Predictors of favorable growth patterns during the obesity epidemic among US school children

Virtual Nutrition Counseling in Pediatric Primary Care: An Integrated Approach to the Prevention and Management of Pediatric Obesity

Given the rising prevalence of pediatric obesity, new approaches to the delivery of targeted nutrition counseling to not only prevent but also treat pediatric obesity are needed. The integration of a dietitian virtually was a successful quality improvement measure in this academic pediatric primary care clinic. The virtual dietitian provided age-appropriate nutrition counseling at well-child visits from 9 months to 6 years of age. Dietary counseling was also provided for children with overweight and obesity regardless of age. Vegetable, fruit, snack, and dairy intake was assessed in children who received counseling versus those who had traditional well childcare. Improved dairy habits were noted in the counseling cohort. A decrease in body mass index was not demonstrated in the patients with obesity or overweight; however, patient and provider satisfaction was quite high with this novel quality improvement measure. Virtual nutrition counseling can be easily integrated to facilitate a comprehensive pediatric medical home.

A Look Back at Healthy Lifestyle Behavioral Patterns among School-Age Children: Are We Neglecting Healthy Weight for Overweight Kids?

Objective: To describe prevalence of healthy lifestyle behaviors (HLBs) between two school-age cohorts of racial-ethnically diverse children. Methods: Using two Early Childhood Longitudinal Study cohorts (ECLS-K 1999 and 2010), we compared percentage change in HLBs (sleep, physical activity, screen time, and family meals) by child weight groups and within racial-ethnic groups. Weight groups of interest included healthy weight (HW; BMI 5th-84th percentile), overweight (OW; ≥ 85th-94th), obese (OB; ≥ 95th-99th percentile), and severely obese (SO; ≥ 99th percentile). Results: OW children within the 2010 cohort reported greater percentage change (range: 2.0%-15.1% increase) in HLBs, whereas HW children demonstrated lower percentage change (range: -6.2% to 8.7% increase). OB and SO children showed significant lower percentage change in reducing screen time (range: -11.0% and -12.7%, respectively). HW Latino children demonstrated the least favorable trends with overall declines noted for 4/5 HLBs. Screen time was noted to have the greatest degree of favorable change (2%-14%) across weight groups, whereas adequate sleep duration demonstrated the lowest favorable percentage change (2%-2.8%). Conclusion: Fewer HW and OB children were participating in recommended HLBs compared with OW children in 2010. Recent health campaigns may have helped providers prioritize the identification and counseling of OW children, yet our data suggest that we may be neglecting the role of HLB counseling in OB and HW children. Continued analysis on the social determinants that impact HLBs in school-age and HW/OB minority children should inform how we can best tailor counseling and messages in the coming decades.

Five-year change in body mass index category of childhood and the establishment of an obesity prediction model

The prevalence of childhood obesity in China has recently become increasingly severe, and intervention measures are needed to stop its growth. Currently, there is a lack of assessment and prediction methods for childhood obesity. We develop a predictive model that uses currently measured predictors [gender, age, urban/rural, height and body mass index (BMI)] to quantify children’s probabilities of belonging to one of four BMI category 5 years later and identify the high-risk group for possible intervention. A total of 88,980 students underwent a routine standard physical examination and were reexamined 5 years later to complete the study. The full model shows that boys, urban residence and height have positive effects and that age has a negative effect on transition to the overweight or obese category along with significant BMI effects. Our model correctly predicts BMI categories 5 years later for 70% of the students. From 2018 to 2023, the prevalence of obesity in rural boys and girls is expected to increase by 4% and 2%, respectively, while that in urban boys and girls is expected to remain unchanged. Predictive models help us assess the severity of childhood obesity and take targeted interventions and treatments to prevent it.

Effects of School-Based Exergaming on Urban Children's Physical Activity and Cardiorespiratory Fitness: A Quasi-Experimental Study

Background: Modern-day technology is appealing to children. Few studies, however, have conducted longitudinal analyses of a school-based exergaming program’s effect on physical activity (PA) behaviors and fitness in children. Therefore, this study examined the longitudinal effect of an 8-month school-based exergaming intervention on children’s objectively-measured PA and cardiorespiratory fitness (CRF). Materials and Methods: Eighty-one fourth grade students (X¯age = 9.23 ± 0.62; 39 girls; 54.3% African American, 30.9% Non-Hispanic White, 14.8% other) participated in this study from 2014–2015. The intervention school’s children participated in a once-weekly 50-min exergaming intervention during recess throughout the school year, while the control school continued regular recess. Children’s in-school PA and sedentary behavior (SB) were measured with ActiGraphGT3X+ accelerometers, with CRF assessed via the half-mile run. All measurements were taken at baseline, mid-intervention (four months) and post-intervention (eight months). Repeated-measures two-way ANCOVAs using age and race as covariates were conducted to examine between-school differences over time for SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and CRF. Results: Significant time by group interactions were observed for LPA, F(1, 79) = 7.82, η² = 0.09, p < 0.01, and MVPA, F(1, 79) = 4.58, η² = 0.06, p < 0.05, as LPA increased among the control group, while MVPA increased among intervention group. Children in both groups experienced decreased SB during the intervention (intervention: −7.63 min; control: −17.59 min), but demonstrated lower CRF over time (intervention: +46.73 s; control: +61.60 s). Conclusions: Observations suggested that school-based exergaming implementation may be effective in increasing children’s MVPA and decreasing their SB over the course an academic year (i.e., ~eight months). More research is needed, however, to discern how modifications to school-based exergaming might also promote improved CRF in children.

Effect of Daily Exposure to an Isolated Soy Protein Supplement on Body Composition, Energy and Macronutrient Intake, Bone Formation Markers, and Lipid Profile in Children in Colombia

A soy protein-based supplement may optimize bone health, support physical growth, and stimulate bone formation. This study aimed to assess the effect of a daily soy protein supplement (SPS) on nutritional status, bone formation markers, lipid profile, and daily energy and macronutrient intake in children. One hundred seven participants (62 girls), ages 2 to 9, started the study and were randomly assigned to lunch fruit juice with (n = 57, intervention group) or without (n = 50, control group) addition of 45 g (230 Kcal) of a commercial SPS during 12 months; 84 children (51 girls, 33 boys) completed the study (45 and 39 intervention and control, respectively). Nutritional assessment included anthropometry and nutrient intakes; initial and final blood samples were taken; insulin-like growth factor-I (IGF-I), osteocalcin, bone specific alkaline phosphatase (BAP), insulin-like growth factor binding protein-3 (IGFBP-3), cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were analyzed. Statistically significant changes (p < .05) in body mass index and weight for age Z scores were observed between groups while changes in body composition were not. Changes in energy, total protein, and carbohydrate intakes were significantly higher in the intervention group (p < .01). Calorie intake changes were statistically significant between groups (p < .001), and BAP decreased in both groups, with values within normal ranges. Osteocalcin, IGFBP-3, and lipid profile were not different between groups. IGF-I levels and IGF/IGFBP-3 ratio increased significantly in both groups. In conclusion, changes in macronutrient and energy intake and nutritional status in the intervention group compared to control group may ensure harmonious and adequate bone health and development.

Entrenched obesity in childhood: findings from a national cohort study

PURPOSE

Given the high levels of obesity among U.S. children, we examine whether obesity in childhood is a passing phenomenon or remains entrenched into adolescence.

METHODS

Data are from the prospective nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (analytic sample = 6600). Anthropometrics were measured six times during 1998-2007. Overweight and obesity were defined using CDC cut-points. Entrenched obesity was defined as obesity between ages 5-9 coupled with persistent obesity at ages 11 and 14.

RESULTS

Almost 30% of children experienced obesity at some point between ages 5.6 and 14.1 years; 63% of children who ever had obesity between ages 5.6 and 9.1 and 72% of those who had obesity at kindergarten entry experienced entrenched obesity. Children with severe obesity in kindergarten or who had obesity at more than 1 year during early elementary were very likely to experience obesity through age 14, regardless of their sex, race, or socioeconomic backgrounds.

CONCLUSIONS

Prevention should focus on early childhood, as obesity at school entry is not often a passing phenomenon. Even one timepoint of obesity measured during the early elementary school years may be an indicator of risk for long-term obesity.

Multilevel Correlates of Healthy BMI Maintenance and Return to a Healthy BMI among Children in Massachusetts

OBJECTIVES

To examine predictors of healthy BMI maintenance (HBM) or return to a healthy BMI (RHB) among children.

METHODS

We studied 33,272 children in Massachusetts between 2008 and 2012. We used multinomial logistic regression to examine associations of individual- and neighborhood-level factors with the odds of: (1) HBM: maintenance of a healthy BMI ≥5th to <85th percentile and (2) RHB: transition to a healthy BMI range from an initial BMI ≥85th percentile between two clinic visits spanning an average of 3.5 years.

RESULTS

Racial/ethnic minorities had lower odds of HBM and RHB than non-Hispanic white children. Higher neighborhood educational attainment was associated with an increased odds of HBM and RHB. Higher neighborhood median household income, proximity to a supermarket, and access to more open recreational space were associated with a higher odds of HBM. Children of ages 2-5 years at baseline had higher odds of RHB and HBM than children 13 years and older.

CONCLUSIONS

Early childhood interventions and efforts to create health-promoting neighborhoods including improving access to supermarkets and open recreational space could have important effects on obesity prevention and management.

Evaluating Coincident Relationships Between Obesity Incidence and Normal Weight Incidence From Birth Through Kindergarten for US Children

PURPOSE

We examine the concurrent relationship between obesity incidence and normal weight status incidence and prevalence in children between 9 months and kindergarten.

DESIGN

Multistage, probability sample from the Early Childhood Longitudinal Study-Birth cohort.

SETTING

United States.

PARTICIPANTS

Representative sample of US preschool children (n = 9950) followed from birth through kindergarten.

MEASURES

From direct, anthropometric measures, we reported prevalence and incidence rates across 4 follow-up periods.

ANALYSIS

In addition to prevalence and incidence rates, we reported risk ratios based on multiple definitions and estimated predicted probabilities of obesity and normal weight status using clinically meaningful body mass index (BMI)-for-age percentiles.

RESULTS

Obesity prevalence (13%-20%) was much smaller than normal weight status prevalence (66%-70%). Lower socioeconomic status, Hispanic, and non-Hispanic black children had greater risk of obesity. During 9 months to kindergarten, obesity incidence decreased two-thirds (15.6%), while normal weight status incidence decreased almost one-half (44.6%). Coincidently, normal weight status incidence (ranged from 23% to 45%) was consistently and substantially higher than obesity incidence (ranged from 5% to 15%). During 4 years to kindergarten, the obesity risk for overweight children was 13 times higher than that for normal weight status children.

CONCLUSION

Overall rates of obese and normal weight incidence were substantial at 9 months, trended lower, but remained high through kindergarten. At 4 years to kindergarten, children with relatively high initial BMI were very likely to become obese but far less likely to achieve normal weight status.