Psychological issues in pediatric obesity

Infant Obesity Prevention Programs for Underrepresented Mothers in a Home Visiting Program: A Qualitative and Community-Engaged Needs Assessment

A qualitative, community-engaged assessment was conducted to identify needs and priorities for infant obesity prevention programs among mothers participating in home visiting programs. Thirty-two stakeholders (i.e., community partners, mothers, home visitors) affiliated with a home visiting program serving low-income families during the prenatal to age three period participated in group level assessment sessions or individual qualitative interviews. Results indicated families face many challenges to obesity prevention particularly in terms of healthy eating. An obesity prevention program can address these challenges by offering realistic feeding options and non-judgmental peer support, improving access to resources, and tailoring program content to individual family needs and preferences. Informational needs, family factors in healthy eating outcomes, and the importance of access and awareness of programs were also noted. To ensure the cultural- and contextual-relevance of infant obesity prevention programs for underserved populations, needs and preferences among community stakeholders and the focal population should be used as a roadmap for intervention development.

Weight Loss and Glycemic Control After Bariatric Surgery in Adolescents With Severe Obesity: A Randomized Controlled Trial

PURPOSE

Bariatric surgery is regarded as a valuable treatment option for adolescents with severe obesity. However, high-quality evidence of its superiority over prolonged conservative treatment with multidisciplinary lifestyle intervention (MLI) is limited. This study investigated the efficacy and safety of bariatric surgery in adolescents without sufficient weight loss after MLI for severe obesity.

METHODS

A two-group randomized controlled trial was designed to assess one-year health effects of bariatric surgery in adolescents with severe obesity. The participants were referred by pediatricians after completing MLI without sufficient effects. Eligible for participation were adolescents aged 14-16 years with severe obesity (age- and sex-adjusted body mass index (BMI) using the International Obesity Task Force cutoffs: BMI ≥40 kg/m2, or ≥35 kg/m2 in combination with comorbidity). Participants were assigned to MLI combined with laparoscopic adjustable gastric banding (n = 29) versus only MLI (n = 30). Participants were included from 2011 to 2019. Main outcomes were weight change and sex- and age-specific BMI loss. Additionaly, glucose metabolism, blood pressure and lipid profile were analysed.

RESULTS

53 patients completed the 12-months follow-up (89.8%). Mean (±standard deviation [SD]) weight loss in the surgery group was 11.2 ± 7.8% after 12 months, compared to a weight gain of 1.7 ± 8.1% in the control group. The fasting insulin, insulin resistance score and lipid profile improved significantly in the surgery group.

DISCUSSION

Bariatric surgery was associated with substantial weight loss and improvements in glucose and lipid metabolism after 12 months compared to conservative treatment in adolescents with severe obesity.

A population-based study of children suggests blunted morning cortisol rhythms are associated with alterations of the systemic inflammatory state

BACKGROUND

In children, digital media, lifestyle, and the COVID pandemic have impacted sunlight exposure, exercise, and diet patterns - cues that entrain the circadian clock. We hypothesized that low morning cortisol reflects a weak circadian clock, impacting the pro-inflammatory state. The primary objective was to test relationships between diurnal cortisol fluctuations and the inflammatory state in children as a means of providing indirect support for this hypothesis.

METHODS

The Cardiovascular Health Intervention Program (CHIP) was a population-based cross-sectional and longitudinal study of circadian health in public elementary school children in Southern Maine, USA (recruitment period 2012-2017). Participants were 689 students in 4th grade (baseline; age=9.2 ± 0.4 years), and 647 students in 5th grade (age=10.5 ± 0.5 years). Nine salivary cortisol measures per child (2 awakening and 1 prior to bed for 3 sequential days) (n = 1336 child phenotype days; n = 7987 cortisol assays), 10 cytokines measured in morning and evening saliva samples (n = 202 child phenotype days), and lipids were measured. Clinical outcomes were blood pressure, weight and height (body mass index [BMI]; BMI = kg/m2), among others.

FINDINGS

Upon-waking cortisol levels were 0.28 ± 0.13 µg/dL, 30-minute post-waking 0.33 ± 0.15 µg/dL, and evening 0.08 ± 0.10 µg/dL. Salivary cytokine levels (n = 202) showed interleukins (IL) IL-1β and IL-8 were highest in early morning (upon awakening; AM), and IL-6 and tumor necrosis factor (TNF) TNF-α highest before bed (PM) (IL-1β AM > PM [-4.02 fold; p < 0.001]; IL-8 AM > PM [-1.36 fold; p < 0.001]; IL-6 AM < PM [+1.49 fold; p < 0.001]; TNF-α AM < PM [+1.73 fold; p = 0.03]. Regression modeling showed high morning cortisol was associated with high morning IL-1β (p = 3.82 ×10-6), but low evening IL-1β (p = 6.27 ×10-4). Regression modeling of BMI z-score as the response variable showed the expected significant relationships to high density lipoprotein (HDL) (negative; p < 0.001), mean arterial pressure (positive; p < 0.001), and morning cortisol (negative; p = 0.01) but only weak relationships to either evening cortisol (p = 0.1) or cytokine (positive; p = 0.02; from the model with smallest Rsquared) levels.

INTERPRETATION

We provide preliminary data on diurnal fluctuations of inflammatory cytokines in saliva in a population-based cohort of children. Correlation of morning and evening cortisol levels with inflammatory cytokines in the same saliva samples showed that high morning cortisol was associated with high morning IL-1β and low evening IL-1β. Future studies may test the hypothesis that strong diurnal cycling of IL-1β may serve as a homeostatic mechanism keeping the immune system in check, and that low morning cortisol (possible circadian misalignment) may lead to less stringent control of inflammatory networks.

Sugar-Sweetened Beverages and Depressive and Social Anxiety Symptoms Among Children and Adolescents Aged 7–17 Years, Stratified by Body Composition

Background

Rare studies investigated the associations between sugar-sweetened beverage (SSB) consumption with depressive and social anxiety symptoms among children and adolescents, particularly in different stratification of body composition, which was our purpose.

Methods

A cross-sectional survey of children and adolescents aged 7–17 years was conducted in Beijing, China, in 2020, with an average age of 12.07 (SD: 3.09) years. Children's Depression Inventory (CDI) questionnaires and social anxiety scale for children (SASC) were completed in the baseline questionnaires. SSB consumption and body composition were assessed using child-reported questionnaires and a GE Healthcare Lunar iDXA dual-energy X-ray bone densitometer. Multivariate logistic regression was used to assess the associations between SSB consumption with depressive and social anxiety symptoms. Confounders were evaluated by child-reported and parental questionnaires, including age, sex, parental educational attainment, maternal smoking status, single-child status, BMI, incomes, fruit consumption, physical activity, screen time, and the frequency of fried food consumption. Stratified analyses were performed to explore whether the associations were influenced by body composition.

Results

A total of 1,311 children and adolescents, including 658 boys and 653 girls, were included in the final analysis. There were 13.96 and 29.75% of the study population with depressive and social anxiety symptoms, respectively. Overall, about 63.77% of the children and adolescents consumed SSB, and the average SSB intake was 0.35 servings per day. In the fully adjusted model, compared to participants who did not consume SSB each day, SSB consumption of ≥1 servings/day was positively associated with depressive symptoms [odds ratio (OR) = 2.28, 95% CI = 1.30–4.01] and social anxiety (OR = 1.10, 95% CI = 0.69–1.77), though the latter did not reach statistical significance. When individuals had higher body fat or lower fat-free mass (FFM) or muscle, the ORs of depressive symptoms were more evident among children and adolescents who drank SSB for ≥1 servings/day (P < 0.05).

Conclusion

Higher consumption of SSB could be associated with increased OR of depressive symptoms in children and adolescents. The association remained robust, especially in groups with higher body fat or lower fat-free mass or muscle.

Can sweet food-specific inhibitory control training via a mobile application improve eating behavior in children with obesity?

OBJECTIVES

Consumption of excess sugar, a common energy-dense nutrient-poor food, is a risk factor for obesity in school-aged children. Food-specific inhibition training, where responses to palatable food stimuli, such as sweet foods, are consistently and repeatedly inhibited, reduces sweet food intake in adults. However, no studies have yet examined the effectiveness of inhibitory control training specifically targeting sweet foods among children with high sugar cravings. We examined whether sweet food-specific inhibitory control training (SF-ICT), administered via a mobile app, reduced choice and consumption of sweet foods, and weight in a sample of children aged 7-11 with overweight or obesity and who had high sugar cravings (N = 46).

DESIGN

This study was designed as a 2 × 3 between-within design.

METHODS

Participants were randomly allocated to a single-blind design with two conditions: they either received 7 sessions of active or control go/no-go training in which either sweet foods or non-food cues were paired with no-go signals. Participants' weight, sweet food choice, and consumption were measured pre and post-training, and at three-month follow-up.

RESULTS

The results revealed that participants in the active group showed a significant reduction in sweet food choice and intake from pre to post-training relative to the control group. The effects of the training on reducing sweet food intake persisted over the 3-month follow-up No significant changes in weight loss were observed.

CONCLUSIONS

These results provide preliminary evidence that sweet food-specific inhibitory control training (SF-ICT) via a mobile app is effective in modifying eating behavior among children with excessive consumption of sugary foods. Further research is required to clarify under what conditions the benefits of training would expand to weight loss.

Liraglutide combined with intense lifestyle modification in the management of obesity in adolescents

OBJECTIVES

Childhood obesity is a public health concern worldwide, with rates continuing to rise, despite preventive measures. Lifestyle modification remains the mainstay in the treatment of patients with excessive weight, but unfortunately, this is not always successful. Options for medical management of obesity in the paediatric population are limited.

METHODS

Seven adolescents (all girls, mean age 14.9 years) with a body mass index (BMI) above 98th percentile and serious complications secondary to obesity were offered an intense weight management programme. The participants were reviewed by a multidisciplinary team every two weeks for advice and support, and treated with daily subcutaneous injections of liraglutide (dose range 1.2-3.0 mg). Scores for anxiety and depression were evaluated using the Revised Child Anxiety and Depression Scale.

RESULTS

The results showed a significant weight loss over the three months with an average reduction of 5.4 kg (4.2%; 95% CI 1.93-8.78; p=0.0087). The mean drop in BMI was 2.1 kg/m², which is statistically significant (95% CI 0.973-3.199; p=0.0037). Resolution of complications (raised intracranial pressure and steatohepatitis) was noted following weight loss. Anxiety and depressive symptoms improved over the three-month intervention course, especially features of separation anxiety disorder. Liraglutide was well tolerated by all patients.

CONCLUSIONS

Liraglutide medication, alongside a dedicated multidisciplinary team guided lifestyle therapy, is effective and safe in the treatment for excessive weight in adolescents, leading to the reversal of the complications related to obesity and improvement in the psychological symptoms.

Body mass index and peer victimization: A transactional model

Past research has shown concurrent associations between adolescent's body mass index (BMI) and classroom bullying victimization experiences. The goal of this three‐wave longitudinal study is to examine a transactional model of associations between BMI and bullying victimization among adolescents in India. We investigate concurrent unidirectional and bidirectional relations between BMI and victimization. In a sample of 1238 students from nine schools (Grades 7–9; M‐age_T1 = 13.15, SD = 1.16) in Indore, India, we used self‐ and peer‐reports to measure bullying victimization in the classroom, and objective measurement of students' height and weight to collect data on adolescents' BMI, across three waves in one school year. Structural equational modeling was used to test transactional relations between BMI and bullying victimization. For self‐reported victimization, there was no concurrent or over time association between BMI and victimization for boys or girls in the present study. For peer‐reported victimization, we observed concurrent associations between BMI and victimization for boys and girls and a prospective relation where higher BMI corresponded to less victimization over time for boys. The study yielded mainly concurrent relations between BMI and victimization among adolescents in India. Results from western countries may not generalize to India.

Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis

BACKGROUND

Clinical depression (including major depression, dysthymia, and unspecified depression) is common in children and adolescents with obesity and overweight. The objective of this systematic review and meta-analysis was to examine prevalence of clinical depression among overweight and obese children.

METHODS

PubMed, EMBASE, Web of Science, Medline, Cochrane library, and PsycINFO databases were systematically and independently searched by three researchers from the inception dates to April 01, 2019. The fixed-effects model was used to perform meta-analysis. Data analyses were performed with STATA Version 12.0.

RESULTS

Eleven studies with 69,893 subjects were included; 5 studies examined major depressive disorder (MDD), while the remaining 6 studies examined other types of clinical depression. In the overweight and obese group, the prevalence of clinical depression ranged from 1.7% to 26.7% in obese subjects and from 4.0% to 16.9% in overweight subjects. In studies on MDD, prevalence ranged from 10.1% to 26.7% in obese subjects and from 9.0% to 16.9% in overweight subjects. The odd ratios (ORs) of clinical depression ranged from 0.92 to 4.39 between obese subjects and healthy controls (i.e., normal-weight controls), and ranged from 0.96 to 1.67 between overweight subjects and controls. Compared to healthy controls, obese (OR = 1.851, 95% CI: 1.410-2.429) but not overweight (OR = 1.068, 95% CI: 0.889-1.283) children and adolescents were more likely to have MDD.

CONCLUSION

Obese children and adolescents had a significantly higher risk for MDD compared with healthy controls. Considering the negative health outcomes of depression, regular screening and effective treatments should be implemented for obese children and adolescents.

An educational intervention to prevent overweight in pre-school years: a cluster randomised trial with a focus on disadvantaged families

BACKGROUND

Early prevention is a promising strategy for reducing obesity in childhood, and Early Years settings are ideal venues for interventions. This work evaluated an educational intervention with the primary aim of preventing overweight and obesity in pre-school children.

METHODS

A pragmatic, cluster randomised trial with a parallel, matched-pair design was undertaken. Interventions were targeted at both the cluster (Early Years' Centres, matched by geographical area) and individual participant level (families: mother and 2-year old child). At the cluster level, a staff training intervention used the educational resource Be Active, Eat Healthy. Policies and provision for healthy eating and physical activity were evaluated at baseline and 12-months. The intervention at participant level was the Healthy Heroes Activity Pack: delivered over 6 months by Centre staff to promote healthy eating and physical activity in a fun, interactive way. Child and parent height and weight were measured at four time-points over 2 years. The trial primary outcome was the change in BMI z-score of the child between ages 2 and 4 years. Secondary outcomes consisted of parent-reported measures administered at baseline and two-year follow-up.

RESULTS

Five pairs of Early Years' Centres were recruited. Four pairs were analysed as one Centre withdrew (47 intervention families; 34 control families). At the cluster level, improvement in Centre policies and practices was similar for both groups (p = 0.830). At the participant level, the intervention group reduced their mean BMI z-score between age 2 and 4 years (p = 0.002; change difference 0.49; 95% CI 0.17 to 0.80) whereas the control group showed increasing BMI z-score throughout. Changes in parent-reported outcomes and parent BMI (p = 0.582) were similar in both groups.

CONCLUSIONS

The Healthy Heroes educational resource deterred excess weight gain in pre-school children from poor socioeconomic areas. With training, Early Years' staff can implement the Healthy Heroes programme.

TRIAL REGISTRATION

ISRCTN22620137 Registered 21st December 2016.

Weight status and nonadherence to asthma maintenance therapy among children enrolled in a public drug insurance plan

Objective: The pediatric obese-asthma phenotype is associated with poor control, perhaps because of medication nonadherence. This study aimed to assess whether weight status is associated with nonadherence in children prescribed new asthma maintenance therapies.Methods: A historical cohort was constructed from a clinical database linking individual patient and prescription data to Quebec's prescription claims registry. Children aged 2-18 years with specialist-diagnosed asthma who were newly prescribed one of the following maintenance controllers: leukotriene receptor antagonists (LTRA); low-dose inhaled corticosteroids (ICS); medium/high-dose ICS; or combination therapy (ICS with long-acting beta-2 agonists and/or LTRA), at the Asthma Center of the Montreal Children's Hospital from 2000-2007 were included. Primary nonadherence was defined as not claiming any prescriptions, whereas secondary nonadherence was measured with the proportion of prescribed days covered (PPDC ≤ 50%) among primary adherers over a 6-month follow-up period. A modified Poisson regression model served to estimate the effect of excess weight (BMI > 85^th percentile) on primary and secondary nonadherence.Results: Approximately one third of patients were primary nonadherers and 60% took less than 50% of prescribed therapy. Excess weight was associated with a trend toward increased risk of primary nonadherence in children newly prescribed low-dose ICS (RR 1.53, 95%CI 0.94-2.49), and of secondary nonadherence in children initiating medium/high-dose ICS (RR 1.24; 95%CI 0.98-1.59).Conclusions: Excess weight status is a possible determinant of primary nonadherence in children initiating low-dose ICS and secondary nonadherence to higher-dose ICS regimens. This hypothesis-generating study suggests that nonadherence may be a potential contributor to higher morbidity in children with obese-asthma.

Post-2000 growth trajectories in children aged 4-11 years: A review and quantitative analysis

Children's body mass index (BMI) growth trajectories are associated with adult health outcomes, and vary by geography and epoch. Understanding these trajectories could help to identify high risk children and thus support improved health outcomes. In this review, we compare and quantitatively analyse BMI level and trajectory data published since 2010. We characterise recent growth in children aged 4-11 years, an age range most frequently targeted for BMI intervention, yet less studied than young childhood or infancy. Through searches in OVID, we identified 54 relevant texts which describe either post-2000 summary BMI values by age and gender in cohorts with sample sizes of over 1000 children, or the results of latent class analyses of BMI trajectories within the 4-11 year age range. Population level median growth curves were projected and visualised as weighted means. These BMI curves, based on data from 729,692 children, can be visually clustered into 'high' and 'low' charting groups with extreme outlying values. Within populations, latent class analyses converge on 3-4 individual child trajectories, two of which predispose adult overweight. These growth pathways diverge early in childhood, yet are not effectively distinguished via isolated BMI measurements taken between 4 and 11 years, meaning some high risk children may currently be poorly identified.

A traditional dietary pattern is associated with lower odds of overweight and obesity among preschool children in Lebanon: a cross-sectional study

PURPOSE

The high burden of preschool overweight in the Middle East and North Africa highlights the need for rigorous investigations of its determinants. This study aims at identifying dietary patterns amongst preschoolers in Lebanon and assessing their association with overweight and obesity.

METHODS

A national cross-sectional survey was conducted amongst 2-5-year-old children (n = 525). Socio-demographic, dietary, lifestyle and anthropometric variables were collected. Dietary patterns were derived by factor analysis. Overweight/obesity was defined based on the World Health Organization 2006 criteria (BMI-for-age z-score > + 2).

RESULTS

Two patterns, "Fast Food and Sweets" and "Traditional Lebanese", were identified. The "Fast Food and Sweets" pattern was characterized by higher consumption of sweetened beverages, fast foods, salty snacks and sweets. The "Traditional Lebanese" was driven by higher intakes of cereals, dairy products, fruits and vegetables. Children belonging to the 3rd tertile of the Traditional pattern scores had significantly lower odds of overweight/obesity compared to the 1st tertile (OR 0.33; 95% CI 0.11, 0.97). Higher maternal education and higher frequency of eating with family predicted adherence to the traditional pattern, while the presence of a household helper was a negative determinant. Adherence to the Fast Food and Sweets pattern was positively associated with the child's age, and negatively associated with female gender and maternal education.

CONCLUSIONS

The "Traditional Lebanese" pattern was associated with decreased risk of preschool overweight. Policies aiming at re-anchoring this traditional dietary pattern in contemporary lifestyles may be developed as potential preventive strategies against overweight in this age group.

Human Wounds and Its Burden: An Updated Compendium of Estimates

Significance: A 2018 retrospective analysis of Medicare beneficiaries identified that ∼8.2 million people had wounds with or without infections. Medicare cost estimates for acute and chronic wound treatments ranged from $28.1 billion to $96.8 billion. Highest expenses were for surgical wounds followed by diabetic foot ulcers, with a higher trend toward costs associated with outpatient wound care compared with inpatient. Increasing costs of health care, an aging population, recognition of difficult-to-treat infection threats such as biofilms, and the continued threat of diabetes and obesity worldwide make chronic wounds a substantial clinical, social, and economic challenge. Recent Advances: Chronic wounds are not a problem in an otherwise healthy population. Underlying conditions ranging from malnutrition, to stress, to metabolic syndrome, predispose patients to chronic, nonhealing wounds. From an economic point of view, the annual wound care products market is expected to reach $15-22 billion by 2024. The National Institutes of Health's (NIH) Research Portfolio Online Reporting Tool (RePORT) now lists wounds as a category. Future Directions: A continued rise in the economic, clinical, and social impact of wounds warrants a more structured approach and proportionate investment in wound care, education, and related research.

Weight Loss in Adolescents After Bariatric Surgery: A Systematic Review

INTRODUCTION

Bariatric surgery is a treatment option for the obese adolescent. There are three primary surgical procedures: the bypass, sleeve gastrectomy, and lap band. The most recent literature was reviewed to examine changes in weight, comorbidities, and complications after bariatric surgery in the adolescent.

METHOD

A systematic search was performed to identify original research articles published in the United States between the years of 2000 and 2017 with patients between the ages of 11 and 21 years that provided greater than 30 days of results.

RESULTS

A total of 23 articles were identified. Weight loss, improvement in comorbidities, and complications after all procedures were reported.

DISCUSSION

Outcomes were not reported in a standardized fashion, creating much difficulty in interpreting and comparing results. The sleeve gastrectomy is increasing in incidence, whereas the lap band is decreasing. Further research is needed to draw more definitive conclusions regarding long-term results in the adolescent undergoing bariatric surgery.

Analyzing the distinguishing factors that affect childhood obesity in South Korea

Understanding obesity in children is crucial because it can lead to adulthood obesity and result in fatal chronic diseases. Distinctive factors associated with obesity in adults have been described, but distinctive factors related to children remain unclear. We analyzed the correlation between the percentage of body mass index and lifestyle habits by conducting surveys on physical, nutritional, and psychological factors, and we used annual physical examination data to compare different traits among elementary school students (n = 197) and middle school students (n = 461). Our study revealed that the computing hours in elementary school students with overweight and obesity were significantly correlated with the percentage of body mass index (r = 0.29 on school days and r = 0.35 on days off, all P < 0.05). No statistically significant difference was found (all P > 0.05) in the computing hours of middle school students with overweight and obesity. Childhood obesity can cause depression and reduce children's quality of life because of their distorted body perception. In conclusion, physical factors directly affecting childhood obesity and psychological and environmental factors surrounding a child should be considered.

Dietary factors and their association with childhood obesity in the Middle East: A systematic review

BACKGROUND:

Childhood obesity is a global epidemic that is related to environmental and genetic factors and has adverse consequences throughout life, being obese is a serious health problem in childhood and increases the risk of many co-morbidities.

AIM:

The purpose of this systematic review is to illustrate that dietary factors correlate with obesity among children studied in the Middle East area.

METHODS:

Studies were screened by searching two databases in August 2017 and considered as eligible for inclusion if they: (a) are observational studies, (b) define at least one dietary factor for obese children aged 6-12 years, (c) are undertaken in the Middle East area, and (d) are written in English. The search dependent words and terms used are: diet, nutrition, pediatric obesity, physical activity, Middle East, overweight, children, excess weight, childhood, obesity and dietary factors. Papers were initially evaluated for eligibility based on title and abstract. The full text of articles of studies that met, or appeared to meet, the inclusion criteria, were saved. Quality assessment was conducted using the NIH tool for observational cohort and cross-sectional studies. Out of 730 studies, 4 papers met the inclusion criteria and rated as good quality. These studies were from Iran ( n=2), Saudi Arabia ( n=1) and Lebanon ( n=1) during 2008 and 2016.

RESULTS:

Dietary factors identified were breakfast intake, junk-food consumption, energy intake and micronutrient intake. The present systematic review shows that several dietary behaviors such as missing breakfast, excessive fat and refined carbohydrate intake with low micronutrient intake due to low consumption of fruits, vegetables and milk/diary, are associated with obesity in children in the Middle East.

CONCLUSIONS:

A healthy diet during childhood to control weight and prevent obesity is recommended for a healthy, lifelong adulthood.

Gut Microbiota Markers in Obese Adolescent and Adult Patients: Age-Dependent Differential Patterns

Obesity levels, especially in children, have dramatically increased over the last few decades. Recently, several studies highlighted the involvement of gut microbiota in the pathophysiology of obesity. We investigated the composition of gut microbiota in obese adolescents and adults compared to age-matched normal weight (NW) volunteers in order to assemble age- and obesity-related microbiota profiles. The composition of gut microbiota was analyzed by 16S rRNA-based metagenomics. Ecological representations of microbial communities were computed, and univariate, multivariate, and correlation analyses performed on bacterial profiles. The prediction of metagenome functional content from 16S rRNA gene surveys was carried out. Ecological analyses revealed a dissimilarity among the subgroups, and resultant microbiota profiles differed between obese adolescents and adults. Using statistical analyses, we assigned, as microbial markers, Faecalibacterium prausnitzii and Actinomyces to the microbiota of obese adolescents, and Parabacteroides, Rikenellaceae, Bacteroides caccae, Barnesiellaceae, and Oscillospira to the microbiota of NW adolescents. The predicted metabolic profiles resulted different in adolescent groups. Particularly, biosynthesis of primary bile acid and steroid acids, metabolism of fructose, mannose, galactose, butanoate, and pentose phosphate and glycolysis/gluconeogenesis were for the majority associated to obese, while biosynthesis and metabolism of glycan, biosynthesis of secondary bile acid, metabolism of steroid hormone and lipoic acid were associated to NW adolescents. Our study revealed unique features of gut microbiota in terms of ecological patterns, microbial composition and metabolism in obese patients. The assignment of novel obesity bacterial markers may open avenues for the development of patient-tailored treatments dependent on age-related microbiota profiles.

Parenting practices and overweight status of junior high school students in China: A nationally representative study of 19,487 students from 112 schools

The study aimed to examine the level of parental responsiveness and demandingness for junior high students in China and its association with child weight status; assess if it differs by student socio-demographic characteristics; and to test the association between parenting and child physical activity. Nationally representative survey data collected from 19,487 students in 112 middle schools across China in 2013-2014 academic year were analyzed in 2016. Children's anthropometrics and perceptions of parenting practices were accessed by self-administered questionnaire. Multilevel logistic regression models were fit to test the association controlling for child age, sex, school region, and parental education. The majority of adolescents reported their parents were highly responsive in terms of emotional support and involvement (high: 64.1% vs. low: 9.2%), although more parents were not perceived as highly demanding (high: 21.4% vs. low: 35.5%). Children were more likely to be overweight or obese if their parents were highly responsive (OR=1.4 [95%CI: 1.2,1.6]) and demanding (OR=1.1 [95%CI: 1.0,1.3]) compared to those with medium parenting scores. Older children, boys, children with highly educated parents, or in urban schools had greater odds of being overweight or obese by receiving highly responsive parenting compared to their counterparts. Children with highly demanding or responsive parenting had longer physical activity duration and higher physical activity participation rates than their counterparts. High responsiveness and demandingness among Chinese parents were associated with the risk of child overweight and obesity. Further research is needed to examine the causal relationship between parenting practices and childhood obesity in China.

The Body Mass Index of Adolescents Attending Seventh-Day Adventist Schools in Australia: 2001-2012

BACKGROUND

We examined the body mass index (BMI) of students attending Seventh-day Adventist (Adventist) schools in Australia in 2001 and 2012.

METHODS

A total of 3069 students attending Adventist schools in Australia responded to a health and lifestyle survey in 2001 (N = 1335) and 2012 (N = 1734). The survey captured self-reported height and weight, demographics (age, sex, year level, religion), and select health behaviors.

RESULTS

Compared with national norms, lower rates of overweight and obesity were observed in the study cohort, but higher rates of underweight. There was no change in the mean BMI of the students attending Adventist schools in Australia from 2001 to 2012. Regression analyses indicated that a lower BMI was associated with age, sex, more regularly eating breakfast, consuming less soft drink, and having a regular exercise program. The students reported a high consumption of fruits, vegetables, and whole grains compared with Australian national norms, and 29% claimed to be vegetarian.

CONCLUSIONS

Students attending Adventist schools appear to have a lower prevalence of overweight and obesity than the secular population, but a higher prevalence of underweight. The mechanisms through which Adventist schools may influence student's BMI warrants further investigation.

Prebiotics as a modulator of gut microbiota in paediatric obesity

This review highlights our current understanding of the role of gut microbiota in paediatric obesity and the potential role for dietary manipulation of the gut microbiota with prebiotics in managing paediatric obesity. The aetiology of obesity is multifactorial and is now known to include microbial dysbiosis in the gut. Prebiotics are non-digestible carbohydrates which selectively modulate the number and/or composition of gut microbes. The goal of prebiotic consumption is to restore symbiosis and thereby confer health benefits to the host. There is convincing evidence that prebiotics can reduce adiposity and improve metabolic health in preclinical rodent models. Furthermore, there are several clinical trials in adult humans highlighting metabolic and appetite-regulating benefits of prebiotics. In paediatric obesity, however, there are very limited data regarding the potential role of prebiotics as a dietary intervention for obesity management. As the prevalence of paediatric obesity and obesity-associated comorbidities increases globally, interventions that target the progression of obesity from an early age are essential in slowing the obesity epidemic. This review emphasizes the need for further research assessing the role of prebiotics, particularly as an intervention in effectively managing paediatric obesity.

Serum C-reactive protein levels and body mass index in children and adolescents with CHD

BACKGROUND

The prevalence of overweight in children with CHD is about 26.9%. Increase in adipose tissue is related to the secretion of proinflammatory markers such as C-reactive protein. Assuming that children with CHD are exposed to other inherent risk factors for heart disease, our objective was to evaluate the correlation between levels of C-reactive protein and body mass index in children and adolescents with CHD.

METHODS

A cross-sectional study with 377 children and adolescents with CHD in a clinical setting of a reference hospital was carried out. C-reactive protein data were collected after 12 hours of fasting. Nutritional status was classified according to body mass index. The patients were divided into three groups: cyanotic, acyanotic, and minimal heart defects (controls).

RESULTS

The mean age was 9.9±4.2 years, and 53.6% of the sample included males. The cyanotic group represented 22.3%, acyanotic 42.2%, and minimal defects 35.5% of the sample. The average body mass index percentile was 57.23±32.06. The median values of C-reactive protein were as follows: cyanotic 0.340, acyanotic with clinical repercussion 0.203, and minimal defects 0.128. There was a significant difference between the minimal defects and the cyanotic groups (p=0.023). There was a significant correlation between C-reactive protein and body mass index percentile (r=0.293, p<0.01). C-reactive protein levels were higher in girls (p=0.034). There were no significant correlations between C-reactive protein and age or birth weight.

CONCLUSION

The correlation between body mass index percentile and C-reactive protein was confirmed in this population. The prevention of overweight is paramount to avoid overlapping modifiable risk factors to those already inherent to the CHD.

Psychological consequences of childhood obesity: psychiatric comorbidity and prevention

Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs.

Association of some psychosocial factors with anthropometric measures in nationally representative sample of Iranian adolescents: the CASPIAN-III study

Background

During the last two decades, adolescent obesity has increased in western countries. In Iran-as a developing country- the prevalence of obesity is raised among youngsters as well. This study conducted to identify an association of adolescents’ loneliness, self-confidence and relationship with others in home and school environment with their weight status.

Methods

In this cross-sectional national survey, 5682 students aged 10–18 years from urban and rural districts of 27 provinces of Iran were selected via stratified multi-stage sampling method. Data on psychological problems of students was gathered through a questionnaire. Height, weight, and waist circumferences were measured according to standard protocols. Body mass index (BMI) and waist- to-height ratio was calculated.

Results

Boys which did not have best friends, spend time with their friends after school or get acceptance from them, had higher BMI than others. Only girls who did not spend time with their friends had higher BMI (19.48 ± 4.28) vs. (19.09 ± 3.92) and WC (71.04 ± 21.29) vs. (69.15 ± 17.43) than others, P < 0.05. In both sexes, adolescents who had sense of pressure about doing homework or had difficulties in relationship with their parents had higher BMI and WC values. Girls who reported being victim of violent behaviors (being bullied), had lower BMI compared to others. Risk of being overweight and obese, but not abdominal obese was statistically higher in adolescents not having close friends (OR = 1.81, CI: 1.11–2.95). Lack of self-confidence increased only the risk of obesity in teens (OR = 1033, CI: 1.09–1.64).

Conclusions

Our findings suggest that strategies for prevention of overweight and obesity in adolescent should be taking into account a deeper knowledge of psychosocial issues due to be able to design more effective programs for treating overweight teens.

Rural-Urban Differences in Perceptions of Child Overweight Among Children and Adolescents, Their Guardians and Health Care Professionals in the United States

RESEARCH OBJECTIVE

Children and adolescents residing in rural environments with higher prevalence of an overweight population may develop inaccurate perceptions of a healthy weight. This study examines rural-urban differences in perceptions of child overweight among overweight (85 ≤ BMI percentile < 95) and obese children (BMI percentile ≥ 95), their guardians and health care providers (HCPs), and children's concomitant weight control.

METHODS

The cross-sectional study was based on the 2005-2010 NHANES data (1,844 overweight and obese children and adolescents, aged 8-15 years). Rurality was defined using the 2003 RUCC. The weight status was based on the standardized measures of children's height and weight. Children reported whether they considered themselves overweight and whether they were trying to lose weight. Proxy respondents (ie, guardians) reported whether they considered their child to be overweight and whether an HCP had ever told them their child was overweight. Weighted percentages and predicted probabilities from multivariable logistic regressions were calculated, accounting for the complex, multistage, probability sampling design and nonresponse.

FINDINGS

Rural residents comprised 18.8% of the study population; 41.8% of them were overweight and 58.2% were obese compared to 46.7% and 53.3% of urban peers, respectively. Misperceptions of children's weight status were 11.3 and 6.0 percentage points higher in rural children and their guardians, respectively. Recall of an HCP identification of child overweight was 6.3 percentage points lower among rural versus urban guardians.

CONCLUSION

Obesity prevention efforts may be fostered by improving accuracy of child overweight perceptions. This may be particularly impactful in rural settings, where weight misperceptions are high.

Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents

Australia is predicted to have the highest overweight/obesity rate in the world by 2022 outranking the USA and UK. The purpose of this systematic review was to evaluate the associations between childhood obesity and physical and psychological health co-morbidities. Therefore, a systematic literature search was conducted from six databases (2004-2014). Studies were included if they investigated obesity-related co-morbidities with participants residing in Australia aged 0-18 years. Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of non-alcohol fatty liver disease and were experiencing more negative psychological outcomes (depression, low self-esteem and lower scores of health-related quality of life). Many other health consequences have either not been investigated in Australia, or as frequently as in other countries.

CONCLUSIONS

Given Australia's current overweight/obesity prevalence and trajectory, Australia-based studies are needed to identify the suspected co-morbidities, understand the range of individual, social and environmental mechanisms driving obesity, and help identify policies, interventions and strategies that will change the future trajectory and 'disease burden' both in Australia and internationally.

WHAT IS KNOWN

• Trend analyses have shown that obesity prevalence in Australia is increasing and will outrank UK and the USA by 2022. • Every third Australian child/adolescent between 5 and 19 years old is predicted to be classified as overweight or obese by 2025. • Childhood obesity is associated with multiple immediate physical and psychological health co-morbidities as well as co-morbidities in adulthood. These have often been identified and examined individually. What is New: • This paper presents a holistic picture of childhood obesity and the associated multiple co-morbidities in Australia. • The extensive health-related outcomes from childhood obesity and those requiring further research are identified. • The findings of this paper will influence the development of local/regional, state and national strategies to change Australia's future trajectory.