Search

Background The prevalence of childhood obesity in the U.S. has tripled over the last three decades. However, fewer than 1% of children with severe obesity undergo surgical weight loss interventions each year. Materials and methods All patients age 10 to 19 years old who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 through 2018 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were included in this retrospective cohort analysis. The primary outcomes were mortality and overall complications. Procedural trends, readmission and reoperation rates were also examined using a multivariate regression model. Results Patients had a mean BMI of 47.3 kg/m2 and 80.0% were either 18 or 19 years old (n = 4,051). There were two reported deaths. Reoperation within 30 days occurred in 1.1% of patients, readmission in 3.5%, and complications in 1.2%. Among all readmissions, primary reasons included nausea/vomiting or nutritional depletion (41.3%) and abdominal pain (16.3%). RYGB was associated with higher odds for readmission (p = 0.006) and complications (p = 0.005). Higher BMI and younger age were not associated with an increased likelihood to experience poorer outcomes. The proportion of patients undergoing SG increased yearly over RYGB from 73.9% in 2015 to 84.3% in 2018. Conclusions Bariatric surgery appears to be low risk for adolescents and SG has become the operation of choice. More research on early consideration of surgical therapy in adolescents with severe obesity is needed given the safety profile. Level of Evidence III

Objective To examine whether patterns of body mass index (BMI) percentile gains across childhood predict BMI percentile, overweight and obesity, waist circumference, and elevated or prehypertensive blood pressure at age 15. Methods Trained technicians in the Study of Early Child Care and Youth Development assessed children's weight and height from birth to 15 years and waist circumference and blood pressure at age 15 (n = 1,132). Children's BMI percentile trajectories from age 2 to age 13 along with 28 demographic and social covariates were used to predict BMI percentile, waist circumference, overweight, obesity, and elevated or prehypertensive blood pressure. Linear and logistic regressions were used to predict BMI percentile, overweight, obesity, waist circumference, and elevated or prehypertensive blood pressure. Results Children were classified into one of four BMI percentile trajectories: "low stable" (28.4%), "low-to-high" (11.8%), "median stable" (29.0%), and "high rising" (30.7%). Children in trajectory classes characterized by persistent above average BMI percentile or by periods of rapid BMI percentile gains were more likely than their peers to experience poor weight and elevated or prehypertensive outcomes in adolescence. Trajectory class membership explained substantially more variance in adolescent health outcomes than demographic covariates alone. Estimated maternal BMI was a key independent predictor of adolescent outcomes. Conclusions Different patterns of BMI percentile gains, namely those with rapid gains or persistently above average BMI percentile, from ages 2-13 predicted weight, waist circumference, and elevated or prehypertensive blood pressure at age 15, above and beyond demographic and social characteristics.

Childhood obesity is a public health challenge. Between 1999 and 2012, the prevalence in Mexico of overweight and obesity in schoolchildren went from 25.5 to 32 %.To report current prevalence of overweight and obesity in schoolchildren from the municipality of Durango, Mexico.Cross-sectional survey conducted between January 2017 and December 2018. A total of 24,600 children aged between six and 11 years from 138 schools of the municipality of Durango were included. The body mass index reference values established by the World Health Organization were used to determine the presence of overweight and obesity.The prevalence of overweight was 19.7 %, of obesity, 16 %, and of overweight and obesity combined, 35.7 %. In the six-year-old group, a prevalence of overweight-obesity of 25.4 % was found, and in the 11-year-old group, 41.1 %.The prevalence of overweight-obesity in children aged from 6 to 11 years in the municipality of Durango is higher than those reported in the national survey by states in 2012 and in the 2016 national survey; a trend towards an increase with age was observed.La obesidad infantil es un reto de salud pública. Entre 1999 y 2012, en México la prevalencia de sobrepeso y obesidad (SO) en niños escolares pasó de 25.5 a 32 %.Reportar la prevalencia actual de SO en niños escolares del municipio de Durango, México.Encuesta transversal realizada entre enero de 2017 y diciembre de 2018. Se incluyeron 24 600 niños de seis a 11 años, de 138 escuelas del municipio de Durango. Se utilizaron los valores de referencia del índice de masa corporal establecidos por la Organización Mundial de la Salud para determinar la presencia de SO.La prevalencia de sobrepeso fue de 19.7 %, la de obesidad de 16 % y la de SO de 35.7 %. En el grupo de seis años se encontró una prevalencia de SO de 25.4 % y en el de 11 años, de 41.1 %.La prevalencia de SO en niños de seis a 11 años del municipio de Durango es más elevada que la reportada en la encuesta nacional por entidad federativa en 2012 y la nacional en 2016; se observó tendencia al incremento en la prevalencia conforme aumenta la edad.

Introduction and objectives Childhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions. Methods This longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigacion Farmacoepidemiologica en Atencion Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region. Results The overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age. Conclusions Overweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age.

Background Parental-feeding behaviors are common intervention targets for childhood obesity, but often only deliver small changes. Childhood BMI is partly driven by genetic effects, and the extent to which parental-feeding interventions can mediate child genetic liability is not known. Here we aim to examine how potential interventions on parental-feeding behaviors can mitigate some of the association between child genetic liability and BMI in early adolescence, using causal inference methods. Methods Data from the Avon Longitudinal Study of Parents and Children were used to estimate an interventional disparity measure for a child polygenic score for BMI (PGS-BMI) on BMI at 12 years. The approach compares counterfactual outcomes for different hypothetical interventions on parental-feeding styles applied when children are 10–11 years (n = 4248). Results are presented as adjusted total association (Adj-Ta) between genetic liability (PGS-BMI) and BMI at 12 years, versus the interventional disparity measure-direct effect (IDM-DE), which represents the association that would remain, had we intervened on parental-feeding under different scenarios. Results For children in the top quintile of genetic liability, an intervention shifting parental feeding to the levels of children with lowest genetic risk, resulted in a difference of 0.81 kg/m2 in BMI at 12 years (Adj-Ta = 3.27, 95% CI: 3.04, 3.49; versus IDM-DE = 2.46, 95% CI: 2.24, 2.67). Conclusions Findings suggest that parental-feeding interventions have the potential to buffer some of the genetic liability for childhood obesity. Further, we highlight a novel way to analyze potential interventions for health conditions only using secondary data analyses, by combining methodology from statistical genetics and social epidemiology.

The paper provides a review of current regulatory documents of international organizations, which deals with the organizational aspects of optimizing physical activity among children. It is shown that according to the World Health Organization (WHO; 2015), the major causes of death are cardiovascular diseases and their complications, the formation of which is most strongly associated with obesity, which has its roots in childhood. The global WHO recommendations for physical activity to promote health (2010) and the guidelines of the American Heart Association regarding the organization of physical activity among children (2014) are provided. The criteria of selecting the type of physical activity for children and adolescents according to the Centers for Disease Control and Prevention (2011) are presented. The results of the WHO working group activity to end childhood obesity (2015) were analyzed. The need for a multisectoral government, educational and social activities was stressed., В статье приведен обзор текущих регламентирующих документов международных организаций, посвященный организационным вопросам оптимизации физической активности детей. Показано, что, по данным Всемирной организации здравоохранения (ВОЗ; 2015), основной причиной смертности населения являются кардиоваскулярные заболевания и их осложнения, формирование которых в наибольшей степени связано с ожирением, имеющим корни в детском возрасте. Приведены глобальные рекомендации ВОЗ относительно физической активности для укрепления здоровья (2010) и рекомендации Американской кардиологической ассоциации относительно организации физической активности детей (2014). Представлены критерии выбора типа физической активности для детей и подростков по данным Centers for Disease Control and Prevention (2011). Проанализированы результаты работы рабочей группы ВОЗ по прекращению детского ожирения (2015). Сделаны акценты на необходимости проведения мультисекторальных государственных, образовательных и социальных мероприятий., У статті наведено огляд поточних регламентуючих документів міжнародних фахових товариств, присвячений організаційним питанням оптимізації фізичної активності дітей. Показано, що, за даними Всесвітньої організації охорони здоров’я (ВООЗ; 2015), основною причиною смертності населення є кардіоваскулярні захворювання та їх ускладнення, формування яких найбільшою мірою пов’язане з ожирінням, що має коріння в дитячому віці. Наведено глобальні рекомендації ВООЗ щодо фізичної активності для зміцнення здоров’я (2010) та рекомендації Американської кардіологічної асоціації стосовно організації фізичної активності дітей (2014). Наведено критерії вибору типу фізичної активності для дітей і підлітків за даними Centers for Disease Control and Prevention (2011). Проаналізовано результати звіту робочої групи ВООЗ із припинення дитячого ожиріння (2015). Зроблено акценти на необхідності проведення мультисекторальних державних, освітніх і соціальних заходів.

Background Research has demonstrated dietary quality benefits of family meals and meals prepared at home. Less is known about associations between the proportion of family evening meals made at home and key personal, behavioral, and environmental characteristics. Moreover, most studies often measure these data retrospectively. Objective The objective of this study is to describe the proportion of evening meals made at home measured in real time and to assess associations between personal, behavioral, and environmental characteristics that are associated with a higher proportion of evening meals prepared and consumed at home. Design This study is a cross-sectional secondary analysis of baseline data collected during 2017 and 2018 from the New Ulm at Home study, a randomized controlled trial conducted in rural Minnesota to evaluate the effectiveness of a childhood obesity prevention program for school-aged children. Participants/setting The present study analyzes a subset of the New Ulm at Home trial data from families (N = 108) who completed at least four evening meal screeners collected in real time with ecological momentary assessment technology over a 2-week period. Main outcome measure The main outcome measure was the proportion of family evening meals made at home, calculated using two cutpoints (≤50% of evening meals prepared at home vs >50%; ≤70% vs >70%). Statistical analysis Descriptive statistics were used to describe the proportion of evening meals prepared at home. Logistic regression analyses adjusted for parent education were used to assess associations between family characteristics and the two different proportions of meals made at home. Results Most family evening meals were prepared and eaten at home (62%). Logistic regression models indicated meal planning skills (odds ratio=1.19, 95% CI 1.01 to 1.39) and mealtime routines (odds ratio=1.20, 95% CI 1.03 to 1.40) were significantly associated with odds of preparing more than 50% of evening meals at home. Only meal planning skills (odds ratio=1.27, 95% CI 1.06 to 1.51) was significantly associated with odds of preparing more than 70% of evening meals at home. Conclusions Study findings indicated mealtime routines and meal planning skills were associated with preparing more than 50% of evening meals at home, but only meal planning skills were associated with preparing more than 70% of evening meals at home, which may suggest the importance of adapting interventions for families. Future research should build on these findings in randomized controlled trials.

Background: It is well known that the family environment is associated with child health behavior and outcomes. However, there is a lack of available instruments to measure family health behaviors, even more so in languages other than English. The aim of the present study was to adapt and validate the Family Health Behavior Scale (FHBS) for Brazilian families.Methods: The FHBS was translated and culturally adapted for the Brazilian families. Psychometric properties (content validity, construct validity, and concurrent validity) and reliability (internal consistency, ceiling-floor effect, and test-retest) were evaluated in a sample of healthy community-dwelling children who were between 5 to 12 years old, of both sexes. Caregivers responded to the FHBS. Concurrent validity was assessed by comparing the FHBS scale with Body Mass Index (BMI) percentile, percent body fat, and physical activity level.Results: 272 children (54% girls) with a mean age of 7.9 years (SD = 2.0) and their caregivers were tested. Confirmatory analysis of the initial 4-factor structure (as proposed in the original English version of the questionnaire) suggested its performance was below acceptable. Exploratory factor analysis showed however an acceptable fit (Kaiser-Meyer-Olkin index = 0.79), and the factor loadings suggested a 7-factor model. Children who were considered obese (BMI percentile ≥ 97) had lower mean total FHBS scores than children who had a healthy weight or were overweight. Children who were classified as having a healthy fat percentage had higher FHBS scores than children classified as having an excessively high fat percentage. Children who were physically active had significantly higher total FHBS scores than children who were physically inactive. Cronbach's alpha was 0.81 and we noted acceptable values of the ceiling-floor effect. Test-retest analyses showed lower agreement and intraclass correlation coefficients ​​than expected 0.63 (95% CI 0.41 to 0.78).Conclusion: The adapted Family Health Behavior Scale for the Brazilian population showed adequate psychometric properties.

Interest in and research on hidradenitis suppurativa (HS) have increased during the past decade, resulting in expanded knowledge about associated comorbidities and treatment efficacy. Knowledge about pediatric-onset HS is still limited, based on case studies, small case series, and extrapolation from adult studies. With increasing prevalence of childhood obesity, decreasing pubertal age, and increasing awareness of HS, physicians may start encountering younger HS patients. This review presents an updated discussion on the epidemiology, pathophysiology, and associated comorbidities in HS, with a focus on pediatric and adolescent patients. It also suggests recommendations for investigation and treatment based on current evidence.

Objective Adverse childhood experiences (ACEs) contribute to poor overall health among children with obesity. This study evaluated how one potential protective factor—family resilience—affects the association between ACEs and childhood obesity. Methods This analysis was a secondary analysis of the 2016–2018 National Survey of Children's Health (NSCH), a repeated cross‐sectional survey based on parent report. Nine ACEs were queried. Family resilience was assessed with four items (potential range 0–12). The primary outcome was child weight status. Multivariable ordinal logistic regression was used, adjusting for potential confounders and the interaction between ACEs and family resilience. Results For 49,365 children ages 10–17, the median number of ACEs was 1 (IQR 0, 2), the median family resilience score was 10 (IQR 8,12), 15.3% of children had overweight, and 15.4% of children had obesity. Among the 51.3% of children who experienced one or more ACEs, higher family resilience scores attenuated the odds of being in a higher weight category. This pattern was not observed in children with zero ACEs. Conclusions In the 2016–2018 NSCH, children ages 10–17 who were exposed to ACEs had higher rates of overweight and obesity, the odds of which may be reduced when children also have higher family resilience.

Introduction. Recently, many studies have been devoted to the study of type 2 diabetes mellitus (DM2) worldwide. In most countries of the world, the increase in the prevalence of DM2 among children and adolescents is accompanied by an increase in childhood obesity. The presence of obesity or overweight in children can complicate the diagnosis of various types of DM. Detection and treatment of DM2 is extremely important for the society due to the wide range of severe diabetes complications.The aim of this work was to analyze the frequency of DM2 according to the Register of patients with DM, and to determine the state of glycemic control in children with DM2. Materials and methods. An analysis of glycemic control in children with DM2 who received various treatment regimens: with diet and lifestyle modifications, or with additional oral hypoglycemic agents (metformin monotherapy, or combination with insulin therapy). The glycemic control was assessed by measurement of glycated hemoglobin (HbA1c) level. Results. According to the data Register in Ukraine, the prevalence of DM among children has a tendency to rise — from 8.6 per 10 thousand children in 2005, to 13.14 — in 2019 year. The prevalence of DM2 in 2019 was 0.47 % of all cases of DM, and its prevalence contained 0.062 per 10 thousand children under 19 years of age with significant differences in the frequency of its diagnosis in different regions of Ukraine. We analyzed the state of glycemic control in children with DM2 aged from 9 up to 19 years old (Me 16.2 [15.5; 18.0]), with a disease duration 0.5—12 years (Me 4.5 [1.0] ; 7.5]). The age of diagnosis of DM2 was 2-17 years old (Me 11.7 [8.5; 15.0]), and 91.3 % of patients had obesity. Diet and lifestyle modifications were used in 34.8 % of patients, metformin monotherapy in 52.2 %, and metformin and insulin combination therapy in 13 % of patients. HbA1c values ​​ranged from 5.0 to 11.4 % (Me 7.2 % [5,8; 8,0]). The proportion of children who had ideal or optimal glycemic control (HbA1c 7.0—7.5 %) was 52.2 %, suboptimal (HbA1c 7.6—9.0 %) — 39.1 %, high-risk glycemic control (HbA1c> 9.1 %) — 8.7 % of children. The most unsatisfactory HbA1c levels ​​were registered in children who received metformin in combination with insulin (Me 10.6 % [10,15; 11,4]). Chronic complications of DM2 have not been reported.Conclusions. We found a low prevalence of DM2 among the pediatric population in Ukraine, more likely due to the low quality of its detection among children diagnosed with DM, as well as among children among high risk groups. Most children with DM 2 were obese. The majority of patients with DM2 (52.2 %) received metformin monotherapy, more than a third did not receive oral hypoglycemic agents. In most children with DM2 (52,2 %), the state of glycemic control corresponded to the optimal (

Childhood obesity has a rising prevalence and is associated with significant morbidity, social and psychological consequences. In England, 21% of children aged between 10 and 11 are obese, with the highest rates being among children from lower socioeconomic groups. Primary care is responsible for managing most children who are overweight or obese. Consultations should generate positive conversations about childhood obesity and rule out underlying conditions and co-morbidities. Families may need support to recognise contributing factors and should be encouraged to identify simple, achievable strategies to promote healthier choices. Follow-up is essential, and families should be referred on to appropriate services for ongoing support.

Background Obesity constitutes a critical risk for adolescent health. This study aimed at identifying youth‐friendly components of obesity treatment. Methods In this feasibility study, an adolescent obesity treatment platform was implemented at two Pediatric outpatient clinics in Sweden. Body mass index (BMI), BMI z‐score, and the category of obesity (International Obesity Task Force) were compared before and after the intervention and with data on standard care from the Swedish Childhood Obesity Treatment Register. Results The study included 99 participants (49 females) aged 13–18 years from 1 September 2014, to 31 December 2016. A pediatric nurse met the participants on average 6.5 times in the average inclusion period of 15 months. Physical activity sessions attracted 63 participants. Acceptance Commitment Therapy and In Real Life groups attracted 24 participants. At inclusion, 62 participants had obesity and 37 severe obesity, and 71/99 (72%) remained in the same category. The mean BMI increased from 32.0 to 33.4 kg/m2 (p

Background There is limited evidence regarding socioeconomic inequalities of exposure to the food environment and its contribution to childhood obesity. Methods We used data from 4235 children from the Generation R Study, a large birth-cohort conducted in the city of Rotterdam, The Netherlands. We included 11,277 person-observations of body mass index (BMI) and 6240 person-observations of DXA-derived fat mass index (FMI) and fat-free mass index (FFMI) when children were between 4 and 14 years. We applied linear regression models to evaluate changes in the relative and absolute exposure of fast-food outlets, and the healthiness of the food environment within 400 m from home by maternal education. Furthermore, we used individual-level fixed-effects models to study changes in the food environment to changes in BMI, FMI and FFMI. Results Children from lower educated mothers were exposed to more fast-food outlets at any time-point between the age of 4 and 14 years. Over a median period of 7.1 years, the absolute (0.6 fast-food outlet (95% CI: 0.4–0.8)) and relative (2.0%-point (95% CI: 0.7–3.4)) amount of fast-food outlets increased more for children from lower as compared to higher educated mothers. The food environment became more unhealthy over time, but no differences in trends were seen by maternal education level. Changes in the food environment were not associated with subsequent changes in BMI, FMI and FFMI. For children from lower educated mothers not exposed to fast-food at first, we found some evidence that the introduction of fast-food was associated with small increases in BMI. Conclusions Our findings provide evidence of widening inequalities in exposure to fast-food in an already poor food environment. Access to more fast-food outlets does not seem to have an additional impact on BMI in contemporary contexts with ubiquitous fast-food outlets.

Objective: This study assessed the effectiveness of a school‐based intervention in reducing adolescents’ sugar‐sweetened beverage (SSB) consumption and percentage of energy from SSBs. Secondary outcomes were SSB consumption within school, average daily energy intake, and body mass index z‐scores. Methods: Six secondary schools located in New South Wales, Australia were recruited to participate in a six‐month pilot randomised controlled trial (1:1). The intervention included components targeting the school nutrition environment, curricula and community. Outcomes were collected via online surveys, observations, anthropometric measurements and project records. Between‐group differences were assessed via linear mixed models. Results: At the six‐month intervention endpoint (n=862) there were no statistically significant differences between students in intervention or control schools for mean daily intake of SSBs (8.55mL; CI −26.77, 43.87; p=0.63), percentage daily energy from SSBs (0.12% kJ; CI −0.55, 0.80; p=0.72), or for secondary outcomes. Acceptability of the school‐based strategies were high, however intervention fidelity varied across schools. Conclusion: While acceptable, improving fidelity of implementation and increasing the duration or intensity of the intervention may be required to reduce SSB intake. Implications for public health: Engaging parents and education stakeholders in the development phase to co‐design interventions may prove beneficial in improving intervention fidelity and enhance behavioural outcomes.

Childhood obesity has been rising in all world regions - 2019 estimates were that 158 million children aged 5-19 are living with obesity, of whom many live in LMICs1 . Yet there has been limited to no progress to halt the rise in more than 20 years and this number is projected to increase to 254 million by 20301 . NCD Child, a global multi-stakeholder coalition focused on the prevention and control of noncommunicable diseases (NCDs) in children, is concerned with the rising rates of obesity during childhood and its consequences.

There are few studies comparing adherence to Canadian 24-hour Movement Guidelines (24-h MG) before and during the COVID-19 pandemic and exploring the pandemic’s effect on childhood obesity. This survey-based 2-year study investigated changes in obesity and adherence to the 24-h MG in children before and during the COVID-19 pandemic. Data were collected at two points in time: pre-COVID-19 (May 2019; T1; n = 247) and during-COVID-19 (May 2021; T2; n = 171). Participants were healthy elementary school children aged between 6–12 years in northeastern Japan. The questionnaire comprised items on physical activity, screen time, sleep duration, adherence to the 24-h MG, and anthropometric and demographic characteristics. Among all participants, a statistically significant difference (p < 0.001) between the average body mass index at T1 (M = 16.06 kg/m2, SD = 2.08 kg/m2) and T2 (M = 18.01 kg/m2, SD = 3.21 kg/m2) was observed, where 17.8% were overweight and obese at T1 and 24% at T2, and 10.9% adhered to all 24 h MG at T1 and 4.1% at T2. To prevent obesity in children during the COVID-19 pandemic, environmental changes should be evaluated and appropriate preventive measures taken, including pro-community health programs that encourage parent-children outdoor activities.

Objective This study examined whether the efficacy of a standard‐of‐care pediatric obesity treatment was affected by the COVID‐19 pandemic. Methods Analyses leveraged data from an ongoing pediatric obesity treatment trial involving 230 lower‐income, urban children aged 6 to 12 years. Mixed‐effects regression models compared children who participated in a 12‐month weight‐management intervention before versus during the COVID‐19 pandemic on change from baseline in BMI z score (ΔzBMI) at 3, 6, 9, and 12 months. Results The observed pattern of ΔzBMI was significantly different before versus during the pandemic (χ2 = 22.73, p < 0.0001). Children treated before the pandemic maintained an average weight loss of −0.06 ΔzBMI at 12 months, whereas children treated during the pandemic steadily gained weight over time, averaging a net gain of 0.11 ΔzBMI at 12 months (χ2 = 34.99, p < 0.0001). Treatment session completion did not differ before versus during the pandemic (60.4% vs. 55.7%, respectively; p = 0.30) or account for differences in ΔzBMI. Conclusions Similar reductions in intervention efficacy may be anticipated in other pediatric obesity treatment trials conducted during the COVID‐19 pandemic. Many families that have struggled with managing their child’s weight during this period may need encouragement to continue engaging in structured weight management as society renormalizes.

This study examined the association between breastfeeding, type of childbirth, and family structure with childhood obesity. During 2014-2016, 1728 Greek students attending primary schools and their parents were enrolled. Children's weight status was measured and classified according to the International Obesity Task Force criteria. A self-administered questionnaire assessing the type of childbirth, the family structure, and several perinatal and demographic characteristics was used. Factors associated with higher breastfeeding rates were the type of childbirth, high maternal educational level, and nuclear family structure. No association was found between childhood obesity and type of childbirth (p = 0.64) and family structure (p = 0.26). Although the short-term beneficial effects of breastfeeding on childhood obesity are undeniable and it is of great importance to all health professionals to promote breastfeeding, no significant long-term effects on obesity in adolescence were observed. More studies are needed in order to elucidate the role of breastfeeding in obesity status in adolescence.

AIM The purpose of this study was to assess for an association between higher body mass index and disease severity, morbidity and mortality in children admitted for an acute respiratory distress and failure. METHODS A single-institution retrospective cross-sectional study performed in the United States evaluating paediatric patients, 2-20 years of age, admitted for diagnoses related to acute respiratory distress and acute respiratory failure. Main outcomes include disease severity as assessed using the respiratory component of the Paediatric Early Warning Score (PEWS) with adjustment for altered mental status (Resp-PEWS + AMS), hospital or intensive care length of stay (LOS) and death. RESULTS Children with obesity made up 42/334 (13%) of the cohort. There was no significant difference in Resp-PEWS + AMS between obese and non-obese cohorts (mean of 0.93, {standard deviation 1.11} vs. 1.13 {1.35}, range 0-6, rank sum p = 0.46). There was no significant difference in overall hospital LOS or intensive care LOS. Multivariate analysis including diagnosis as a control variable did not change the results. CONCLUSION We found that body habitus was not an independent factor for illness severity or clinical outcomes.

Background: Studies on childhood obesity mainly focus on the genetic component and on the lifestyle that may be associated with the development of obesity. However, the study of perinatal factors in their programming effect toward future obesity in children or adults is somewhat more recent, and there are still mechanisms to be disentangled. Summary: In this narrative review, a comprehensive route based on the influence of some early factors in life in the contribution to later obesity development is presented. Maternal pre-pregnancy BMI and gestational weight gain have been pointed out as independent determinants of infant later adiposity. Lifestyle interventions could have an impact on pregnant mothers through epigenetic mechanisms capable of redirecting the genetic expression of their children toward a future healthy weight and body composition and dietary-related microbiome modifications in mothers and newborns might also be related. After birth, infant feeding during the first months of life is directly associated with its body composition and nutritional status. From this point of view, all the expert committees in the world are committed to promote exclusive breastfeeding up to 6 months of age and to continue at least until the first year of life together with complementary feeding based on healthy dietary patterns such as Mediterranean Diet. Key Messages: To develop future effective programs to tackle early obesity, it is necessary not only by controlling lifestyle behaviors like infant feeding but also understanding the role of other mechanisms like the effect of perinatal factors such as maternal diet during pregnancy, epigenetics, or microbiome.

Obesity is becoming increasingly prevalent in paediatric populations worldwide. In addition to increasing prevalence, the severity of obesity is also continuing to rise. Taken together, these findings demonstrate a worrying trend and highlight one of the most significant challenges to public health. Childhood obesity affects multiple organs in the body and is associated with both significant morbidity and ultimately premature mortality. The prevalence of complications associated with obesity, including dyslipidaemia, hypertension, fatty liver disease and psychosocial complications are becoming increasingly prevalent within the paediatric populations. Treatment guidelines currently focus on intervention with lifestyle and behavioural modifications, with pharmacotherapy and surgery reserved for patients who are refractory to such treatment. Research into adult obesity has established pharmacological novel therapies, which have been approved and established in clinical practice; however, the research and implementation of such therapies in paediatric populations have been lagging behind. Despite the relative lack of widespread research in comparison to the adult population, newer therapies are being trialled, which should allow a greater availability of treatment options for childhood obesity in the future. This review summarizes the current evidence for the management of obesity in terms of medical and surgical options. Both future therapeutic agents and those which cause weight loss but have an alternative indication are also included and discussed as part of the review. The review summarizes the most recent research for each intervention and demonstrates the potential efficacy and limitations of each treatment option.

Background: Childhood obesity has been growing steadily, at an earlier age, and currently comprises a public health issue. A number of studies have pointed to perinatal factors as possible determinants in the development of childhood obesity. Objective: To evaluate the influence of perinatal factors on the development of obesity in children and adolescents in southern Brazil. Design: Retrospective cohort study in which a linkage was made between anthropometric data of children and adolescents aged 0 to 15 years who had been registered in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2016 and their perinatal data registered in the Live Birth Information System (SINASC) from 2000 to 2014. The SINASC was used to extract maternal covariables (age, schooling, marital status), prenatal variables (parity and number of prenatal visits), and perinatal variables (type of delivery, sex, and birth weight). Variables such as age, inclusion in the Bolsa Família income transfer program, and the number of anthropometric evaluations were extracted from SISVAN. Results: The sample comprised 537 children and adolescents. The median age was 8 years (interquartile range: 2-11 years). The prevalence of obesity was 15.1%. Poisson regression revealed a higher risk of obesity in children born via cesarean delivery (relative risk [RR] = 1.48; 95% CI: 1.01-2.17), children of primiparous mothers (RR = 1.72; 95% CI: 1.16-2.53), girls (RR = 1.77; 95% CI:1.21-2.60), and those aged between 5 and 9 years (RR = 26.8; 95% CI: 3.75-191.55) and older than 10 years (RR = 20.74; 95% CI: 2.89-148.61). Conclusions: The linkage between SINASC and SISVAN allowed identification of prenatal and perinatal risk factors for the development of childhood obesity. These findings should contribute to the development of health promotion and prevention policies.

INTRODUCTION Biopsychosocial approaches to health care are critical to addressing childhood obesity. This study aimed to examine how multiple indicators of the home environment related to child weight-related outcomes. We hypothesized that families with home environments of higher chaos and stress, and lower quality parent-child interactions, would have children with a higher body mass index (BMI), less healthy dietary intake, and less healthy eating behaviors. METHODS Data were drawn from the cross-sectional Phase I of the Family Matters study. Participants were 150 racially/ethnically diverse families with a child between 5 to 7 (mean, 6.4) years old. We used a latent profile analysis approach. A 4-class solution fit the data well, and we used predicted class posterior probabilities to assign families to classes. We then regressed the results onto the distal outcomes of child BMI, healthy dietary intake, and healthy eating behaviors. RESULTS Families were classified as Collaborative-Chill (n = 38), Busy Bees (n = 37), Engaged (n = 61), and Inconsistent-Distant (n = 14). Collaborative-Chill was used as the reference class. Inconsistent-Distant families had children with higher BMI (P < .001) that were more food responsive (P < .001). Busy Bees families had children who were more food responsive (P = .04) and more satiety responsive (P = .02). Engaged families had children who were marginally more food responsive (P = .06). CONCLUSION Household chaos, parent stress, and parent-child interactions are important components of the home environment implicated in children's weight-related outcomes. Health care providers should consider these indicators with child patients who struggle with obesity.

Purpose Childhood obesity has become a concern for the Brazilian Unified Health System, which has recently started to investigate children's eating habits in basic health units. This study examined the trends and ultra-processed foods (UPF) consumption in Brazilian children. Design and methods This repeated cross-sectional study included 492,630 children (2–9 years old), from different Brazilian regions, in the years 2015 and 2019. The children's food consumption was assessed by nurses using a nationally standardized instrument. Information was provided by the Food and Nutrition Surveillance System Brazilian. Results The UPF consumption in Brazilian children is generally high and was higher among children in the South and Midwest regions. The consumption of sweetened beverages was more prevalent among all the UPF assessed and continues to increase among children in the Northeast region. Declining trends in UPF consumption were observed in children from all regions, except for the Northeast region, whose trends increased in almost all evaluated foods. Practice implications Nurses, especially, have a primary role in guiding the reduction of UPF consumption, as they are the first health professionals to have access to this information. Increasing trends in UPF consumption can be mitigated by the inclusion of nutritionists in basic health units. Brazilian children need to be assisted by public policies that promote food education.

Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 75% from 2000 to 2015. Thus, there is an urgent need for tools that can assess early CVD risk in youth, which may lead to better risk stratification, preventative intervention, and personalised medicine. Vascular ageing (the deterioration in vascular structure and function) is a pivotal progenitor of health degeneration associated with elevated BP. Exposure to adverse environmental and genetic factors from fetal life promotes the development and accumulation of subclinical vascular changes that direct an individual towards a trajectory of early vascular ageing (EVA)-an independent predictor of target organ damage in the heart, brain, and kidneys. Therefore, characterising vascular ageing from youth may provide a window into cardiovascular risk later in life. However, vascular ageing measurements only have value when techniques are accurate/validated and when reliable thresholds are available for defining normal ranges and ranges that signal increased risk of disease. The aim of this paper is to summarise current evidence on the importance of vascular ageing assessment in youth and the impact of interventions to prevent or delay EVA, to highlight the need for standardisation and validation of measurement techniques in children and adolescents, and the importance of establishing reference values for vascular ageing measures in this population.

Background We developed an integrated model called Microsimulation for Income and Child Health (MICH) that provides a tool for analysing the prospective effects of fiscal policies on childhood health in European countries. The aim of this first MICH study is to evaluate the impact of alternative fiscal policies on childhood overweight and obesity in Italy. Methods MICH model is composed of three integrated modules. Firstly, module 1 (M1) simulates the effects of fiscal policies on disposable household income using the tax-benefit microsimulation program EUROMOD fed with the Italian EU-SILC 2010 data. Secondly, module 2 (M2) exploits data provided by the Italian birth cohort called Nascita e Infanzia: gli Effetti dell’Ambiente (NINFEA), translated as Birth and Childhood: the Effects of the Environment study, and runs a series of concatenated regressions in order to estimate the prospective effects of income on child body mass index (BMI) at different ages. Finally, module 3 (M3) uses dynamic microsimulation techniques that combine the population structure and incomes obtained by M1, with regression model specifications and estimated effect sizes provided by M2, projecting BMI distributions according to the simulated policy scenarios. Results Both universal benefits, such as universal basic income (BI), and targeted interventions, such as child benefit (CB) for poorer households, have a significant effect on childhood overweight, with a prevalence ratio (PR) in 10-year-old children—in comparison with the baseline fiscal system—of 0.88 (95%CI 0.82–0.93) and 0.89 (95%CI 0.83–0.94), respectively. The impact of the fiscal reforms was even larger for child obesity, reaching a PR of 0.67 (95%CI 0·50–0.83) for the simulated BI and 0.64 (95%CI 0.44–0.84) for CB at the same age. While both types of policies show similar effects, the estimated costs for a 1% prevalence reduction in overweight and obesity with respect to the baseline scenario is much lower with a more focalised benefit policy than with universal ones. Conclusions Our results show that fiscal policies can have a strong impact on childhood health conditions. Focalised interventions that increase family income, especially in the most vulnerable populations, can help to prevent child overweight and obesity. Robust microsimulation models to forecast the effects of fiscal policies on health should be considered as one of the instruments to reach the Health in All Policies (HiAP) goals.

Background A technology-based intervention, such as a mobile application, was a growing interest and potentially effective modality for treating obesity. The study aimed to evaluate the effectiveness of the OBEST, a new mobile/tablet-based application in reducing weight and encouraging healthy eating behaviors and quality of life in children with obesity. The application could assist healthcare professionals to treat children and adolescents with obesity. Methods A randomized controlled trial was conducted in the hospital and school settings in Chiang Mai, Thailand. Seventy-seven children and adolescents with obesity were randomized into two groups; one received standard care combined with the OBEST application, and the other received only standard care. The outcomes were changes in weight, healthy eating behaviors, and quality of life assessed by the Pediatric Quality of Life Inventory (PedsQL) from baseline to six-month follow-up between the two groups. Results The results showed that the intervention group reduced more body mass index (BMI) and had a higher number of participants engaging in healthy eating behaviors than the standard care group but did not reach a statistically significant level, except for less frequent consumption of fast food. The participants in the intervention group had 4.5 times higher odds of decreased engaging in fast-food consumption than the standard care group at 6 months follow-up (odds ratio, 4.5 [95% CI, 1.41 to 14.35]). There were no statistically significant changes in PedsQL scores over 6 months in between groups. Conclusions The current study was unable to detect a significant effect of the OBEST application as an adjunct tool to the standard treatment on reducing weight in obese children and adolescents. However, the mobile application might help to increase engaging in healthy eating behaviors. Further studies with a larger sample are needed to confirm our findings. Trial registration The trial was retrospectively registered at the Thai Clinical Trials Registry (trial registration number: TCTR20200604008, on June 4, 2020).

To inform future policies, the study objectives were to determine to what extent the policies included in the 5-year Plan of Action for the Prevention of Obesity in Children and Adolescents-proposed by Pan American Health Organization (PAHO) and signed by 19 Latin America countries in 2014-have been implemented and evaluated.A scoping review of the Governmental websites for Latin American countries and a literature review was conducted to identify whether policies have been implemented and evaluated. Key information was abstracted.The review identified 115 PAHO policies/interventions implemented (43% implemented after signing the proposed plan in 2014). Nearly all (18/19) countries implemented food guidelines or school feeding programs, but fiscal and marketing policies were less commonly implemented (6/19). Through the review, 44 evaluations of PAHO policies were identified of which 23% were qualitative and 77% quantitative. The results of these evaluations were in general positive (e.g., decrease in sugar-sweetened beverages consumption following tax implementation) but no studies evaluated the outcome of reduced obesity.PAHO recommended policies have been implemented to various degrees in Latin America since 2014 and more research is required to understand their impacts on child and adolescent obesity.

Introduction: Childhood obesity, caused due to excessive fat accumulation, is one of the leading causes of preventable deaths associated with several non-communicable diseases. In Nepal, there is limited data available on the status of overweight and obesity among school children. The objective of this study was to find out the prevalence of childhood overnutrition among school going children in a municipality. Methods: A descriptive cross-sectional study was conducted from June 2019 to July 2019, in four schools of a municipality selected by simple random sampling. Ethical approval was obtained from Nepal Health Research Council (Registration number 380/2019). Data was collected using census sampling from children aged 5-18 years through self-administered questionnaires to the children’s parents. The data was entered into the Statistical Package for Social Sciences for analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 379 school children, the prevalence of overnutrition was found to be 38 (10.03%) (95% Confidence Interval= 7.01-13.05). Prevalence of overnutrition was highest in children of age group 10-13 years 23 (60.5%), in females 27 (71.1%), those consuming junk food 4-6 times weekly 14 (36.8%) and those performing daily physical activity less than 60 minutes 24 (63.2%). Conclusions: The prevalence of childhood overnutrition is similar in comparison to other studies done in similar settings.

Background Genetic correlations, causalities and pathways between large-scale complex exposures and ovarian and breast cancers need systematic exploration. Methods Mendelian randomisation (MR) and genetic correlation (GC) were used to identify causal biomarkers from 95 cancer-related exposures for risk of breast cancer [BC: oestrogen receptor-positive (ER + BC) and oestrogen receptor-negative (ER - BC) subtypes] and ovarian cancer [OC: high-grade serous (HGSOC), low-grade serous, invasive mucinous (IMOC), endometrioid (EOC) and clear cell (CCOC) subtypes]. Results Of 31 identified robust risk factors, 16 were new causal biomarkers for BC and OC. Body mass index (BMI), body fat mass (BFM), comparative body size at age 10 (CBS-10), waist circumference (WC) and education attainment were shared risk factors for overall BC and OC. Childhood obesity, BMI, CBS-10, WC, schizophrenia and age at menopause were significantly associated with ER + BC and ER - BC. Omega-6:omega-3 fatty acids, body fat-free mass and basal metabolic rate were positively associated with CCOC and EOC; BFM, linoleic acid, omega-6 fatty acids, CBS-10 and birth weight were significantly associated with IMOC; and body fat percentage, BFM and adiponectin were significantly associated with HGSOC. Both GC and MR identified 13 shared factors. Factors were stratified into five priority levels, and visual causal networks were constructed for future interventions. Conclusions With analysis of large-scale exposures for breast and ovarian cancers, causalities, genetic correlations, shared or specific factors, risk factor priority and causal pathways and networks were identified.

Objectives The later achievement of gross motor milestones during infancy is associated with adiposity in early childhood. However, the associations between gross motor development and adiposity after entering primary school are unclear. This study examined the associations between the ages at which six gross motor milestones were achieved and adiposity during early school years. Methods This retrospective study was conducted in 2012 and 2013. Data were collected from 225 first-grade primary school children (mean age, 6.9 years; 39% girls). Adiposity was assessed using dual-energy X-ray absorptiometry and expressed as body fat percentage. Data describing the ages of achieving six gross motor milestones (holding head up, sitting, crawling, standing supported, walking supported, and independent walking) were obtained from the Maternal and Child Health Handbooks. Results Mean body fat percentage was 21.7%. Multiple linear regression analyses revealed that later ages of achieving crawling (p Conclusions Achieving crawling, standing supported, and walking supported later predict increased body fat when aged 6–7 years. The practice of observing gross motor milestone achievements may allow early targeted interventions to optimize body composition before beginning school and thereby, potentially prevent childhood obesity.

Globally, Childhood obesity is one of the most serious public health challenges in the 21st century. In 2017, the Commission on Ending Childhood Obesity (ECHO) reported that worldwide obesity increased 10-fold among children and adolescents during the last 40 years. According to World Health Organization (WHO) & Childhood Obesity Surveillance Initiative (COSI) data, childhood obesity rates are highest in the Southern European Countries in the World. Childhood obesity is one of the most important public concerns due to increased incidence with a high morbidity rate. This study was intended to identify the parent's attitude on causes and its prevention of childhood obesity in Jazan province. With the Stratified Random sampling method, 100 obese children's parents were selected. Initially, personal information was obtained about a child and mother, and then "Google Form" 5-point Likert's scale was administered to assess parents' attitude on obesity and its prevention. It has four domains (General information on obesity - 2 questions, causes of obesity - 14, consequences of obesity - 4, and prevention of obesity - 10) with 30 questions. The results of the study are expressed as mean and standard deviation (mean percentage). The parent’s attitude score was expressed in terms of obesity 5.86 ± 1.27 (58.6%), causes 38.75 ± 6.52 (55.36%), consequences 11.65 ± 2.36 (58.25%) and prevention 29 ± 5.15 (58%). The overall mean score and standard deviation were 86.67 ± 13.81 (54.84%). The parents had an average attitude score (64.57%) on the causes and prevention of childhood obesity. There was no association between attitude scores with the demographic variables, except the variable age associated with attitude scores. Obesity prevention requires effective intervention measures. The research study proposed that family education and impulse are essential for treating childhood obesity. Schools play a significant role in promoting healthy eating habits and physical activity.

Objectives To examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days—gestation through age 2 years—among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity. Methods A multilevel framework informed interview guide development. Using purposeful sampling, we recruited study participants who were (1) able to speak English or Spanish and (2) resided or employed in Washington Heights or the South Bronx. Participants included community leaders (local government officials, community board members, and employees from community- and faith-based organizations) as well as community members. Trained research staff conducted semi-structured in-depth interviews. Using immersion/crystallization and template style coding, the study team performed thematic analysis until no new relevant themes emerged. Results Among the 19 female study participants, perceived facilitators to SSB policy and program implementation included sustained partnerships with broad coalitions; continual education and clear messaging; and increased accessibility to healthier beverages. Perceived barriers included systems-level challenges accessing programs that support healthy beverage options, and individual-level lack of access to affordable healthy beverages. Acceptable potential intervention strategies included messaging that emphasizes health in pregnancy and infancy; policies that require healthy beverages as the default option in restaurants; and policies that remove SSBs from childcare settings. Some strongly favored SSB excise taxes while others opposed them, but all participants supported reinvestment of SSB tax revenue into health resources among marginalized communities. Conclusions A multi-pronged approach that incorporates engagement, access, equitable reinvestment of revenue, and continual clear messaging may facilitate implementation of policies and programs to reduce SSB consumption in the first 1000 days.

BACKGROUND/OBJECTIVE The evidence that maternal non-nutritive sweetener (NNS) intake during pregnancy increases childhood obesity risk is conflicting. A potential reason for this is that all prior studies examined childhood body mass index (BMI) at only one timepoint and at different ages. We examined the extent to which NNS intake during pregnancy is associated with offspring BMI z-score and body fat longitudinally from birth to 18 years. SUBJECTS A total of 1683 children from Project Viva, a prospective pre-birth cohort, were recruited from 1999 to 2002 in Massachusetts. METHODS We assessed maternal NNS intake in the first and second trimesters of pregnancy using a semiquantitative food frequency questionnaire. Our outcomes were offspring BMI z-score, (at birth, infancy (median 6.3 months), early childhood (3.2 years), mid-childhood (7.7 years), and early adolescence (12.9 years)), sum of skinfolds (SS), fat mass index (FMI) measured by dual x-ray absorptiometry, and BMI z-score trajectory from birth to 18 years. We adjusted models for maternal pre-pregnancy BMI, age, race/ethnicity, education, parity, pre-pregnancy physical activity, smoking, and paternal BMI and education. RESULTS A total of 70% of mothers were white and pre-pregnancy BMI was 24.6 ± 5.2 kg/m2. The highest quartile of NNS intake (Q4: 0.98 ± 0.91 servings/day) was associated with higher BMI z-score in infancy (β 0.20 units; 95% CI 0.02, 0.38), early childhood (0.21; 0.05, 0.37), mid-childhood (0.21; 0.02, 0.40), and early adolescence (0.14; -0.07, 0.35) compared with Q1 intake (Q1: 0.00 ± 0.00 servings/day). Q4 was also associated with higher SS in early childhood (1.17 mm; 0.47, 1.88), mid-childhood (2.33 mm; 0.80, 3.87), and early adolescence (2.27 mm; -0.06, 4.60) and higher FMI in mid-childhood (0.26 kg/m2; -0.07, 0.59). Associations of maternal NNS intake with offspring BMI z-score became stronger with increasing age from 3 to 18 years (Pinteraction

Pediatric overweight/obesity has assumed epidemic proportions in India. It is associated with several significant complications and tracks into adulthood. The mainstay of management is a holistic lifestyle modification that must be adopted by the family as a whole. It involves dietary changes, regular physical activity, and behavioral changes that favor a healthy way of life. Regular follow-up, and attention to keeping up the motivation of the child and family achieves good results. In the present paper, a stepwise approach to prevention and management of childhood obesity is presented along with the recommendations for screening and management of associated complications and the role of pharmacotherapy and bariatric surgery.

OBJECTIVE Drinking sugar-sweetened beverages is a risk factor for developing childhood obesity and nonalcoholic fatty liver disease (NAFLD). This study investigated the impact of an educational poster in pediatric offices on family's knowledge of sugar content in beverages and assessed awareness of NAFLD. DESIGN Preclinic visit surveys asked patients' caregivers about the sugar content in beverages and awareness of NAFLD. Postclinic visit surveys assessed improvement in knowledge of sugar content and willingness to change dietary habits. SETTING Outpatient visits in a single center in Houston between September and November 2019. PARTICIPANTS One hundred and forty-nine caregivers were surveyed, and patients' median age was 5.5 years (range, 0-18 years) with 57% males. INTERVENTION Educational posters displayed the sugar content of common beverages in each clinic room. MAIN OUTCOME MEASURES Outcomes measured included pre-post clinic visit change and predictors of change in (1) knowledge of sugar content in beverages and (2) intent to change beverage consumption. Baseline awareness of NAFLD and associated predictors were also assessed. ANALYSIS Logistic regression identified factors associated with an intended change in beverage consumption, change in survey score, and NAFLD awareness. RESULTS Increased knowledge of sugar content with median scores of 25% preclinic to 50% postclinic (P < 0.001). Eighty-eight percent of caregivers were very/moderately likely to provide their children fewer sugar-sweetened beverages. Sixty percent of caregivers were aware of NAFLD, but only 32.8% were concerned. CONCLUSIONS AND IMPLICATIONS Posters in clinics increased awareness of the sugar content in beverages, and most caregivers reported intent to decrease children's sugary beverage consumption.

BackgroundWhole-systems approaches (WSAs) are well placed to tackle the complex local environmental influences on overweight and obesity, yet there are few examples of WSAs in practice. Amsterdam Healthy Weight Approach (AHWA) is a long-term, municipality-led program to improve children's physical activity, diet, and sleep through action in the home, neighborhood, school, and city. Adopting a WSA, local political, physical, social, educational, and healthcare drivers of childhood obesity are viewed as a complex adaptive system. Since 2013, AHWA has reached >15,000 children. During this time, the estimated prevalence of 2–18-year-olds with overweight or obesity in Amsterdam has declined from 21% in 2012 to 18.7% in 2017. Declining trends are rarely observed in cities. There is a need to formally articulate AHWA program theory in order to: (i) inform future program evaluation which can interpret this decline within the context of AHWA and (ii) contribute a real-life example of a WSA to the literature.MethodsThis study aimed to formally document the program theory of AHWA to permit future evaluation. A logic framework was developed through extensive document review and discussion, during program implementation.ResultsThe working principles of the WSA underpinning AHWA were made explicit in an overarching theory of change, articulated in a logic framework. The framework was operationalized using an illustrative example of sugar intake.ConclusionsThe logic framework will inform AHWA development, monitoring, and evaluation and responds to a wider need to outline the working principles of WSAs in public health.

Background Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships. Methods We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos. Results Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred. Conclusions Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.

Background: in the United Kingdom, rates of childhood obesity are high and inequalities in obesity have widened in recent years. Children with obesity face heightened risks of living with obesity as adults and suffering from associated morbidities. Addressing population prevalence and inequalities in childhood obesity is a key priority for public health policymakers in the United Kingdom and elsewhere. Where randomized controlled trials are not possible, potential policy actions can be simulated using causal modeling techniques. Objectives: using data from the Southampton Women's Survey (SWS), a cohort with high quality dietary and lifestyle data, the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities of childhood obesity was investigated. Methods: predicted probabilities of obesity (using UK90 cut-offs) at age 6–7 years were estimated from logistic marginal structural models adjusting for observed calorie consumption at age 3 years (using food diaries) and confounding. A series of policy-relevant intervention scenarios were modeled to simulate reductions in energy intake (differing in effectiveness, the targeting mechanisms, and level of uptake). Results: at age 6–7 years, 8.3% of children were living with obesity, after accounting for observed energy intake and confounding. A universal intervention to lower median energy intake to the estimated average requirement (a 13% decrease), with an uptake of 75%, reduced obesity prevalence by 1% but relative and absolute inequalities remained broadly unchanged. Conclusions: simulated interventions substantially reduced population prevalence of obesity, which may be useful in informing policymakers.

Purpose Childhood obesity is a major global issue that causes a variety of health problems and high social costs. Many previous studies have investigated childhood obesity using cross-sectional data, but few longitudinal cohort studies have been performed, especially in the Korean population. Methods We analyzed the incidence and prevalence of obesity and overweight in a Korean prospective cohort study of children that were followed-up from age 7 to age 36. The study eventually recruited a total of 1216 participants, with 16 follow-up surveys over 30 years (1986–2017). Results The annual incidence of obesity showed a small peak (2.1%) at age 13 when the cohort entered middle school, but a rapid increase (6.4%) when participants reached the age of 20. The prevalence of obesity and overweight at age 8 was 0.8% and 0.9%, respectively, and increased rapidly from age 12 (obesity 2.2%, overweight 4.6%), reaching 9.5% and 15.9%, respectively, at age 20. The prevalence of obesity and overweight was consistently higher in girls than in boys during the childhood period, but this trend reversed in adulthood. Conclusions Incidence and prevalence of obesity and overweight increased markedly after the final grades of elementary school in females, but after adolescence in males.

Childhood obesity carries a high risk of serious life-threatening cardiometabolic diseases in adulthood, which are associated with low-grade inflammation. The aim of the present study was to measure serum cytokine concentrations in obese children recruited during endocrinology consultations and compared to lean control the results. Blood serum concentrations of interferon gamma (IFNγ), IL-1β, Interleukin 6 IL-6, IL-10, and TNF-α were analysed applying Luminex xMap technology with Millipore reagent kits. Statistical analyses were performed using t-test comparisons and Spearman correlations. Obese children had highly significant increased levels of circulating IFNγ (p < 0.0001), IL-6 (p < 0.0001), and IL-10 (p < 0.0001), compared to lean controls. IL-1β and TNFα levels, however, were not elevated. Significant correlation of serum cytokines to per cent excess body mass was only observed with IL-6 (rs = 0.21, p < 0.03), although IL-1β (rs = 0.18, p < 0.08) results were suggestive of a trend. A significant association of obesity in childhood with serum concentrations of IFNγ, IL-6, and IL-10 is consistent with a role for low-grade inflammatory processes early in the aetiology of this disease. IL-6 further appears to be a candidate cytokine for assessment of degree of sub-acute inflammation associated with excess weight in the young.

OBJECTIVE This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood. METHOD The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity. RESULTS A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control. CONCLUSION This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.

“Childhood Obesity and its co-morbidities is considered as a prime health hitch that lay up consideration among the public health society. Obesity and above the over weight has bagged the fifth position in the global risk for mortality. The obesity shows a very early onset in life which has laid the utmost importance in the prevention of it among the children. Neck circumference is being considered as the marker of upper body subcutaneous tissue distribution. Aim: The main objective is to evaluate the association between neck circumference and obesity among the children. Methodology: This is a cross sectional study conducted between the periods of august 2019 - September 2019, among 150 male + 129 female students, aged 11 to 18 years. Anthropometric markers of obesity- body mass index (BMI), waist circumference (WC), Hip circumference (HC), waist hip ratio (WHR), neck circumference (NC) were collected. Pearson’s correlation coefficient was used to compute the neck circumference with other obesity indices. Results: The mean BMI was 27.70±1.27 kg/m² and 27.72±2.12 kg/m², mean neck circumference was 35.42±2.26 cm and 32.85±1.92 in above the over weight /obesity boys + girls respectively. The hip circumference in boys was found to be greater than girls, which is higher in above the over weight /obesity students with P

Ожиріння є однією з актуальних медико-соціальних проблем сучасності. Відзначається збільшення поширеності ожиріння серед дітей. Кількість дітей у світі віком до 5 років із надлишковою масою тіла та ожирінням становить 44 мільйони. Ожиріння в дитячому віці є фактором ризику для розвитку тяжкої супутньої патології. Дитяче ожиріння — тяжкий прогностичний фактор ожиріння в дорослих. Реєструється підвищений рівень передчасної смерті в дорослих, які страждали від ожиріння в дитинстві. Заходи профілактики та лікування дитячого ожиріння повинні бути спрямовані на всю родину, а не тільки на хвору дитину. З метою профілактики ожиріння слід обмежувати надлишкове вживання калорій. Для підвищення ефективності профілактики ожиріння в дітей вживання енергії потрібно поєднувати з підвищенням фізичної активності. Основним методом лікування ожиріння в дітей є модифікація способу життя, що включає корекцію харчування, призначення фізичних навантажень та поведінкову терапію. Впровадження шкільних програм, що передбачають збільшення фізичної активності та оптимізацію харчування школярів, підвищує ефективність боротьби з дитячим ожирінням. Фармакотерапія при ожирінні в дітей призначається при неефективності програм з модифікації способу життя. Для медикаментозного лікування ожиріння в дітей застосовується орлістат. Ефективність фармакотерапії підвищується при її поєднанні з комплексними програмами з модифікації способу життя. За кордоном при морбідному ожирінні в підлітків у разі неефективності нехірургічного лікування використовується баріатрична хірургія. У результаті оперативного втручання знижується індекс маси тіла, покращується перебіг супутніх захворювань, підвищується якість життя пацієнтів. Баріатрична хірургія пов’язана з ризиком розвитку побічних ефектів, що потребує проведення безперервного моніторингу ускладнень. Для лікування та профілактики ожиріння в дітей необхідним є мультидисциплінарний підхід із залученням спеціалістів різного профілю.

RATIONALE Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. OBJECTIVES To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. METHODS We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). MEASUREMENTS AND MAIN RESULTS We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). CONCLUSIONS This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.

Childhood obesity prevalence is increasing worldwide. The most common cause of obesity in children is a positive energy balance due to excess caloric intake in contrast to caloric expenditure combined with a genetic predisposition for weight gain. Obesity causes type 2 diabetes mellitus, hypertension, cardiovascular diseases, osteoporosis and some cancers. There is limited information on the efficacy and safety of medications for weight loss in children. In this paper, definition, etiopathogenesis, differential diagnosis, co-morbidities, and treatment of obesity in children will be reviewed.

The analysis of the prevalence and morbidity of obesity in children and adolescents in Ukraine for a period of 2010–2013 was conducted. Obesity reaches 17.2 % among endocrine diseases, which take 4th place in the structure of prevalence according to the disease classes for children and adolescents. Analysis of time series in terms of obesity prevalence in the pediatric age group showed that the indicator has positive dynamics and, according to constructed mathematical models, was prone to the relative increase in the nearest future. A mathematical model is characterized by a high rate of approximation (R2 = 0.9659), which determines the increase in the prevalence of obesity in children and adolescents till 2017. The following preventive measures should be considered as important ones: expertise of microenvironment (living conditions, kindergartens, schools); study of morbidity according to official statistics; medical examinations of the child population with an analysis of health (physical development, resistance, morbidity); selection of risk groups of developing pathology; organization of follow-up; introduction of modern medical technology.