Body Mass Index Percentile Categories Research Articles

Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy.

Individuals with cerebral palsy may be at risk of obesity, but outcomes and risk factors are understudied. The study objectives are to evaluate the frequency of body mass index (BMI) weight categories of individuals with cerebral palsy and the odds of cardiometabolic-specific diseases and medications. We hypothesize subjects with cerebral palsy and an increased body mass index will have higher odds of cardiometabolic specific diseases and medications. This is a retrospective observational cohort study utilizing TriNetX, an electronic health record database, in subjects with cerebral palsy aged 2-18 years with an available body mass index. The study population was divided into 4 body mass index percentile categories, underweight (<5th body mass index percentile), healthy weight (≥5th to <85th percentile), overweight (≥85th to <95th percentile), and obese (≥95th percentile), and the odds of the following variables were evaluated: diagnostic codes and medication codes. We computed the odds ratio to test for associations between the body mass index categories and the variables of interest. A total of 5993 subjects were included: underweight (251, 4.2%), healthy weight (2390, 39.9%), overweight (943, 15.7%), and obese (2409, 40.2%). Obese subjects had a higher odds of asthma, diabetes mellitus, hypertension, and sleep apnea when compared to the health weight group. This study found patients with cerebral palsy classified as obese had higher odds of cardiometabolic comorbidity and medication codes that influence weight. Body mass index measurements are limited in this population but may be used cautiously to evaluate the body type of children with cerebral palsy and monitor cardiometabolic-associated comorbidity occurrence.

Fasting C-peptide values among adolescents in the National Health and Nutrition Examination Surveys.

To report fasting C-peptide values and variations across demographics in healthy non-diabetic adolescents included in the National Health and Nutrition Examination Surveys (NHANES) dataset. In this analysis, we used fasting C-peptide data from the 1999 to 2004 NHANES dataset for participants aged 12 to <18 years (n=2063). The mean ± SE age of the participants was 14.99 ± 0.06 years. The participants included 992 girls and 1071 boys, and more than 80% of participants had a body mass index (BMI) percentile of <85%. Among boys, the most notable finding was the increase in geometric mean C-peptide level from 0.51 nmol/L at age 12, to 0.65 nmol/L at age 15 years. Among girls, levels fluctuated around a geometric mean of 0.67 nmol/L. Girls had significantly higher mean log-transformed C-peptide concentrations than boys (P < 0.0001) after adjusting for age, race and BMI percentile category. After adjusting for age and BMI percentile category, non-Hispanic Black boys and girls had significantly lower C-peptide levels than non-Hispanic White (P=0.0026 and P=0.0093) and Mexican American boys and girls (P < 0.0001 and P < 0.0001), respectively. Despite these findings, both insulin and homeostatic model assessment of insulin resistance were greater in non-Hispanic Black compared to non-Hispanic White participants. Here we describe fasting C-peptide levels in a non-diabetic adolescent population. These data provide crucial insight into evaluating racial differences in endogenous insulin release and clearance and will provide novel information which can be used in assessing residual β-cell function and response to intervention therapy.

Association of phthalate replacement DINCH metabolite concentrations with adiposity in a multi-site, multi-racial cohort of children

BACKGROUND AND AIM: 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) is a recent plasticizer replacing high molecular weight phthalate diesters in items such as toys, medical devices, and food packaging. Little is known regarding the association of DINCH exposure and adiposity in children. METHODS: Analyses included 629 racial/ethnically diverse children ages 4-8 in the Environmental Influences on Child Health Outcomes (ECHO) study, a follow-up of the NICHD Fetal Growth Studies at 10 US sites. Urinary oxidative metabolites of DINCH (cyclohexane-1,2-dicarboxylic acid mono carboxyisooctyl [MCOCH] and cyclohexane-1,2-dicarboxylic acid mono hydroxyisononyl [MHNCH] esters) were determined using liquid chromatography tandem-mass spectrometry (UPLC-ESI-MS/MS). Values were divided by molecular weight and summed to obtain a composite DINCH value (nmol/ml). Outcomes were child’s body mass index (BMI) z-score, waist circumference z-score, percent body fat, and categorized BMI percentiles (85, 85 to 95, ≥95). Multivariable linear and logistic regression models adjusted for urine specific gravity, gender, age, race/ethnicity, birth weight, prolonged exclusive breastfeeding, reported physical activity level, frequency of fast-food consumption, cigarette smoke exposure, neighborhood traffic, mother’s education and pre-pregnancy BMI were used to analyze the association between natural log transformed DINCH levels and outcomes. RESULTS:88% of children had DINCH levels at or above the limit of detection. For each unit increase in natural log transformed DINCH there was a significant decrease in BMI z-score (β [95% CI]: -0.103 [-0.180, -0.026]), waist circumference z-score (β [95% CI]: -0.126 [-0.198, -0.054]) and percent body fat (β [95% CI]: -0.022 [-0.035, -0.009]). DINCH levels were not associated with overweight [OR=0.82 (95% CI: 0.66, 1.02)] or obese [OR=0.88 (95% CI: 0.69, 1.12)] versus normal BMI percentile categories. CONCLUSIONS:In this cross-sectional analysis there were significant inverse associations between children’s DINCH exposure levels and adiposity measures. Additional research is needed to confirm this association and identify possible interactions between DINCH and joint exposure to other related chemicals. KEYWORDS: Phthalates, Obesity and metabolic disorders, Children's environmental health

Associations between Trust of Healthcare Provider and Body Mass Index in Adolescents

ABSTRACT Adolescent obesity continues to be a serious concern around the world, placing young people at risk for chronic conditions and early death. Research has shown that social relationships are important in making health behavior changes, such as following health-care recommendations for eating and physical activity. Specifically, the trust of health-care providers has been shown to be important in making health behavior change. Evidence suggests that obese young adults are less trusting of health-care providers than their healthy weight peers, but it is not known if this also applies to obese adolescents. The purpose of this secondary analysis study was to determine relationships between the trust of health-care providers and body mass index percentile in adolescents. Participants were 224 adolescents aged 14–19 years attending a public high school in the Midwestern United States. The Wake Forest Physician Trust scale measured the trust of health-care providers. Height and weight were collected at a school screening; body mass index percentile categories were determined according to age- and sex-adjusted body mass index percentiles. One-way analysis of variance and post hoc Tukey tests showed trust scores varied significantly between body mass index percentile categories of girls. Results suggest it may be necessary for health-care providers to make additional efforts to build trust with obese adolescent girls than with other groups of adolescents.

Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index.

To examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. A retrospective study was conducted using 1 year of electronic health records following an index primary care visit for children 3 to 17 years old in 2016. Index visits occurred at >40 pediatric practices affiliated with a Northeastern health system. Using normal BMI as a reference group, we examined the extent to which children's BMI percentile categories were associated with primary care visits, emergency department (ED) visits, hospitalizations, and ED visit acuity. Age, sex, race/ethnicity, and insurance status were used as covariates. Of those with biologically plausible values for height and weight (n=30,352), the prevalences of overweight, obesity, and severe obesity were 16.3%, 12.4%, and 5.7%, respectively. Children outside of the normal BMI range made more primary care visits; however, relative patterns of ED utilization were not consistent. Children with obesity versus normal BMI were less likely to have ED visits of high acuity. Risk of hospitalization was higher among children with overweight or severe obesity. Children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management.

Obesity Is Associated With Increased Thoracic Kyphosis in Adolescent Idiopathic Scoliosis Patients and Nonscoliotic Adolescents

Study DesignRetrospective comparative cohort study. ObjectiveTo compare radiographic parameters between adolescents with a greater body mass index (BMI) percentile to underweight individuals. Summary of Background DataIncreased BMI percentile has been associated with increased complications after surgical correction of adolescent idiopathic scoliosis (AIS). However, association between BMI percentile and preoperative sagittal plane alignment has not been evaluated. The purpose of this study was to evaluate the effect of BMI percentile on sagittal alignment in AIS patients compared with nonscoliotic adolescents. MethodsPosterior-anterior and lateral spinal radiographs of 1,551 AIS patients with a thoracic major curve (Lenke 1–4) and 70 nonscoliotic adolescent patients were compared. BMI percentile was determined based on age and sex, and patients were divided into four categories: underweight (<5th percentile), normal-weight (5th–85th percentile), overweight (85th–95th percentile), and obese (≥95th percentile). ResultsCoronal plane deformity magnitude was not significantly different between the 4 categories of AIS patients (p = .51). Increased BMI percentile was associated with increased thoracic kyphosis globally (T2–T12: p < .005) as well as segmentally (T2–T5: p < .001; T5–T12: p < .001) in patients with AIS. This was also true in obese adolescents without spinal deformity (p < .04). Lumbar lordosis, pelvic incidence, and pelvic tilt were not significantly different between AIS patients in the four BMI percentile categories (p > .07). Pelvic incidence was significantly greater in AIS patients compared with nonscoliotic adolescents (54 ± 13 vs. 46 ± 11; p = .01). ConclusionIncreased BMI percentile is associated with increased thoracic kyphosis in AIS patients and nonscoliotic adolescents. Excess weight may reduce anterior vertebral growth. AIS patients have an increased pelvic incidence compared with nonscoliotic adolescents; however, this variable is not influenced by body mass. These relationships should be taken into account when planning sagittal plane deformity correction or considering neuro axis disorders (also associated with increased kyphosis) in patients with scoliosis. Level of EvidenceLevel II.

Levels of and Changes in Childhood Body Mass Index in Relation to Risk of Atrial Fibrillation and Atrial Flutter in Adulthood.

Children with obesity have a cardiometabolic risk profile that may predispose them to cardiovascular diseases. We examined the associations of childhood body mass index (BMI) and changes in BMI with the risk of atrial fibrillation and flutter (AFF) in adulthood. We conducted a population-based cohort study of Danish schoolchildren aged 7-13 years born from 1930 to 1989. Among 314,140 children, 17,594 were diagnosed with AFF as adults (1977-2014). In both men and women, above-average BMIs in childhood were associated with increased risks of AFF. Children who were persistently heavy at ages 7 and 13 years and children whose BMIs increased from the internal 25.0th-75.0th percentiles or from the internal 75.1th-90.0th percentiles between ages 7 and 13 years had higher risks of AFF in adulthood than children whose BMIs remained in the internal 25.0th-75.0th percentiles at both ages. A decrease in BMI percentile categories between 7 and 13 years of age reduced risks of AFF in adulthood, with risks of AFF reverting to levels similar to those in the reference group for women but not for men. In conclusion, risks of AFF in adulthood increased with higher childhood BMIs. Remission from overweight by age 13 years reduced AFF risks, especially in women.

Obesity Increases Risk of Loss of Reduction After Casting for Diaphyseal Fractures of the Radius and Ulna in Children: An Observational Cohort Study.

To determine if high body mass index (BMI) increases the risk of loss of reduction (LOR) following closed reduction and casting for displaced concomitant fractures of the radial and ulnar shafts in pediatric patients. Retrospective cohort study. A single, tertiary care, urban children's hospital. Pediatric patients 2-18 years of age with closed, displaced, concomitant diaphyseal fractures of the radius and ulna (OTA/AO 22-A3) who underwent closed reduction and casting at the study site. BMI percentile of ≥95 was defined as obese. For nonobese patients, BMI percentile of ≥85 was defined as overweight. BMI percentile category, fracture angulation, sex, age, fracture location, and number of follow-up visits were recorded. Radiographs and health records were reviewed to note clinical and radiographic cases of LOR. The primary outcome was LOR (clinical or radiographic). Overall, 124 subjects (74 male and 50 female subjects) underwent acceptable closed reduction and casting. Median patient age was 7.6 years (range, 2.2-17.8 years). There were 14 cases of LOR. LOR rates were 7.2%, 16.7%, and 44.4% for the nonoverweight, overweight, and obese cohorts, respectively (P = 0.005). Regression analysis revealed that LOR was positively associated with higher BMI category (odds ratio for overweight 4.49; P = 0.082; odds ratio for obese 7.52; P = 0.020) and patient age in years (odds ratio, 1.38; P = 0.001). Given the high risk of LOR in overweight and obese children with displaced concomitant fractures of the radial and ulnar shafts, our findings suggest that attentive and frequent follow-up is warranted. In these patients, the initial reduction should be closely scrutinized, and a lower threshold for surgical fixation may be considered. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A Collaborative Approach to Childhood Obesity Surveillance From a Local Health Department.

DuPage County Health Department collected de-identified data from health forms submitted by participating schools for academic years 2011-2015 for kindergarten, sixth-, and ninth-grade students to determine the prevalence of obesity and elevated blood pressure among public school students. The prevalence of obesity in students for the 2014-2015 school year was 15.1%, and the prevalence of elevated blood pressure was 22.8%. Students in the "obese" body mass index percentile category had an elevated blood pressure prevalence of 44.2%, which was higher than students in the "nonobese" category (P < .001). Significant differences were also observed both by sex and by grade. The results identify the need to support implementation and evaluation of policies to reduce childhood obesity and improve health outcomes. By partnering with schools to obtain preexisting health data, state or local health departments with limited resources may replicate these methods to develop a childhood obesity surveillance system.

Recurrent venous thrombosis related to overweight and obesity: results from the MEGA follow‐up study

Background Studies on the risk of recurrent venous thrombosis in patients with excess body weight have yielded conflicting results. Objective To estimate whether excess body weight increases the risk of recurrent venous thrombosis. Patients/Methods We included 3889 patients, followed after a first venous thrombosis for a median of 5.6 years. Body mass index (BMI) was calculated as weight in kilograms/height in meters squared, and classified according to three a priori-defined categories (normal weight, overweight, and obesity), as well as by percentiles. Crude incidence rates with 95% confidence intervals (CIs) of recurrent venous thrombosis were estimated as the number of events over the accumulated follow-up time in each BMI category. Cox regression models were used to compare groups, adjusted for age and sex. Results The incidence rate of recurrent venous thrombosis was 3.3 per 100 patient-years. Adjusted hazard ratios of recurrent venous thrombosis in overweight or obese patients in comparison with patients with normal weight were 1.05 (95% CI 0.88-1.27) and 0.94 (95% CI 0.74-1.19), respectively. Stratification by BMI percentile categories yielded similar results. The association between BMI and recurrent venous thrombosis was also absent after stratification by sex, (although a small effect for overweight, but not for obese women, was found), or into those with a first provoked or unprovoked event, or deep vein thrombosis and pulmonary embolism. Conclusions We found no evidence of an association between excess body weight and recurrent venous thrombosis. Measuring BMI is not a useful tool to identify patients at high risk of recurrence.

Caregiver's Country of Birth Is a Significant Determinant of Accurate Perception of Preschool-Age Children's Weight.

One in four preschool-age children in the United States are currently overweight or obese. Previous studies have shown that caregivers of this age group often have difficulty accurately recognizing their child's weight status. The purpose of this study was to examine factors associated with accurate/inaccurate perception of child body mass index (BMI) among a multicultural sample of caregivers who were predominantly low-income and foreign-born. A total of 980 caregivers (72% Hispanic, 71% born outside of the United States) of preschool-age children (N= 1,105) were asked if their child was normal weight, overweight, or obese. Answers were compared to actual child BMI percentile category via chi-square analysis. Logistic regression analysis was performed to assess predictors of accurate perception of child BMI percentile category. More than one third of preschoolers were either overweight (18.4%) or obese (16.5%). The majority (92%) of caregivers of an overweight/obese child inaccurately perceived that their child was in a normal BMI category. Overall, foreign-born caregivers were significantly less likely to accurately perceive their child's BMI percentile category versus U.S.-born caregivers (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.48-0.88). Specifically, those born in South America (OR = 0.59, 95% CI = 0.36-0.98), Central America/Mexico (OR = 0.59, 95% CI = 0.41-0.85), and Caribbean Hispanic nations (OR = 0.54, 95% CI = 0.35-0.83) were significantly less likely to accurately perceive their child's BMI category versus U.S.-born caregivers. The results of this study suggest that foreign-born caregivers of U.S. preschool-age overweight/obese children in particular do not accurately perceive their child's BMI status. Health care professionals serving foreign-born caregivers may consider additional culturally appropriate healthy weight counseling for these families.

Role of the Waist/Height Ratio in the Cardiometabolic Risk Assessment of Children Classified by Body Mass Index

The aim of this study was to determine the utility of waist/height ratio (WHtR) in the specification of cardiometabolic risk in children already stratified by body mass index (BMI). Reflective of its association with cardiometabolic risk, BMI is a commonly used indirect indicator of adiposity in children. The WHtR, a marker of central adiposity, has been advocated as a possibly superior indicator of cardiometabolic risk. Cross-sectional analysis of 5 National Health and Nutrition Examination Surveys from 1999 to 2008 (ages 5 to 18 years of age). The BMI percentile categories (normal, overweight, and obese) were further stratified on the basis of WHtR (<0.5, 0.5 to <0.6, ≥ 0.6). Outcome measures were lipid and glycemic profiles, C-reactive protein, liver transaminases, prevalence of hypertension, and metabolic syndrome. Data were available for 14,493 subjects. Overweight and obese subjects with a WHtR <0.5 had a cardiometabolic risk approaching that of subjects with a normal BMI percentile category. Increasing WHtR was significantly associated with increased cardiometabolic risk in overweight and obese subjects, with the greatest associations observed in the obese population. Of obese subjects with WHtR ≥ 0.6, 26% had elevated non-high-density lipoprotein levels, 18% had elevated C-reactive protein levels, 69% had an elevated homeostatic model assessment-insulin resistance, and 32% had metabolic syndrome. The WHtR further specifies cardiometabolic risk within classifications stratification on the basis of BMI percentile. A significant proportion of obese children with increased WHtRs have abnormal cardiometabolic risk factor levels. The WHtR should be included in the routine screening and assessment of overweight and obese children, and those with an elevated WHtR should undergo a further cardiometabolic risk assessment.

Perceived Weight Status Effect on Adolescent Health-Risk Behaviors: Findings from 2007 and 2009 Rhode Island Youth Risk Behavioral Survey

The goal of this study is to systematically examine the associations between perceived weight status and selected health-risk behaviors among Rhode Island adolescents. We utilized the biennial 2007 and 2009 Rhode Island representative Youth Risk Behavior Survey data. The combined statewide sample contained 5,423 randomly selected public high school students. Perceived weight status was classified into very underweight, slightly underweight, about the right weight, slightly overweight, and very overweight according to the question “How do you describe your weight?” Adolescent’s body mass index (BMI) was calculated from self-reported height and weight. BMI percentile was categorized as extremely underweight, underweight, normal, overweight, and obese. Multivariable logistic regression models were used to analyze perceived weight status associated with six categories of priority health-risk factors. Perceived very underweight and very overweight were statistically significantly associated with 17 out of 22 health-risk behaviors. The relationships can be expressed as a “U”-shaped curve in terms of odds ratios in adolescents. There were no such similar consistent patterns between BMI percentile categories and health-risk behaviors. Perceived weight status, rather than BMI percentile categories, has an important influence on health-risk behaviors. Our results may assist health programs to intervene with high-risk students by changing their cognitive behaviors.

The relationship of school absenteeism with body mass index, academic achievement, and socioeconomic status among fourth-grade children.

Data from a school-based study concerning fourth-grade children's dietary recall accuracy were linked with data from the South Carolina Department of Education (SCDE) through the South Carolina Budget and Control Board Office of Research and Statistics (ORS) to investigate the relationships of children's school absenteeism with body mass index (BMI), academic achievement, and socioeconomic status (SES). Data for all variables were available for 920 fourth-grade children during 2 school years (2005-2006, 2006-2007). Number of school days absent for each child and eligibility for free/reduced-price school meals (SES measure) were provided to ORS by SCDE. Children's weight and height were measured by research staff; age/sex-specific BMI percentile was calculated and grouped into categories. For academic achievement, Palmetto Achievement Challenge Tests scores were provided by the school district. The associations of absenteeism with BMI, academic achievement, SES, and school year were investigated with logistic binomial models using the modified sandwich variance estimator to adjust for multiple outcomes within schools. The relationships between absenteeism and each of BMI percentile category and SES were not significant (all coefficient p values > .118). The relationship between absenteeism and academic achievement was inversely significant (p value < .0001; coefficient = -.087). These results support the inverse relationship between absenteeism and academic achievement that was expected and has been found by other researchers. The lack of significant results concerning the relationships between absenteeism and both BMI and SES differs from earlier, limited research. More research to investigate these relationships is needed.

Objective Measurement of Physical Activity Levels Of US Children By BMI Category

PURPOSE: To describe objectively measured physical activity (PA) levels derived from accelerometer data for US children by BMI category across gender, age and ethnic groups. METHODS: A sub-set of data from the 2003-2006 NHANES cycles, where PA was measured using Actigraph for a week, was employed in this study. 5219 children (50% females) aged 6-19 y with at least one day of Actigraph data were included in the analysis. SAS survey procedures were used for statistical analysis and a Bayesian approach was used to estimate prevalence of children meeting the moderate PA recommendation, i.e., 60 or more minutes of at least moderate-intensity activity on 5 or more days per week. RESULTS: About 22% of US children met the 60-minute moderate intensity PA recommendation. PA levels decreased across body mass index percentile (BMIPCT) categories, with 24% of healthy weight or underweight (HWUW; BMIPCT <85) children, 18.6% of children at risk of overweight (ROW; BMIPCT >85 but <95), and l5.4% of overweight (OW; BMIPCT >95) children meeting the PA recommendation. Gender differences were observed in the percentages of children meeting the PA recommendation across BMIPCT categories (29%, 24% and 19.7% of males vs. 19.4%, 13.2% and 10.5% of females, respectively). ROW non-Hispanic Black children (NHB; 25.6%) were more active than ROW Mexican American (MA; 18.5%) and ROW non-Hispanic Whites (NHW; 17.2%) children, while OW MA children (19.3%) were more active than OW NHW (14.4%) and NHB (14.2%) children. Among HWUW children, ethnic differences were not evident. Children's PA levels dramatically declined from age 6-11 y (42% met PA recommendations) to age 12-19 y (7.2%), and the similar patterns were observed across HWUW, ROW and OW categories (46.8%, 36.4% and 28.7% of children aged 6-11 y vs. 7.7%, 6.8% and 5.7% of children aged 12-19 y, respectively). CONCLUSIONS: Using accelerometers to measure PA, NHANES 2003-2006 data indicate that only 22% of US children met the moderate PA recommendation for children. Regardless of BMIPCT category, female children and children aged 12-19 y are the least active among subcategories. Contrary to previous self-report PA data in children, accelerometer data indicates higher percentages of NHB and MA children across BMIPCT categories met the moderate PA recommendation compared to their NHW counterparts.

Perception of overweight and self‐esteem during adolescence

To examine sex- and race/ethnicity-specific relationships between adolescents' self-esteem and weight perception. Descriptive analysis and logistic regression of Wave II of the National Longitudinal Study of Adolescent Health (N = 6,427 males, 6,574 females; ages 11-21) examined associations between low self-esteem and perceived overweight within body mass index (BMI) percentile categories, controlling for sociodemographics and stratified by sex and race/ethnicity. 25.1% and 8% of normal weight females and males, respectively, perceived themselves as overweight, with variation by race/ethnicity. Low self-esteem was most strongly associated with misperceived overweight in moderate BMI percentile categories (males: OR = 2.34; 95% CI: 1.60-3.41; females: OR = 2.39; 95% CI: 1.82, 3.16). Odds of correctly perceived overweight were higher for low (versus high) self-esteem in white and black females but not males of any race/ethnicity. Understanding subgroup differences by race/ethnicity in perceived overweight-self-esteem relationships may inform eating disorders' prevention strategies.

American Heart Association Childhood Obesity Research Summit Report

I. The Problem: Childhood Obesity—A Burgeoning Epidemic e490II. Childhood Obesity Research Summit.........e490III. Pathophysiology and Morbidity ofChildhood Obesity e490A. Pathophysiology of Obesity e490B. Medical Consequences of Childhood Obesity. . .e490C. Psychosocial and Societal Consequences ofChildhood Obesity e490IV. Current Healthcare Practices in ChildhoodObesity Prevention and Treatment e492A. Lifestyle Assessment: Diet and Physical Activity . . . .e492B. Clinical Assessment e493C. Psychosocial/Behavioral Assessment .......e493D. Implementing Effective Prevention andTreatment Options: Diet e494E. Implementing Effective Prevention and TreatmentOptions: Exercise and Sedentary Behaviors . . . .e495F. Implementing Effective Prevention TreatmentOptions: Family and Behavioral Approaches . . .e496G. Behavioral Management e497H. Medical and Pharmacological Management. . . .e497I. Surgical Management e498V. Barriers to Optimum Care e498A. Healthcare System Factors e4981. Preparedness of Providers e4982. Models of Coverage and Care e4993. Uninsurance and Underinsurance AmongChildren and Families e5004. Healthcare Providers and Settings asRole Models e500B. The Challenge of Behavior Change ........e5011. Motivational Interviewing for Pediatric Obesity. .e5012. Psychosocial Factors InfluencingBehavior Change e5023. Environmental Factors InfluencingBehavioral Change e503VI. Practice-Based Resources for Preventionand Management e503A. Models From Other Disciplines e5031. Adult Chronic Care Model e5032. Treatment of Heart Failure e5043. Treatment of Type 2 Diabetes Mellitus .....e5044. Treatment of Childhood Asthma.........e505B. Public Health Measures forChildhood Obesity e5061. Tobacco Control: Implications forChildhood Obesity e506C. Specific Research Issues e5061. Specifying Priorities in the Context of aComplex, Multifactorial Problem ........e5062. Taking a Developmental Approach .......e5073. Engaging Stakeholders e5074. Targeting the Appropriate Outcome .......e508VII. Research Challenges e509A. Research in the Busy Practice e509B. Bring Research Into Practices: Web-BasedAssessment for the PediatricObesity Clinic e509C. Research Agenda: NHLBI and thePediatric Heart Network e510D. Research Agenda: The Children’sOncology Group e510E. Research Agenda: CDC e511F. Research Agenda: Foundations e511VIII. Research and Policy: KnowledgeTranslation e512A. From Practice to Policy to Practice ........e512IX. Concluding Remarks e512Appendix A: Planning Committee e513Appendix B: Presenters e513