An Update on Mental Health Problems and Cognitive Behavioral Therapy in Pediatric Obesity

A family-based behavioral group obesity randomized control feasibility trial across a clinical trials network: a focus on contact hours

OBJECTIVE

This ancillary study's purpose is to describe the relationship between dose of treatment and body mass index (BMI) outcomes in a tele-behavioral health program delivered in the IDeA States Pediatric Clinical Trials Network to children and their families living in rural communities.

METHODS

Participants randomized to the intervention were able to receive 26 contact hours (15 hr of group sessions and 11 hr of individual sessions) of material focused on nutrition, physical activity, and behavioral caregiver training delivered via interactive televideo. Dose of the intervention received by child/caregiver dyads (n = 52) from rural areas was measured as contact hours. The total doses of group, individual, and total contact hours were analyzed, and generalized linear mixed models were utilized to determine how dose received impacted BMI outcomes.

RESULTS

The majority (64.4%) of participants received the target of at least 80% (20.8 hr) of the total intervention dose. Older children (9-11 years) achieved significantly less intervention dose than targeted (M = 19.7; p = .031); as did males (M = 17.2; p < .001), children who identified as Black (M = 17.8; p < .001), and children from Site 3 (M = 18.0; p < .001). Dose was not significantly related to BMI outcomes in children or caregivers.

CONCLUSIONS

As this study is underpowered and took place during the early stages of the COVID-19 pandemic, results should be interpreted with caution, but contact hours did not predict health outcomes for families living in rural communities.

Effects of school closure on lifestyle behaviours and health outcomes in children during the COVID-19 pandemic in Chile: A time-matched analysis

BACKGROUND

The COVID-19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self-esteem, self-concept) in children.

METHODS

We measured 247 children before school closure (October-November 2019) and after school reopening (October-November 2021) (COVID-19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age-matched children with cross-sectional measurements in October-November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two-way ANOVA was used to test age-by-group interactions, indicating an effect of school closure.

RESULTS

In 7-to-9-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger-than-expected increases in fat percentage (by 6.1 percent point). In 8-to-10-year-old children, the COVID-19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger-than-expected increases in fat percentage (by 8.3 percent points), z-score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9-to-11-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.3 points) and increases in self-concept (by 0.2 points). The response in dietary habits, fitness, or self-esteem was not different between groups.

CONCLUSION

Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children.

Testing a family system-based intervention (ENTREN-F Programme) for a paediatric obesity sample by a randomized controlled trial

This study evaluated the effectiveness of 'ENTREN-F' -a multi-component, family system-based intervention-for managing paediatric obesity at National Health Primary Care. A 3-arm, parallel-design, single-blinded randomized controlled trial (RCT), 165 families were randomized: Arm 1) ENTREN-F(n = 62) is a 12-week cognitive-behavioural intervention (CBT) family system-based programme, addressing lifestyle changes, children's emotional and social development and the family system, Arm 2) 'ENTREN' (n = 52) is a CBT family-based programme for children and parents, not addressing the family system, and Arm 3) Control group (CG) (n = 51) covers individual behavioural monitoring. All children were clinical interviewed to assess a diagnosis. Their effectiveness was assessed against six-month changes in children's body mass index (BMI) z-score, children's psychological well-being, levels of expressed maternal emotion, depression symptoms, parental feeding practices, levels of physical activity and sedentary lifestyles. The maintenance of the changes was evaluated for two years. High-attendance rates for ENTREN-F (72.6% vs. 66% vs. 33%, respectively) indicated its greater acceptance. After programme completion, the BMI z-score reduced by .5 points in almost 50% ENTREN-F (n = 22/45), 21.9% ENTREN (n = 7/32) and 11.8% (n = 2/17) CG participants. There were no significant differences between the three trial arms for anthropometric, psychological, or family-related measures. At the two-year follow-up, both ENTREN-F and ENTREN showed similar long-term effectiveness without between-group differences, and weight trajectories were favourable. ENTREN-F appears effective for childhood obesity management; however, the COVID-19 pandemic limited the sample size. Also, the tendency towards multiple differences in child and family outcomes could not be statistically shown. It also provides further evidence of the role of psychological and family-related factors that may underlie the origin and maintenance of weight gain.

Effectiveness of an mHealth App That Uses Financial Incentives and Gamification to Promote Health Behavior Change in Adolescents and Caregivers: Protocol for a Clinic-Based Randomized Controlled Trial

BACKGROUND

Adolescent and adult obesity continues to be a public health epidemic in the United States. Despite the popularity of mHealth apps with gamification among adolescents, there are insufficient studies to evaluate the efficacy of gamified mHealth apps and financial incentives to motivate sustained health behavior change in adolescents or their adult caregivers.

OBJECTIVE

This study aims to evaluate the effectiveness of gamification techniques and financial incentives used in the novel "CommitFit" mHealth app to motivate health behavior change and improve various mental and physical health metrics in adolescents and their caregivers.

METHODS

This study is a 3-month randomized controlled trial (RCT) with 30 adolescents (aged 13-15 years) and their adult caregivers (N=60). It evaluates "CommitFit," which uses gamification including points and leaderboards to motivate logging and achievement of self-selected health behavior goals (eg, more water, sleep, physical activity, fruits, or vegetables or fewer sugary beverages). The RCT had three arms, each with 10 dyads: (1) CommitFit-only users; (2) CommitFit$, where adolescents were paid US $0.05 for each point they earned; and (3) waitlist control. Intervention dyads used the app for 3 months and had the option to use it for the fourth month without prompts or extra financial incentives. User analytic software was used to evaluate the frequency of user logs and goal achievement. Monthly surveys evaluated self-reported change in the 5 CommitFit health behaviors. Changes in BMI and blood pressure were evaluated for all participants at 3 clinical visits. Mental health, gamification, and behavior economics surveys were completed during the clinical visits.

RESULTS

Recruitment began in August 2023 and was completed in 10 weeks. The research team successfully recruited and enrolled 30 dyads. Researchers emailed and called 89 caregivers on a physician-approved adolescent patient list, a 33% recruitment rate. Data collection and analysis will be conducted in the spring and summer of 2024. The results of this study are anticipated to be published between late 2024 and early 2025.

CONCLUSIONS

This RCT will expand knowledge of the effectiveness of gamification techniques, financial incentives, and mHealth apps to motivate sustained health behavior change among adolescents and caregivers. These results may offer new opportunities to caregivers, health insurers, health care systems, and clinicians to motivate health behavior change in adolescents and caregivers, with the ultimate goal of preventing or reducing obesity and obesity-related diseases. Additional gamification, mental health surveys, and app user analytics included in the study may provide further insight into the characteristics of adolescents or caregivers who would benefit the most from using a gamified mHealth app like CommitFit.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63505.

Tracking the Prevalence of Obesity in Portuguese School-Aged Children: What Future to Expect?

BACKGROUND

Childhood obesity presents a significant public health concern globally, with implications for cardiovascular health and metabolic syndrome. In Portugal, approximately 31.6% of children are affected, highlighting the urgency for intervention strategies. This study aimed to assess the prevalence of overweight and obesity in Portuguese school-aged children, with a focus on sex and age differences.

METHODS

Anthropometric measurements were conducted on 1564 children aged 6-10 years, including weight, height, and skinfold thickness. Body Mass Index (BMI) and the percentage of body fat were calculated using established methods.

RESULTS

The results revealed significant differences in BMI (≤0.001) and body fat percentage (≤0.001) among different BMI categories, with a notable prevalence of overweight and obesity, particularly among boys. A total of 37% of the studied population is overweight or obese, among which 40.1% and 33.9% are boys and girls, respectively.

CONCLUSIONS

This study highlights statistically significant differences in BMI and body fat percentage for both sexes in different BMI categories. A large proportion of the population is overweight or obese, with a greater prevalence in boys. In short, childhood obesity has a negative impact on body composition and is associated with significant differences in anthropometric parameters, emphasizing the importance of preventative and intervention strategies to address this health problem.

Systematic review and meta analysis of psychological interventions to prevent or treat pediatric chronic disease in rural communities

OBJECTIVE

The purpose of this systematic review and meta-analysis was to examine the effectiveness of psychological interventions at improving physical or mental health outcomes for youth living in rural communities who have, or are at-risk for, any chronic medical condition in comparison to control interventions conducted in rural communities.

METHODS

Following prospective registration (OSF.IO/7TDQJ), 7 databases were searched through July 1, 2023. Studies were included if they were a randomized control trial of a psychological intervention conducted with youth living in a rural area who had, or were at-risk for, a chronic medical condition. Risk of bias was assessed with the Cochrane risk of bias version 2 tool. A qualitative synthesis and meta-analysis were conducted.

RESULTS

15 studies met inclusion criteria. Obesity studies (n = 13) primarily focused on body mass index metrics, with limited significant findings across studies. Asthma treatment interventions (n = 2) showed no impact on hospitalizations. 3 studies evaluated mental health outcomes with no significant group differences observed. We meta-analytically analyzed 9 studies that evaluated body mass index z-scores and identified an overall null effect (Hedge's g = 0.01, 95% CI [-0.07, 0.09], p = .85).

CONCLUSIONS

Most included studies focused on pediatric obesity, and there was a limited range of health outcomes reported. Compared to controls, minimal significant improvements in health outcomes were identified for psychological interventions for youth living in rural communities. Future efforts may benefit from situating this work more systematically within a health disparities framework with a focus on understanding mechanisms of disparities and translating this work into interventions and policy changes.

What is the disease burden from childhood and adolescent obesity?: a narrative review

The prevalence of childhood and adolescent obesity has increased and exacerbated during the coronavirus disease 2019 pandemic, both in Korea and globally. Childhood and adolescent obesity poses significant risks for premature morbidity and mortality. The development of serious comorbidities depends not only on the duration of obesity but also on the age of onset. Obesity in children and adolescents affects almost all organ systems, including the endocrine, cardiovascular, gastrointestinal, reproductive, nervous, and immune systems. Obesity in children and adolescents affects growth, cognitive function, and psychosocial interactions during development, in addition to aggravating known adult comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, nonalcoholic fatty liver disease, obstructive sleep apnea, and cancer. Childhood and adolescent obesity are highly associated with increased cardiometabolic risk factors and prevalence of metabolic syndrome. The risk of cardiovascular and metabolic diseases in later life can be considerably decreased by even a small weight loss before the onset of puberty. Childhood and adolescent obesity is a disease that requires treatment and is associated with many comorbidities and disease burdens. Therefore, early detection and therapeutic intervention are crucial.

Risk Factors for Overweight and Obesity in Later School-Aged Children: Focus on Lifestyle Behaviours and Psychosocial Characteristics

The study analysed the 12th wave (2019) of data from the Panel Study on Korean Children conducted by the Korea Institute of Child Care and Education. A total of 1174 children were selected as the subjects of the study. The results concerning the identifying factors influencing overweight and obesity in later school-aged children revealed that when compared to boys, girls were 1.66 times more likely to be overweight or obese. Moreover, for every one-hour increase in media usage time, the likelihood of being overweight or obese increased by 1.23 times, and for every one-point increase in body dissatisfaction, the probability of being overweight or obese increased by 2.07 times. However, among personality traits, neuroticism was associated with a 0.96 times lower likelihood of being overweight or obese. These findings underscore the significance of considering not only lifestyle factors but also psychosocial characteristics such as body dissatisfaction and neuroticism as predictive factors for overweight and obesity in later school-aged children, providing a basis for intervention.

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.

Body Mass Index Changes in Children and Adolescents Treated with Methylphenidate for Attention Deficit Hyperactivity Disorder

Objectives

Attention Deficit Hyperactivity Disorder (ADHD) and obesity are major pediatric public health problems. The present study aimed to examine the association between these two health parties in our pediatric populations.

Materials & Methods

This study is a single group retrospective cohort study about Body Mass Index (BMI) changes in 149 children and adolescents between 3-18 years old with a diagnosis of ADHD based on one child and adolescent psychiatrist interview according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria (DSM-IV-TR). All participants were treated with methylphenidate. Besides, they were reassessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Persian version (K-SADS-PL-P). Furthermore, the height, weight, and BMI of participants were calculated. The data were analyzed by descriptive statistics, repeated measures, and Wilks' lambda analysis using IBM SPSS Statistics version 23.

Results

The mean age of patients was 8.2±2.6 years, and 71.8% were boys. The obtained results showed that those treated with methylphenidate for more extended periods had higher BMI increases (p <0.001). The change in BMI was not related to the age at the start of treatment (p = 0.125), but this index was significantly different based on the years under treatment (p = 0.002). Moreover, changes in BMI were not significant based on gender (p = 0.850), the type of ADHD specifiers (p= 0.686), and concomitant drugs (p = 0.783).

Conclusion

This study's findings suggest that long-term use of ADHD medications could raise the risk of obesity in children.

The Ongoing Impact of COVID-19 on Pediatric Obesity

In the developed world, pediatric obesity (PO) has been a major health concern since the last century, and this condition may lead to detrimental life-long physical and mental comorbidities. Currently, its prevalence has increased in low- and middle-income countries and in many high-income countries. Thus, the provision of effective and tailored care for children and their families has become vital. The social consequences of the COVID-19 pandemic are known everywhere, and among these, it has been argued that the COVID-19 pandemic has had a major impact on PO. Overall, the growth of PO over the last decade has been enhanced by the pandemic. During the COVID-19 pandemic, children, adolescents and young adults gained weight as the pediatric population dealt with sedentary lifestyles and changes in food habits. In this review, we want to highlight the impact that the COVID-19 pandemic had on PO.

Metabolic syndrome, adiposity, diet, and emotional eating are associated with oxidative stress in adolescents

Background

Metabolic syndrome (MS), a condition related to adiposity and oxidative stress, can develop in adolescence, a critical stage in life that impacts health in adulthood. However, there is scarce scientific research about the relationship between lifestyle factors, emotion management, and oxidative stress in this phase of life.

Aim

To analyze whether nutritional parameters, lifestyle factors, emotion management, and MS in adolescents are associated with oxidative stress measured by the biomarker 8-isoprostane.

Methods

A cross-sectional study was carried out in 132 adolescents (48.5% girls, aged 12 ± 0.48 years) and data were collected on nutritional parameters (anthropometric measurements, biochemical analyzes, and blood pressure), lifestyle factors (physical activity, sleep, and diet), and emotion management (self-esteem, emotional eating, and mood). 8-isoprostane was analyzed in spot urine samples. The study population was categorized in three groups (healthy, at-risk, and with MS) using the International Diabetes Federation definition of MS in adolescents. To capture more complex interactions, a multiple linear regression was used to analyze the association between 8-isoprostane and the aforementioned variables.

Results

Urinary 8-isoprostane levels were significantly higher in the MS group compared to the healthy group (1,280 ± 543 pg./mg vs. 950 ± 416 pg./mg respectively). In addition, univariable analysis revealed positive significant associations between 8-isoprostane and body mass index, waist circumference, waist-to-height ratio, body fat percentage, blood lipid profile and glucose, emotional eating, and refined cereal intake. Conversely, a negative significant association was found between 8-isoprostane and sleep duration and fish intake. The multiple linear regression analysis revealed associations between 8-isoprostane and LDL-c (β = 0.173 value of p = 0.049), emotional eating (low β = 0.443, value of p = 0.036; high β = 0.152, value of p = 0.470), refined cereal intake (β =0.191, value of p = 0.024), and fish intake (β = -0.187, value of p = 0.050).

Conclusion

The MS group, LDL-c, emotional eating, and high refined cereals and low fish intakes were associated with higher levels of oxidative stress in an adolescent population.

Adequacy of energy and macronutrients intake in differently active slovenian adolescents

OBJECTIVE

Evaluate the adequacy of energy/macronutrient intake in adolescents according to the Slovenian national recommendations adopted from the recommendations of the German Nutrition Society and to identify differences in energy/macronutrient intake between differently active adolescents.

METHODS

Data on energy and macronutrient intake (24-hour dietary recall), physical activity (SHAPES questionnaire), and anthropometric characteristics (body mass and height) of adolescents were obtained on a representative sample of first-year secondary school students (average (SD) age: 15.3 (0.5) years; N = 341), who were included in the national survey The Analysis of Children's Development in Slovenia (ACDSi) in 2013/14.

RESULTS

75% of adolescents met the national recommendations for carbohydrates and proteins and 44% for fats, whereas only 10% of adolescents met the recommendations for energy intake. Energy/macronutrient intakes were significantly higher in vigorously physically active (VPA) boys compared to moderately (MPA) and less (LPA) physically active boys. No such differences were observed between girls of different physical activity levels.

CONCLUSION

Adolescents need to be encouraged to meet their energy needs according to gender and physical activity (especially VPA girls) and to reach for higher quality foods in adequate macronutrient proportions.

Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise

Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.

Guidelines for treating child and adolescent obesity: A systematic review

Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.

Medical treatment of weight loss in children and adolescents with obesity

Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.

Perceptions of a family-based lifestyle intervention for children with overweight and obesity: a qualitative study on sustainability, self-regulation, and program optimization

BACKGROUND

Family-based lifestyle interventions (FBLIs) are an important method for treating childhood weight problems. Despite being recognized as an effective intervention method, the optimal structure of these interventions for children's overweight and obesity has yet to be determined. Our aim was to better understand participants' (a) implementation of behaviour strategies and long-term outcomes, (b) perceptions regarding the optimal structure of FBLIs, and (c) insights into psychological concepts that may explain the success of these programs.

METHODS

Purposive sampling was used to recruit participants. We conducted focus groups as well as one-to-one interviews with parents (n = 53) and children (n = 50; aged 7-13, M = 9.4 yr, SD = 3.1) three months following their involvement in a 10-week, multi-component, FBLI involving education and activities relating to healthy nutrition, physical activity, and behavior modification. Using an interpretivist approach, a qualitative study design was employed to examine participant experiences.

RESULTS

We identified three higher-order categories: (a) participants' program experiences and perceptions (b) lifestyle changes post-program, and (c) recommendations for optimizing family-based programs. Themes identified within these categories included (a) support and structure & content, (b) diet and physical activity, and (c) in-program recommendations and post-program recommendations.

CONCLUSIONS

We identified several challenges that can impair lasting behavior change (e.g., physical activity participation) following involvement in a FBLI. On optimizing these programs, participants emphasized fun, interactive content, interpersonal support, appropriate educational content, and behavior change techniques. Concepts rooted in motivational theory could help address calls for greater theoretical and mechanistic insight in FBLIs. Findings may support research advancement and assist health professionals to more consistently realize the potential of these interventions.

ENTREN-F family-system based intervention for managing childhood obesity: Study protocol for a randomized controlled trial at primary care

BACKGROUND

Pediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention ("ENTREN-F" program) for managing childhood obesity, compared to the "ENTREN" program (no "F" - without specific family-system-based workshop) and a control group (behavioral monitoring).

METHODS/DESIGN

The ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial's primary outcomes included changes in child body mass index (BMI) z-scores, child's psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling.

DISCUSSION

To our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children's psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.

The Aim2Be mHealth Intervention for Children With Overweight or Obesity and Their Parents: Person-Centered Analyses to Uncover Digital Phenotypes

Background

Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals’ patterns of interactions with specific app features (digital phenotypes).

Objective

This study aims to identify digital phenotypes among 214 parent-child dyads who used the Aim2Be mHealth app as part of a randomized controlled trial conducted between 2019 and 2020, and explores whether participants’ characteristics and health outcomes differed across phenotypes.

Methods

Latent class analysis was used to identify distinct parent and child phenotypes based on their use of the app’s behavioral, gamified, and social features over 3 months. Multinomial logistic regression models were used to assess whether the phenotypes differed by demographic characteristics. Covariate-adjusted mixed-effect models evaluated changes in BMI z scores (zBMI), diet, physical activity, and screen time across phenotypes.

Results

Among parents, 5 digital phenotypes were identified: socially engaged (35/214, 16.3%), independently engaged (18/214, 8.4%) (socially and independently engaged parents are those who used mainly the social or the behavioral features of the app, respectively), fully engaged (26/214, 12.1%), partially engaged (32/214, 15%), and unengaged (103/214, 48.1%) users. Married parents were more likely to be fully engaged than independently engaged (P=.02) or unengaged (P=.01) users. Socially engaged parents were older than fully engaged (P=.02) and unengaged (P=.01) parents. The latent class analysis revealed 4 phenotypes among children: fully engaged (32/214, 15%), partially engaged (61/214, 28.5%), dabblers (42/214, 19.6%), and unengaged (79/214, 36.9%) users. Fully engaged children were younger than dabblers (P=.04) and unengaged (P=.003) children. Dabblers lived in higher-income households than fully and partially engaged children (P=.03 and P=.047, respectively). Fully engaged children were more likely to have fully engaged (P<.001) and partially engaged (P<.001) parents than unengaged children. Compared with unengaged children, fully and partially engaged children had decreased total sugar (P=.006 and P=.004, respectively) and energy intake (P=.03 and P=.04, respectively) after 3 months of app use. Partially engaged children also had decreased sugary beverage intake compared with unengaged children (P=.03). Similarly, children with fully engaged parents had decreased zBMI, whereas children with unengaged parents had increased zBMI over time (P=.005). Finally, children with independently engaged parents had decreased caloric intake, whereas children with unengaged parents had increased caloric intake over time (P=.02).

Conclusions

Full parent-child engagement is critical for the success of mHealth interventions. Further research is needed to understand program design elements that can affect participants’ engagement in supporting behavior change.

Trial Registration

ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/NCT03651284

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-020-4080-2

Obesity in children and adolescents: epidemiology, causes, assessment, and management

This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.

Treatment of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews

This Academy of Nutrition and Dietetics Position Paper describes current evidence on multi-component interventions with nutrition to treat pediatric overweight and obesity and discusses implications for RDNs. An umbrella review of eight systematic reviews provides evidence that multi-component interventions that include nutrition improve body mass index z-scores in all ages and in a variety of settings. More evidence is needed regarding appropriate body mass index measures to track weight and health status changes in children and adolescents with overweight and obesity. Current evidence indicates that multi-component interventions that include nutrition do not negatively impact psychosocial outcomes, but research on long-term outcomes is needed. Evolving technology and societal circumstances have created opportunities to provide innovative, collaborative, and engaging interventions through telehealth. RDNs specializing in pediatric overweight and obesity treatment play a crucial role in providing a wide range of evidence-based interventions in a variety of settings. These skills are important for tailoring treatment to each child or adolescent while accounting for community and societal factors, which can lead to improved health across the lifespan.

Impact of an Elementary School-Based Wellness Initiative on Child Obesity Prevalence: LiveWell Kids

Despite major public health investments over the past several decades, little progress has been made in reducing the prevalence of obesity among school-aged children in the United States. In 2007, the Redondo Beach Unified School District (RBUSD) and the Beach Cities Health District launched a wellness initiative, LiveWell Kids, that included multi-level interventions to improve nutrition and increase physical activity. The initiative also included annual measurements of height and weight among all kindergartners and first, third, and fifth graders in the eight elementary schools in the RBUSD. To assess trends in obesity prevalence, we analyzed height and weight data collected during the 2008 to 2009 to 2018 to 2019 school years. To more fully assess the impact of the initiative, we conducted a least-squares regression difference-in-differences analysis of data from the California Physical Fitness Testing Program on measured height and weight among fifth graders from the RBUSD, three neighboring school districts, and Los Angeles County overall. Among elementary school students in the RBUSD, obesity prevalence decreased from 13.9% in 2008 to 2009 to 6.4% in 2018 to 2019. Significant declines in prevalence were observed in all eight elementary schools, and across all grade levels and demographic groups. Among fifth graders, a similar decline in obesity prevalence was not observed in the other school districts or the county overall. The findings suggest that interventions that adhere to the socio-ecologic model and engage students, parents, and school personnel at all levels while also addressing school and community environments may reduce obesity prevalence among elementary school-aged children.

Stress Management as an Effective Complementary Therapeutic Strategy for Weight Loss in Children and Adolescents with Obesity: A Systematic Review of Randomized Controlled Trials

Lifestyle intervention programs, including mindfulness and stress management/emotional control training techniques have been infrequently studied in children. The aim of this systematic review was to assess whether implementing stress management/emotional control training strategies in the context of a body weight loss program in children and adolescents is associated with improved body weight outcome in this age group. A systematic literature search was conducted to identify relevant studies published before 31 December 2020 in the following databases: Medline (PubMed), Scopus, and Cochrane Central Registry of Controlled Trials. Only randomized clinical trials (RCTs) on mindfulness or stress management in children and adolescents with obesity were included in this systematic review. Six RCTs fulfilled the study inclusion criteria and included intervention (112 subjects) and control (137 subjects) groups. The interventions used were Mindfulness-Based Stress Reduction therapy for 8 weeks (three studies), a mindfulness-based group program for adolescents (one study), and Mindful Eating Intervention for 6 weeks (one study) and 10 weeks (one study). The intervention group demonstrated reduced adiposity markers as compared to controls in four of the six included studies. The presented studies support the hypothesis that a structured, mindfulness-based intervention program may lead to a decrease in the biomarkers of obesity.

Evaluation of the Trends, Characteristics, and Outcomes in North American Youth Undergoing Elective Bariatric Surgery

BACKGROUND

Severe obesity is increasingly common in youth and young adults, but outcomes following bariatric surgery remain largely unknown. The purpose of this study was to examine the trends, clinical characteristics, and postoperative outcomes of youth who underwent bariatric surgery.

METHODS

This retrospective cohort study was conducted using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2018 inclusive. All youth and young adults aged 15-24 who underwent elective sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were included. Bivariate analysis of trends, clinical characteristics, and postoperative outcomes was performed using Chi-squared tests for categorical variables and independent two sample t test for continuous variables. Multivariable logistic regression modeling was used to determine patient and operative factors predictive of serious complications.

RESULTS

A total of 21,592 youth and young adults underwent bariatric surgery during the study time frame, representing 3.7% of total cases (n = 583,567) within the MBSAQIP. The cohort had a mean age of 21.5 ± 2.0 years and a mean BMI of 47.2 ± 8.0 kg/m² and were predominantly female (84%). A relatively constant number of youth and young adult cases per hospital were observed over time (7.4 cases/center in 2015 vs. 6.7 cases/center in 2018). Overall, < 5% of cases required reoperation, reintervention, and readmission, or led to serious complications within 30 days of surgery. Multivariable logistic regression analysis identified RYGB as the single greatest independent predictor of serious complications (OR 3.1; 95% CI 2.58-3.64; p < 0.0001). Additional factors predictive of serious complications included female sex (OR 1.31; 95% CI 1.01-1.70; p = 0.04), sleep apnea (OR 1.27; 95% CI 1.02-1.58), and non-insulin-dependent diabetes (OR 1.35; 95% CI 1.04-1.75; p = 0.025).

CONCLUSION

Bariatric surgery in youth is safe but comprised only 3.7% of total MBSAQIP cases from 2015 to 2018. These data should serve as a call to government and healthcare agencies to develop policies and strategies that prioritize bariatric surgery for young people living with severe obesity.