Stigma Experienced by Children and Adolescents With Obesity

Social, cultural and ethnic determinants of obesity: From pathogenesis to treatment

AIMS

Obesity is a multifactorial disease influenced by several factors including poor diet, physical inactivity, and genetic predisposition. In recent years, the social and environmental context, along with race/ethnicity and gender, have been recognized as factors influencing obesity risk beyond traditional risk factors. This review aims to increase knowledge of these causal determinants and their implications for the treatment and management of obesity, addressing not only the individual but also the societal sphere.

DATA SYNTHESIS

A growing body of evidence emphasizes the interaction between the physical and social environments in shaping personal behaviors related to obesity. Social disparities, such as socioeconomic status (income, education, employment), racial/ethnic differences, and gender, contribute significantly to weight gain from childhood to adulthood. These factors increase the risk of obesity and related cardiovascular risk factors, independent of clinical and demographic variables, and may lead to stigma and discrimination against those affected.

CONCLUSIONS

Obesity prevention solutions, from community programs to national policies, may be more effective if they address social, gender, and ethnic barriers. Understanding obesity requires a comprehensive approach that includes social, environmental, and psychological factors, as well as biological causes, to help obesity experts develop more effective interventions tailored to obesity and related diseases.

Weight Stigma in Adolescents With Obesity From Low-Income Backgrounds: Qualitative Perspectives From Adolescents and Caregivers

PURPOSE

Weight stigma is a common experience for adolescents at high weight statuses. Prior research regarding experiences of weight stigma in adolescence has been in primarily homogenous samples. The present study sought to characterize weight stigma experiences and internalization in adolescents from low-income backgrounds. This was done by reporting on teen's experiences of weight stigma in daily life and in conversations with health-care professionals, and examining the effect of internalization of this stigma.

METHODS

This study is a secondary analysis of semi-structured qualitative interviews conducted with adolescents with high weight from low-income backgrounds who had been referred to weight management, as well as their caregivers. Data was analyzed using applied thematic analysis.

RESULTS

Fifty-five participants (29 adolescents and 26 caregivers) from low-income backgrounds participated in semi-structured interviews. Given the broader focus of the primary study, weight stigma was not a focus of interviews. However, almost all participants identified weight stigma and bias as influencing their lives and medical care. Identified themes included the following: (1) difficulty identifying preferences regarding weight-related terminology; (2) commonality of experienced weight stigma; and (3) significant effect of internalized weight bias on adolescent daily living.

DISCUSSION

Overall, the present study identified nearly ubiquitous experiences of weight stigma for a sample of youth from low-income backgrounds living in larger bodies. This highlights the pervasive presence of weight stigma and bias throughout adolescents' lives, including in health-care settings. These findings are particularly stark, given that weight stigma was not a topic within the interview guide.

The recruitment of adolescents with obesity to a randomised controlled trial: A Fast Track to Health sub-study

AIMS

Behavioural weight management interventions facilitate short to medium-term weight and cardiometabolic improvements in adolescent obesity. However, recruiting adolescents to trials of such interventions is challenging. This study describes strategies used to recruit adolescents with obesity into the Fast Track to Health (Fast Track) trial, conducted at two tertiary paediatric centres in Australia.

METHODS

Fast Track (HREC/17/SCHN/164) was a randomised controlled trial that recruited 13-17-year-olds with obesity and ≥ 1 cardiometabolic complication, from December 2017 to March 2022. Families underwent phone screening, followed by in-person screening appointments. Recruitment strategies were grouped and enrolment yield by strategy was calculated.

RESULTS

Of 308 inquiries received, 141 (45.8 %) adolescents were recruited. The most successful strategy was referral from specialists at participating centres (21.2 % enrolment yield), followed by referrals from family/friends (6.5 %), other doctors/general practitioners (3.6 %), and social media (3.6 %). Social media was used for 11 months only (enrolment yield - 8.5 %). Recruitment strategies with low yield were study flyers/posters (1.6 %), digital/print media (1.3 %), and the study website (1.0 %). Of 137 adolescents excluded at phone screening, most were due to disinterest in participation or inability to make contact (60.6 %). Of 171 adolescents attending in-person screening, 30 did not meet inclusion criteria (n = 7 of those excluded had no metabolic complications, n = 7 were outside the BMI range).

CONCLUSION

Connecting with medical specialists may be important to support the engagement of treatment-seeking adolescents with obesity in clinical trials. Further research is needed to identify methods of enhancing clinical trial recruitment in primary care, community settings, and online.

GLP-1 Receptor Agonists for Treatment of Pediatric Obesity: Behavioral Health Considerations

Background: Despite the rapid increase in glucagon-like peptide-1 receptor agonist (GLP-1) use for management of weight among adolescents (ages 12-18 years), there is limited guidance on associated behavioral health considerations. Adolescents on GLP-1 therapy represent a potentially vulnerable population at risk of experiencing medical and psychosocial effects of obesity and comorbidities, as well as side effects and behavioral implications of the medications. Method: This perspective discusses behavioral and psychosocial considerations for adolescents seeking GLP-1s. The limited and developing literature on the use of GLP-1s for pediatric obesity treatment was reviewed to evaluate key aspects of psychosocial functioning and health behavior engagement and to stimulate discussion, research, clinical innovation, and advocacy to support best practices for youth seeking GLP-1s to address weight concerns. Results: There is currently sparse research on the effects of GLP-1s on adolescents' psychosocial functioning. In the context of clinical practice, it may be important to assess for symptoms of eating disorders/disordered eating behaviors, mood instability, and general psychosocial functioning as well as quality of life, social support, health behaviors, and readiness to change prior to the initiation of and throughout the course of GLP-1 treatment. Conclusions: This perspective serves as a call to action for research and clinical innovation to address the psychosocial effects of GLP-1s on adolescents. Screening, monitoring, and future research will be key to ensuring safe and effective use of GLP-1 therapy as well as optimal psychosocial outcomes for youth utilizing GLP-1 medications for obesity treatment.

Youth Perspectives on the Use of Medications for Weight Loss

PURPOSE

Semaglutide (Ozempic, Wegovy) has surged in popularity for its weight loss effects. Its widespread media coverage may have an outsized impact on adolescents and young adults due to their higher engagement in social media and their vulnerability to unintended consequences of weight-related discourse (e.g., body dissatisfaction, disordered eating, weight stigma). This study aimed to determine youth familiarity with and opinions about use of medications such as Ozempic and Wegovy for weight loss.

METHODS

Five open-ended questions were asked to 753 youth participants (14-24 years) in the MyVoice nationwide text message poll in March 2024. Responses were analyzed using content analysis and coding differences resolved by consensus. Differences by demographic characteristics were explored using chi-square tests.

RESULTS

Overall, 547 (73%) youth responded; average age was 20.4 ± 2.5 years, with 50.3% identifying as female. Nearly three-quarters (73.6%) had heard of medications like Ozempic and Wegovy, but the majority (57.5%) stated that these medications should not be used by youth. Three primary concerns arose: (1) safety; (2) inappropriate use; and (3) role of personal responsibility for healthy lifestyle (a belief that was more common among males than females or other gender).

DISCUSSION

Awareness about semaglutide was high, but perceptions of use were generally negative or hesitant, particularly among males, who emphasized the importance of healthy lifestyle behaviors. Hesitancy due to safety concerns and the role of weight stigma should be explored to determine the potential impact on users of such medications when medically indicated.

Effects of two forms of school-based high-intensity interval training on body fat, blood pressure, and cardiorespiratory fitness in adolescents: randomized control trial with eight-week follow-up-the PEER-HEART study

Introduction

This study examined the effects of 8-week interventions based on two variants of typical exercises, namely, high-intensity interval training (HIIT) and high-intensity plyometric training (HIPT), on body fat (BF%), blood pressure, and cardiorespiratory fitness (CRF). In addition, the sustainability of the effects after another 8 weeks was assessed.

Methods

The project was designed as a randomized controlled trial with eight groups of participants (two variants, two sexes, and two groups (experimental and control)) and was conducted in a school physical education (PE) program. The outcomes analyzed were the BF%, systolic (SBP), diastolic blood pressure (DBP), and CRF expressed in terms of maximum oxygen uptake (VO2max). A total of 307 healthy adolescents participated in this study and were randomly assigned into the two groups. During the 8 weeks, the participants completed two exercise sessions each week with progressively increasing volumes. For the first 2 weeks, the sessions involved four rounds of 20 s of intense effort followed by 10 s of rest; this increased to six rounds during weeks 3-4 and eight rounds during weeks 5-8. The HIPT program was based on plyometric exercises, whereas the HIIT was based on bodyweight resistance exercises.

Results

Multidimensional analysis of variance (ANOVA) indicated a statistically significant second-order interaction (time × variant × group: Ʌ = 0.943, F = 2.20, p < 0.027, η2 pG = 0.057, d = 0.25), confirming the changes in the BF%, SBP, DBP, and VO2max dependent on the type of intervention and group assignment. The ANOVA results revealed significant main and interaction effects for BF%, SBP, and DBP, with time and the HIIT variant as the main contributors (BF%: F = 3.911, p = 0.023, η2 pG = 0.001, d = 0.04 vs. F = 9.900, p < 0.001, η2 pG = 0.001, d = 0.03; SBP: F = 31.801, p < 0.001, η2 pG = 0.012, d = 0.16 vs. F = 8.939, p = 0.003, η 2 pG = 0.026, d = 0.16; DBP: F = 3.470, p = 0.033, η2 pG = 0.002, d = 0.06 vs. F = 4.982, p = 0.026, η2 pG = 0.014, d = 0.12). The second-order interaction for VO2max (time × sex × group: F = 6.960, p = 0.001, η2 pG = 0.003, d = 0.05) indicated that the improvements over time were not related to the training variant. Although these effects were small (low eta values), post hoc tests (all comparisons in post-intervention, p > 0.05) showed that both the HIIT and HIPT groups exhibited beneficial changes compared to controls; however, no statistically significant differences were observed between the experimental and control groups. Furthermore, the observed improvements were maintained through the 8-week follow-up period, as demonstrated by no significant changes between the post-intervention and follow-up measurements (p > 0.05). Discriminant analysis showed that BF% and SBP were the key variables for the two exercise variants in men, with HIPT yielding greater reductions in SBP and HIIT resulting in more pronounced decreases in BF%.

Discussion

In conclusion, both HIIT and HIPT interventions effectively improved health-related parameters, providing valuable enrichment to the PE lessons in schools. These benefits were also sustained for at least 8 weeks post-intervention.

Exploring the perceptions of obesity, health habits, stigma, and eating behaviors in Brazil

BACKGROUND

Obesity is a chronic and complex disease influenced by various factors that hinder weight loss and maintenance. However, perceptions of obesity are often marked by stigma. This study assessed perceptions of obesity, weight stigma, health habits, and emotional eating in a representative sample of the Brazilian population.

METHODS

This cross-sectional study included a representative sample of 2560 Brazilian participants. Data were collected from structured online questionnaires covering demographic aspects, perceptions of obesity, stigma, health habits, and behaviors related to emotional eating.

RESULTS

The prevalence of obesity in the sample was 26%. However, 61% of these individuals did not receive a formal diagnosis. Although 76% of the participants considered obesity a disease, 65% believed that diet and exercise were sufficient treatments. Only 5% of the participants with obesity considered 10% weight loss beneficial for associated comorbidities. It was widely believed that normalizing body mass index (BMI) is necessary for positive health outcomes. Emotional eating behaviors were slightly more prevalent among individuals with obesity (25%) but were present across all BMI ranges.

CONCLUSIONS

The findings of this investigation underscore the necessity for comprehensive education regarding obesity as a complex multifactorial condition. They emphasize the importance of promoting awareness of the benefits associated with modest weight reduction, improving the diagnosis and documentation of obesity in clinical settings, and implementing targeted interventions to address misconceptions concerning treatment modalities and the impact of emotional eating behaviors.

The real-life experiences of people living with overweight and obesity: A psychosocial perspective

Understanding the lived experience of obesity, just like any other chronic outcome, is essential to addressing deep routed inequalities and stigma associated with obesity, as well as creating more inclusive and effective policies and healthcare. The psychosocial aspects of obesity are vast and as such the lived experience of obesity differs between individuals and groups. However, there are consistent psychosocial issues identified within empirical studies as well as lived experience accounts that require consideration and potential adaption in the design and delivery of care including weight management and obesity services. Improving perceptions and understanding of the lived experience can also foster empathy which appears to be lacking based on research examining everyday encounters, media portrayal of people living with obesity, and in healthcare settings. Stigma and discrimination are consistent and, in some instances, occur daily in many societal settings leading to mental and physical health concerns, social disengagement and dysfunctional relationships with significant others, as well as avoidance of health promoting activities and settings. Using a narrative review approach, our aim was to examine the empirical evidence generated in countries across the world, reporting on the real-life experiences of people living with obesity. Our search strategy was informed by existing empirical evidence of the psychosocial aspects of obesity and an in-depth interview exploring the lived experience of obesity specifically conducted to inform this article. In doing so, we highlight key psychosocial aspects and provide a voice for a personal account of the challenges experienced in child and adulthood. Recommendations are offered for stakeholders including policymakers and practitioners that aim to address these real-life challenges experienced by people living with obesity. PLAIN LANGUAGE SUMMARY: In this publication, the authors provide a detailed review of the lived experiences of people living with obesity with a focus on the psychological and social factors and experiences across the life course. The paper also uniquely presents real-life experiences from Sarah, who identifies as living with obesity. In doing so, the authors highlight exposure to and experiences of weight management related behaviours and weight stigma from an early age. Experiences of weight stigma and feelings of being excluded from social settings and more generally society are evidenced throughout. Indeed, Sarah's accounts support the research evidence presented, where for instance, she highlights feeling excluded as a younger person when not being able to purchase "trendy" clothing and as an adult when buying clothing for work, experiences of weight stigma in workplaces and issues related to travelling as well as the actions she takes to avoid imposing on other people. The key lived experiences, both from the research evidence and Sarah's accounts, provide insights about the link between obesity and mental health, where for instance, the experiences of weight stigma and feeling excluded from society are associated with mental health outcomes including reduced self-worth and self-esteem, increased depression and increased risk of self-harming. The authors provide a list of ways to address weight stigma in society as well as in healthcare, a setting where weight stigma is often reported by people living with obesity, and calls for greater involvement of people living with obesity in policy, healthcare development and practice, as well as the need to address the widespread weight stigma and discrimination. [Plain language summary added March 2025, after original online publication].

Lack of association between breastfeeding duration and body mass index in children and adolescents - A Swedish cohort study

AIMS

The aim of the study was to investigate the association between breastfeeding duration and body mass index (BMI), overweight and obesity in children during follow-up until 16 years of age.

METHODS

Observational cohort study of mothers and their children born 1999-2000 in a municipality in southwestern Sweden. Data were retrieved from antenatal clinics, primary care child health care centres and school health care. The study exposure was breastfeeding duration measured in months and categorised by duration < 6 months and ≥ 6 months. The study outcomes were development of BMI, and overweight and obesity according to ISO-BMI.

RESULTS

The study population comprised 312 mothers and their 319 children of whom 120 were breastfed < 6 months and 199 ≥ 6 months. The overall partial or exclusive median breastfeeding duration was 6.5 months. No associations were found between breastfeeding duration in months and BMI in unadjusted (p = 0.70) and adjusted (p = 0.92) linear mixed-effects models with repeated BMI recordings at approximately 4, 7, 10, 13 and 16 years. Further, no associations were found in subgroup analyses for girls and boys. The adjusted analyses were adjusted for maternal age, smoking, BMI and parity, and for the child's sex, gestational age at birth and birth weight. Unadjusted logistic mixed-effects models with repeated ISO-BMI classifications at approximately 4, 7, 10, 13 and 16 years showed no associations between breastfeeding duration (≥6 months versus < 6 months) and overweight or obesity as compared to underweight or normal weight, in total (odds ratio 1.46, 95% confidence interval 0.69-3.08) or in boys and girls separately.

CONCLUSIONS

We found no association between breastfeeding duration and childhood and adolescence BMI up to 16 years of age or the development of overweight or obesity.

Cross-Sectional and Longitudinal Associations Among Weight Stigma, Psychological Distress, and Eating Behaviors in Youth with Obesity: A Clinical Sample

Background and Objectives: Obesity in youth is a growing public health concern, placing them at higher risk for adverse physical and psychological outcomes. Understanding the predictors that affect weight management, particularly the role of internalized weight stigma, psychosocial factors, and eating behaviors, is essential for developing an effective intervention at longitudinal follow-up. Materials and Methods: We enrolled 102 youths with obesity aged 10 to 18 years old from clinical settings. Baseline demographic data, psychosocial measures, including the Weight Self-Stigma Questionnaire (WSSQ) and Hospital Anxiety and Depression Scale (HADS), and eating behavior scales, such as the Three-Factor Eating Questionnaire (TFEQ-R21) and eating disorder as Sick, Control, One, Fat, Food questionnaire (SCOFF), were collected in the first visit. We conducted a study with both cross-sectional and longitudinal components. Correlational bivariate analysis was conducted to explore relationships between key variables. The factors affecting BMI changes were investigated using generalized estimating equations (GEEs) as part of a longitudinal analysis. Results: The mean age of participants was 13.22 years and 63.7% were male. Bivariate correlation analysis revealed positive relationships between initial BMI Z-scores and WSSQ scores (r = 0.196, p < 0.05). In bivariate analysis, a negative correlation was found between the difference in BMI Z-scores and visit number (r = -0.428, p < 0.01). GEE analysis demonstrated that initial BMI Z-scores (coefficient = 1.342, p < 0.001) and anxiety (coefficient = 0.050, p < 0.001) were significant positive predictors of BMI Z-scores, while depression was negatively associated (coefficient = -0.081, p < 0.001). Excluding the TFEQ subscales, SCOFF improved the model's QIC and highlighted WSSQ as a significant, albeit weak, predictor (p = 0.615 in the full model versus p < 0.05 in the reduced model). Conclusions: Psychosocial factors, particularly anxiety and weight stigma, are associated with elevated BMI Z-scores in youth affected by obesity in this study. The baseline age, BMI Z-score, internalized weight stigma, and psychological stress influenced the body weight trajectory over time. Frequent clinical follow-ups contribute to improved BMI outcomes. Future research may examine the efficacy of weight management by reducing weight stigma and psychological distress along with the outpatient care of obesity.

Definition and diagnostic criteria of clinical obesity

Current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level, which undermines medically-sound approaches to health care and policy. This Commission sought to define clinical obesity as a condition of illness that, akin to the notion of chronic disease in other medical specialties, directly results from the effect of excess adiposity on the function of organs and tissues. The specific aim of the Commission was to establish objective criteria for disease diagnosis, aiding clinical decision making and prioritisation of therapeutic interventions and public health strategies. To this end, a group of 58 experts—representing multiple medical specialties and countries—discussed available evidence and participated in a consensus development process. Among these commissioners were people with lived experience of obesity to ensure consideration of patients’ perspectives. The Commission defines obesity as a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue, and with causes that are multifactorial and still incompletely understood. We define clinical obesity as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications (eg, heart attack, stroke, and renal failure). We define preclinical obesity as a state of excess adiposity with preserved function of other tissues and organs and a varying, but generally increased, risk of developing clinical obesity and several other non-communicable diseases (eg, type 2 diabetes, cardiovascular disease, certain types of cancer, and mental disorders). Although the risk of mortality and obesity-associated diseases can rise as a continuum across increasing levels of fat mass, we differentiate between preclinical and clinical obesity (ie, health vs illness) for clinical and policy-related purposes. We recommend that BMI should be used only as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health. Excess adiposity should be confirmed by either direct measurement of body fat, where available, or at least one anthropometric criterion (eg, waist circumference, waist-to-hip ratio, or waist-to-height ratio) in addition to BMI, using validated methods and cutoff points appropriate to age, gender, and ethnicity. In people with very high BMI (ie, >40 kg/m2), however, excess adiposity can pragmatically be assumed, and no further confirmation is required. We also recommend that people with confirmed obesity status (ie, excess adiposity with or without abnormal organ or tissue function) should be assessed for clinical obesity. The diagnosis of clinical obesity requires one or both of the following main criteria: evidence of reduced organ or tissue function due to obesity (ie, signs, symptoms, or diagnostic tests showing abnormalities in the function of one or more tissue or organ system); or substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on mobility, other basic activities of daily living (eg, bathing, dressing, toileting, continence, and eating), or both. People with clinical obesity should receive timely, evidence-based treatment, with the aim to induce improvement (or remission, when possible) of clinical manifestations of obesity and prevent progression to end-organ damage. People with preclinical obesity should undergo evidence-based health counselling, monitoring of their health status over time, and, when applicable, appropriate intervention to reduce risk of developing clinical obesity and other obesity-related diseases, as appropriate for the level of individual health risk. Policy makers and health authorities should ensure adequate and equitable access to available evidence-based treatments for individuals with clinical obesity, as appropriate for people with a chronic and potentially life-threatening illness. Public health strategies to reduce the incidence and prevalence of obesity at population levels must be based on current scientific evidence, rather than unproven assumptions that blame individual responsibility for the development of obesity. Weight-based bias and stigma are major obstacles in efforts to effectively prevent and treat obesity; health-care professionals and policy makers should receive proper training to address this important issue of obesity. All recommendations presented in this Commission have been agreed with the highest level of consensus among the commissioners (grade of agreement 90–100%) and have been endorsed by 76 organisations worldwide, including scientific societies and patient advocacy groups.

Digital components and interaction types in counseling interventions for childhood and adolescent obesity: A systematic review

Objectives

Childhood and adolescent obesity are an increasing global health concern. This study aimed to evaluate the effectiveness of digital components and interaction types in counseling interventions for prevention and treatment.

Methods

All studies were searched in online databases and grey literature, including PubMed (Medline), Web of Science, CINAHL, Scopus, IEEE Xplore Digital Library, Journal of Medical Internet Research (JMIR), MedNar, EBSCO Open Dissertations. The search period is from inception to June 2023, and the languages are Finnish, English and Swedish. The research quality was evaluated using the web-based data management system Covidence for prevalence studies. The study protocol was registered with PROSPERO (registration number: CRD42021247595).

Results

In this review, 4,407 studies were screened, and 22 were included. These involved 3,433 participants and 264 child-parent pairs. The digital approaches included multicomponent elements like internet platforms, text messaging, video conferencing, online communities, wearable technology, and mobile apps, allowing one-way, two-way, and face-to-face interactions. Two studies showed statistically significant effects of treatment on BMI and waist-to-hip ratio. Most interventions reported positive outcomes, with no significant differences between groups, and none showed null effects during follow-up.

Conclusions

Digital multicomponents like mobile apps and wearables can help obese children and adolescents adopt healthier lifestyles. While these interventions show promise for obesity management, further research is needed to assess their effectiveness, particularly regarding nurses' perspectives.

Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

OBJECTIVE

Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity.

METHODS

Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post-baseline, including patient-reported outcome measures (PROMs), cardiometabolic and anthropometric outcomes, and adverse events (AEs). We pooled data using a random effects model and assessed certainty of evidence (CoE) related to minimally important difference estimates for outcomes using GRADE.

RESULTS

We included 73 unique RCTs (n = 6305 participants, 53% female). Intervention types included physical activity (n = 1437), nutrition (n = 447), psychological (n = 1336), technology-based (n = 901) or multicomponent (≥2 intervention types, n = 2184). Physical activity had a small effect on health-related quality of life (HRQoL), varying effects ranging from moderate to very large on blood pressure, lipids and insulin resistance, and a small effect on BMIz. Nutrition had a small effect on lipids, insulin resistance and BMIz. Psychological interventions showed a small effect on HRQoL and triglycerides and moderate benefits on depressive symptoms, while technology interventions showed small benefits on blood pressure and BMIz. Multicomponent interventions had a large benefit on anxiety, small benefit on depressive symptoms, with large to very large benefits on lipids, and small benefits for diastolic blood pressure, insulin resistance and BMIz. AEs were reported infrequently, and when reported, were described as mild.

CONCLUSION

Physical activity and multicomponent interventions showed improvements in PROMs, cardiometabolic and anthropometric outcomes. Future trials should consistently measure PROMs, evaluate outcomes beyond the intervention period, and study children <6 years of age.

Adopting national recommendations for clinical management of pediatric obesity in primary care

ABSTRACT

The World Health Organization reports that more than 390 million children and adolescents have obesity, with the US facing a prevalence of 14 million among this population and incurring an annual medical cost of $1.3 billion. Childhood and adolescent obesity stems from genetic, environmental, and socioecological factors, indicating the need for an evolving approach to pediatric obesity management. The updated 2023 American Academy of Pediatrics guideline for evaluation and treatment of pediatric obesity advocates for a child-centric strategy, considering health equity, racism, weight bias stigmatism, and adverse childhood experiences. Management includes intensive health behavior and lifestyle treatment, partnership with communities to build comprehensive treatment programs, promotion of early intervention, consideration of pharmacotherapy for children age 12 years and older, selective use of bariatric surgery, screening for and treatment of comorbidities, integration of mental health treatment, and use of motivational interviewing to engage patients in their care. Pediatric primary care providers play a key role in identification of obesity and encouragement of obesity treatment. Proactive management of childhood obesity benefits individuals, families, and the nation. Early intervention holds the promise of substantial cost savings on obesity-related healthcare. Healthcare providers wield significant influence in reducing childhood morbidity and enhancing the overall health of US children and adolescents.

Evaluating the impact of motor quotient physical fitness training on health-related fitness indicators and obesity risk in children aged 7-8 years in Tianjin, China

This study aimed to evaluate the impact of Motor Quotient (MQ) physical fitness training on health-related fitness indicators and obesity risk in children aged 7-8 years in Tianjin, China. A total of 60 obese participants were randomly divided into an experimental group (N = 30) and a control group (N = 30). The intervention program focused on improving children's physical, behavioral, and task-related capabilities through structured MQ training. Key results indicated that the experimental group demonstrated significant improvements in Body Mass Index (BMI), with a reduction from 21.28 ± 1.15 kg/m² to 18.86 ± 1.24 kg/m² for boys (p < 0.001) and from 21.04 ± 1.54 kg/m² to 17.47 ± 1.07 kg/m² for girls (p < 0.001). Physical performance metrics improved substantially, including enhanced 2 × 30 m Shuttle Run times (boys: +12.97%, girls: +13.96%, both p < 0.001) and increased Plank duration (boys: +41.36%, girls: +35.26%, both p < 0.01), reflecting improved cardiovascular endurance and core strength. Significant gains were also observed in task-related motor skills, such as Hand-eye Coordination, Behavior Imitation, and Reaction capability (all p < 0.001). Behavioral adaptations included higher scores in exercise behavior (p < 0.01), while strong correlations were found between BMI and cardiovascular fitness indicators, such as the 20 m Backward Run (r = 0.974, p < 0.001). These findings highlight the effectiveness of MQ training in reducing obesity risk and improving multidimensional fitness outcomes. The program demonstrates significant potential as a practical and evidence-based strategy to promote health-related fitness and motor development in children.

Parental Roles and Challenges in Managing Pediatric Obesity: Insights from Focus Group Interviews in Korea

Background

Pediatric obesity is a global public health concern. South Korea is witnessing a notable increase in obesity rates among children and adolescents, despite various governmental interventions. Parents play a crucial role in preventing and managing pediatric obesity, as they are typically the primary observers of their child's weight and daily habits.

Methods

This study involved 10 parents of overweight or obese children and adolescents in South Korea, identified from a 2023 Student Health Examination. Focus group interviews were conducted to explore participants' experiences, followed by a rigorous qualitative content analysis of the data.

Results

The analysis revealed one main theme, parental roles and challenges in managing pediatric obesity, that encompassed five categories: parental awareness and perception of pediatric obesity; causes of pediatric obesity; parental strategies for managing obesity; barriers to management; and support systems and resources. Parental recognition of their child's obesity was predominantly initiated through student health examinations at school, and the cause of obesity was multifactorial. Parents use various strategies, such as dietary changes and exercise promotion, but face barriers, including stigma and resource constraints. Parents demand comprehensive support from schools, healthcare providers, and community programs to effectively manage obesity.

Conclusion

These findings highlight the need for tailored interventions to address parents' specific obstacles in managing pediatric obesity. Enhancing parental awareness, providing clear information, and strengthening support systems are essential for preventing and managing pediatric obesity in South Korea.

Involving national stakeholders in a systems approach to map drivers of childhood obesity and actions to prevent childhood obesity in Denmark: the Generation Healthy Kids Study

BACKGROUND

Childhood obesity is a preventable global public health challenge, increasingly recognized as a complex problem, stemming from complex drivers. Obesity is characterized by multiple interdependencies and diverse influences at different societal levels. Tackling childhood obesity calls for a holistic approach that engages with complexity and recognizes that there is no single "magic bullet" intervention to prevent obesity. To facilitate a shared understanding of the complex structures and relationships that determine children's weight development, systems approaches have shown promising potential. However, systems approaches require more development and research in public health.

AIM

This paper describes the processes of gathering national stakeholders to create a system map of childhood obesity drivers in Denmark to map existing obesity prevention initiatives and define real-world actions to prevent childhood obesity in local communities in Denmark. The system map and action ideas will inform the development of community-based activities in a large-scale national study, the Generation Healthy Kids Study.

METHODS

During two workshops in the autumn of 2022, national stakeholders (n = 45) were involved in generating and revising a system map. We used a scripted approach inspired by group model building and community-based systems dynamics methods to engage stakeholders, collect and visualize their knowledge on childhood obesity, create consensus on the drivers of childhood health, identify local and national intervention opportunities for prevention of childhood obesity and develop actions to create system changes.

RESULTS

The study identified the following six sub-systems of factors influencing childhood obesity: (1) family; (2) diet and dietary habits; (3) physical activity and active living; (4) mental health and wellbeing; (5) screen, media and sleep; and (6) competencies of professionals.

CONCLUSIONS

A systems approach to childhood obesity was useful to generate a shared understanding of the underlying drivers of childhood overweight and obesity and has potential for informing initiatives at local and national level in Denmark. However, challenges were experienced regarding the usefulness of the system mapping process, with a tension between the map as a step in a shared process towards actions and the map as means to gain a deeper understanding of the complex system of childhood overweight and obesity and how to change the system.

Parental Weight Stigma Associated with Self-Directed Weight Talk and Use of Health-Related Restrictive Feeding Practices

BACKGROUND

Parents are important conduits of weight- and health-related messaging. Weight-related communication and approaches to child feeding used by parents may reflect their past experiences with weight stigma and are understudied pathways through which intergenerational weight stigma may be transmitted.

OBJECTIVE

The aim of this study was to examine how experienced and internalized weight stigma among parents of children with higher weights are associated with weight-related communication and the feeding practices they use.

DESIGN

The Listening to Parents study is a cross-sectional study of 103 parent-child dyads who completed in-person study visits at the University of Michigan in Ann Arbor between November 2022 through June 2023.

PARTICIPANTS/SETTING

Participants were parents of children (ages 6 through 14 years, identified by parents as "heavier or overweight") who completed the Stigmatizing Situations Inventory Brief and Weight Bias Internalization Scale-Modified, as well as questions about weight-related communication and the Comprehensive Feeding Practices Questionnaire.

MAIN OUTCOME MEASURES

Outcomes included 5 items corresponding to parental weight-related communication (ie, self-directed, other-directed, and child-directed weight talk, child-directed weight teasing, and child-directed encouragement to lose weight) and 3 Comprehensive Feeding Practices Questionnaire subscales (ie, Monitoring, Restriction for Health, and Restriction for Weight Control).

STATISTICAL ANALYSES PERFORMED

Linear regression models were used to examine associations between mean scored parent-experienced and parent-internalized weight stigma and weight-related communication and feeding practices. Models were adjusted for child gender, parent-perceived child weight status, parental race and ethnicity, parental body mass index, and household income-to-needs ratio.

RESULTS

In covariate-adjusted models, parent-internalized weight stigma was positively associated with self-directed weight talk (β = .20, SE = .078; P = .01) and greater use of health-related restrictive child feeding practices (β = .16, SE = .070; P = .02). No other significant associations in covariate-adjusted models were observed.

CONCLUSIONS

Although parents with greater internalized weight stigma may engage in more self-directed weight talk, they may also be more attuned to the harms of weight stigma and seek to minimize child-directed weight talk and weight teasing.

Optimal exercise dose on Body Mass Index (BMI) in children and adolescents with overweight and obesity: a systematic review and bayesian model-based network meta-analysis

BACKGROUND

Exercise is widely used for obesity management, but the optimal doses of exercise for improving body mass index (BMI) in children and adolescents with overweight and obesity remain unclear. This study aimed to evaluate the dose‒response effects of various exercises on BMI in children and adolescents with overweight and obesity.

METHODS

A systematic search was conducted in Web of Science (Core Collection), PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library for randomized controlled trials on relevant studies, covering literature up to July 2024. Three independent reviewers assessed bias via the Cochrane risk of bias tool. The quality of evidence was assessed using Confidence in Network Meta-Analysis framework. A dose‒response network meta-analysis was used to evaluate the impact of various exercise interventions and explore dose‒response relationships. All outcomes were analyzed with the mean difference (MD) and 95% credible intervals (CrIs) calculated for combined statistics.

RESULTS

The study included 39 publications with 1,814 participants, 47.3% female and a median age of 14 years. The intervention involved six exercise modalities. High-intensity interval training demonstrated a significant reduction in BMI (MD = -1.33, 95% CrIs - 2.01 to -0.66), followed by combined exercise (MD = -1.25, 95% CrIs - 1.93 to -0.61), moderate-intensity continuous training (MD = -1.09, 95% CrIs - 1.73 to -0.45), and mixed aerobic exercise (MD = -1.05, 95% CrIs - 1.67 to -0.42). There was an 'L'-shaped nonlinear dose-response relationship between total exercise dose and BMI, with 200 METs-min/day identified as the minimum exercise dose required to achieve a clinically meaningful reduction in BMI.

CONCLUSION

Low-quality evidence indicates that HIIT, CE, MAE, and MICT improve BMI in children and adolescents with overweight and obesity, with clarified exercise doses for clinical benefit. These findings are relevant for exercise prescription and public health policy.

TRIAL REGISTRATION

CRD42024566450.

Rationale, design, and methodology of My Body Is Fit and Fabulous at school (MyBFF@school) study: a multi-pronged intervention program to combat obesity among Malaysian schoolchildren

BACKGROUND

Childhood obesity has increased rapidly in recent years and is now a global epidemic. To combat this, MyBFF@school program, a multi-faceted obesity intervention incorporating physical activity in the form of small-sided games (SSG), nutrition, and psychology components for schoolchildren was designed. This paper is aimed at describing the protocol of the MyBFF@school program and presenting the baseline findings including the overweight and obesity prevalence.

METHODS

MyBFF@school is a school-based, cluster randomized controlled trial (C-RCT) study. The investigators selected government schools from Federal Territory of Kuala Lumpur, Selangor and Negeri Sembilan by stratified proportionate random sampling based on the multi-ethnic population and the urban-rural location of schools. Subsequently, the schools were assigned randomly to intervention and control groups. The intervention schools underwent MyBFF@school program, whereas the control followed standard school curriculum for a duration of six months. The intervention modules replaced the existing two physical education classes and one co-curriculum activity per week. Three assessments i.e. at baseline, month-3 and month-6 were conducted. Anthropometric, clinical examination, blood, physical fitness, nutrition, and psychology parameters were collected.

RESULTS

Twenty-three out of 1,196 primary schools (seven interventions and 16 controls) and 15 out of 416 secondary schools (six interventions and nine controls). The investigators screened 11,950 primary (age 9-11 years) and 10,866 secondary (age 13, 14, 16 years) schoolchildren. The investigators found 3,516 primary schoolchildren (29.4%) and 2,910 secondary schoolchildren (26.8%) had BMI z-score of more than + 1SD who were eligible for the study. Of these, 39.7% (N = 1397) of the primary and 35.8% (N = 1041) of the secondary schoolchildren agreed to participate in the study. The mean (SD) characteristics for the participating primary and secondary schoolchildren were: BMI z-score, + 2.29 (± 0.81) and + 2.10 (± 0.71); waist circumference, 75.06 (± 9.6) cm and 85.5 (± 10.9) cm; percentage body fat, 37.8% (± 6.5%) and 39.2% (± 7.3%); and muscle mass, 14.7 (± 2.9) and 23.1 (± 5.2) kg respectively.

CONCLUSION

MyBFF@school program, a school-based multi-pronged intervention was designed to combat childhood obesity. Screening of 22,816 primary and secondary schoolchildren found 29.4% of primary schoolchildren and 26.8% of secondary schoolchildren to be overweight and obese which reflected the urgency for an effective intervention.

TRIAL REGISTRATION

Clinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13-439-16563. Registered July 23, 2013. The intervention program was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and Educational Planning and Research Division (EPRD), Ministry of Education Malaysia. It was funded by the Ministry of Health Malaysia.

Prevalence and predictors of positive childhood experiences and their relationship with adverse childhood experiences among young adults in Delhi-NCR, India

BACKGROUND

Although positive childhood experiences (PCEs) have been reported to be crucial for healthy development and better mental and physical health outcomes, their epidemiology and relationship with adverse childhood experiences (ACE) exposure in low and middle-income countries, including India remain underexplored.

AIMS

The present study aimed to ascertain the prevalence and predictors of PCE exposure and understand the relationship between PCE and ACE exposure among young adults in Delhi-NCR, India.

METHODS

The present cross-sectional study involved a total of 1,573 young adults (18-25 years) of both sexes (69.7% females) recruited from two Universities in Delhi-NCR, India. PCEs and ACEs were measured using the Benevolent Childhood Experiences scale and ACE-International Questionnaire.

RESULTS

Of the total participants, 42.6% reported experiencing all 10 PCEs, while 50.2% had experienced 6 to 9, and 7.2% had experienced 0 to 5 PCEs. Further, the mean PCE score of the sample was 8.64. Certain sociodemographic groups, for instance, participants from immigrant families, sexual minority groups and those who were obese during childhood than their respective counterparts were at lower odds of high PCE exposure. Also, the study found a significant inverse correlation between ACE and PCE exposure levels; however, the effect size was moderate.

CONCLUSIONS

The study indicates the need for targeted PCE promotion interventions for disadvantaged sociodemographic groups. The intervention should simultaneously aim at reducing ACEs, as PCE promotion alone may not always lead to ACE reduction.

Moving Beyond Research to Public Health Practice: Spread And Scale of Interventions that Support Healthy Childhood Growth

Equitable access to affordable, effective, and safe obesity prevention and treatment remains a problem for many children and families in the U.S. In 2023, the American Academy of Pediatrics (AAP) published its first Clinical Practice Guideline (CPG) for pediatric obesity evaluation and treatment, aiding the field's awareness of effective approaches. CDC has supported the adapting and packaging of existing, effective Family Healthy Weight Programs that deliver CPG-recommended intensive behavioral treatment for kids. Currently, at least six family-centered programs are recognized by CDC and can be implemented in clinical and community settings to support child health. CDC and other national partners are coordinating the movement of these research-tested FHWPs into public health practice. This work includes implementing FHWPs in over 60 US communities and supporting national-level infrastructure improvements. CDC is committed to engaging with stakeholders to help scale proven strategies that ensure all children receive the care they need to thrive.

Comparing and intervening on behavioral demand for snack foods among justice-involved adolescents: A preliminary translational analysis

Obesity may be more prevalent among populations who are of low socioeconomic status, have limited access to nutrient-dense foods, or both. One such population is justice-involved youth. This series of translational experiments builds on previous research on food reinforcement and behavioral demand by (a) assaying demand for snack foods among justice-involved adolescents and (b) evaluating the effect of a nutrition intervention on justice-involved adolescents' demand for healthier alternatives. In Experiment 1, participants completed preference assessments for high- and low-energy-density snack foods and corresponding commodity purchasing tasks. The results indicated significant differences in demand based on energy density and preference. In Experiment 2, justice-involved adolescents received a nutrition intervention. Following intervention, participants repeated preference assessments and commodity purchasing tasks. The researchers used mixed-effects modeling to evaluate the effect of (a) the intervention, (b) participant age, and (c) the amount of intervention received on pre-post differences in demand for healthier alternatives. Results and implications are discussed along with future directions for improving conditions of confinement for justice-involved adolescents.

How to reduce the adverse effects of weight stigma on the quality of life: a preferred reported items for systematic reviews and meta-analyses (PRISMA)

Introduction

Obesity, affecting 38% of adults globally, carries economic burdens and health risks like cardiovascular disease and diabetes. Weight-loss programs often face challenges due to stigma and poor body image, impacting individuals' quality of life. Research on interventions targeting weight stigma is lacking, emphasizing the need for comprehensive approaches addressing psychological and behavioral aspects for effective care.

Methods

A systematic literature review was conducted according to PRISMA guidelines. We searched into three databases (PubMed, APA PsycArticles/PsycInfo, and Web of Science) articles published between 1975 and 2024. Studies were eligible if they involved people living with overweight or obesity who participate in a psychological program targeting, or not, weight stigma and if at least one outcome was related to weight stigma.

Results

We selected 24 studies published between 2009 and 2022, the majority concerning English-speaking countries. Reduction in weight stigma was observed in 23/24 studies, particularly through cognitive-behavioral techniques (18/24 studies), while others studies emphasized individual predispositions and the need for longer, and denser interventions.

Conclusion

Three relevant characteristics emerged from the studies analysed: content, duration and tools. Cognitive-behavioral techniques were central, aiding participants in managing their condition and coping with stigma. Interventions reducing Weight Bias Internalization (WBI) led to improved psychosocial determinants, yet the mechanisms remain unclear. Future research should address intervention duration, participant involvement, and the association between WBI and psychosocial factors to enhance outcomes and understanding.

Tackling obesity while preventing obesity stigma

Obesity is a significant public health problem. Prevalence is rising in children and young people, with lifelong health impacts and implications for paediatric clinical practice. Obesity stigma is increasingly acknowledged as a problem within health services. Health professionals can inadvertently contribute to this stigma, which is harmful and in itself can promote weight gain. A complex web of factors contributes to obesity, and a simplistic approach exclusively focused on personal responsibility, diet and exercise is unhelpful. A more nuanced, sensitive and informed approach is needed, with careful use of language and non-judgemental partnership working.

Discrimination against adolescents with chronic diseases: a systematic review

Discrimination is a social construct that discredits individuals based on attributes deemed socially undesirable. Adolescence is a period of transition where individuals acquire skills, values, and experiences that prepare them for adulthood. Adverse experiences during adolescence could particularly affect these acquisitions. For adolescents, discrimination is an experience that can lead to social and health consequences. Our hypothesis is that adolescents with chronic disease are more likely to be exposed to discrimination than their healthy peers. This systematic review aimed to study the prevalence, nature, and the additional risk of discrimination in adolescents with chronic disease compared to their healthy peers. A systematic review was conducted following PRISMA guidelines, including both quantitative and qualitative studies, published between January 2000 and December 2022. Searches were conducted using several electronic databases, including PubMed, COCHRANE, PsycINFO, EMBASE, CAIRN, and CINAHL. Included articles studied adolescents between 12 and 18 years old affected by one of the most prevalent chronic diseases (obesity, epilepsy, diabetes, respiratory diseases including asthma and cystic fibrosis, cancer, and cardiovascular disease). Those articles reported discrimination from the adolescents' perspective and studied the association between discrimination and disease. We identified 27 studies conducted across almost all continents, including a total of 3,290,446 adolescents. Most of the studies are cross-sectional and recent (published after 2017). They are mainly focused on obesity and epilepsy. All types of discrimination were studied, although cyberbullying was explored in only one study. The prevalence of discrimination was reported in 11 studies and varies depending on the type of chronic disease and contexts (from 14% in adolescents with cystic fibrosis to 99% in adolescents with diabetes). Discrimination was mostly self-reported by the adolescents and it came from multiple sources: peers, parents, or educational and healthcare professionals. It seems that the presence of a chronic disease exposes individuals to an additional risk of discrimination, even though quantifying this risk was not possible due to the diversity of methods.

CONCLUSION

Discrimination against adolescents with chronic diseases has received poorly studied in literature even though they appear to be more vulnerable than their peers. The phenomenon is complex since discrimination occurs through several forms and originates from diverse sources. Given the multiple repercussions of discrimination on all aspects of adolescents' life and development, it is essential to study it further. Awareness of discrimination's diversity will allow to establish preventing actions. Early screening could help limit discrimination's prejudice on adolescents' quality of life.

WHAT IS KNOWN

• Discrimination has a significant impact on the life of individuals who experienced it. • Some risk factors of discrimination are already known, e.g., age, gender, disability, ethnic origin. • There is no strong evidence that having a chronic disease at adolescence increases the risk of discrimination.

WHAT IS NEW

• Adolescents with chronic disease have an additional risk of discrimination coming from their peers, their parents, and professionals. • The discrimination could be explained by the permanent physical difference, the occasional visibility of the symptoms or physical limitations, and the sociocultural constructs of the disease.

Generation Healthy Kids: Protocol for a cluster-randomized controlled trial of a multi-component and multi-setting intervention to promote healthy weight and wellbeing in 6-11-year-old children in Denmark

BACKGROUND

Childhood obesity can have significant negative consequences for children's wellbeing and long-term health. Prior school-based interventions to prevent child overweight and obesity have shown limited effects, highlighting the necessity for comprehensive approaches addressing complex drivers of childhood obesity. "Generation Healthy Kids" (GHK) is a multi-setting, multi-component intervention to promote healthy weight development, health and wellbeing in Danish children aged 6-11 years. This protocol describes the GHK main trial, which is a cluster-randomized trial evaluating effectiveness and implementation of the GHK intervention.

METHODS

Twenty-four schools from the Capital, Zealand and Southern Denmark Regions are randomly allocated 1:1 to intervention or control. The intervention will run for two school years (18-20 months) from October 2023 to June 2025 and will include children in 1st-3rd grade (approx. n = 1,600). The intervention targets multiple settings, including families, schools, after-school clubs, and local communities. Within four focus areas-diet, physical activity, screen media use, and sleep habits-the intervention incorporates several fixed elements, including a school lunch program and three weekly sessions of physical activity at school. Furthermore, building on whole-systems thinking, the intervention encompasses co-created elements developed in collaboration with local stakeholders, e.g. municipalities, sports clubs and supermarkets. This part of the intervention emphasizes building local capacity and engagement to promote child health. Effectiveness data will be collected from participating children and families at baseline, and at the end of school year one (after 6-8 months) and school year two (after 18-20 months). The primary outcome is the change in fat mass, measured by air-displacement plethysmography, from baseline to end-of-study in the intervention group compared to the control group. This is supplemented with numerous secondary outcomes and other prespecified outcomes related to child health and wellbeing. Furthermore, thorough process evaluation will be performed.

DISCUSSION

GHK combines evidence-based intervention elements targeting multiple settings with a whole-systems approach focusing on capacity building and stakeholder involvement. This novel approach holds promise as an innovative way to promote child health and wellbeing and prevent childhood obesity.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05940675 (registered on 4 July 2023).

Online Cognitive-Behavioral Therapy-Based Nutritional Intervention via Instagram for Overweight and Obesity

BACKGROUND/OBJECTIVES

Obesity is a multifactorial chronic disease treated through lifestyle modifications, pharmacotherapy, and surgery. With the rise of social media, platforms like Instagram have become tools for lifestyle interventions. This study evaluated the impact of a cognitive-behavioral-therapy-based nutritional intervention via Instagram on body weight, eating behavior, and mental health in individuals with overweight and obesity.

METHODS

A 5-week online intervention delivered daily nutritional, cognitive, and behavioral content via a private Instagram account using live sessions, reels, feed posts, polls, and stories. Standardized dietary plans were sent by e-mail. Self-reported weight and waist circumference and questionnaires on eating behavior, self-esteem, stress, and anxiety were collected. Engagement and interaction were measured through comments, likes, number of followers, story retention, participation in live sessions, and direct messages.

RESULTS

The final sample included 66 participants (63 women), 27 with overweight and 39 with obesity, and a mean age of 40.5 ± 10.6 years. After the intervention, body weight decreased by 1.1 kg, while waist circumference remained unchanged. Participants with obesity showed significant improvements in binge eating, uncontrolled eating, self-esteem, stress, and anxiety, while those with overweight showed improvements in binge eating and stress. Weight loss was associated with reduced binge eating and lower cognitive restriction, while lower uncontrolled eating was related to decreased emotional eating, anxiety, and stress. Additionally, participation in live sessions was associated with reduced binge eating.

CONCLUSIONS

This online intervention via Instagram was effective in improving weight loss, eating behavior, and mental health symptoms in participants with overweight and obesity.

Growing up in a larger body: youth- and parent-reported triggers for illness and barriers to recovery from anorexia nervosa

BACKGROUND

A significant portion of youth with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) have history of 'overweight/obesity' (i.e., body mass index ≥ 85th percentile for age-and-sex) prior to the onset of the eating disorder (ED) diagnosis, but research on this population remains limited. The present study used semi-structured interviews to explore themes related to triggers of weight loss, treatment, and recovery among youth with AN/AAN and history of 'overweight/obesity,' and their parents.

METHOD

The sample included eleven youth and parent dyads (Median [IQR] age of youth = 16.0 (1.5) years, 90.9% female, 90.9% White, 27.3% Hispanic) who were evaluated for an ED in a multidisciplinary ED program at a pediatric hospital between November 2020 and April 2021. Nine youth and separately, nine parents of these 11 dyads completed semi-structured interviews with the research team. Seven matched pairs of patients and parents completed demographic surveys and study interviews. Interviews were recorded, transcribed, and coded by four research team members using a reflexive thematic approach.

RESULTS

Weight stigma was the most frequently reported theme for a trigger for weight loss that led to the onset for developing AN/AAN by both youth and parents. Regarding barriers to recovery, themes from more than a half of youth included uncertainty of weight goals in treatment and feeling they are "not sick enough." Notable themes for attitudes towards treatment from most parents included general agreement with clinician recommendations, but also an uncertainty of weight restoration goals and a belief that their child need to have a "normal" weight.

CONCLUSION

These results highlighted how the majority of interviewed youth with history of 'overweight/obesity' reported weight stigma as both a trigger for the development of AN/AAN as well as a barrier to recovering. Internalized weight stigma among parents may influence their attitudes towards weight restoration as a treatment goal where these youth and parents may experience uncertainty of weight goals in treatment. This study demonstrated triggers and barriers to treatment that may be unique to youth with ED and history of 'overweight/obesity' and more research is needed to address weight stigma in multidisciplinary ED treatment for this understudied population.

Feasibility and acceptability of school-based intervention components to promote healthy weight and well-being among 6-11-year-olds in Denmark: mixed methods findings from the Generation Healthy Kids feasibility study

BACKGROUND

Overweight and obesity among children is a serious public health challenge worldwide which may lead to a range of negative physical, mental, and social consequences in childhood and later in life. There is a strong need for developing new innovative, integrated approaches and programs which can prevent overweight in children effectively and can be embedded into everyday practices. The Generation Healthy Kids intervention is a multi-component, multi-setting intervention aiming to promote healthy weight and well-being in children aged 6-11 years in Denmark. The present study investigates the feasibility and acceptability of 10 selected school-based intervention components and barriers and facilitators for implementation.

METHODS

A seven-week feasibility study was conducted in January to March 2023 among children in 1st and 2nd grade at a Danish public school, testing the multi-component intervention targeting children's meal-, physical activity-, sleep- and screen habits. Process evaluation data were collected using multiple methods (surveys, logbooks, evaluation sheets, registrations, counts, interviews, and observations) and data sources (parents, school staff, and school leader).

RESULTS

Most intervention components were feasible to deliver at the school, but only four components were fully delivered as intended, while the remaining components to some or low degree were delivered as intended. Some components were found acceptable by all/nearly all children (e.g., 40 min of high intensity training three times a week), and others by some or few children (e.g., reusable water bottles and midmorning snack). Intervention activities for the parents and families were found acceptable by all/nearly all participating parents. Parents' acceptability of the intervention activities delivered to their children at school could not be assessed, as only few parents participated in surveys and none in interviews. School staff's acceptability of the intervention tasks they were asked to deliver varied but was overall relatively high. Facilitators and barriers for implementation of intervention components were identified at both individual-, school class-, and school level.

CONCLUSIONS

The study underlines the importance of conducting feasibility studies as preparation for large trials. The findings will be used to refine intervention components, implementation strategies and data collection procedures before the Generation Healthy Kids main trial.

Partnerships with primary care providers: Opportunities to prevent eating disorders and mitigate their progression in young people

Epidemiologic research has identified numerous interpersonal and individual risk factors for and warning signs of emerging eating disorders in adolescents. These findings have informed public health prevention and treatment strategies, including translation of findings to clinical recommendations for primary care providers (PCPs). A next step in this translational work could include a comprehensive approach where PCPs are seen as partners in efforts to improve population health outcomes. PCPs have great potential to implement high-yield interventions that prevent or attenuate the course of adolescent eating disorders. To illustrate this potential, we present a case that highlights missed opportunities for a PCP to prevent, detect, and intervene during a patient's developing eating disorder. We then relate the case to two emerging research programs that utilize PCP partnerships: one trains PCPs in Strengths-Based Adolescent Healthcare to improve eating disorder prevention; the other adapts Family-Based Treatment for primary care to improve early access to evidence-based treatment. In addition to these promising areas of research, efforts are needed to widen requirements for eating disorder curricula in medical training programs and to address weight stigma in primary care. Together these efforts will help PCPs become effective partners in the prevention and treatment of eating disorders.

Associations between Positive Childhood Experiences (PCEs), Discrimination, and Internalizing/Externalizing in Pre-Adolescents

OBJECTIVE

This study aimed to investigate the relationships between four types of perceived discrimination (based on race and ethnicity, nationality/country of origin, gender identity, weight/body size), individually and cumulatively; positive childhood experiences (PCEs); and behavioral symptoms among pre-adolescent youth.

METHODS

This study was a secondary analysis of data from the Adolescent Brain Cognitive Development (ABCD) Study, a US-based cohort study of pre-adolescent youth in the United States (N = 10,915). Our outcome was emotional/behavioral symptoms measured by the Child Behavior Checklist. Primary exposures were four types of discrimination, a count of 0-5 PCEs, and other adverse childhood experiences (ACEs). Multiple logistic regression models were used to estimate the relationship between perceived discrimination and clinical-range behavioral symptoms, including the role of PCEs and ACEs.

RESULTS

Weight discrimination was the most frequent exposure (n = 643, 5.9%). Race and weight perceived discrimination were associated with clinical-range externalizing and internalizing symptoms, respectively, but these associations were non significant once other ACEs were added to models. Cumulative discrimination was associated with clinical-range Child Behavior Checklist (CBCL) scores, even when accounting for other ACEs (aOR=1.47, 95% CI=1.2-1.8). PCEs slightly reduced the strength of this relationship and were independently associated with reduced symptoms (aOR=0.82, 95% CI=0.72-0.93).

CONCLUSIONS

Results of this national study suggest cumulative discrimination can exert emotional/behavioral health harm among youth. PCEs were independently associated with reduced behavioral symptoms. There is a need for further research on how to prevent discrimination and bolster PCEs by targeting upstream social inequities in communities.

Recent trends and disparities in screen-based sedentary behavior and physical activity among U.S. overweight youth, 2018-2022

BACKGROUND

Sedentary behavior (SB) and physical activity (PA) are crucial factors influencing health outcomes in overweight children and adolescents. However, recent changes in SB and PA trends among U.S. overweight youth have not been well described, limiting the development of evidence-based clinical and public health interventions.

METHODS

Serial, cross-sectional analyses were conducted using data from the National Survey of Children's Health (NSCH) on U.S. overweight youth aged 6-17 years, spanning from 2018 to 2022. Linear regression models were employed to analyze time trends, with survey year as the exposure and recreational screen time (ST), adherence to the ≤2 h/day ST guideline, and adherence to the ≥1 h/day PA guideline as the outcomes. Multivariable-adjusted logistic and linear regressions were used to evaluate trends, adjusting for age group, sex, race/ethnicity, household income, and the highest education level of primary caregivers.

RESULTS

Data from 11,865 individuals (mean age 12.3 years [SD 2.9]; 6417 [52.3 %] girls) were analyzed. From 2018 to 2022, the average ST duration among overweight youth increased from 3.7 h to 4.1 h per day, a statistically significant increase (p = 0.07). The estimated prevalence of overweight youth meeting the ≤2 h/day ST guideline decreased from 44.6 % to 30.0 % (p = 0.007). Additionally, the prevalence of meeting the ≥1 h/day PA guideline remained low and stable, ranging from 8.4 % to 12.3 % during the analysis period (p = 0.6).

DISCUSSION

In this nationally representative sample of U.S. overweight youth, ST increased by nearly 0.4 h/day over the five-year observation period, while adherence to the ≤2 h/day ST guideline decreased. Adherence to the ≥1 h/day PA guideline remained consistently low. These patterns were consistent across sociodemographic subgroups (age group, sex, ethnicity, and household income). These findings underscore the need for enhanced public health initiatives targeting U.S. youth to reduce recreational screen time and promote a physically active lifestyle.

Pediatric Obesity Pharmacotherapy: State of the Science, Research Gaps, and Opportunities

Pediatric obesity is a major public health problem, affecting nearly 20% of children and adolescents living in the United States. In 2023, the American Academy of Pediatrics released its first clinical practice guideline for the evaluation and management of child and adolescent obesity and recommended integrating health behavior and lifestyle interventions with pharmacological treatment when medically indicated. However, there is a limited evidence base to guide antiobesity medication treatment decisions in clinical practice and limited data on long-term safety during this critical period of growth and development in youth. Thus, in November of 2023, the National Institute of Diabetes and Digestive and Kidney Diseases sponsored a workshop to identify knowledge gaps and opportunities for research on the use of pharmacotherapy for obesity in children and adolescents. Leading scientific and clinical experts in obesity pathophysiology and treatment, pharmacotherapy, clinical trial design, and health equity and disparities, among others, identified gaps in clinical trial design, guidance for clinical use of medications in children and adolescents, additional treatment outcomes beyond body fat or weight, and improvement in care delivery. Adolescent patients and caregivers with lived experience of obesity and weight management were also invited to participate in a panel discussion, providing personal perspectives on living with obesity, clinical care considerations, and research needs. This article summarizes the workshop proceedings on the state of the science and identifies gaps and opportunities for future research to inform optimal and equitable medical management of children and adolescents with obesity.

Addressing weight bias among pediatric healthcare clinical staff

BACKGROUND

Children with obesity may experience weight-based discrimination as a result of weight bias and stigma, which can have deleterious effects on their health and wellbeing, including increased risk of dysregulated, maladaptive, and disordered eating such as restriction, purging, and binging. Prior work has shown that weight bias occurs from healthcare workers caring for adults, but less is known about the prevalence of weight bias in the pediatric healthcare setting.

METHODS

We aimed to determine what proportion of pediatric healthcare professionals had attitudes of weight bias at our own institution by constructing a survey with questions from validated weight bias survey tools. Results revealed nearly half of all respondents had witnessed another healthcare professional make negative remarks about a patient with obesity, and many shared that they lacked the proper education/training and equipment to properly care for patients with obesity. Based on survey results, we created an electronic-based training module to educate healthcare professionals on weight bias and discrimination and how they may negatively affect care provided to children and families with obesity at our institution. Engagement with hospital leadership was a key strategy to ensure participation from medical and nursing/allied health staff in the survey, although only nursing/allied health leadership required the online training module resulting in limited physician engagement.

RESULTS

Feedback received regarding the training module was overwhelmingly positive.

CONCLUSIONS

Our efforts illustrate that weight bias and discrimination exist in pediatric institutions, and that participation in a tailored electronic-based training module may be viewed as a helpful tool to raise awareness of how weight-based discrimination and bias can negatively affect patient care.

Predictors of Social Exclusion among Adolescents: The Weight of Physical Self-Concept Dimensions

Background: Social exclusion victimization among adolescents causes significant damage and harm to development and social balance. Many of the aggressions that lead to this are based on social stigmas, particularly related to physical appearance in school settings involving physical and sports activities. This study investigates the relationship between victimization through social exclusion (both manifest and subtle forms) and physical self-concept, specifically examining ability, attractiveness, physical condition, and strength. Methods: A total of 876 adolescents (mean age = 14.91; standard deviation = 1.71 years), evenly divided between boys and girls, from secondary schools in Andalusia, Spain participated. They completed a self-report questionnaire assessing physical abilities, attractiveness, physical condition, and self-perceived strength, alongside an instrument measuring experiences of social exclusion and manifest exclusion. Results: Our findings indicate that physical ability, attractiveness, and condition are negative statistical predictors of both manifest and subtle exclusion victimization, while self-perceived strength is a statistical predictor of subtle exclusion. Manifest exclusion impacts both genders similarly, but girls are more vulnerable to subtle forms of exclusion. Regardless of gender, physical ability and attractiveness significantly predict both types of exclusion. Conclusions: Our results highlight the importance of physical self-concept for wellbeing and maintaining self-concept balance. The inclusion of interventions addressing social exclusion in physical education is crucial, particularly those that work to mitigate social stigmas against adolescents who struggle in physical or sporting activities. A gender-sensitive approach should also be incorporated. The growing field of research on adolescent social exclusion, both manifest and subtle, underscores the need for further exploration of its links to physical condition, physical activity, self-perception, and societal stereotypes.

An exploratory examination of medical and nursing students' intentions to discuss body image, weight, and eating disorders with their patients

BACKGROUND

Although many people have concerns about their body image, weight, and eating behaviors these issues are not usually discussed in a productive manner with medical providers. Thus, we examined nursing and medical students' willingness to discuss patients' weight, body image, and eating disorders and reasons why they may do so.

METHOD

One hundred and eighty-three nursing and medical students (Mage = 25.06, SD = 5.43) participated in this study. Participants completed open-ended questions pertaining to their willingness to discuss body image, eating, and weight-related issues with future patients. We further queried students' perspective on body mass index (BMI) as a measure of weight status and sought to determine if participants' own weight, weight concerns, appearance evaluation, body appreciation, and experiences of stigma were associated with their willingness to discuss weight-related issues with prospective patients.

RESULTS

Coding of qualitative data indicated that nursing and medical students were "sometimes" willing to discuss prospective patients' weight, body image, and eating disorders, especially if a health concern was evident. Nursing students seemed somewhat more willing to discuss weight issues than medical students and willingness to discuss one of these issues (e.g., body image) was positively associated with willingness discuss the others. Plans for future discussions of body image and weight were marginally associated with personal experiences of weight stigma. The majority of participants indicated that BMI was not a valid measure of health.

CONCLUSIONS

Taken together, findings suggest that future providers' conversations with patients about these sensitive topics are less likely to be associated with their own experiences and more with the relevance of these topics to specific patients.

Differences in body dissatisfaction between individuals with and without stigma toward obesity: A study of preadolescents and adolescents

INTRODUCTION

Previous studies have focused on understanding the biopsychosocial implications of obesity stigma and have made proposals to minimize its negative consequences, as well as recommendations to eliminate or reduce this stigma; however, knowing which individuals stigmatize obesity and why will allow us to have a broader picture of stigmatization and thus help in planning interventions with greater impact.

OBJECTIVE

The aims were to describe the stigmatization toward obesity in preadolescents and adolescents and to determine whether there are differences in body dissatisfaction, abnormal eating behaviors and self-esteem among those with and without stigma toward obesity.

METHODS

A total of 307 preadolescents and 349 adolescents answered a set of questionnaires that evaluated abnormal eating behaviors, body dissatisfaction, self-esteem and stigma.

RESULTS

Fifty-nine percent of the participants stigmatized individuals with obesity, with preadolescents having the greatest stigma levels. Differences were observed only in body dissatisfaction, where the group of preadolescents who stigmatized individuals with obesity and the group of adolescents who did not stigmatize individuals with obesity reported higher levels of body dissatisfaction.

CONCLUSION

Obesity is stigmatized at early ages, regardless of sex; however, preadolescents with stigma toward obesity and adolescents without stigma toward obesity have greater body dissatisfaction, indicating that body dissatisfaction plays a crucial role in the stigmatization of obesity.

LEVEL OF EVIDENCE

Level V, cross-sectional analytical study.

Weight Bias and Stigma in Pediatric Obesity

Weight stigma is pervasive during childhood and adolescent years. Well-established physical and psychosocial health consequences of weight stigma, like disordered eating behaviors, low self-esteem, and higher depressive symptoms, make it especially harmful during a critical period of development for youth. Lasting negative health impacts of these experiences highlight the importance of addressing weight stigma early on. The pediatric health care setting, both physical and social components, can be one of many sources of weight-stigmatizing experiences for youth. This observation has prompted calls for action in the health care setting to reduce weight biases and stigmatizing behavior among pediatric providers.

Overview of the Treatment of Pediatric Obesity and the 2023 Clinical Practice Guidelines

In 2023, the American Academy of Pediatrics (AAP) published its first clinical practice guideline (CPG) for the treatment of obesity. The CPG is organized by key action statements (KAS) and consensus recommendations that address screening, diagnosis and evaluatin of children and adolescents with obesity, assessment of comorbidities and evidence-based treatment options. The evidence base for each KAS and recommendation is detailed alongside care recommendations. Alongisde the publication of the CPG, the AAP published many resources for pediatric clinicians to support implementation of these recommendations to daily practice.

Physical Examination and Evaluation for Comorbidities in Youth with Obesity

Obesity is a complex and chronic disease that can affect the entire body. The review of systems and physical examination are important components of the evaluation. Laboratory assessment is directed toward known cardiometabolic comorbidities. Regular follow-up visits with repeated review of systems, physical examination, and laboratory testing can facilitate early detection and management of comorbidities of this chronic disease.

Evaluating the distinct effects of body mass index at childhood and adulthood on adult major psychiatric disorders

Children with high body mass index (BMI) are at heightened risk of developing health issues in adulthood, yet the causality between childhood BMI and adult psychiatric disorders remains unclear. Using a life course Mendelian randomization (MR) framework, we investigated the causal effects of childhood and adulthood BMI on adult psychiatric disorders, including Alzheimer's disease, anxiety, major depressive disorder, obsessive-compulsive disorder (OCD), and schizophrenia, using data from the Psychiatric Genomics Consortium and FinnGen study. Childhood BMI was significantly associated with an increased risk of schizophrenia, while adulthood BMI was associated with a decreased risk of OCD and schizophrenia. Multivariable MR analyses indicated a direct causal effect of childhood BMI on schizophrenia, independent of adulthood BMI and lifestyle factors. No evidence of causal associations was found between childhood BMI and other psychiatric outcomes. The sensitivity analyses yielded broadly consistent findings. These findings highlight the critical importance of early-life interventions to mitigate the long-term consequences of childhood adiposity.

Understanding Differences in Medical Student Perceptions of Treatment Adherence Based on Weight Status in Pediatric Care

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.

Obesity in Adolescents: A Review

Importance

Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems. Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.

Observations

Obesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile. Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction. Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment. Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare. Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year. Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research.

Conclusions and Relevance

The prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%.

Obesity-related behaviors and health-related quality of life in socioeconomically vulnerable children: A cross-sectional study

PURPOSE

This study aims to explore obesity-related behaviors (ORB) and health-related quality of life (HRQoL) in socioeconomically vulnerable children, while also examining potential associations between these variables.

DESIGN AND METHODS

A total of 721 children enrolled in after-school care programs for socioeconomically vulnerable children participated in this study. Height (in cm) and weight (in kg) were measured directly by trained research assistants. ORB, including eating behaviors and physical activity, was assessed utilizing the Nutrition Quotient Questionnaire. HRQoL was measured utilizing the PedsQL™ 4.0. Data were analyzed using logistic regression.

RESULTS

The findings revealed that participants exhibited lower levels of ORB and reduced HRQoL, particularly in the physical health dimension of HRQoL. Inadequate physical activity and poor dietary habits were strongly associated with a 2.625-fold (OR = 2.625, 95% CI = 1.867-3.691) and a 4.251-fold (OR = 4.251, 95% CI = 2.466-7.328) increase, respectively, in the likelihood of having low HRQoL. Surprisingly, the study did not find a significant link between ORB levels and obesity, and obesity status did not predict a higher probability of low HRQoL.

CONCLUSIONS

This study underscores the need for tailored interventions designed specifically for children from socioeconomically vulnerable families to address their unique challenges.

PRACTICE IMPLICATIONS

This research provides valuable insights for pediatric nurses and healthcare providers, highlighting the crucial role of promoting healthy ORB in socioeconomically vulnerable children to address disparities in childhood obesity and HRQoL.

Practical guidelines for eating disorder risk mitigation in patients undergoing obesity treatment for the pediatric provider

PURPOSE OF REVIEW

Pediatric obesity is a growing concern globally. Patients with a history of overweight/obesity often experience stigmatization, especially in the healthcare setting, and are at increased risk of developing psychological comorbidities including eating disorders. This review appraises the most recent studies evaluating eating disorder risk in youth undergoing treatment for obesity, identifies gaps in the literature, and offers practical guidelines to pediatric providers regarding the management of this population.

RECENT FINDINGS

Recent studies suggest that structured weight management programs may decrease the risk of and/or improve symptoms of certain eating disorders such as binge eating disorder and bulimia nervosa. There is a paucity of research on some components of obesity management such as obesity pharmacotherapeutics and eating disorder risk.

SUMMARY

Children and adolescents with obesity are a psychologically vulnerable population with increased risk for the development of eating disorders. Further study is needed to evaluate general risk in the setting of specialized and primary care obesity interventions and develop appropriate screening and mitigation tools. Some evidence-based strategies can aid pediatric providers in both weight management and eating disorder prevention and risk assessment.

Childhood obesity and adolescent follow-up depressive symptoms: exploring a moderated mediation model of body esteem and gender

Obesity is a well-recognized risk factor for adolescent depressive symptoms, but mediating mechanisms of this association have scarcely been studied. This study is unique in examining an indirect pathway of this link via body esteem (BE) prospectively from childhood (8-12 years) to adolescence (13-18 years). In addition, potential gender moderation was examined. This study utilized data from a case-control study comparing 100 children with and without obesity matched on important confounders (age, gender, and socioeconomic status). Our findings provide support for the mediating role of BE in the link between childhood weight status and adolescent depressive symptoms at a 5-year follow-up. This mediation effect did not differ between boys and girls. The findings suggest the relevance of specifically targeting children's BE in preventive intervention programs among children with obesity to prevent future mental health problems.