A narrative literature review of the development of obesity in infancy and childhood

Do parental risk factors for type 2 diabetes predict offspring risk of overweight and obesity? The Feel4Diabetes study

OBJECTIVES

The prevention of children being overweight/obese is of utmost importance. Parental characteristics play a pivotal role in shaping offspring weight status. This study aimed to examine associations between parental obesity and children's overweight/obesity status, and whether other parental type 2 diabetes (T2D) risk factors can predict children's obesity status.

METHODS

Logistic regression and receiver operating characteristic (ROC) analyses were conducted, using cross-sectional data from a European cohort of 20 151 adults (10 967 mothers; 9184 fathers) and children (n = 10 967) participating in the Feel4Diabetes study. Anthropometric measurements were conducted in children, and overweight/obesity was defined according to the International Obesity Task Force criteria. Parents' T2D risk was assessed applying the Finnish Diabetes Risk Score (FINDRISC).

RESULTS

After adjusting for all other FINDRISC variables, region and maternal/parental education, maternal (adjusted odds ratio [aOR]: 2.64; 95% confidence interval [CI], 2.18-3.20) and parental (aOR: 3.21; 95% CI, 2.65-3.91) obesity, maternal (aOR: 1.46; 95% CI, 1.23-1.74) and parental (aOR: 1.59; 95% CI, 1.32-1.92) high waist circumference, as well as maternal (aOR: 1.60; 95% CI, 1.27-2.01) and parental (aOR: 1.87; 95% CI, 1.58-2.21) high FINDRISC score, were associated with child overweight/obesity status. Maternal (area under the curve- ROC: 0.638; 95% CI, 0.628-0.647) and paternal body mass index (BMI; area under the curve-ROC: 0.632; 95% CI, 0.622-0.642) were the most accurate in predicting child overweight/obesity status.

CONCLUSIONS

Among parental risk factors for T2D, maternal/parental overweight/obesity status, central obesity, and high FINDRISC score were the main predictors of childhood overweight/obesity status, with BMI the most accurate. Maternal or paternal BMI is simple to use, and might be useful for the early identification of children at risk of being overweight/obese rather than other T2D factors.

Parental Perspectives of the Impact of COVID-19 Lockdown on Food-Related Behaviors: Systematic Review

Home confinement during the COVID-19 pandemic has been accompanied by dramatic changes in household food dynamics that can significantly influence health. This systematic literature review presents parental perspectives of the impact of COVID-19 lockdown (up to 30 June 2022) on food preparation and meal routines, as well as other food-related behaviors, capturing both favorable and unfavorable changes in the household food environment. Themes and trends are identified and associations with other lifestyle factors are assessed. Overall, families enjoyed more time together around food, including planning meals, cooking, and eating together. Eating more diverse foods and balanced home-cooked meals (e.g., fresh fruit and vegetables) was combined with overeating and increased snacking (e.g., high-calorie snacks, desserts, and sweets), as parents became more permissive towards food; however, food insecurity increased among families with the lowest income. Adoption of meal planning skills and online shopping behavior emerged alongside behaviors aimed at self-sufficiency, such as bulk purchasing and stockpiling of non-perishable processed foods. These results are an important first step in recognizing how this pandemic may be affecting the family food environment, including low-income families. Future obesity prevention and treatment initiatives, but also ongoing efforts to address food management, parental feeding practices, and food insecurity, can account for these changes moving forward.

Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review

Background

Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups.

Methods

A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals.

Results

Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake.

Conclusions

Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01164-1.

Maternal Sleep Quality is Associated with Personal and Parenting Weight-Related Behaviors

Mothers of young children tend to report poor-quality sleep, yet little is known about links between maternal sleep quality and weight-related behaviors and parenting practices. Thus, mothers of preschoolers completed an online cross-sectional survey assessing their sleep, physical activity, dietary behaviors, eating styles, child feeding practices, family meal behaviors, and health parameters. Comparisons by sleep quality using the Pittsburgh Sleep Quality Index item (i.e., very bad/bad, n = 87; fair, n = 255; and good/very good, n = 193) revealed mothers with poor-quality sleep had weight-related behaviors associated with higher Body Mass Index (BMI) (lower physical activity, fewer fruits/vegetables, more emotional and disinhibited eating). Poor-quality sleepers also engaged in parenting practices contrary to recommendations, such as less frequent modeling of healthy eating and physical activity, more control of child feeding, and fewer family meals. Mothers reporting poor-quality sleep tended to have lower parenting self-efficacy, poorer overall health status, more days of poor mental and physical health, greater depression, more stress, and higher BMIs. Future nutrition research should establish the directionality between sleep quality and health behaviors. Future interventions should help mothers develop strategies for improving sleep quality, such as increased physical activity and fruit and vegetable intake, and helping mothers realize how their sleep quality may affect parenting practices.

Cognitive, emotional, and behavioral contributors to early childhood weight status

Pediatric obesity is a serious public health concern affecting almost 16% of two- to five-year-olds. Prior research has not sufficiently addressed how various factors combine to contribute to the heterogeneous condition of obesity. The goal of this study was to assess multiple individual factors to determine how they collectively contribute to weight status in young children, as this information could lead to tailored interventions. This was a cross-sectional, population-based study of three- to five-year-olds. Child height and weight were measured. Parents completed a demographic survey and validated questionnaires regarding these child characteristics: internalizing and externalizing behaviors, sleep problems, executive functions, and food approach and food avoid behaviors. Data for 154 participants (mean age: 4.4 ± 0.8 years; mean body mass index-z: .28 ± 1.0; 50% male) were analyzed using linear and logistic regression and a stepwise regression procedure. In the stepwise selection procedure for the binary outcome of obese/overweight versus normal weight, food avoid (p = .151), food approach (p = .017), and the White demographic variable (p = .117) were identified as important predictors. In conclusion, when considering various cognitive, emotional, and behavioral factors, only food approach and food avoid eating behaviors predicted weight status in young children, suggesting prevention and intervention efforts should specifically address these aspects in young children.

Risk Factors for Childhood Overweight and Obesity in Ukraine and Germany

OBJECTIVE

The prevalence of overweight and obesity in childhood and adolescence are rapidly increasing and influenced by genetic, familial, environmental, socioeconomic and cultural factors. The aim of the study was to compare risk factors for childhood obesity in Ukraine (UA) and Germany (DE) using comparable investigative tools.

METHODS

Two groups of children, aged 8 to 18 years, from DE (93 children) and UA (95 children) were divided into overweight and obese groups. Anthropometric data and detailed medical history were collected.

RESULTS

Risk factors in pregnancy (prematurity, weight gain >20 kg, early contractions) were equally frequent in both groups. Positive correlations of body mass index (BMI)-standard deviation score (SDS) between children and mothers were noted. The proportion of family members with diabetes mellitus was lower in the UA group. Obesity was more frequent at one year of age in DE children. The DE group also became overweight at an earlier age and remained overweight over a longer period of time compared to UA. The mean BMI-SDS of obese children was lower in the UA group. In both groups waist circumference to height ratio was >0.5, indicating presence of a cardiometabolic risk factor. About half of the patients in both groups had blood pressure values exceeding the 95^th percentile.

CONCLUSION

Similar risk factors for obesity were observed among two groups of children in UA and DE. Differences were observed regarding the prevalence of specific risk factors for childhood obesity. Population-specific distribution of risk factors needs to be considered in order to optimize prevention and treatment strategies.

Demographic, Social and Health-Related Variables that Predict Normal-Weight Preschool Children Having Overweight or Obesity When Entering Primary Education in Chile

We determined which variables are predictive of normal-weight (N) Chilean 4-year-olds developing overweight/obesity when entering primary school. This study used national data of preschoolers (PK, age 4) in 2011 through 2015, and the same children in the first grade (1st G, age 6) in 2013 through 2017. We formed longitudinal cohorts considering PK as the baseline and 1st G as the follow-up and included anthropometric, socio-demographic, and health variables in PK and anthropometry in the 1st G. We report the percentage N who remained N at follow-up (N-N) or gained excessive weight (N-OW) and (N-OB), by sex. We ran univariate logistic regressions to determine for each variable, its association with gaining excessive weight (N-OW + OB), incorporating significant variables (p < 0.001) in multivariate logistic regression. A total of 483,509 (251,150 girls) of PK had anthropometry in the 1st G. In PK, 22% of the children were obese; in the 1st G (24.8% and 19.7% in boys and girls, respectively). Of normal-weight children, 30% developed OW + OB. The predictive variables were: Being born macrosomic, attending a very vulnerable school, being indigenous, the mother’s low schooling, and the child being cared for by the grandmother after school. In this study, the factors predicting that normal-weight preschoolers gain excessive weight gain in a short period of time are mostly related to poverty. Prevention should focus on this population.

Gross Motor Skills and School Day Physical Activity: Mediating Effect of Perceived Competence

The purpose of this study was to examine the relationship between gross motor skills and school day steps per minute, testing various motivational constructs as potential mediators. A convenience sample of 66 sixth-grade children (mean age = 11.6 ± 0.5 years; 30 boys, 36 girls) were recruited from one public “Zoom” school. Gross motor skills were assessed using the Test for Gross Motor Development-3rd Edition. Motivational constructs were assessed using a series of validated questionnaires. Children wore a pedometer for one school week. A bootstrap mediation analysis was employed using gross motor skills scores as the predictor variable and steps per minute as the outcome variable; the motivational constructs consisted of perceived competence, enjoyment, and self-efficacy as potential mediators. The results from a bootstrap mediation analysis yielded a statistically significant average causal mediation effect (ACME) using perceived competence as the mediator (ACME = 0.022, 95% CI [0.001, 0.054], p = .018). Perceived competence mediated 30.8% of the total effect between gross motor skill scores and steps per minute, with the entire model explaining approximately 13.6% of the variance. The relationship between gross motor skills and school day physical activity may be mediated through perceived competence in sixth-grade children.

Do Anxiety Disorders Play a Role in Adolescent Obesity?

BACKGROUND

There have been few prospective studies on the association between anxiety disorders and adolescent obesity; none examine potential reciprocal effects.

PURPOSE

The purpose of this paper is to examine the prospective association between anxiety disorders and obesity among adolescents.

METHODS

Using data from a two-wave, prospective study of 3134 adolescents, we examined reciprocal effects between body weight and DSM-IV anxiety disorders.

RESULTS

Weight status did not increase future risk of anxiety disorders nor did anxiety disorders at baseline increase risk of future obesity in the overall sample. Stratifying by gender revealed an increased risk of overweight and obesity in males with anxiety disorders, but not for females. Major depression did not mediate these associations.

CONCLUSION

Similar to prospective studies of depression, it appears anxiety disorders may increase risk of obesity. However, more research is needed on the role of psychopathology in adolescent obesity, in particular anxiety disorders and possible moderators (such as gender) and mediators.

Under 5 Energize: Tracking Progress of a Preschool Nutrition and Physical Activity Programme with Regional Measures of Body Size and Dental Health at Age of Four Years

To reduce weight gain and encourage healthy eating including reduced sugar intake, Under 5 Energize (U5E) was introduced to 121 early-childhood-centres in the Waikato region of New Zealand in July 2013. Using anonymized data collected from January 2013 to September 2016 through free physical assessments of all 4-year-olds provided by the NZ Ministry of Health, the prevalence of obesity and dental decay children measured in the Waikato region was examined. Data were divided into four periods representing pre-implementation and 3 years of gradual implementation. Obesity was defined according to International Obesity Task Force criteria. Of 18,774 Waikato children included in the analysis, 32% were indigenous Māori, and 32% attended an U5E centre. Pre-implementation prevalences of obesity (4%) and visible dental decay (11%) of children attending and not-attending U5E centres were not different. While obesity prevalence did not change significantly over time, prevalence of dental decay decreased among children at U5E (trend p = 0.003) but not non-U5E (trend p = 0.14) centres, such that prevalences were significantly different between children at U5E vs. non-U5E centres at Year 3 (p = 0.02). The U5E intervention is a small but arguably effective part of the wider system approach that is required to improve children's future health.

Risk factor of type 2 diabetes mellitus among adolescents from rural area of India

Context:

Health system is likely to encounter more adolescents with Type 2 diabetes mellitus (T2DM) as a consequence of obesity and sedentary lifestyle. Intervention at various stages of the life cycle is needed as cumulative effect of risk factors accumulated from fetal life to adult increases risk of noncommunicable disease.

Aims:

The aim of this study was to find out awareness regarding T2DM and distribution of risk factor for T2DM in adolescents from the rural areas of Wardha district, India.

Methodology:

A cross-sectional study conducted in the rural area of India involves 412 adolescent boys and girls selected by systematic random sampling technique. Data collected by a face-to-face interview and waist-hip ratio (WHR), body mass index, random capillary blood glucose (RCBG) were estimated.

Results:

65.1% were aware of T2DM. Girls, older adolescents, higher education were associated with awareness (P < 0.001). Totally, 204 (49.51%) had some risk factors for T2DM, of these 191 (46.6%) had sedentary lifestyle, 153 (31.7%) adolescents had nutritional risk factors, 69 (43.4%) boys had WHR >0.90 and 113 (71.1%) girls had WHR >0.85, 103 (25%) adolescents had RCBG ≥110 mg/dl, and 77 (18.7%) participants reported family history of DM.

Conclusions:

Considering the risk factors of T2DM among adolescents from the rural area, there is a need for prevention programs for creating awareness related to T2DM, early identification of risk factor for T2DM, and targeted interventions. The study may serve as a formative research for developing and testing interventions aimed at primary prevention of T2DM among adolescents from rural India.

Environmental and school influences on physical activity in South Asian children from low socio-economic backgrounds: A qualitative study

South Asian (SA) children are less active but have enhanced metabolic risk factors. Physical activity (PA) is a modifiable risk factor for metabolic disease. Evidence suggests that environmental factors and socio-economic status influence PA behaviour. The purpose of this study was to understand PA environments, barriers and facilitators of PA in deprived environments for children from SA backgrounds. Focus groups were conducted with 5 groups of children aged 7-9 years (n = 33; male = 16, female = 17; SA = 17, White = 8 and Black = 8) from two schools in deprived wards of Coventry, England. Thematic analysis was used to identify key themes and subthemes across all transcripts. From the results, emergent themes included school and home environment, outdoor activity, equipment, weather, parental constraints and safety. Ethnic differences were apparent for sources of beliefs and knowledge and religious practice as constraints for PA. The findings suggest that school provides a good foundation for PA attitude, knowledge and behaviour, especially for SA children. To increase PA, multi-component interventions are needed, which focus on changing the home environment (i.e. junk food and media time), encouraging outdoors activity, changing perceptions of safety and weather conditions, which provide parental constraints for children. Interventions also need to be considerate to religious practices that might constrain time.

Sick of sitting

Sitting too much kills. Epidemiological, physiological and molecular data suggest that sedentary lifestyle can explain, in part, how modernity is associated with obesity, more than 30 chronic diseases and conditions and high healthcare costs. Excessive sitting--sitting disease--is not innate to the human condition. People were designed to be bipedal and, before the industrial revolution, people moved substantially more throughout the day than they do presently. It is encouraging that solutions exist to reverse sitting disease. Work environments, schools, communities and cities can be re-imagined and re-invented as walking spaces, and people thereby offered more active, happier, healthier and more productive lives.

Determinants of Weight Gain during the First Two Years of Life--The GECKO Drenthe Birth Cohort

Objectives

To explain weight gain patterns in the first two years of life, we compared the predictive values of potential risk factors individually and within four different domains: prenatal, nutrition, lifestyle and socioeconomic factors.

Methods

In a Dutch population-based birth cohort, length and weight were measured in 2475 infants at 1, 6, 12 and 24 months. Factors that might influence weight gain (e.g. birth weight, parental BMI, breastfeeding, hours of sleep and maternal education) were retrieved from health care files and parental questionnaires. Factors were compared with linear regression to best explain differences in weight gain, defined as changes in Z-score of weight-for-age and weight-for-length over 1–6, 6–12 and 12–24 months. In a two-step approach, factors were first studied individually for their association with growth velocity, followed by a comparison of the explained variance of the four domains.

Results

Birth weight and type of feeding were most importantly related to weight gain in the first six months. Breastfeeding versus formula feeding showed distinct growth patterns in the first six months, but not thereafter. From six months onwards, the ability to explain differences in weight gain decreased substantially (from R²_total = 38.7% to R²_total<7%).

Conclusion

Birth weight and breast feeding were most important to explain early weight gain, especially in the first six months of life. After the first six months of life other yet undetermined factors start to play a role.

Adiposity and Insulin Resistance in Children from a Rural Community in Mexico

BACKGROUND AND AIMS

The study of the incidence of overweight and obesity as well as body composition and insulin resistance in children from rural communities is scarce. The aims of the study were a) to characterize the adiposity and homeostasis model assessment of insulin resistance (HOMA-IR) in school-age children from a rural community and b) to determine factors associated with fat mass and HOMA-IR in this population.

METHODS

A total of 41 school-aged children (15 males and 26 females; 9.9 ± 2.5 years old) from a Mexican rural community was studied. Trained observers had previously assessed the children's nutritional status during the first 6 months of life. Anthropometry, energy intake, physical activity, body composition and biochemical parameters were measured.

RESULTS

The overall prevalence of overweight/obesity was 7.3%. The mean energy intake of children was below international recommendations (1,235 ± 400 kcal/day). A higher percentage of fat mass was observed in females (20.3 ± 8.5) than in males (14.1 ± 5.1) (p = 0.006). There were seven children with IR, but we did not observe a correlation between HOMA and BMI percentiles (Pearson's r = 0.09, p = 0.57). In a regression model, gender (females) was the primary factor associated with the percentage of fat mass. The growth velocity during the first 6 months of life was associated with HOMA-IR.

CONCLUSIONS

There is a low frequency of overweight and obesity in children from rural communities in Mexico. However, these children appear to have increased risk of adiposity and insulin resistance.

SIRT1 gene variants are related to risk of childhood obesity

Obesity is a multifactorial disorder resulting from the interaction between genetic, psychological, physical, environmental, and socioeconomic factors. SIRT1 gene has important effects on the regulation of adiponectin, caloric restriction, insulin sensitivity, coronary atherosclerosis, and cardiovascular diseases. The aim of this study was to investigate the association between childhood obesity and SIRT1 gene polymorphisms regarding rs7895833 A > G in the promoter region, rs7069102 C > G in intron 4, and rs2273773 C > T in exon 5 using PCR-CTPP method in 120 obese and 120 normal weight children. In this study, BMI, systolic and diastolic blood pressure, LDL cholesterol, triglyceride, and insulin levels were significantly higher and HDL-cholesterol levels were significantly lower in obese children compared to normal weight children. For rs7895833 A > G, the rate of having AG genotype and G allele was significantly higher in obese children compared to non-obese group (p < 0.001). The risk for obesity was increased by 1.9 times in G allele carriers; therefore, A allele may be protective against obesity. Both study groups had CT heterozygote genotype for rs2273773 C > T. There was no significant difference for rs7069102 C > G gene polymorphism between groups.

CONCLUSION

This is the first study reporting an association between SIRT1 gene polymorphisms and obesity in children.

Systematic development and validation of a theory-based questionnaire to assess toddler feeding

This paper describes the development and validation of a 27-item caregiver-reported questionnaire on toddler feeding. The development of the Toddler Feeding Behavior Questionnaire was based on a theory of interactive feeding that incorporates caregivers' responses to concerns about their children's dietary intake, appetite, size, and behaviors rather than relying exclusively on caregiver actions. Content validity included review by an expert panel (n = 7) and testing in a pilot sample (n = 105) of low-income mothers of toddlers. Construct validity and reliability were assessed among a second sample of low-income mothers of predominately African-American (70%) toddlers aged 12-32 mo (n = 297) participating in the baseline evaluation of a toddler overweight prevention study. Internal consistency (Cronbach's α: 0.64-0.87) and test-retest (0.57-0.88) reliability were acceptable for most constructs. Exploratory and confirmatory factor analyses revealed 5 theoretically derived constructs of feeding: responsive, forceful/pressuring, restrictive, indulgent, and uninvolved (root mean square error of approximation = 0.047, comparative fit index = 0.90, standardized root mean square residual = 0.06). Statistically significant (P < 0.05) convergent validity results further validated the scale, confirming established relations between feeding behaviors, toddler overweight status, perceived toddler fussiness, and maternal mental health. The Toddler Feeding Behavior Questionnaire adds to the field by providing a brief instrument that can be administered in 5 min to examine how caregiver-reported feeding behaviors relate to toddler health and behavior.

Pediatrician-led motivational interviewing to treat overweight children: an RCT

OBJECTIVE

The aim of this study was to evaluate the effect of family pediatrician-led motivational interviews (MIs) on BMI of overweight (85th ≥ BMI percentile ≥ 95 th) children aged 4 to 7 years.

METHODS

All the family pediatricians working in Reggio Emilia Province (Italy) were invited to participate in the study; 95% accepted. Specific training was provided. Parents were asked to participate in the trial if they recognized their child as overweight. Children were individually randomly assigned to MIs or usual care. All children were invited for a baseline and a 12-month visit to assess BMI and lifestyle behaviors. The usual care group received an information leaflet, and the intervention group received 5 MI family meetings. The primary outcome was the individual variation of BMI, assessed by pediatricians unblinded to treatment groups.

RESULTS

Of 419 eligible families, 372 (89%) participated; 187 children were randomized to MIs and 185 to the usual care group. Ninety-five percent of the children attended the 12-month visit. The average BMI increased by 0.49 and 0.79 during the intervention in the MI and control groups, respectively (difference: -0.30; P = .007). MI had no effect in boys or in children whose mothers had a low educational level. Positive changes in parent-reported lifestyle behaviors occurred more frequently in the MI group than in the control group.

CONCLUSIONS

The pediatrician-led MI was overall effective in controlling BMI in these overweight children aged 4 to 7 years, even though no effect was observed in male children or when the mother's education level was low.

Infrequent attention to dietary and physical activity behaviours in conversations in Swedish child health services

AIM

To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children.

METHODS

Twenty-three nurses audio-recorded one session each. Recordings were assessed and topics were classified according to predetermined categories.

RESULTS

The three most frequent topics of conversation concerned physical examinations of the child (30% of session time), talking to the child to establish or maintain contact and interest (15%), and development of language skills (12%). Dietary habits came on fourth place (10%), and physical activity ranked 14 (4%).

CONCLUSION

Attention to dietary and physical activity behaviours in children is infrequent in Swedish child health services. Concern is raised about the efficacy of prevention efforts against childhood obesity.