WITHDRAWN: Interventions for treating obesity in children

The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial

BACKGROUND

There is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents' inclusion in their adolescents' obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents' obesity treatment.

METHODS

Participants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up.

DISCUSSION

Results of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03851796. Registered: February 22, 2019.

Bariatric surgery in the management of childhood and adolescence obesity

BACKGROUND

Nowadays, childhood obesity is literally a global pandemic health problem. According to current data, pediatric obesity is strongly associated with adult excess weight status as well as the development of certain co morbidities, already present in childhood, including cardiovascular disorders (dyslipidemia, hypertension), endocrine/metabolic (Type 2 diabetes, fatty liver disease, metabolic syndrome), respiratory, gastrointestinal, and musculoskeletal problems. Additionally, children with obesity frequently experience psychosocial issues, such as mood disorders, anxiety, prejudice and low self-esteem.

METHODS AND RESULTS

The aim of this article was to evaluate whether or not bariatric surgery is an effective and safe treatment option for childhood obesity. This paper is based on a literature search in Pub Med for articles referring to the medical co morbidities and the results of different types of bariatric surgery for the treatment of childhood obesity (up to 18 years) until December 2021. The following keywords were used as MESH terms: childhood obesity, adolescence obesity, co morbidities and bariatric surgery. The bibliographic references of the studies found in these databases were also reviewed.

CONCLUSION

Although some researchers demonstrate that surgical interventions in adolescents might be a reliable intervention to lose weight in a maintainable way and reverse many of the co morbidities associated with severe obesity, their safety and long-term efficacy are still not clarified. Thus, large long-term prospective studies, with detailed recording of complications and co morbidity resolution are obviously needed in order to determine the role of surgical treatment in childhood obesity.

Multidisciplinary Treatment for Childhood Obesity: A Two-Year Experience in the Province of Naples, Italy

Childhood obesity must be faced through an integrated multi-level preventive approach. This study was aimed at assessing the adherence and the outcomes of an outpatient service for childhood obesity treatment activated in the province of Naples, Italy, throughout a 2-year follow-up period. At first visit (T0), weight, height, waist circumference, and body composition of children were assessed, together with sociodemographic features and physical activity levels of children and parents. Anthropometric and body composition parameters of children were measured at 6 ± 3 months (T1) and 12 ± 3 months (T2). A total of 451 non-related children who accessed the service were analyzed: 220 (48.7%) of them returned at least once (attrition rate 51.3%). Returner outpatients showed higher age (p = 0.046) and father’s educational level (p = 0.041) than non-returner ones. Adherence to the treatment was found to be related to father’s (Rho = 0.140, p = 0.005) and mother’s (Rho = 0.109, p = 0.026) educational level. All the outcomes improved between T0 and T1 (p < 0.001), while only body mass index (BMI) decreased significantly at T2. Changes in BMI-SDS were associated with baseline value (OR 0.158, 95%CI 0.017−0.298, p = 0.029). The multidisciplinary approach seems to be promising to treat childhood obesity in this geographic context. Lower parents’ educational level should be considered as an attrition determinant.

Results Reporting and Early Termination of Childhood Obesity Trials Registered on ClinicalTrials.gov

OBJECTIVE

Childhood obesity is one of the most severe challenges of public health in the twenty-first century and may increase the risk of various physical and psychological diseases in adulthood. The prevalence and predictors of unreported results and premature termination in pediatric obesity research are not clear. We aimed to characterize childhood obesity trials registered on ClinicalTrials.gov and identify features associated with early termination and lack of results reporting.

METHODS

Records were downloaded and screened for all childhood obesity trials from the inception of ClinicalTrials.gov to July 29, 2021. We performed descriptive analyses of characteristics, Cox regression for early termination, and logistic regression for lack of results reporting.

RESULTS

We identified 1,312 trials registered at ClinicalTrials.gov. Among clinicalTrials.gov registered childhood obesity-related intervention trials, trial unreported results were 88.5 and 4.3% of trials were prematurely terminated. Additionally, the factors that reduced the risk of unreported outcomes were US-registered clinical studies and drug intervention trials. Factors associated with a reduced risk of early termination are National Institutes of Health (NIH) or other federal agency funding and large trials.

CONCLUSION

The problem of unreported results in clinical trials of childhood obesity is serious. Therefore, timely bulletin of the results and reasons for termination remain urgent aims for childhood obesity trials.

60 Minutes Per Day in Moderate to Vigorous Physical Activity as a Natural Health Protector in Young Population

The aim of this study was to check whether following the recommendations of the World Health Organization (WHO) concerning physical activity protects children and adolescents against the occurrence of overweight and obesity. A total of 1002 children were included in the analysis. The average age of the studied children was 9.36 years ± 3.52 years. Measurement of height and body mass was performed for every child, followed by physical activity assessment over seven days. In each group analyzed, the overweight and obese children had a shorter time in moderate to vigorous physical activity (MVPA) than the children with normal body mass. Among the children spending < 60 min per day in MVPA, the risk of occurrence of overweight and obesity was greater than among children with physical activity > 60 min per day. It was also shown that the greatest risk of occurrence of body mass disorder was a situation in which the mother’s gestational weight gain (GWG) is over 18 kg and the child does not spend a minimum of 60 min/day in MVPA. Not meeting the recommendation is connected with an increased chance of the occurrence of overweight and obesity. The level of physical activity influences the incidence of overweight and obesity. The children with overweight and obesity spent less time per day in MVPA. An increased body mass in mothers during pregnancy associated with a child’s low level of physical activity increases the risk of the occurrence of overweight and obesity.

Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis

The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: -0.12; 95% CI: -0.18 to -0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: -0.41 kg/m2; 95% CI: -0.60 to -0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: -1.59; 95% CI: -2.95 to -0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: -0.07; 95% CI: -0.14 to -0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: -0.08; 95% CI: -0.16 to -0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: -0.13; 95% CI: -0.25 to -0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: -0.13; 95% CI: -0.20 to -0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: -0.88; 95% CI: -1.265 to -0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: -3.01; 95% CI: -5.56 to -0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: -0.08; 95% CI: -0.16 to -0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: -0.16; 95% CI: -0.26 to -0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: -0.09; 95% CI: -0.14 to -0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.

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

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

Translation of two healthy eating and active living support programs for parents of 2-6 year old children: a parallel partially randomised preference trial protocol (the 'time for healthy habits' trial)

Background

Parents are key decision makers and role models in establishing and maintaining healthy behaviours in their children. Interventions involving parents have been shown to be more effective than those that do not, but there are barriers to participation. Efficacy trials have previously been conducted on two such parent-focussed healthy eating and active living interventions with the potential to overcome these barriers - Healthy Habits (telephone-based) and Time2bHealthy (online) with promising results. Further research is now required to determine the effectiveness of these interventions in a real-world context. The Time for Healthy Habits study is a 3-arm partially randomised preference trial which aims to evaluate the effectiveness and cost-effectiveness of two theory-based programs to promote healthy eating and appropriate levels of movement behaviours (physical activity, sedentary behaviour and sleep) for parents of 2- to 6-year-old children (Healthy Habits Plus telephone-based program and Time2bHealthy online program), when compared to a comparison group receiving written materials.

Methods

Participants will be recruited across five Local Health Districts in New South Wales, Australia. The partially randomised preference design initially allows for participants to decide if they wish to be randomised or opt to select their preferred intervention and has been recommended for use to test effectiveness in a real-world setting. Both interventions incorporate multiple behaviour change techniques and support parents to improve their children’s healthy eating, and movement behaviours (physical activity, sedentary behaviour and sleep) and run for 12 weeks, followed by a 3-month and 9-month post-baseline follow-up. Participants will also be asked to complete a process evaluation questionnaire at the completion of the intervention (3-months post-baseline). Outcomes include fruit and vegetable intake (primary outcome), non-core food intake, weight status, physical activity, sedentary behaviour, and sleep habits.

Discussion

To our knowledge, this is the first translational research trial evaluating the effectiveness and cost-effectiveness of a healthy eating and active living intervention in the 2- to 6-years age group. The results will build the evidence base in regard to translation of effective childhood obesity prevention interventions and inform the implementation and delivery of community based childhood obesity prevention programs.

Trial registration

UTN: U1111–1228-9748, ACTRN: 12619000396123p.

Long-Term Effects of Vitamin D Supplementation in Obese Children During Integrated Weight-Loss Programme-A Double Blind Randomized Placebo-Controlled Trial

Background: Vitamin D was studied in regards to its possible impact on body mass reduction and metabolic changes in adults and children with obesity yet there were no studies assessing the impact of vitamin D supplementation during a weight management program in children and adolescence. The aim of our study was to assess the influence of 26 weeks of vitamin D supplementation in overweight and obese children undergoing an integrated 12–months’ long weight loss program on body mass reduction, body composition and bone mineral density. Methods: A double–blind randomized placebo–controlled trial. Vitamin D deficient patients (<30 ng/ml level of vitamin D) aged 6–14, participating in multidisciplinary weight management program were randomly allocated to receiving vitamin D (1200 IU) or placebo for the first 26 weeks of the intervention. Results: Out of the 152 qualified patients, 109 (72%) completed a full cycle of four visits scheduled in the program. There were no difference in the level of BMI (body mass index) change – both raw BMI and BMI centiles. Although the reduction of BMI centiles was greater in the vitamin D vs. placebo group (−4.28 ± 8.43 vs. −2.53 ± 6.10) the difference was not statistically significant (p = 0.319). Similarly the reduction in fat mass—assessed both using bioimpedance and DEXa was achieved, yet the differences between the groups were not statistically significant. Conclusions: Our study ads substantial results to support the thesis on no effect of vitamin D supplementation on body weight reduction in children and adolescents with vitamin D insufficiency undergoing a weight management program.