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We evaluated the prevalence of high weight status in children ages 0 to 24 months (m) using data from electronic health records (EHR) and NHANES. We also examined relationships between weight status during infancy and obesity at 24 months of age.EHR data from 4 institutions in North and South Carolina included patients born January 1, 2013-October 10, 2017 (N = 147,290). NHANES data included study waves from 1999 to 2018 (unweighted N = 5121). We calculated weight-for-length (WFL), weight-for-age (WFA), and body mass index (BMI), excluding implausible values, and categorized weight status (85th, 85th to95th, or ≥95th percentile), assessing prevalence at birth, 6, 12, 18, and 24 months. Utilizing individual, longitudinal EHR data, we used separate regression models to assess obesity risk at 24 months based on anthropometrics at birth, 6, 12, and 18 months, adjusting for sex, race/ethnicity, insurance, and health system.Prevalence of BMI ≥95th percentile in EHR data at 6, 12, 18, and 24 months were 9.7%, 15.7%, 19.6%, and 20.5%, respectively. With NHANES the prevalence was 11.6%, 15.0%, 16.0%, and 8.4%. For both, the prevalence of high weight status was higher in Hispanic children. In EHR data, high weight status at 6, 12, and 18 months was associated with obesity at 24 months, with stronger associations as BMI category increased and as age increased.High weight status is common in infants and young children, although lower at 24 months in NHANES than EHR data. In EHR data, high BMI at 6, 12, and 18 months was associated with increased risk of obesity at 24 months.

The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are clinically based, effective treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori key questions.

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are effective clinically based treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori Key Questions.

Introduction: Fewer than 1/4th of US youth meet physical activity guidelines, leading to physical fitness-related cardiovascular disease disparities tracking into adulthood. Neighborhood opportunity may serve as a critical modifiable factor to reduce youth cardiovascular health-related disparities. The present analysis uses the Child Opportunity Index (COI), a comprehensive measure of children’s neighborhood opportunity, to examine associations between neighborhood context and multiple youth cardiovascular fitness outcomes. Methods: Data were drawn from the NYC FITNESSGRAM (n = 300,000), comprising of fitness data from New York City (NYC) public school youth (grades K-12). Generalized linear mixed models were run to estimate overall and sex-stratified associations between overall COI and individual COI indicators (greenspace, healthy food, walkability, commute time) and youth cardiovascular fitness (body mass index (BMI) percentiles, curl-ups, push-ups, PACER, and sit and reach). Geographically weighted regression (GWR) models explored spatial variation of COI-fitness associations across NYC. Results: Overall COI was associated with improved youth cardiovascular fitness outcomes, with the strongest magnitude of effects across aerobic capacity and muscular strength and endurance measures (PACER: β: 0.15, 95% CI: 0.14, 0.15, curl-ups: β: 0.13, 95% CI: 0.12, 1490.13, and push-ups: β: 0.13, 95% CI: 0.12, 0.13). Greenspace was positively associated with muscular endurance (curl-ups: β: 1.13, 95% CI:0.76, 1.50; push-ups: β: 1.53, 95% CI: 1.21, 1.84), and walkability and commuting time were positively associated with aerobic capacity (PACER: β: 2.11, 95% CI: 1.72, 2.50; β: 2.03, 95% CI: 1.87, 2.19, respectively). Stratified models showed strengthened COI-fitness associations among girls versus boys. GWR models were largely consistent with findings from multilevel models, except for overall COI-BMI associations, which varied in magnitude and direction across regions in NYC. Conclusion: Neighborhood opportunity was associated with multiple measures of youth cardiovascular fitness, though geographic models demonstrate that certain associations vary in magnitude and direction across NYC. Continued research on neighborhood factors and cardiovascular fitness may better inform public health efforts to reduce health disparities modifiable through comprehensive place-based interventions.

Overweight and obesity rates increased dramatically among United States youth from 1999-2016, particularly among adolescents. Promoting physical activity can reduce youth obesity rates, particularly among overweight adolescents, most of whom do not meet guidelines for at least 60 minutes of daily physical activity. Neighborhood public transportation usage is an important environmental factor that has potential to impact adolescent physical activity. We examined the association between neighborhood public transportation usage and adolescent body mass index (BMI) drawing from the Family Life, Activity, Sun, Health, and Eating (FLASHE) study, a cross-sectional national survey conducted in 2014 that assessed cancer preventative behaviors, including physical activity and diet, among adolescents (aged 12-17 years, n=1,737) and their parents. We used linear regression models to test the moderating effects of age, sex, and socioeconomic status and the mediating effect of physical activity on the association between neighborhood public transportation usage and adolescent BMI. The analytic sample included 357 adolescents of middle school (44%) and high school (56%) ages evenly distributed by sex (51% female) with 39% of the sample below 200% of the Federal Poverty Line. On average, adolescents had a BMI percent of the 95 th percentile of 81.77 (17.09) or 22.24 (4.67) BMI and self-reported 71 daily (out-of-school) moderate-to-vigorous activity minutes. While we found no overall association between neighborhood public transportation usage and BMI, we found that low neighborhood public transportation is associated with increased BMI among high school (14% (95% CI 5.72, 21.41)) and male (7.16 (95% CI -13.41, -0.91)) adolescents respectively. We also found that physical activity does not mediate the effect of neighborhood public transportation usage on adolescent BMI. Our findings suggest that our adult reported public transportation measure could be pointing to neighborhood factors, such as poverty or crime, that affect the association between neighborhood public transit and adolescent BMI. Our findings help inform future research on the dynamic relationships between individual and social environmental factors that impact adolescent physical activity.

Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3-17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95