Management Of Childhood Obesity Research Articles

Lifestyle-based subtypes of childhood obesity and their association with cardiometabolic factors: A cluster analysis.

Lifestyle factors play an important role in the development and management of childhood obesity and its related cardiometabolic complications. We aimed to explore childhood obesity subtypes based on lifestyle factors and examine their association with cardiometabolic health. We included 1550 children with obesity from the National Health and Nutrition Examination Survey. Cluster analysis identified obesity subtypes based on four lifestyle factors (physical activity, diet quality, sedentary time and smoking). Multiple linear regression assessed their association with cardiometabolic factors. Five subtypes of childhood obesity were identified: unhealthy subtype (n = 571; 36.8%), physically active subtype (n = 185; 21.1%), healthy diet subtype (n = 404; 26.1%), smoking subtype (n = 125; 8.1%) and non-sedentary subtype (n = 265; 17.1%). Compared with the unhealthy subtype, the physically active subtype had lower insulin and HOMA-IR levels, and smoking subtype was associated with lower HDL levels. When compared with children with normal weight, all obesity subtypes had worse cardiometabolic profile, except the physically active subtype who had similar DBP, HbA1c and TC levels; smoking subtype who had similar TC levels; and healthy diet and non-sedentary subtypes who had similar DBP levels. Children of different lifestyle-based obesity subtypes might have different cardiometabolic risks. Our new classification system might help personalize assessment of childhood obesity.

The combined pioglitazone and topiramate therapy for management of pediatric patients with severe MASLD.

Metabolic dysfunction associated steatotic liver disease (MASLD) is the most common cause of chronic hepatitis in adult and pediatric patients. Adolescents with severe MASLD can demonstrate a more aggressive disease phenotype as they more commonly develop liver fibrosis than BMI matched adults. Therefore, MASLD is the fastest growing indication for liver transplants in young adults. Pioglitazone has been shown to improve liver histology in adult patients with MASLD, and in some studies, it attenuated liver fibrosis. Despite its perceived efficacy, pioglitazone is not widely used, likely due to its side effect profile, specifically increased weight gain. Topiramate lowers body weight in adolescents and in combination with phentermine, is one of the few FDA-approved medications for the management of obesity in children over 12 years of age. We performed a retrospective review of the outcomes in pediatric patients with severe MASLD, treated with the combined pioglitazone and topiramate therapy. Here, we report a case series of seven adolescents with severe MASLD and ≥F2 liver fibrosis treated with the combined pioglitazone and topiramate therapy. The combined therapy improved mean serum ALT from 165 ± 80 U/L to 89 ± 62 U/L after 12 months mean duration of treatment. One patient who completed 24 months of the combined therapy demonstrated a decrease in liver stiffness from 8.9 kPa to 5.6 kPa, as assessed by FibroScan elastography. There was a significant increase in body weight during this time, however, body mass index as a percentage of the 95 th percentile adjusted for age and gender did not increase significantly, 151 ± 29% vs. 152 ± 28%. Moreover, waist circumference, mid-upper arm circumference, percent body fat, and muscle mass were not significantly different before and after treatment. Serum lipid levels and hemoglobin A1c also did not change with the treatment. In summary, this case series provides encouraging results about the efficacy of the combined pioglitazone and topiramate therapy for the management of adolescents with severe MASLD, which should be further explored in clinical studies.

Managing childhood obesity: teleconsultation as good as routine care

Managing childhood obesity: teleconsultation as good as routine care

A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: The ReFRESH study design

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

Association between cardiovascular risk and maternal perception of BMI in Peruvian schoolchildren.

In the modern era, the maternal perception of children's nutritional status has emerged as a critical area of study, given its potential influence on nutritional interventions and long-term child health. The relationship between this perception and children's Body Mass Index (BMI) by age is particularly intriguing, as it may reveal discrepancies between perception and reality. The aim of this study was to evaluate Peruvian mothers' perception of their children's Body Mass Index (BMI) in relation to age and to determine how this perception associates with the children's cardiovascular risk. The study also analyzed sociodemographic factors that might influence this perception. The study included 130 mothers of schoolchildren aged 5 to 11 from a school in Lima. Mothers' perceptions of their children's weight were assessed using pictograms, and sociodemographic characteristics were collected through a questionnaire. Weight and height measurements were taken to calculate BMI, and waist circumference was measured to classify cardiovascular risk. A total of 57.4% of the schoolchildren presented with excess malnutrition, and 51.5% of the mothers incorrectly classified the actual BMI/Age of their children (kappa 0.11; p ≤ 0.05). Additionally, it was found that the schoolchild's age is associated with the mother's failure to accurately perceive her child's weight (OR 1.59). Lastly, there was a significant association between maternal perception and cardiovascular risk (p ≤ 0.05). There is a significant discrepancy between maternal perception and the actual nutritional status of children, which can increase cardiovascular risk. It is necessary to implement intervention and education strategies targeted at parents to enhance the recognition and management of childhood overweight and obesity.

Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways.

Childhood obesity, affecting 29% of 7-9-year-olds across 33 European countries, is a significant public health challenge. Its persistence into adulthood poses grave health risks influenced by genetic, environmental, and socio-economic factors. Belgium introduced a new care pathway in December 2023, based on the Edmonton Obesity Staging System for Pediatrics (EOSS-P), addressing four health domains and staging obesity severity. This pathway operates across three levels: primary care physicians, Paediatric Multidisciplinary Obesity Management Centres (PMOCs), and Centers of Expertise for Paediatric Obesity Management (CEPOs). Each stage of EOSS-P demands tailored interventions. Early stages involve dietary interventions, physical activity promotion, and behavior modifications. As obesity severity progresses, treatments intensify, encompassing psychological support, anti-obesity medications, and, in some cases, bariatric surgery. Throughout these stages, the involvement of multidisciplinary teams is crucial, emphasizing family-based approaches and continuous monitoring. This article provides detailed guidelines for healthcare professionals, delineating interventions and recommendations tailored to each EOSS-P stage. It emphasizes a holistic approach that extends beyond BMI-based diagnosis, promoting personalized care and prompt escalations between care levels, thereby ensuring optimal management of childhood obesity. This comprehensive framework aims to address the complexities of childhood obesity, emphasizing the importance of timely and targeted interventions for better health outcomes.

Obesity and Preventive Intervention Among Children: A Narrative Review.

Childhood obesity has become a major public health concern around the world, with a rise in prevalence over the last few decades. This abstract provides an overview of pediatric obesity, including its causes, implications, and potential treatments. Childhood obesity is caused by a complex combination of environmental, genetic, and behavioralvariables. A child's likelihood of developing obesity is influenced by factors, such as socioeconomic status, family dynamics, and cultural norms. Childhood obesity leads to extensive repercussions, elevating the risk of chronic conditions, such as diabetes, cardiovascular diseases, and mental health challenges. Furthermore, children dealing with obesity often face social stigmatization, diminished self-esteem, and academic struggles. Efforts to prevent and manage childhood obesity should employ a comprehensive and multi-tiered approach. This involves enacting policies geared towardenhancing nutrition in schools and communities, advocating for increased physical activity (PA), and curbing sedentary behaviors.

Current and future state of pharmacological management of pediatric obesity.

Pediatric obesity is a highly prevalent chronic disease, which has traditionally been treated with lifestyle therapy alone. Yet for many youth, lifestyle intervention as a monotherapy is often insufficient for achieving clinically significant and durable BMI reduction. While metabolic/bariatric surgery achieves robust and long-lasting outcomes, it is neither widely accessible nor wanted by most pediatric patients and families. In the past 3 years, this treatment gap between lifestyle therapy and metabolic/bariatric surgery has been filled with a number of landmark clinical trials examining the safety and efficacy of anti-obesity medication (AOM) for use in children and adolescents. These trials include studies of liraglutide, phentermine/topiramate ER, semaglutide, and setmelanotide, all of which have led to FDA and/or EMA approval. Concurrent with this developing evidence base, in 2023, the American Academy of Pediatrics published their first Clinical Practice Guideline on the assessment and management of childhood obesity. The Guideline includes the recommendation that pediatric health care providers should offer AOM to youth ages ≥12 years with obesity. Recognizing that AOM use in the pediatric population will likely become the standard of care and to provide perspective on the recently generated data regarding new AOM, this narrative review summarizes the published randomized controlled trials (RCTs) from the past 10 years that examine AOM for the pediatric population. This report additionally includes RCTs examining AOM for special populations of pediatric obesity including monogenic obesity, Bardet Biedl syndrome, Prader Willi syndrome, and hypothalamic obesity. Finally, the clinical application of AOM for children and adolescents, as well as future directions and challenges are discussed.

Dental implications of childhood obesity and prevention and management methods in dental office

Childhood obesity is a common chronic disease in childhood, and its prevalence and socioeconomic costs have increased worldwide over the past 40 years. The World Health Organization has designated obesity as a global epidemic, emphasizing the need for its treatment and management. The impacts of childhood obesity on dentistry include a higher risk of dental caries, advanced dental development, as well as psychological changes (anxiety, depression, attention deficit hyperactiv-ity disorder) and physical changes (increased complications, changes in drug metabolism) that should be considered when implementing preventive strategies, orthodontic treatment, behavior management and sedative procedures. Dentists should regularly check child’s body mass index and diet for every child visiting dental office. Parental obesity, consumption of sugar-sweetened beverages, poor dietary habits, and lack of exercise can be a risk factors for obesity in normal/overweight child. Diet counseling should be provided to high-risk children and their parents. Preventing childhood obesity is crucial, and the key point in treating childhood obesity is behavior modification therapy, which focuses on regulating daily eatinghabits and physical activity. Dentists should recognize the seriousness of childhood obesity and participate in the prevention and management of the obesity epidemic, thus enhancing oral and systemic health

Evaluating the Implementation of the Connect for Health Pediatric Weight Management Program

Adoption of primary care interventions to reduce childhood obesity is limited. Progress in reducing obesity prevalence and eliminating disparities can be achieved by implementing effective childhood obesity management interventions in primary care settings. To examine the extent to which implementation strategies supported the uptake of research evidence and implementation of the Connect for Health pediatric weight management program. This quality improvement study took place at 3 geographically and demographically diverse health care organizations with substantially high numbers of children living in low-income communities in Denver, Colorado; Boston, Massachusetts; and Greenville, South Carolina, from November 2019 to April 2022. Participants included pediatric primary care clinicians and staff and families with children aged 2 to 12 years with a body mass index (BMI) in the 85th percentile or higher. Pediatric weight management program with clinician-facing tools (ie, clinical decision support tools) and family-facing tools (ie, educational handouts, text messaging program, community resource guide) along with implementation strategies (ie, training and feedback, technical assistance, virtual learning community, aligning with hospital performance metrics) to support the uptake. Primary outcomes were constructs from the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework examined through parent, clinician, and leadership surveys and electronic health record data to understand the number of children screened and identified, use of the clinical decision support tools, program acceptability, fidelity to the intervention and implementation strategies, and program sustainability. The program screened and identified 18 333 children across 3 organizations (Denver Health, 8480 children [46.3%]; mean [SD] age, 7.97 [3.31] years; 3863 [45.5%] female; Massachusetts General Hospital (MGH), 6190 children [33.8%]; mean [SD] age, 7.49 [3.19] years; 2920 [47.2%] female; Prisma Health, 3663 children [20.0%]; mean [SD] age, 7.33 [3.15] years; 1692 [46.2%] female) as having an elevated BMI. The actionable flagging system was used for 8718 children (48%). The reach was equitable, with 7843 children (92.4%) from Denver Health, 4071 children (65.8%) from MGH, and 1720 children (47%) from Prisma Health being from racially and ethnically minoritized groups. The sites had high fidelity to the program and 6 implementation strategies, with 4 strategies (67%) used consistently at Denver Health, 6 (100%) at MGH, and 5 (83%) at Prisma Health. A high program acceptability was found across the 3 health care organizations; for example, the mean (SD) Acceptability of Intervention Measure score was 3.72 (0.84) at Denver Health, 3.82 (0.86) at MGH, and 4.28 (0.68) at Prisma Health. The implementation strategies were associated with 7091 (39%) uses of the clinical decision support tool. The mean (SD) program sustainability scores were 4.46 (1.61) at Denver Health, 5.63 (1.28) at MGH, and 5.54 (0.92) at Prisma Health. These findings suggest that by understanding what strategies enable the adoption of scalable and implementation-ready programs by other health care organizations, it is feasible to improve the screening, identification, and management of children with overweight or obesity and mitigate existing disparities.

Management of Obesity in Children

Management of Obesity in Children

Barriers to Managing Childhood Obesity in the General Practice Amidst of the Double Burden of Malnutrition: A Sri Lankan Perspective

Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries. Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community. In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach. While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems. Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries. Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community. In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach. While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems.

Metabolic and Bariatric Surgery in Children: Current Practices and Outcomes.

This review will examine the most current evidence for Metabolic and Bariatric Surgery (MBS) in the pediatric population, specifically in terms of weight loss outcomes and improvement in comorbid conditions and complications. Additionally, we compare surgical and non-surgical interventions, review current guidelines, and propose a stepwise evidence-based approach to the management of obesity in children. MBS is a safe option for appropriately selected pediatric patients which leads to significant and sustained weight loss. This weight loss is associated with improvement of related comorbid conditions. Laparoscopic sleeve gastrectomy (LSG) has emerged as the procedure of choice with a better safety profile. Despite the evidence, very few adolescents undergo MBS. New pharmacologic agents specifically the GLP-1/GIP agents have shown early promise especially in patients under body mass index 40, but the long-term effects are unknown. MBS is an effective tool in the management of pediatric obesity, and its use has been recommended by professional societies. Early referral to a multidisciplinary obesity team can help identify appropriate patients.

Nursing interventions in childhood obesity

Introduction: obesity is a chronic disease characterized by a high percentage of fat in the human body, caused mainly by endogenous (genetic), biological and exogenous causes (life habits), representing a serious public health problem. Objective: to know the nursing interventions in childhood obesity. Methods: a systemic review of scientific articles was carried out using the PICO strategy. The search was carried out according to PRISMA parameters where initially 40 articles were obtained, of which 18 were included under inclusion criteria such as: Original studies, clinical trials, systematic reviews and meta-analysis, free access, English and Spanish languages and that have been published. between the years 2019 and 2023; while, the exclusion criteria were: degree thesis and documents that did not meet the inclusion criteria. The databases were: ELSEVIER, MEDLINE, Redalyc, SCIELO, Latindex, Dialnet, Latin REV, Scopus using descriptors in health sciences (DECS) from Bireme and the Medical Subject Headings (MESH) from the National Library of Medicine in English, such as: (interventions) AND (childhood obesity AND (Nursing). Results: nursing interventions focused mainly on improving eating behaviors and reducing sedentary lifestyle. Those related to the family were more successful, because, by training adults the quality of life of the child is improved. Conclusions: The training of nursing staff is essential for the management and care of childhood obesity

Children's behaviour and childhood obesity.

Childhood obesity is amajor complex and multifaceted public health challenge with significant short- and long-term health consequences. It is also associated with asignificant reduction in quality of life and poorer mental health outcomes. In general, obesity occurs when energy intake exceeds energy expenditure. In children, however, the former can be interpreted as when achild has abody mass index (BMI) at or above the 95th percentile for children of the same age, sex, and ethnicity on growth charts. Obesity in children is influenced by acomplex interplay of genetic, environmental, socio-economic, and behavioural factors. The relationship between achild's behaviour and childhood obesity is multifaceted and influenced by various factors, including dietary habits, physical activity levels, sedentary behaviours, family dynamics, socio-economic status, and environmental factors. Effective strategies for preventing and managing childhood obesity require acomprehensive, multi-sectoral approach that addresses individual, family, community, and educational institutes. Thus, addressing childhood obesity requires acomprehensive approach that addresses not only biological and environmental factors but also behavioural factors that influence children's eating behaviours, physical activity levels, sleep patterns, and emotional well-being. Early intervention and ongoing support are crucial for promoting healthy growth and development and reducing the burden of childhood obesity on individuals, families, and societies. This review discusses factors that influence the child's behaviour and the relationship between the child's behaviour and childhood obesity.

Scoping literature review and focus groups with healthcare professionals on psychosocial and lifestyle assessments for childhood obesity care.

Background: Childhood obesity is a complex disease resulting from the interaction of multiple factors. The effective management of childhood obesity requires assessing the psychosocial and lifestyle factors that may play a role in the development and maintenance of obesity. This study centers on available scientific literature on psychosocial and lifestyle assessments for childhood obesity, and experiences and views of healthcare professionals with regard to assessing psychosocial and lifestyle factors within Dutch integrated care.
 Methods: Two methods were used. First, a scoping review (in PubMed, Embase, PsycInfo, IBSS, Scopus and Web of Science) was performed by systematically searching for scientific literature on psychosocial and lifestyle assessments for childhood obesity. Data were analysed by extracting data in Microsoft Excel. Second, focus group discussions were held with healthcare professionals from a variety of disciplines and domains to explore their experiences and views about assessing psychosocial and lifestyle factors within Dutch integrated care. Data were analysed using template analysis, complemented with open coding in MAXQDA.
 Results: The results provide an overview of relevant psychosocial and lifestyle factors that should be assessed and were classified as child, family, parental and lifestyle (e.g. nutrition, physical activity and sleep factors) and structured into psychological and social aspects.
 Insights into how to assess psychosocial and lifestyle factors were identified as well, including talking about psychosocial factors, lifestyle and weight; the professional-patient relationship; and attitudes of healthcare professionals.
 Conclusions: This study provides an overview of psychosocial and lifestyle factors that should be identified within the context of childhood obesity care, as they may contribute to the development and maintenance of obesity. The results highlight the importance of both what is assessed and how it is assessed. The results of this study can be used to develop practical tools for facilitating healthcare professionals in conducting a psychosocial and lifestyle assessment.

Protocol to implement nutritional interventions for the management of childhood obesity in Primary Health Care

Objective: To create and validate a protocol to implement nutritional interventions for the management of childhood obesity in the Primary Health Care scope. Methods: This is a methodological study organized into three phases: elaboration of a systematic review of the “overview” type using the PRISMA recommendations; preparation of the clinical protocol; and content validation using the AGREE II and AGREE-REX instruments. Results: A total of 17 studies were included to create the protocol, indicating effectiveness in interventions with outcomes in a significant BMI reduction, change in eating behaviors and habits, and increase in the knowledge level about healthy eating. The clinical protocol assessment obtained a score >70% and, according to the parameter used (≥50% high quality), it was considered adequate for implementation in the children's health field, more specifically in the management of childhood obesity. Conclusion: A care protocol for the management of childhood obesity in the Primary Health Care scope positively represents a sustainable and flexible strategy with performance of several social actors such as health professionals and family members, among others, contributing to reducing risks of comorbidities associated with obesity and health costs, as well as to promoting healthier behaviors in the pediatric population.

A scoping review of physical activity-based interventions for obesity management in children and adolescents during the COVID-19 pandemic.

Overweight and obesity have emerged as global health issues among children and adolescents. Restrictions related to the COVID-19 pandemic have aggravated the threat of paediatric obesity due to the prevalent reduction in physical activity (PA) in children and adolescents. However, this has also created an opportunity for healthcare professionals to explore new strategies to address this persistent problem. A systematically conducted scoping review was performed on 15 online databases to summarise and analyse the design, efficacy, and feasibility of PA-based weight management interventions for children and adolescents during the pandemic. Finally, we reviewed 23 eligible studies that were published between 2021 and 2023. The included interventions were presented to 1938 children and adolescents and 355 parents using a virtual or virtually blended face-to-face approach during the pandemic. The intervention design included a basic PA programme with three optional components (nutritional education, sociopsychological counselling, and medication consultations). Implementation generally resulted in favourable changes in body mass index (BMI) and/or body size or composition (primary outcomes), as well as health behaviours, physical health or fitness, and individual well-being (secondary outcomes). A longer duration of exposure to the intervention, female sex, and older age were associated with a higher efficacy of the included interventions. Moreover, the interventions showed high feasibility, with medium-high participant attendance, high acceptance/satisfaction in both children and adolescents and their parents and teachers, and strong participant engagement. This may be related to the high accessibility of health information, timely social support, and enhanced self-efficacy. In conclusion, both the virtual and blended delivery of well-planned weight management interventions during the pandemic show promise for the treatment and control of paediatric obesity. The lessons learned from the pandemic may help improve the design of future interventions and inform the proper integration of new technologies that have emerged in the post-pandemic world.

Improved Clinical Practice for Childhood Obesity Screening and Management

Childhood obesity is a profound problem in America. The Chronic Care Model (CCM) is a comprehensive approach to chronic disease management that improves patient outcomes and has been successfully applied to pediatric obesity. This purpose of this study was to improve clinical practice according to evidence-based practice and streamline workflow for childhood obesity screening and management in the primary care setting based on CCM concepts. For resource-limited pediatric clinics, this study offers a model for initiating improvements in childhood obesity screening and management.

Indian Academy of Pediatrics Revised Guidelines on Evaluation, Prevention and Management of Childhood Obesity

Indian Academy of Pediatrics Revised Guidelines on Evaluation, Prevention and Management of Childhood Obesity