Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of Shaping America's Health and the Obesity Society

Comprehending the Epidemiology and Aetiology of Childhood Obesity: Integrating Life Course Approaches for Prevention and Intervention

INTRODUCTION

Childhood obesity is defined as a medical condition characterised by abnormally high amounts of body fat relative to lean body mass, which increases the risk of adverse health outcomes among children and adolescents from birth to 18 years. The prevalence of childhood obesity, which has serious healthcare implications, is surging, together with its healthcare burden. In this review we explore the intricate interplay of hereditary, environmental, behavioural, cultural and metabolic factors contributing to the global increase in childhood obesity rates. We examine the influence of prenatal factors, genetic predispositions and epigenetic mechanisms on obesity susceptibility and treatment strategies, emphasising the importance of a multilevel life course framework to understand the multifactorial causes of obesity.

METHODS

This narrative review examines the epidemiology, burden, aetiology and impact of childhood obesity by focusing on published literature and the efficacy of multilevel interventions. Comprehensive algorithms are provided to illustrate the causes of childhood obesity through the lens of a multilevel life course framework, taking into consideration individual, family, community and societal factors.

RESULTS

Genetic predispositions, including inherited tendencies towards emotional eating, metabolic variations and body fat distribution, significantly influence a child's obesity risk. Environmental factors, such as limited access to nutritious food, sedentary behaviour, insufficient opportunities for physical activity and obesogenic environments, contribute to the increasing prevalence of childhood obesity. Prenatal influences, including maternal hyperglycaemia and nutritional exposures, lead to epigenetic alterations that predispose children to obesity and metabolic disorders. The social environment, including parental influences, cultural norms and peer dynamics, shapes children's dietary habits and physical activity levels. Additionally, the review highlights the importance of early detection of metabolic alterations associated with paediatric obesity and insulin resistance and the potential for epigenetic mechanisms as therapeutic targets. Recommendations are made for tailored medical nutrition therapy, screening for syndromic obesity and multilevel interventions targeting individual and societal factors.

CONCLUSIONS

This review underscores the necessity of a comprehensive, multilevel approach that integrates genetic, environmental, behavioural and cultural factors along with lifestyle modifications and public health initiatives to address the complex and multifaceted issue of childhood obesity effectively. Targeted interventions across the life course, policy reforms, community engagement and technological innovations are recommended to mitigate obesity risks and promote long-term health. An infographic is available for this article. INFOGRAPHIC.

Efficacy of a Community- and Family-Based Intervention on Cardiovascular Fitness and Cardiometabolic Disease Risk Factors Among Primarily Latino Families

BackgroundTargeting cardiovascular fitness (CVF), rather than weight loss, may be a more acceptable and feasible outcome among Latinos.PurposeThe purpose of this study was to test the short-term efficacy of Athletes for Life (AFL), a fitness- and lifestyle-focused behavioral intervention to improve CVF and performance among Latino families.MethodsLatino parent-child dyads (n = 137) were randomized to either AFL program or a waitlist control condition. AFL consisted of 24 group family-based, nutrition and sport/fitness oriented 90-minute sessions (twice-weekly). Measures included 1-mile run/walk time, three-minute step test, accelerometer-measured physical activity, body mass index (BMI), waist circumference, DEXA-measured % body fat, cardiometabolic risk biomarkers, and sociodemographic characteristics. Group differences at post-intervention were tested using ANCOVA analyses adjusting for outcome values at baseline and demographic variables.ResultsParents were primarily female (93%), aged 38.3 ± 6.9 years, and 96% Latino and children were 8.8 ± 1.7 years old and 58% female. Intervention participants showed significantly faster adjusted post-intervention 1-mile run/walk times compared to control group participants (difference of -76.6 seconds P < 0.01 and -44 seconds P = 0.04, respectively). Parents also showed a significantly higher adjusted relative VO2 max (ml/kg/min) compared to control group parents (43.91, SE = 0.41 vs 42.93, SE = 0.44, respectively, P < 0.01). There were no significant post-intervention group differences on physical activity, BMI, waist circumference, % body fat or cardiometabolic biomarkers P > 0.05.ConclusionsThe AFL program successfully improved aerobic performance among underserved Latino families with no observable changes in adiposity. These results support that fitness may be a more viable and acceptable outcome among Latino families than weight loss.

Understanding the association of longitudinal body mass index patterns in children and their parents: A data-driven study from the TARGet Kids! cohort

BACKGROUND

Obesity remains a persistent global health issue across generations. Targeting family-level factors may help improve child and adolescent body mass index (BMI) outcomes. While associations between parental and offspring BMI are well-documented, the temporal patterns and risk factors driving these relationships remain unclear. This study aimed to identify longitudinal family-level BMI patterns incorporating child, maternal, and paternal BMI and apply interpretable machine learning (ML) methods to uncover key predictors.

METHODS

This longitudinal study included 6092 children and their parents from the TARGet Kids! cohort, with BMI measurements collected from birth to 150 months. Group-based multi-trajectory modeling identified joint trajectories of child BMI-for-age Z-scores (zBMI) and parental BMI. Five ML classifiers predicted group membership using 78 predictors spanning sociodemographic, dietary, parental health, and child lifestyle variables. To explore the modifying effect of parental overweight/obesity (OW/OB) on the relationship between child age and BMI, Bayesian generalized additive mixed models (GAMMs) with smoothed term interactions were applied.

RESULTS

Five distinct joint trajectory groups were identified. Children in the highest BMI trajectory group typically had both parents following similar high BMI trajectories. Parental OW/OB status emerged as the strongest predictor of child OW/OB (37 % classification probability), followed by breastfeeding duration (17 %) and child physical activity (15 %). The influence of parental OW/OB was particularly pronounced in early childhood (0-60 months). Bayesian GAMMs confirmed the robust, longitudinal association between child and parental BMI trajectories.

CONCLUSIONS

Parental BMI patterns strongly influence child BMI development, with age-dependent effects. These findings highlight the importance of early family-based interventions.

Using Parks and Recreation Providers to Enhance Obesity Treatment: A Randomized Controlled Trial

OBJECTIVE

Intensive health behavior and lifestyle treatment (IHBLT) is recommended for children aged 6-18 years with obesity. The objective was to evaluate the effectiveness of Fit Together, a health care and parks and recreation partnership to deliver IHBLT.

METHODS

A randomized controlled trial was conducted from 2018 to 2021. Youths (aged 5-17 years) with obesity were recruited from primary care clinics and randomized to a waitlist control or Fit Together (ie, clinical obesity care plus group-based lifestyle sessions at a local recreation center). Primary outcomes, child body mass index relative to the 95th percentile (BMIp95) and submaximal heart rate, were collected at baseline and 6 months. Generalized estimating equation models were used to assess changes in primary outcomes for those affected and not affected by COVID-19 study disruptions.

RESULTS

Participants (n = 255) had a mean (SD) age of 10.0 (3.0) years, were 39% Hispanic, and were 38% non-Hispanic Black. Intervention youths not affected by COVID-19 disruptions experienced a significant decrease in BMIp95 (β = -3.05; 95% confidence interval [CI], -5.08 to -1.01) compared with controls. There was no difference in BMIp95 between intervention and control youths affected by COVID-19 disruptions (β = -3.25; 95% CI, -7.98 to 1.48). For the entire cohort, intervention youths had a significant decrease in BMIp95 compared with control youths (β = -3.32; 95% CI, -5.69 to -0.96). Submaximal heart rate was only available for the nondisrupted group, but there was no difference between intervention and control youths (β = -7.18; 95% CI, -16.12 to 1.76).

CONCLUSION

Effective child obesity treatment can be implemented in local communities through a partnership between clinical practices and parks and recreation providers. Future research will explore this model in combination with newer, more effective obesity treatments.

Responsive feeding practices among Arabic and Mongolian speaking migrant mothers in Australia: A qualitative study

Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi-structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian-speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic-speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian-speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic-speaking mothers often supplemented with formula top-ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic-speaking mothers used food-based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure-feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds.

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Exploring parents' perceptions and experiences of childhood obesity and management in Riyadh, Saudi Arabia: an interpretive qualitative study

BACKGROUND

Childhood obesity is a public health concern in Riyadh, Saudi Arabia, where cultural and social factors shape parental perceptions. This study explores how Riyadh-based parents view childhood obesity.

METHODS

A hybrid approach to thematic analysis was employed, combining deductive and inductive coding to allow for emergent themes directly from the data. Semistructured interviews were conducted with twelve parents in Riyadh, Saudi Arabia, whose children were identified as overweight or obese. The data were analysed to identify key themes related to parental perceptions and childhood obesity management.

RESULTS

Four themes emerged from the data: (1) perceptions towards childhood obesity; (2) perceived barriers to weight management; (3) perceived benefits to weight management; and (4) perceived motivators to addressing obesity.

CONCLUSION

Parents in Riyadh often view childhood obesity as a sign of health due to deep-rooted cultural norms. However, as they witness health and social challenges in their children, such as bullying or physical difficulties, their perceptions begin to shift. This study highlights the role of cultural beliefs, lifestyle constraints, and limited institutional support as barriers to managing childhood obesity. Addressing these factors through awareness initiatives and community support could empower parents to more effectively promote healthier behaviours for their children, ultimately contributing to improved health outcomes.

Title: A Qualitative Systematic Review of Parental Perceptions, Motivators, and Barriers to Management of Childhood Obesity

Background

Childhood obesity is a global epidemic affecting millions worldwide. Children living with obesity face increased risks of health-related and psychosocial problems extending into adulthood. Parents and carers play a crucial role in cultivating healthy habits in their children. This review aims to synthesize qualitative research on parental perceptions, motivators, and barriers in managing childhood obesity and their views on weight management programs.

Methods

This systematic review was performed in accordance with the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A variety of electronic databases were explored for qualitative studies published between 2006 and 2023. The CASP checklist was employed to assess the quality of the studies. Data extraction and synthesis were carried out utilizing thematic content analysis.

Results

The search identified 20 peer-reviewed studies meeting the inclusion criteria. Key themes were mapped into five distinct groups: perceptions, facilitators and barriers influencing the management of childhood obesity, as well as facilitators and barriers to enrolment into a weight management program. Parents often perceived obesity as a temporary condition, genetically determined and believed it should not be considered as a major health concern. Identified facilitators included the restriction of screen time, school involvement, goal setting, and enhanced child-parent communication. Conversely, barriers included lack of child motivation, peer influence, easy access to junk food, as well as parental denial, insufficient knowledge or control and logistical challenges.

Conclusion

To tackle childhood obesity, it is essential to adopt a comprehensive strategy that fosters a supportive family environment. Successful initiatives should encompass nutritional education for both parents and children, increase access to healthy food choices, implement home-based programs, and improve the infrastructure that encourages physical activity. Additionally, cultural factors and technological advancements should be considered when designing these interventions.

Systematic Review Registration Number

PROSPERO (CRD42024514219).

Genetic Variants of Obesity in Malaysia: A Scoping Review

BACKGROUND

Obesity is a pressing public health issue in Malaysia, involving not only excess weight but also complex metabolic and physiological changes. Addressing these complexities requires comprehensive strategies, including understanding the population-level differences in obesity susceptibility. This review aims to compile the genetic variants studied among Malaysians and emphasize their implications for obesity risk.

METHODS

Relevant articles published up to March 2024 were extracted from the Scopus, PubMed, and ScienceDirect databases. The review process was conducted in accordance with the PRISMA-ScR guidelines. From an initial pool of 579 articles, 35 of these were selected for the final review.

RESULTS

The identified gene variants, including LEPR (K656N), LEP (G2548A-Indian only), ADIPOQ (rs17366568), UCP2 (45bp-I/D), ADRB3 (rs4994), MC3R (rs3827103), PPARγ (pro12Ala-Malay only), IL1RA (intron 2 VNTR), NFKB1 (rs28362491), and FADS1 (rs174547-Indian only), showed significant associations with obesity as measured by the respective studies.

CONCLUSIONS

Overall, more intensive genetic research is needed, starting with population-based profiling of genetic data on obesity, including among children. Sociocultural contexts and environmental factors influence variations in genetic elements, highlighting the need for targeted interventions to mitigate the impacts of obesity in the population.

The MapMe Body Scales: Validity and Reliability of a Biometrically Accurate, Photorealistic Set of Child Body Size Scales

BACKGROUND/OBJECTIVES

It is vital to identify children whose weight status means that they may benefit from medical or behavioural support, but adult visual judgements of child weight status are inaccurate, and children are seldom routinely weighed and measured. Consequently, there is a need for validated visual tools for use in training, communication, and interventions relating to child weight.

METHODS

This paper presents validation data for a set of innovative photo-realistic colour body size scales depicting boys and girls aged 4-5 and 10-11. Each age- and gender-specific scale consists of 7 figures based on three-dimensional (3D) scans of 388 children to accurately represent the change in body size caused by changing adiposity. To assess scale validity, 238 adult participants (105 men, 132 women, 1 non-binary individual) undertook two tasks: rating figure adiposity using a visual analogue scale and ranking figures in ascending order of adiposity (OSF Reference: gdp9j).

RESULTS

Participants accurately estimated the relative adiposity of each figure, i.e., they were able to tell the difference between figures and correctly rank them by size. This demonstrates scale validity for use in body size tasks. One hundred and fifty-one participants also provided 3-day test-retest data, which demonstrates excellent short-term reliability.

CONCLUSIONS

Overall, the MapMe child body size scales provide an anthropometrically accurate, valid, reliable, and usable tool for size-related tasks and communication with adults regarding child weight.

Predictive Utility of the Multi-Process Action Control Framework for Self-Reported and Device-Measured Physical Activity Behavior of Adolescents

Understanding the correlates of physical activity behavior is imperative for informing the development of interventions to address the low rates of physical activity guideline adherence among adolescents living in the United States. This cross-sectional study examined the predictive utility of the Multi-Process Action Control (M-PAC) framework for explaining self-reported and device-measured physical activity behavior among a Hispanic-majority sample of adolescents. A total of 1849 high school students (mean age = 16.0 ± 1.22 SD years; 52.3% women; 87.8% Hispanic) enrolled in one school district in south-central Texas completed a survey including instruments to assess M-PAC framework constructs (instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit, identity) and moderate-to-vigorous physical activity (MVPA) behavior. A subsample (n = 435) wore accelerometers for seven days. The results from robust linear regression models revealed role identity and habit were significant predictors of self-reported MVPA. Role identity was a significant predictor of accelerometer-derived daily MVPA and raw acceleration in the most active hour but not daily raw acceleration. The findings indicated reflexive processes are robust predictors of adolescent physical activity and should be the focus of interventions designed to promote adoption and maintenance of physical activity during this developmental life stage.

Racial/Ethnic Differences in the Age-Varying Association Between Adherence to 8-5-2-1-0 Guidelines in Adolescents with High BMI

PURPOSE

To examine the association between adherence to sleep, dietary, screen time, and physical activity (PA) (8-5-2-1-0) guidelines and risk of high body mass index (BMI ≥ 85 percentile) among U.S. adolescents and to assess for racial inequities and age-varying effects in these associations.

METHODS

Data from the 2019 Youth Risk Behavior Surveillance System survey were used to conduct multivariable logistic regression models and moderation analysis by race/ethnicity and age using time-varying varying effect models (TVEM) and estimate associations of interest.

RESULTS

Of the 13,518 adolescents aged ≥ 14 years, only 0.5% met all guidelines. Adolescents adhering to sleep guidelines had a 21% reduction in their odds of having a high BMI (OR 0.79, 95% CI 0.67-0.93). Those adhering to PA guidelines had a 34% reduction in their odds of having a high BMI (OR 0.66, 95% CI 0.56-0.79), and those adhering to screen time guidelines had a 17% reduction in their odds of having a high BMI (OR 0.83, 95% CI 0.72-0.95). TVEM showed associations between adherence to sleep and screen time guidelines with high BMI fluctuate and are at specific ages. TVEM revealed substantial racial/ethnic differences in the age-varying association between adherence to 8-5-2-1-0 guidelines and high BMI throughout adolescence.

CONCLUSIONS

Associations between adherence to sleep and screen time guidelines and high BMI fluctuate with age, highlighting the need for nuanced interventions targeting 24-h movement guidelines (sleep, PA, and screen time) across adolescence, particularly given racial/ethnic disparities.

Severe complex neglected infantile Blount disease acute correction by Ilizarov frame: A case report

INTRODUCTION

Blount disease is a disorder causing three proportions of deformity, including varus deformity, procurvatum deformity, and internal tibial rotational deformity. The standardized treatment remains controversial despite extensive reviews. The application of Ilizarov external fixators for circumspect corrections is established. The SCARE 2023 criteria have been followed in reporting the case report.

CASE PRESENTATION

We present the case of a nine-year-old girl who's complaining about bowing on both of her knees. From the examination, we found that the metaphyseodiaphyseal angle of both knees was 50 degrees. On the right knee, there is 125 degrees of procurvatum deformity and 115 degrees of deformity on the left knee. After performing deformity correction with the Ilizarov application, there's clinical improvement in the patient.

CLINICAL DISCUSSION

Some experts advise using physeal distraction to manage the deformity in order to achieve correction. The limited popularity of physeal distraction technique may be attributed to the risks of premature closure of the growth plate that we manage to avoid. The Ilizarov frame provides maximum adjustability for aligning all planes, making it suitable for treating severe deformities. Secure fixation, improved patient mobility, being able to assess patient alignment in a functional standing position, and precision.

CONCLUSION

Acute correction and fixation using circular frames as a treatment option for Blount disease show positive outcomes without any significant complications.

Why COVID-19 Symptomatic Patients Did Not Seek Healthcare Service at the Early Phase of the Pandemic in Bangladesh: Evidence From a Cross-Sectional Study

Objective The health-seeking behavior (HSB) of patients during an outbreak is crucial in mitigating the spread of disease. Poor HSB can increase mortality and make contact tracing more difficult. In this study, we aimed to examine the status of HSB among Bangladeshi educated individuals during the early phase of the COVID-19 pandemic when infection was spreading quickly, and social distancing measures were tightened across the country. Methods We conducted a cross-sectional survey online among Bangladeshi individuals using a virtual snowball sampling method to capture suspected COVID-19 patients who did not undergo COVID-19 diagnostic testing. Descriptive and inferential analyses were performed with statistical significance defined as p<0.05. Results The study consisted of 390 participants with 44.9% having a bachelor's degree, followed by 25.9% with a master's or PhD degree. Commonly reported symptoms among the participants included fever (77.7%), cough (50.5%), headache (46.2%), body pain (36.4%), sore throat (35.6%), anosmia (31.3%), anorexia (13.8%), diarrhea (11.4%), and dyspnea (11.3%). The most common reasons for not taking the COVID-19 test were limited testing facilities (48%), the risk of infection from the test center (46%), fear of social stigma (19%), considering COVID-19 infection as innocuous (18%), and fear of forced quarantine (5%). In regression analysis, participants who lived in rural areas were found to be 2.5 times more likely to buy medications from nearby pharmacies. Males were more likely to self-medicate, with male participants being 3.2 times more likely than female participants to consider COVID-19 infection as harmless (AOR: 3.2, CI: 1.28-7.98). Smokers were more likely to seek help from government hotlines and to use drugs at home. Respondents with higher monthly income were less likely to fear forced quarantine (AOR: 0.27, CI: 0.4-2.02) but more likely to consider the risk of infection at the test center (AOR: 1.75, CI: 0.88-3.49). Conclusion Our study highlights that non-compliance with public health guidelines by educated people during an epidemic indicates a general lack of health literacy and distrust in the healthcare system. Along with improved infrastructure, efforts to enhance public health risk communication and health literacy are necessary to rebuild public trust in the healthcare service.

The role of maternal health beliefs in prevention of preschoolers' obesity

BACKGROUND

Childhood obesity is one of the most serious global public health challenges of the 21st century, affecting every country in the world. Mothers' beliefs and perceptions about their children's obesity and overweight are key to obesity prevention. Given the importance of this issue, the present study aimed to determine perceptions and beliefs of mothers' nutritional behaviors related to overweight preschool children.

MATERIALS AND METHODS

This cross-sectional study was conducted on 350 mothers of preschool children with health records who were referred to child health assessment centers. The data collection tool was a researcher-made questionnaire based on the health belief model. SPSS19 was used for data analysis. P < 0.05 was considered significant.

RESULTS

The participants (350) included 52% 25-36 years old, and 57.3% live in rural areas. There was a significant difference in the mean perceived susceptibility between mothers with obese children and normal-weight children (P < 0.05). There was a significant positive relationship between severity and perceived benefits and a significant negative relationship with mothers' knowledge. There was also a significant negative relationship between self-efficacy and perceived barriers (P > 0.05).

CONCLUSIONS

The results of this study showed that maternal health beliefs were effective in the formation of obesity prevention behaviors in children. In this regard, educational interventions can play an important role in the proper practice of such behaviors.

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

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

Birth History and Cardiovascular Disease Risk Among Youth With Significant Obesity

Children born prematurely have greater lifetime risk for hypertension. We aimed to determine (1) the association between prematurity and cardiovascular disease (CVD) risk factors among 90 children with obesity and elevated blood pressure and (2) if dietary sodium intake modified these associations. Multivariable regression analysis explored for associations between prematurity (<37 weeks gestation; early gestational age) and low birth weight (<2.5 kg) with hypertension, left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). Effect modification by dietary sodium intake was also explored. Patients were predominately male (60%), black (78%), adolescents (13.3 years), and with substantial obesity (body mass index: 36.5 kg/m2). Early gestational age/low birth weight was not an independent predictor for hypertension, LVMI, or LVH. There was no effect modification by sodium load. Our results suggest the increased CVD risk conferred by prematurity is less significant at certain cardiometabolic profiles. Promoting heart-healthy lifestyles to prevent pediatric obesity remains of utmost importance to foster cardiovascular health.

School screening programs to identify hypertension in Hispanic youth

Elevated blood pressure during childhood can lead to hypertension in adulthood and is associated with an increased risk of future cardiovascular disease with early identification as the best option for prevention. This study examines the prevalence of hypertension in Hispanic and White youths and reports the ability of a school-based program to identify hypertension in school-aged children. Approximately 3.5 % of students had hypertension while 7.5 % of students had elevated blood pressure. Elevated body mass index (BMI) was the most common predictor of hypertension in all three grade levels (elementary: 5th grade, middle: 7th grade, and high school: 10th grade). In the elementary school age group, the significant predictors of hypertension were an elevated BMI, sex, and height. In the middle school age group, the factors that were significant predictors of hypertension included ethnicity, an elevated BMI, and height. In high school age students, the only significant predictor of hypertension was elevated BMI; ethnicity alone was not a significant predictor. The only group that ethnicity was a significant predictor of hypertension was the middle school age. Given that at all three grade levels, the Hispanic students had a higher percentage with elevated BMIs compared to White students, they should be considered at higher risk of hypertension.

Addressing the Challenge: A Review of Effective Prevention Strategies for Childhood Obesity in India

Childhood obesity is a growing public health concern in India, with rising prevalence rates and associated health risks. This review examines effective prevention strategies for addressing this issue. Through a comprehensive analysis of research findings, policy initiatives, and community-based interventions, the review identifies critical components of successful prevention efforts. These include multi-sectoral collaborations, tailored interventions addressing socioeconomic and cultural factors, and the involvement of families and healthcare professionals. The importance of addressing childhood obesity in India is underscored, given its significant impact on health outcomes, healthcare costs, and quality of life. The review concludes with a call to action for stakeholders and policymakers to prioritise prevention efforts, allocate resources, and implement evidence-based interventions to combat childhood obesity effectively. By working together, India can mitigate the adverse effects of childhood obesity and promote a healthier future for its children.

Exploring Differences in Physical Health in Young Children With and Without ADHD

OBJECTIVE

To assess differences in child physical health outcomes and metrices associated with obesity in a sample of predominantly Hispanic/Latinx young children with and without attention-deficit/hyperactivity disorder (ADHD).

METHODS

Participants included 127 children diagnosed with ADHD and 96 typically developing (TD) children between 4 and 7 years of age. Objective measures of children's body composition, fitness, and physical activity were conducted. Parents of children completed food recalls to assess their child's dietary intake, diet quality was calculated based on the Healthy Eating Index-2015, and parents completed a survey about their family's health habits.

RESULTS

Logistic regression revealed that those with ADHD were more likely to be classified as having an overweight or obese (Ov/O) body mass index (BMI). Linear regression analyses indicated that children with ADHD performed worse on a fitness test and consumed more calories relative to TD children. Moderation analyses indicated that sex differences in steps were prominent in our TD sample, but not among those with ADHD.

CONCLUSIONS

Young children with ADHD are at greater risk for having an Ov/O BMI, being less fit, and eating a greater intake of calories compared to TD children.

Stakeholders' perception of factors influencing adoption of a pediatric weight management intervention: a qualitative study

Background

Childhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites.

Methods

We interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME).

Results

In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described.

Conclusion

Understanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.

Health-Related Quality of Life in Children with Overweight and Obesity: An Explorative Study Focused on School Functioning and Well-being

Overweight and obesity in childhood has reached epidemic levels, and their roles in physical and psychological health are now recognized. Recently, researchers have focused on the impact of these weight problems in health-related quality of life (HRQoL) domains, which are less investigated in children. This exploratory study examined the differences in HRQoL domains between a clinical group who were overweight/obesity treatment-seeking (n = 58) and a normal-weight group (n = 44) in a sample of 102 children, with a specific focus on school functioning and well-being. The second aim explored the link between our findings and other HRQoL dimensions. After controlling for sex and age, a multivariate analysis of variance showed lower levels in school functioning and well-being dimensions between overweight/obesity than normal-weight (F = 4.72; p < 0.05). Correlation analyses highlighted positive links between lower school functioning and well-being and lower levels of self-esteem (r = 0.308; p < 0.01) and social domains in terms of friendships (r = 0.522 ; p < 0.001) and family relationships (r = 0.561; p < 0.001) in children who were with overweight and obesity. This study discusses the implications of these findings in educational research and practices.

Childhood obesity is linked to putative neuroinflammation in brain white matter, hypothalamus, and striatum

Neuroinflammation is both a consequence and driver of overfeeding and weight gain in rodent obesity models. Advances in magnetic resonance imaging (MRI) enable investigations of brain microstructure that suggests neuroinflammation in human obesity. To assess the convergent validity across MRI techniques and extend previous findings, we used diffusion basis spectrum imaging (DBSI) to characterize obesity-associated alterations in brain microstructure in 601 children (age 9-11 years) from the Adolescent Brain Cognitive DevelopmentSM Study. Compared with children with normal-weight, greater DBSI restricted fraction (RF), reflecting neuroinflammation-related cellularity, was seen in widespread white matter in children with overweight and obesity. Greater DBSI-RF in hypothalamus, caudate nucleus, putamen, and, in particular, nucleus accumbens, correlated with higher baseline body mass index and related anthropometrics. Comparable findings were seen in the striatum with a previously reported restriction spectrum imaging (RSI) model. Gain in waist circumference over 1 and 2 years related, at nominal significance, to greater baseline RSI-assessed restricted diffusion in nucleus accumbens and caudate nucleus, and DBSI-RF in hypothalamus, respectively. Here we demonstrate that childhood obesity is associated with microstructural alterations in white matter, hypothalamus, and striatum. Our results also support the reproducibility, across MRI methods, of findings of obesity-related putative neuroinflammation in children.

A Women's health perspective on managing obesity

While the prevalence of obesity in US men and women is nearly equivalent, obesity management in women requires a different approach that considers age and life stage in development including sexual maturation/reproduction, menopause and post-menopause. In this review, the diagnosis and treatment of obesity using lifestyle modification, pharmacotherapy and metabolic and bariatric surgery are discussed from a women's health perspective, with emphasis on management during pregnancy and post-partum.

Using the RE-AIM framework to evaluate the feasibility of a parent-focused intervention targeting childhood obesity

BACKGROUND

Childhood obesity remains a serious public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviors and outcomes among children, but require thorough evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a community-based, parent-focused childhood obesity intervention ("C.H.A.M.P. Families") using the RE-AIM framework, an evaluation tool for health interventions.

METHODS

A single-group, non-randomized, repeated measures feasibility study was conducted. Participants (n = 16 parents/caregivers of 11 children with obesity) completed a 13-week parent-focused education intervention. The intervention consisted of three main components: (a) eight group-based (parent-only) education sessions; (b) eight home-based (family-centered) activities; and (c) two group-based follow-up support sessions for parents and children. The five dimensions of RE-AIM-reach, effectiveness, adoption, implementation, and maintenance-were assessed using various measures and data sources (e.g., child, parent/caregiver, costing, census) obtained throughout the study period. Outcome variables were measured at baseline, mid-intervention, post-intervention, and at a 6-month follow-up.

RESULTS

Overall, the C.H.A.M.P. Families intervention reached approximately 0.09% of eligible families in London, Ontario. Despite the small number, participants were generally representative of the population from which they were drawn, and program participation rates were high (reach). Findings also suggest that involvement in the program was associated with improved health-related quality of life among children (effectiveness/individual-level maintenance). In addition, the intervention had high fidelity to protocol, attendance rates, and cost-effectiveness (implementation). Lastly, important community partnerships were established and maintained (adoption/setting-level maintenance).

CONCLUSIONS

Based on a detailed and comprehensive RE-AIM evaluation, the C.H.A.M.P. Families intervention appears to be a promising parent-focused approach to the treatment of childhood obesity.

TRIAL REGISTRATION

ISRCTN Registry, Study ID ISRCTN 10752416 . Registered 24 April 2018.

Paternal BMI in the preconception period, and the association with child zBMI

BACKGROUND

Rapid growth and excess weight in early childhood are associated with obesity risk. While maternal preconception BMI has been identified as a potential risk factor, the role of paternal preconception BMI is less clear.

OBJECTIVES

To examine the association between paternal preconception BMI and age- and sex-standardized WHO BMI z-score (zBMI) growth rates, zBMI, and weight status, in 0- to 10-year-old children. To determine whether these associations differed by child sex and maternal preconception weight status.

METHODS

A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!). Children (n = 218) underwent repeated measures of height and weight from birth to 10 years old. Piecewise linear mixed models were used to assess the association between paternal preconception BMI and child zBMI growth rates (zBMI SD units/month) between 0, 4, 30, 48 and 120 months of age. Linear mixed models were used to examine the association with child zBMI, and logistic generalized estimation equations (GEE) were used to assess the association with child weight status. Child sex and maternal preconception weight status were tested as effect modifiers.

RESULTS

Paternal preconception BMI was associated with child zBMI growth rate, mean zBMI and weight status in boys, but not girls. A 5 kg/m² higher paternal preconception BMI was associated with approximately 0.01 zBMI SD unit/month higher growth rate for boys born to mothers with preconception overweight. Higher paternal BMI was associated with higher mean zBMI and increased odds of overweight and obesity in boys, with greater effects seen when mothers had preconception overweight compared to normal weight.

CONCLUSION

Paternal preconception BMI was associated with child zBMI growth rate, zBMI and weight status in boys, with greater effects when the biological mother had preconception overweight or obesity. Further understanding of sex differences in paternal preconception weight effects in children is needed.

Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children

BACKGROUND

This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families.

METHODS

Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443).

RESULTS

During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31).

CONCLUSIONS

Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03334669 , Registered October 2017.

Association of family income to poverty ratio and vibration-controlled transient elastography quantified degree of hepatic steatosis in U.S. adolescents

INTRODUCTION

Inequality in socioeconomic status plays an important role in the prevalence of metabolic diseases in adolescents. The purpose of this study was to explore the association between family income and the degree of hepatic steatosis quantified by vibration-controlled transient elastography (VCTE) among U.S. adolescents.

METHODS

This cross-sectional study included two cycles of the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Multivariate linear regression and smoothing curve fitting were used to investigate the linear and nonlinear relationship between PIR and hepatic steatosis, respectively. Subgroup analysis and interaction tests were used to test whether this relationship was stable across groups.

RESULTS

Of the 1,574 adolescent participants, 456 lived in poor households and 307 lived in wealthy households. After adjusting for all covariates, PIR (Ratio of family income to poverty) was significantly negatively associated with the degree of hepatic steatosis [-4.78 (-7.39, -2.17)], and this remained stable after converting PIR to a categorical variable. In addition, this significant negative association was more pronounced in women [-7.62 (-11.38, -3.87)], non-Hispanic blacks [-7.19 (-14.43, 0.06)], Mexican Americans [-6.80 (-13.63, 0.03)], and participants with BMI >30 cm² [-10.83 (-19.70, -1.96)].

CONCLUSIONS

PIR was significantly and negatively associated with the degree of hepatic steatosis in US adolescents. Additional prospective studies are needed to confirm our findings.

Barriers and Facilitators of Weight Management among School Children with Obesity: A Qualitative Investigation of Parents' Perceptions

Parents play a critical role in influencing the eating habits of their children. This study examined parents' perceptions of factors that contributed to childhood obesity and sought their suggestions on various modalities for overcoming the barriers to healthy eating. Semi-structured in-depth interviews were undertaken with 26 parents of 9-13 years old school children with obesity from the United Arab Emirates. Three main topics covered in the interviews were: (1) Parents' perceptions of their children's weight and eating habits; (2) Attitudes towards healthy eating and weight management; and (3) Suggestions on how their children can adopt a healthy lifestyle. Interview transcripts were thematically analyzed using the NVIVO software to identify the emerging main themes and sub-themes. Parents identified individual/intrapersonal (child), interpersonal (peers, family, nannies), and institutional/school environment barriers and facilitators to a healthier lifestyle. The three major themes that emerged were: (1) Negative effects of obesity on children's lives; (2) Barriers to weight management and healthy lifestyle; and (3) Facilitators to healthy eating. Nutritional education and a supportive home and school environment were suggested for the adoption of a healthy lifestyle by children.

The Influence of Adolescent Sport Participation on Body Mass Index Tracking and the Association between Body Mass Index and Self-Esteem over a Three-Year Period

This study aimed to (1) investigate gender-specific characteristics associated with low sport participation among UK adolescents, and (2) assess gender-specific BMI tracking, and gender-specific associations between BMI and self-esteem based on different levels of adolescent sport participation. Participants were 9046 (4523 female) UK adolescents. At 11- and 14 years self-esteem was self-reported and BMI was calculated from objectively measured height and weight. At 11- years sport participation was parent-reported. Gender-specific sport participation quartile cut-off values categorised boys and girls separately into four graded groups. Gender-specific χ² and independent samples t tests assessed differences in measured variables between the lowest (Q1) and highest (Q4) sport participation quartiles. Adjusted linear regression analyses examined BMI tracking and associations between BMI and self-esteem scores. Gender-specific analyses were conducted separately for sport participation quartiles. Compared to Q4 boys and girls, Q1 boys and girls were more likely to be non-White, low family income, have overweight/obesity at 11 years and report lower self-esteem at 11 years and 14 years. BMI at 11 years was positively associated with BMI at 14 years for boys and girls across sport participation quartiles. BMI at 11 years was inversely associated with self-esteem scores at 11 years for Q1 and Q2 boys, and Q1 and Q4 girls. BMI at 11 years was inversely associated with self-esteem scores at 14 years for Q1, Q3 and Q4 boys, and Q1, Q2, Q3 and Q4 girls. Gender and sport participation influence BMI tracking and the BMI and self-esteem association among adolescents.

Investigating how researcher-defined buffers and self-drawn neighbourhoods capture adolescent availability to physical activity facilities and greenspaces: An exploratory study

BACKGROUND

Modifying the environment is considered an effective population-level approach for increasing healthy behaviours, but associations remain ambiguous. This exploratory study aims to compare researcher-defined buffers and self-drawn neighbourhoods (SDN) to objectively measured availability of physical activity (PA) facilities and greenspaces in adolescents.

METHODS

Seven consecutive days of GPS data were collected in an adolescent sample of 14-18 year olds (n = 69). Using Points of Interest and greenspace data, availability of PA opportunities within activity spaces were determined. We compared 30 different definitions of researcher-defined neighbourhoods and SDNs to objectively measured availability.

RESULTS

Findings showed low agreement for all researcher-defined buffers in measuring the availability of PA facilities in activity spaces. However, results were less clear for greenspace. SDNs also demonstrate low agreement for capturing availability to the PA environment.

CONCLUSION

This exploratory study highlights the inadequacy of researcher-defined buffers and SDNs to define availability to environmental features.

How Racism "Gets Under the Skin": An Examination of the Physical- and Mental-Health Costs of Culturally Compelled Coping

Historically and contemporarily, Black Americans have been compelled to use effortful coping styles characterized by high behavioral and emotional restraint in the face of systematic racism. Lynch and colleagues have previously conceptualized a class of regulatory strategies-overcontrolled coping-characterized by emotional suppression, hypervigilance for threat, and high distress tolerance, which bear close analogy to coping styles frequently used among individuals facing chronic racial stress. However, given the inherent culture of racism in the United States, engaging in highly controlled coping strategies is often necessitated and adaptive, at least in the short term. Thus, for Black Americans this class of coping strategies is conceptualized as culturally compelled coping rather than overcontrolled coping. In the current article, I offer a critical examination of the literature and introduce a novel theoretical model-culturally compelled coping-that culturally translates selected components of Lynch's model. Cultural translation refers to considering how the meaning, function, and consequences of using overcontrolled coping strategies changes when considering how Black Americans exist and cope within a culture of systematic racism. Importantly, this model may offer broad implications for future research and treatment by contextualizing emotion regulation as a central mechanism, partially answering how racism "gets under the skin" and affects the health of Black Americans.

Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity

Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.

Risk factors on testicular function in adolescents

PURPOSE

Adolescence represents an important window for gonadal development. The aim of this review is to carry out a critical excursus of the most recent literature on endogenous and exogenous risk factors related to testicular function, focusing the research on adolescence period.

METHODS

A comprehensive literature search within PubMed was performed to provide a summary of currently available evidence regarding the impact on adolescence of varicocele, cryptorchidism, cancer, diabetes, lifestyle factors, endocrine disruptors, obesity and sexually transmitted diseases. We focused on human studies that evaluated a possible impact of these factors on puberty timing and their effects on andrological health.

RESULTS

Evidence collected seems to suggest that andrological health in adolescence may be impaired by several factors, as varicocele, cryptorchidism, and childhood cancer. Despite an early diagnosis and treatment, many adolescents might still have symptoms and sign of a testicular dysfunction in their adult life and at the current time it is not possible to predict which of them will experience andrological problems. Lifestyle factors might have a role in these discrepancies. Most studies point out towards a correlation between obesity, insulin resistance, alcohol, smoking, use of illegal drugs and testicular function in pubertal boys. Also, endocrine disruptors and sexually transmitted diseases might contribute to impair reproductive health, but more studies in adolescents are needed.

CONCLUSION

According to currently available evidence, there is an emerging global adverse trend of high-risk and unhealthy behaviors in male adolescents. A significant proportion of young men with unsuspected and undiagnosed andrological disorders engage in behaviors that could impair testicular development and function, with an increased risk for later male infertility and/or hypogonadism during the adult life. Therefore, adolescence should be considered a key time for intervention and prevention of later andrological diseases.

Physical Activity and Related Factors in Pre-Adolescent Southern African Children of Diverse Population Groups

Tailored obesity management includes understanding physical activity (PA) and its context, ideally in childhood before the onset of health risk. This cross-sectional study determined, by sex and population, the PA of Southern African pre-adolescent urban primary school children. PA was measured objectively (step count: pedometer) and subjectively (Physical Activity Questionnaire for Older Children [PAQ-C]), taking confounders (phenotype, school-built environment, and socio-economic environment) into account. Body composition was measured with multifrequency bioelectrical impedance analysis (Seca mBCA). PA was adjusted for phenotypic confounders (body size and composition) using multivariate regression. Sex and population differences in PA were determined with two-way ANOVA. Ninety-four healthy pre-adolescents (60% girls, 52% black) with a similar socio-economic status and access to PA participated. Amidst phenotypic differences, average steps/day in girls (10,212) was lower than in boys (11,433) (p = 0.029), and lower in black (9280) than in white (12,258) (p < 0.001) participants. PAQ-C scores (5-point rating) were lower for girls (2.63) than boys (2.92) (p < 0.001) but higher for black (2.89) than white (2.58) (p < 0.001) participants. Objective and subjective measurements were, however, not significantly (r = −0.02; p = 0.876) related and PAQ-C failed to identify reactive changes in the step count. Objectively measured PA of black participants and of girls was consistently lower than for white participants and boys. Target-group specific interventions should therefore be considered.

Disparities in the Prevalence of Childhood Obesity-Related Comorbidities: A Systematic Review

Background

Non-communicable diseases among children are serious consequences of childhood obesity. However, less is known about the disparities in childhood obesity comorbidities burden. This review describes the salient pattern of disparities in the prevalence of childhood obesity-related non-communicable diseases and relevant inequalities in both high- and low/medium-income countries.

Method

A systematic literature search was performed in MEDLINE, Embase, CINAHL, PsycInfo, Scopus, and Web of Science databases by two independent reviewers. Inclusion criteria were as follows: age 2–18 years; the prevalence or incidence of childhood obesity comorbidities reported; and studies published in English from January 2010 to date. No restrictions on the setting. The prevalence data were analyzed using range and median for subgroups based on the country's development status, gender, and geographical region.

Results

Our search identified 6,837 articles, out of which we examined 145 full-text articles and included 54 articles in the analysis. The median prevalence of childhood obesity-related hypertension was 35.6 vs. 12.7% among middle- and low-income countries compared with high-income countries; 37.7 vs. 32.9% among boys compared with girls; and 38.6, 25.3, and 20.1% in Asia, South America, and Europe, respectively. For metabolic syndrome, the median prevalence was 26.9 vs. 5.5% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared with girls; and 40.3, 25.8, and 7.7% in South America, Asia, and Europe, respectively. The prevalence of childhood obesity-related non-alcoholic fatty liver disease was 47.5 vs. 23% among middle- and low-income countries compared with high-income countries; and 52.1, 39.7, and 23.0% in Asia, South America, and Europe, respectively. The median prevalence of dyslipidemia was 43.5 vs. 63% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared to girls; and 73.7 and 49.2% in Australia and Europe, respectively.

Conclusion

There are disparities in the prevalence of childhood obesity-related hypertension, metabolic syndrome, and non-alcoholic fatty liver disease, with middle- and low-income countries, boys, and Asian region having higher prevalence. Implementing targeted interventions for childhood obesity comorbidities should consider socioeconomic disparities and strengthening of research surveillance methods for a better understanding of non-communicable disease burden in the pediatric population.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021288607.

Contextual factors in premature non-communicable disease mortality in selected African countries within the sustainable development goals framework: the implication of voice and accountability

Sustainable Development Goal number 3, target 4 (SDG 3.4), seeks a 30% reduction in premature Non-Communicable Diseases (NCDs) mortality from 2015 levels by 2030. Africa United Nations (UN) Member States continue to experience increasing NCD mortality significantly, with the highest proportion of diabetes mortality among the working-age group. Past efforts to address this burden have been centered primarily on individual risk modifications evident by the NCDs Cluster Program at the World Health Organization (WHO) Africa Regional Office. To achieve a progressive reduction, a comprehensive premature NCD reduction approach which includes a consideration of contexts within which premature NCD, such diabetes mortality arises is necessary. The aim was to examine the relationship between contextual factors and diabetes-related deaths as premature NCD mortality and to enable an improved contextualized evidence-based approach to premature NCD mortality reduction. Country-level data was retrieved for post SDG initiative years (2016-2019) from multiple publicly available data sources for 32 selected Africa UN Member States in the International Diabetes Federation (IDF) East and West Africa Region. Multiple linear regression was employed to examine the relationship between diabetes-related deaths in individuals 20-79 years and contextual factors identified within the SDG framework. Weighted data analysis showed that voice and accountability as a contextual factor explained approximately 47% variability in diabetes-related deaths across the selected Africa UN Member Sates in IDF East and West Region (n=32). Civil society engagement is vital to develop effective premature NCD mortality reduction policies, and strategies and stakeholders’ accountabilities are necessary to ensure adherence to obligations.

Obesity Incidence in U.S. Children and Young Adults: A Pooled Analysis

INTRODUCTION

Obesity prevalence among children and adolescents has risen sharply, yet there is a limited understanding of the age-specific dynamics of obesity as there is no single nationally representative cohort following children into young adulthood. Investigators constructed a pooled data set of 5 nationally representative panels and modeled age-specific obesity incidence from childhood into young adulthood.

METHODS

This longitudinal prospective follow-up used 718,560 person-years of observation in a pooled data set of 5 high-quality nationally representative panels-National Longitudinal Survey of Youth 1979 and 1997, National Longitudinal Study of Adolescent Health, and Early Childhood Longitudinal Study-Kindergarten cohorts of 1998 and 2011-constructed by the authors, covering 1980-2016. Differences in obesity incidence across birth cohorts and disparities in obesity incidence by sex and race/ethnicity (non-Hispanic Black, Hispanic, and non-Hispanic White) were tested in multivariate models. Data were analyzed from September 2018 to October 2021.

RESULTS

Obesity incidence increased by approximately 6% for each 1 year of age (hazard ratio=1.06, 95% CI=1.05, 1.07); however, incidence was nonlinear, exhibiting an inverted "U"-shaped pattern before 15 years of age and then rising from adolescence through 30 years. Obesity incidence more than doubled between the cohorts born in 1957-1965 and those born in 1974-1985 during adolescence. There was no significant change among those born in 1991-1994 and 2003-2006 up to age 15 years. Compared with non-Hispanic White children, non-Hispanic Black and Hispanic children had higher obesity incidence in all study cohorts. The magnitude of these disparities on the relative scale remained stable throughout the study period.

CONCLUSIONS

Although many children become obese before the age of 10, obesity incidence rises from about 15 years into early adulthood, suggesting that interventions are required at multiple developmental stages.

Use of person-centred language among scientific research focused on childhood obesity

BACKGROUND

Stigma towards children with obesity can begin as early as 3 years old, leading to increased risk for poorer mental health outcomes and lower quality of life. This includes discriminatory language used by peers and adults, which may be compounded by use within the medical community and in published research.

OBJECTIVES

Our primary objective was to investigate adherence to person-centred language (PCL) in childhood obesity-related medical publications.

METHODS

We searched PubMed for childhood obesity-related articles from 2018 through 2020, from journals frequently publishing childhood-obesity-related research. Articles were randomized and searched for a list of predetermined, stigmatizing terms.

RESULTS

Of the sample of 300 articles, only 21.7% were adherent to PCL guidelines. The most frequent labels found were 'obese' appearing in 70.33% of articles and 'overweight' in 63.7%. Labels such as 'chubby', 'large', and 'fat' were less common, but still appeared in the medical literature.

CONCLUSIONS

A majority of childhood obesity-related articles did not adhere to PCL guidelines. Given the negative effects of stigma among children with obesity, it is imperative to advocate for PCL use within the medical community. Increased stringency by journal editors and publishers may be the next step in this process.

Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth

Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.

Racial/ethnic differences in maternal feeding practices and beliefs at 6 months postpartum

OBJECTIVE

To examine racial/ethnic differences in maternal feeding practices and beliefs in a sample of low-income smoke-exposed women.

DESIGN

Cross-sectional analysis using data collected during a randomised control trial. Maternal feeding practices and beliefs were assessed using the Infant Feeding Questionnaire (IFQ), which was administered at 6 months postpartum. ANOVA was used to examine differences in IFQ items by race/ethnicity, while multivariable linear regression models were used to examine differences in IFQ factor scores by race/ethnicity adjusting for potential confounders.

SETTING

Participants were recruited from prenatal clinics.

PARTICIPANTS

343 women (39 % non-Hispanic White, 28 % Hispanic/Latina, 13 % Black, and 20 % other).

RESULTS

Racial/ethnic minority mothers were more likely than non-Hispanic White mothers to put cereal in their infant's bottle so that the infant would stay full longer (P = 0·032), state their infant wanted more than just formula or breast milk prior to 4 months (P = 0·019), allow their infant to eat whenever he/she wanted (P = 0·023) and only allow their infant to eat at set times (P < 0·001). Adjusting for potential confounders, racial/ethnic minority mothers had higher scores for factors 1 (concern about infant undereating or becoming underweight), 2 (concern about infant's hunger), 4 (concern about infant overeating or becoming overweight) and 5 (feeding infant on a schedule), and lower scores for factor 7 (social interaction with the infant during feeding) than White mothers. Racial/ethnic differences were not found for the other two factors.

CONCLUSIONS

Differences in maternal feeding practices and beliefs across race/ethnicity are present at 6 months postpartum.

COVID-19 and childhood obesity (CO-BESITY) in the era of new normal life: A need for a policy research

BACKGROUND

In the era of new normal life (after Coronavirus Disease 2019 (COVID-19)), our children are experiencing the double threat of COVID-19 and Childhood Obesity (CO-BESITY). The rate of childhood obesity has been rapidly increasing in developed as well as low middle-income countries during the pandemic.

DESIGN AND METHODS

The current paper aims to identify the probable reasons of increase in childhood obesity during this pandemic and offers suggestions to reduce the burden of it. Literature search was done using PubMed, Google Scholar, and Scopus databases for the key terms "childhood obesity," "obesity," "pandemic," and/or childhood obesity. All the relevant articles were included to support the argument for this viewpoint.

RESULTS

Childhood obesity is a complicated disorder having diverse outcomes. The incidence of childhood obesity is clearly analysed from Bronfenbrenner's model of child development. The model examines an overabundance of bio-psycho-social backgrounds, risks, and probable outcomes on the development of a child. COVID-19 pandemic has disrupted the ecosystem of this dynamic model and has created an economic and social-cultural crisis that has ignited a chain reaction of stressors upon children and their families. In this paper, we have described how this Bronfenbrenner's model of child development also known as the Bioecological Model can be effective for the estimation and prevention of childhood obesity.

CONCLUSION

We propose that this Bioecological Model will help the children and their families further to understand and manage the problem of childhood obesity during this pandemic on their own.

A Mixed-Methods Examination of Referral Processes to Clinic-Community Partnership Programs for the Treatment of Childhood Obesity

Background: Partnerships with community programs have been used to improve access to obesity care and address clinical barriers to childhood obesity management; however, little is known about the program referral process. The objective of this study was to identify factors that affect the referral from clinics to community-based programs. Methods: Active Recreation through Community-Healthcare Engagement Study (ARCHES) is a mixed-method, implementation study designed to test the feasibility of establishing clinic-community partnerships to treat childhood obesity. We collected clinical referral and program attendance data from the six ARCHES clinic-community partnerships and conducted semistructured interviews (n = 19) with key stakeholders. Logistic regression models were used to identify referral characteristics associated with ever attending a community program. We used deductive thematic analysis to examine contextual factors affecting the clinical referral and subsequent attendance at the community programs. Results: Patients referred from individual providers [odds ratio (OR): 3.20, 95% confidence interval (CI): 1.08-9.48], specialty clinics (OR: 2.73, 95% CI: 1.48-5.05), and community wellness clinics (OR: 3.42, 95% CI: 1.05-11.13), had greater odds of ever attending the programs compared with patients from primary care clinics. Patients referred to cohort-based programs compared with open enrollment programs had greater odds of ever attending the programs. Stakeholders emphasized the value of communication within the partnership and with patients in clinical settings. Effective provider communication with patients involved engaging and program endorsing conversations to explain the value of the program. Conclusions: We identified factors that may improve the referral process in clinic-community partnerships to provide resources to primary care providers looking to address childhood obesity. Clinical Trial Registration number: NCT03246763.

The feasibility, acceptability, and benefit of interventions that target eating speed in the clinical treatment of children and adolescents with overweight or obesity: A systematic review and meta-analysis

Eating at a faster speed is positively correlated with having a higher BMI. Modifying eating speed may offer a treatment opportunity for those with overweight and obesity. This review sought to understand the feasibility, acceptability, and benefit to using eating speed interventions in paediatric clinical weight-management settings. The PICO Framework was used. Clinical studies of eating speed interventions as a treatment for paediatric patients with overweight or obesity were included. No limits to search date were implemented. A systematic search of MEDLINE, PsychINFO and EMBASE via OVID, Web of Science and JBI, Database of systematic reviews and Implementation reports, along with trial registers NICE, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials was conducted. Two authors were responsible for screening, extraction, and evaluation of the risk of bias. Fifteen papers reporting twelve interventions addressing eating-speed were identified, involving a total of 486 active participants (range 7-297). Study design was weak with only one full RCT and there were some concerns over quality and risk of bias (Cochrane RoB 2.0). Limited sample sizes and different measured outcomes did not allow powered evaluations of effect for all outcomes. There is some indication, overall, that addressing eating speed has the potential to be a beneficial adjunct to clinical obesity treatment, although the pooled effect estimate did not demonstrate a difference in BMISDS status following eating speed interventions compared to control [pooled mean difference (0.04, 95% CI -0.39 to 0.46, N = 3)]. Developments to improve the engagement to, and acceptability of, interventions are required, alongside rigorous high-quality trials to evaluate effectiveness.

Children's perceptions of factors influencing their physical activity: a focus group study on primary school children

Purpose

Establishing healthy lifestyle behaviours in primary school children is important, as these behaviours are likely to track into adulthood. This study aimed to explore the factors influencing physical activity (PA) in primary school children through their perspectives.

Approach

Eleven focus group discussions and one interview were conducted with 52 children (n = 29 girls) aged 9–12 years from two primary schools in Singapore. Data analyses were conducted using thematic analysis, deductively following the socio-ecological model (SEM) and inductively for themes at each SEM level.

Results

At individual level, children’s perceived enjoyment, health benefits and expectation of rewards motivated them to engage in PA, while time constraints and their apathy towards PA hindered PA engagement. Children’s PA occasions at home were reported to be influenced by parental permission, priorities and availability, and the availability of preferred peers. Physical environmental factors such as opportunities for PA in school, access to facilities for PA and weather influenced children’s time spent on PA and the types of activities they engaged in.

Conclusion

This study summarized some factors that children have reported to influence their PA behaviour. These findings could help inform future interventions aimed at promoting PA among primary school children in Singapore.

Physical activity participation, flourishing and academic engagement in adolescents with obesity

BACKGROUND

Adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers. However, it is unknown how participation in physical activity influences flourishing and academic engagement in adolescents with obesity. The current study examined engagement in varying levels of physical activity and the likelihood of flourishing and academic engagement in adolescents with obesity.

METHODS

Analyses included 26 764 adolescents, ages 10-17 years, from the parent-reported, combined 2016-2017 National Survey of Children's Health. Participants were grouped by physical activity levels (none, low, moderate, daily). Outcome variables included flourishing (finishing tasks, staying calm when faced with a challenge and showing interest in new things) and academic engagement (completing all required homework and caring about doing well in school). Logistic regression models, adjusted for age, sex, race, household income, highest level of education in the household, behavioural conduct problems and depression assessed the likelihood of each outcome comparing physical activity levels among adolescents with obesity.

RESULTS

Adolescents with obesity who participated in any amount of physical activity (low, moderate and daily) or sports had significantly greater likelihood of flourishing and academic engagement compared those that did not engage in any physical activity (p's < 0.05).

CONCLUSIONS

Participation in even low amounts of physical activity or participation in sports increases the likelihood of flourishing and academic engagement in adolescents with obesity, which expands on previous findings that adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers.

Barriers and enablers to nutrition and physical activity in Lima, Peru: an application of the Pen-3 cultural model among families living in pueblos jóvenes

OBJECTIVES

Childhood obesity is increasing in Latin America as nutrition status and economies transition. Peru is one such country with an emerging childhood obesity epidemic. The Peruvian Ministry of Health established goals for achieving reductions in overweight and obesity prevalence among children 5 years and younger by 2021. However, specific intervention strategies for achieving these goals are lacking. Culturally appropriate interventions guided by evidence-based theories are needed to address the emerging problem of overweight and obesity among young children. This study utilized the Pen-3 model, a culture-based conceptual framework to explore barriers and facilitators to healthy diet and physical activity for parents of young children in pueblos jóvenes communities.

DESIGN

A qualitative investigation was conducted as part of a larger cross-sectional survey study of parents of three and four-year-old children at five school sites in the peri-urban slum neighborhoods of southern Lima. Parents were asked to describe barriers and facilitators of healthy diet and physical activity for their preschoolers and families. Thematic analysis guided by PEN-3 model constructs assisted in identifying emergent themes.

RESULTS

Two domains of the Pen-3 model guided the elucidation of barriers and facilitators of health behaviors deemed essential to healthy diet and physical activity. Parental perceptions about neighborhood safety, lack of community resources, such as parks and recreation spaces, and lack of information about appropriate serving sizes and healthy recipes were identified as barriers. Facilitators to healthy behaviors included mothers' views on their role as nurturers, and personal values for family-centered health behaviors.

CONCLUSIONS

Parents identified specific barriers and facilitators of eating healthy and physical activity for their preschoolers and families living in resource poor areas of Peru. Health promotion professionals can utilize findings to inform the design of culturally appropriate family-based interventions in Peru's pueblos jóvenes.

Resting Energy Expenditure and Related Factors in 6- to 9-Year-Old Southern African Children of Diverse Population Groups

Lower resting energy expenditure (REE) may partially explain the disproportionate prevalence of overweight/obesity among black African women. As no previous studies have investigated the REE of Southern African (South. Afr.) children, we aimed to determine, by sex and population group, the REE of 6- to 9-year-old urban school children. In a cross-sectional study with quota sampling, REE was measured with indirect calorimetry (IC). Confounders considered were: body composition (BC) (fat-free mass (FFM), FFM index, fat mass (FM), FM index), assessed using multifrequency bioelectrical impedance analysis, and physical activity (PA) measured with a pedometer. Multivariate regression was used to calculate REE adjusted for phenotypes (BC, z-scores of weight-for-age, height-for-age, body mass index-for-age) and PA. Sex and population differences in REE were determined with two-way ANOVA. Ninety-four healthy children (59.6% girls; 52.1% black) with similar socioeconomic status and PA opportunities participated. Despite BC variations, sex differences in REE were not significant (41 kcal/day; P = 0.375). The REE of black participants was lower than of white (146 kcal/day; P = 0.002). When adjusted for FFM and HFA z-score, the differences in REE declined but remained clinically meaningful at 91 kcal/day (P = 0.039) and 82 kcal/day (P = 0.108), respectively. We recommend the development of population-specific REE prediction equations for South. Afr. children.

Racial and Ethnic Disparities in Childhood Growth Trajectories

Childhood overweight and obesity are a primary social and public health concern. Over the past 30 years, rates of childhood overweight and obesity in the United States of America (USA) have drastically increased, particularly among Black and Latino/a populations. However, they tend to be underrepresented in the childhood obesity literature. This study expands previous literature by identifying different BMI growth trajectories for Black, Latino/a, and White children from birth to age nine. This study found a high prevalence rate of overweight and obesity in a predominantly low-income minority group. Using growth-based trajectory modeling, this study also found different growth trajectories by racial/ethnic groups, with Latino/a children having the most concerning growth trajectories from birth to 9 years. These findings demonstrate that ethnic/racial disparities in childhood overweight and obesity start as early as birth, indicating the need to devote more attention from researchers and health policy-makers to address these disparities as early as possible.