat. There may be sex differences in altering one's motivation to eat.This trial was registered at clinicaltrials.gov as NCT02936284.
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Affiliation(s)
- Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri–Kansas City, Kansas City, MO, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rina D Eiden
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Katherine S Morris
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Katelyn A Carr
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Wood AC, Momin SR, Senn MK, Bridgett DJ. Context Matters: Preliminary Evidence That the Association between Positive Affect and Adiposity in Infancy Varies in Social vs. Non-Social Situations. Nutrients 2022; 14:nu14122391. [PMID: 35745120 PMCID: PMC9227739 DOI: 10.3390/nu14122391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/10/2022] Open
Abstract
Previous studies have suggested that infants high in negative affect have higher levels of adiposity, arising in part via changes in nutrition (e.g., “feeding to soothe”). Few studies have examined whether positive affect shows similar or inverse associations with adiposity. The current study examined cross-sectional and longitudinal relationships between adiposity and observations of positive affect in both a social and a non-social context, using data from infants at four (n = 125) and 12 (n = 80) months of age. Our analyses did not find any cross-sectional associations between positive affect and adiposity (all p > 0.05). However, in the longitudinal analyses, positive affect in a non-social context, when observed at four months of age, was positively associated with weight-for-length at 12 months of age (zWFL; ß = 1.49, SE = 0.67, p = 0.03), while positive affect observed at four months of age in a social context was inversely associated with body fat percentage at 12 months of age (ß = −11.41, SE = 5.44, p = 0.04). These findings provide preliminary evidence that the p positive affect is related to adiposity in infancy and suggest that the direction of association (i.e., direct or inverse) may be specific to the context in which positive affect is measured. Future research should examine the role of nutritional status in any relationships between adiposity and emotion at this early stage.
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Affiliation(s)
- Alexis C. Wood
- USDA/ARS Children’s Nutrition Research Center, 1100 Bates Avenue, Houston, TX 77030, USA; (S.R.M.); (M.K.S.)
- Correspondence: ; Tel.: +713-798-7055
| | - Shabnam R. Momin
- USDA/ARS Children’s Nutrition Research Center, 1100 Bates Avenue, Houston, TX 77030, USA; (S.R.M.); (M.K.S.)
| | - MacKenzie K. Senn
- USDA/ARS Children’s Nutrition Research Center, 1100 Bates Avenue, Houston, TX 77030, USA; (S.R.M.); (M.K.S.)
| | - David J. Bridgett
- Department of Psychology, Northern Illinois University, DeKalb, IL 60115, USA;
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