Excessive Weight Gain In Children Research Articles

Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study.

Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood. The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity. The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child's height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child's physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child's mental health, as well as a 1-day dietary assessment for their child. Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study's sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children's mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ≥CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication. Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children. ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711. DERR1-10.2196/48549.

A collaborative approach to develop an intervention to strengthen health visitors’ role in prevention of excess weight gain in children

BackgroundThe high prevalence of childhood obesity is a concern for public health policy and practitioners, leading to a focus on early prevention. UK health visitors (HVs) are well-positioned to prevent excessive weight gain trends in pre-school children but experience barriers to implementing guideline recommended practices. This research engaged with HVs to design an intervention to strengthen their role in prevention of early childhood obesity.MethodsWe describe the processes we used to develop a behaviour change intervention and measures to test its feasibility. We conducted a systematic review to identify factors associated with implementation of practices recommended for prevention of early childhood obesity. We carried out interactive workshops with HVs who deliver health visiting services in County Durham, England. Workshop format was informed by the behaviour change wheel framework for developing theory-based interventions and incorporated systematic review evidence. As intended recipients of the intervention, HVs provided their views of what is important and acceptable in the local context. The findings of the workshops were combined in an iterative process to inform the four steps of the Implementation Intervention development framework that was adapted as a practical guide for the development process.ResultsTheoretical analysis of the workshop findings revealed HVs’ capabilities, opportunities and motivations related to prevention of excess weight in 0-2 year olds. Intervention strategies deemed most likely to support implementation (enablement, education, training, modelling, persuasion) were combined to design an interactive training intervention. Measures to test acceptability, feasibility, and fidelity of delivery of the proposed intervention were identified.ConclusionsAn interactive training intervention has been designed, informed by theory, evidence, and expert knowledge of HVs, in an area of health promotion that is currently evolving. This research addresses an important evidence-practice gap in prevention of childhood obesity. The use of a systematic approach to the development process, identification of intervention contents and their hypothesised mechanisms of action provides an opportunity for this research to contribute to the body of literature on designing of implementation interventions using a collaborative approach. Future research should be directed to evaluate the acceptability and feasibility of the intervention.

Do Weightbearing Restrictions Cause Excess Weight Gain in Children With LEGG-Calvé-Perthes Disease?

Restricted weight bearing is commonly prescribed in Legg-Calvé-Perthes Disease (LCPD), raising concerns of causing overweight or obesity. This study utilizes prospectively collected data to address the following questions: (1) does body mass index (BMI) Z-score increase over the course of LCPD follow-up; (2) is having a BMI category of normal, overweight, or obese at baseline associated with BMI Z-score changes over the course of follow-up; and (3) is the duration of weight bearing restrictions (no restrictions, <3, 3 to <6, 6 to 9, or >9mo) associated with BMI Z-score changes. Data of 130 children aged 5 to 12 years with unilateral early-stage LCPD were extracted from an international database. Nation-specific BMI Z-scores and percentile-based weight categories were determined, and the duration of follow-up and weight bearing restrictions were calculated. Longitudinal changes in BMI Z-scores were evaluated for the 3 study questions using mixed effects linear regression models with surgery as a covariate. Sensitivity analyses were used to determine the influence of socio-cultural background (USA vs. India) for each study question. During the 35.5±15.9 months of follow-up, no statistically significant increase in BMI Z-scores was observed across the entire cohort, or following stratification by baseline weight categories or the duration of the weight bearing restriction. Sensitivity analyses indicated that patients in the USA had no change in their BMI Z-score. When stratified by weight categories, the normal weight of US children had a small increase in their BMI Z-score (0.005 per mo, 95% confidence interval: 0.0002, 0.009), but this was not seen in other BMI categories. The cohort of Indian children had a small but significant decrease in their BMI Z-score (-0.005/mo, 95% CI: -0.009, -0.0002). After stratification by weight categories, a small decrease of the BMI Z-score was observed only in the Indian overweight children (-0.016 per mo, 95% CI: -0.027, -0.005) and no other BMI category. Weightbearing restrictions over the course of follow-up for our cohort of children with early-stage LCPD were not associated with clinically meaningful increases of BMI Z-scores. Weight gain is multi-factorial and probably not caused by weight bearing restrictions alone. III Diagnostic Study.

Weight Gain during the COVID-19 Pandemic in a High-Risk Cohort of Children in San Francisco, CA.

Pandemic mitigation measures may lead to excess weight gain in children. Our objective was to assess weight gain during the COVID-19 pandemic in children of ages 4-12 years with overweight and obesity in San Francisco, CA. Children with BMI ≥85th percentile measured at a clinic visit from January to March 2020 were recruited. Follow-up BMI measurements were obtained between October 2020 and March 2021 from the electronic medical record or through a video study visit. Pre- and post-BMI measurements were obtained on n = 91 participants. The majority were Latino (85%) and publicly insured (91%). Mean monthly weight gain was 0.73 kg [standard deviation (SD) 0.47], equivalent to yearly weight gain of 8.8 kg. Mean monthly change in BMI z-score was 0.02 (SD 0.04) equivalent to yearly increase in BMI-z of 0.24. Weight gain among children in San Francisco with overweight and obesity during the COVID-19 pandemic far exceeded healthy weight gain for this age group.

Trajectories of objectively measured physical activity and childhood overweight: longitudinal analysis of the IDEFICS/I.Family cohort

BackgroundSince only few longitudinal studies with appropriate study designs investigated the relationship between objectively measured physical activity (PA) and overweight, the degree PA can prevent excess weight gain in children, remains unclear. Moreover, evidence is limited on how childhood overweight determines PA during childhood. Therefore, we analyzed longitudinal trajectories of objectively measured PA and their bi-directional association with weight trajectories of children at 2- and 6-year follow-ups.MethodsLongitudinal data of three subsequent measurements from the IDEFICS/I.Family cohort study were used to analyze the bi-directional association between moderate-to-vigorous PA (MVPA) and weight status by means of multilevel regression models. Analyses comprised 3393 (2-year follow-up) and 1899 (6-year follow-up) children aged 2–15.9 years from eight European countries with valid accelerometer data and body mass index (BMI) measurements. For categorized analyses, children’s weight status was categorized as normal weight or overweight (cutoff: 90th percentile of BMI) and children’s PA as (in-) sufficiently active (cutoffs: 30, 45 and 60 min of MVPA per day).ResultsChildren engaging in at least 60 min MVPA daily at baseline and follow-ups had a lower odds of becoming overweight (odds ratio [OR] at 2-year follow-up: 0.546, 95% CI: 0.378, 0.789 and 6-year follow-up: 0.393, 95% CI: 0.242, 0.638), compared to less active children. Similar associations were found for 45 min MVPA daily. On the other side, children who became overweight had the lowest odds to achieve 45 or 60 min MVPA daily (ORs: 0.459 to 0.634), compared to normal weight children.ConclusionsBi-directional associations between MVPA and weight status were observed. In summary, at least 60 min MVPA are still recommended for the prevention of childhood overweight. To prevent excess weight gain, 45 min MVPA per day also showed preventive effects.

Health behaviour outcomes of a family based intervention for paediatric obesity in primary care: A randomized type II hybrid effectiveness-implementation trial.

Paediatric obesity is a multifaceted public health problem. Family based behavioural interventions are the recommended approach for the prevention of excess weight gain in children and adolescents, yet few have been tested under "real-world" conditions. To evaluate the effectiveness of a family based intervention, delivered in coordination with paediatric primary care, on child and family health outcomes. A sample of 240 families with racially and ethnically diverse (86% non-White) and predominantly low-income children (49% female) ages 6 to 12 years (M=9.5 years) with body mass index (BMI) ≥85th percentile for age and gender were identified in paediatric primary care. Participants were randomized to either the Family Check-Up 4 Health (FCU4Health) program (N=141) or usual care plus information (N=99). FCU4Health, an assessment-driven individually tailored intervention designed to preempt excess weight gain by improving parenting skills was delivered for 6months in clinic, at home and in the community. Child BMI and body fat were assessed using a bioelectrical impedance scale and caregiver-reported health behaviours (eg, diet, physical activity and family health routines) were obtained at baseline, 3, 6 and 12 months. Change in child BMI and percent body fat did not differ by group assignment. Path analysis indicated significant group differences in child health behaviours at 12 months, mediated by improved family health routines at 6months. The FCU4Health, delivered in coordination with paediatric primary care, significantly impacted child and family health behaviours that are associated with the development and maintenance of paediatric obesity. BMI did not significantly differ.

Association between Home Environment in Infancy and Child Movement Behaviors.

Introduction: An adequate balance of movement behaviors, including physical activity (PA), sleep, and screen time, is important for preventing excess weight gain in children. This study examined the relationship between the infant home environment and movement behaviors later in life. Methods: Pregnant women were recruited for a cohort study related to maternal and child development. The home environment was assessed for developmental stimulation, organization, and toys by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) questionnaire when the child was 6 months of age. At 2 years of age, mother-reported child screen time, and child PA and sleep duration were estimated by accelerometry. Child behaviors were compared with the 24-hour Movement Guidelines (≥180 minutes/day of total PA, 11-14 hours/day of sleep, and ≤1 hour/day of screen time). Logistic regression was used to assess the relationship between the home environment and movement behaviors, adjusting for maternal and child covariates. Results: Mother/child dyads (n = 141) were mainly white (84.4%), and middle (32.8%) or low income (48.9%). All children (100%) met the PA guideline, some met the sleep guideline (71.6%), fewer met the screen-time guideline (44.7%), and only one-third (34.0%) met all three guidelines. Children who met the screen-time guideline lived in homes with more developmental stimulation and toys (p < 0.05). Children who met all 3 guidelines lived in homes with more organization and toys (p < 0.05). Conclusion: The infant home environment was associated with appropriate amounts of movement behaviors at 2 years. Promoting organization (i.e., routines) and toys in infancy may help facilitate nonscreen-based habits and healthy development. The clinical trial registration number is NCT01131117.

Does inadequate sleep increase obesity risk in children?

Yes, a link has been established but not a cause-effect relationship. Shorter reported sleep duration in childhood is associated with an increased risk of overweight or obesity years later (strength of recommendation [SOR]: B, meta-analyses of prospective cohort trials with high heterogeneity). In toddlers, accelerometer documentation of short sleep duration is associated with elevation of body mass index (BMI) at 1-year follow-up (SOR: B, prospective cohort). Adequate sleep is recommended to help prevent excessive weight gain in children (SOR: C, expert opinion).

Role of Body Weight in the Onset and the Progression of Idiopathic Premature Pubarche

Background: The term premature pubarche (PP) refers to the appearance of pubic hair before age 8 in girls and before age 9 in boys. Although idiopathic PP (often associated with premature adrenarche) is considered an extreme variation from the norm, it may be an initial sign of persistent hyperandrogenism. Factors contributing to PP onset and progression have not been identified to date. Aims: The objectives of this study are to describe a group of Italian children with PP, to identify potential factors for its onset, and to define its clinical and biochemical progression. Methods: We retrospectively enrolled all infants born between 2001 and 2014 with PP. Children with advanced bone age (BA) underwent functional tests to determine the cause of PP. Hormonal analysis and BA determination were performed annually during a 4-year follow-up period. Results: A total of 334 children with PP were identified: idiopathic PP (92.5%, associated with premature adrenarche in some cases); related to precocious puberty (6.6%); late-onset 21-hydroxylase deficiency (0.9%). Low birth weight was associated with premature adrenal activation. Body mass index (BMI) was the only factor that influenced the progression of BA during follow-up. Conclusions: Low birth weight is a predisposing factor for premature adrenal activation. The increase in BMI in patients with idiopathic PP during the 4-years of follow-up was responsible for BA acceleration. We recommend prevention of excessive weight gain in children with PP and strict adherence to follow-up in order to prevent serious metabolic consequences.

Planning tool for the development of interventions to prevent overweight in childhood and youth

Abstract Background Studies have shown that interventions to prevent excess weight gain in children and teenagers are often planned unsystematically and not evidence-based. Planning high-quality interventions to prevent childhood obesity is a complex process requiring time and personnel, both limited resources in health promotion. The aim of this project is to develop an evidence-based, user-oriented planning tool to support and optimize the planning process of interventions to prevent excess weight gain in children and teenagers. Methods To identify existing tools for planning interventions, a systematic literature review (SLR) was first conducted in the databases PubMed, LIVIVO and Cochrane. In addition, seven interviews were carried out with practitioners in schools and communities to determine difficulties encountered during the planning process. This data served as the foundation for the design of an initial draft of the planning tool, which was subsequently tested in focus group discussions (FGD) with potential users. Results The SLR identified a total of 23 planning tools. Of these, four comprehensive and evidence-based ones were chosen to compare planning steps and context requirements. The interviews revealed that practitioners require support with problem and needs analysis, target setting and the development of theory-based strategies. The first planning step of the tool was tested in FGD and modified in response to group feedback. An optimized version of the tool can be presented. Future work will focus on converting the tool into a web-based application and pretesting it in schools and communities. Conclusions The planning tool will support the systematic development of evidence-based prevention interventions. It provides a comprehensive roadmap to the planning process, guiding the user step by step. The conversion into a web-based application will simplify and support these planning steps. This project is supported by the Federal Ministry of Health, Germany. Key messages The tool enables time-saving, structured and quality-assured planning of prevention interventions. Requirements resulting from practice were considered in the development of the planning tool.

Managing Excessive Weight Gain in Children

Background: Excessive weight gain in the first 2 years of childhood is a risk factor for future obesity. However, the current absence of clear, standardized identification and treatment guidelines may hinder primary care providers' (PCPs) ability to manage early excessive weight gain in children <2. The objective of this study was to explore PCPs' perspectives on evaluating and communicating about early excessive weight gain and to identify PCP-opined barriers to the care of children exhibiting such trends. Methods: A trained interviewer conducted 20 semistructured interviews with PCPs on identifying and communicating with families about early excessive weight gain in children <2 years old. A thematic analysis approach was used to analyze the transcripts. Results: Interviews uncovered three major themes: (1) the approach to identifying excessive weight gain in children <2 showed high variability across participants despite relative consistency in weight assessment methodology, (2) while possessing communication strategies, providers recognized multiple barriers impeding the execution of weight-related conversations with caregivers, and (3) providers perceived the need for additional support to improve their ability to respond to excessive weight gain in children <2 years old. Conclusions: Variability exists in PCP-reported methods used and barriers faced when identifying, communicating, and responding to excessive weight gain in very early childhood. Introducing guidelines and resources to help standardize the assessment and communication of excessive weight gain in children <2 could augment PCPs' strategies for managing accelerated weight-gain trajectories to mitigate rates of childhood obesity.

Implementation and Evaluation of the Abriendo Caminos Program: A Randomized Control Trial Intervention for Hispanic Children and Families

ObjectiveTo describe the methodology of a family-focused, culturally tailored program, Abriendo Caminos, for the prevention of excess weight gain in children. DesignRandomized control trial with outcome assessment at pretest, posttest, and 6 months after intervention or abbreviated-attention control group. SettingCommunity setting across 5 sites (Illinois, California, Iowa, Texas, and Puerto Rico). ParticipantsMexican American and Puerto Rican families (parent and 1 child aged 6–18 years). A sample size of 100 families (50 intervention and 50 control) per site (n = 500) will provide adequate power to detect intervention effects. InterventionFamilies will participate in 6 weekly, 2-hour group workshops on nutrition education through combined presentations and activities, family wellness, and physical activity. Main Outcome MeasuresThe primary outcome is prevention of excess weight gain in children; secondary outcomes include changes in child diet, specifically fruit, vegetable, and sugar-sweetened beverage consumption, and changes in parents’ diets and improvement of family routines. Measures will be collected at baseline, postintervention, and 6 months after. AnalysisModeling to assess changes within and between experimental groups will be checked using standard methods including assessment of model fit, influence diagnostics, adjusted R2, and multicollinearity. Significance of effects will be examined using Type III tests.

Coexistence of Excessive Weight Gain and Celiac Disease in Children: An Unusual Familial Condition

Excessive weight gain in children diagnosed with celiac disease (CD) is becoming more common. We describe 2 siblings (9-year and 6 months-old female and 6-year and 9 months-old male) with obesity showing attenuated gastrointestinal and atypical symptoms in which CD was diagnosed in the absence of a known family history of CD. After children's diagnosis, CD in their parents was also investigated. It was detected in their father affected by overweight. The presentation of patients with CD has changed. While patients with overweight and obesity commonly have symptoms such as abdominal pain, reflux, headache, and constipation due to lifestyle factors, CD should also be considered in patients with or without a family history of CD. Careful nutritional status assessment and follow-up monitoring after the diagnosis of CD are mandatory, especially in subjects who are already overweight at the presentation of this disease.

The Scientific Foundation for the Physical Activity Guidelines for Americans, 2nd Edition.

The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides the evidence base for the Physical Activity Guidelines for Americans, 2nd Edition. The 2018 Physical Activity Guidelines Advisory Committee addressed 38 questions and 104 subquestions selected for their public health relevance, potential to inform public policies and programs, maturity of the relevant science, and applicability to the general US population. Rigorous systematic literature searches and literature reviews were performed using standardized methods. Newly described benefits of physical activity include reduced risk of excessive weight gain in children and adults, incidence of 6 types of cancer, and fall-related injuries in older people. Physical activity is associated with enhanced cognitive function and mental health across the life span, plus improved mental health and physical function. There is no threshold that must be exceeded before benefits begin to accrue; the accrual is most rapid for the least active individuals. Sedentary time is directly associated with elevated risk of all-cause and cardiovascular mortality, incident cardiovascular disease and type 2 diabetes, and selected cancer sites. A wide range of intervention strategies have demonstrated success in increasing physical activity. The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides compelling new evidence to inform physical activity recommendations, practice, and policy.

Relationship of Weight Outcomes, Co-Occurring Conditions, and Severity of Autism Spectrum Disorder in the Study to Explore Early Development

To assess contributing factors to increased obesity risk, by comparing children with autism spectrum disorder (ASD), developmental delays/disorders, and general population controls in weight status, and to examine associations between weight status and presence of co-occurring medical, behavioral, developmental, or psychiatric conditions across groups and ASD severity among children with ASD. The Study to Explore Early Development is a multisite cross-sectional study of children, 2-5 years of age, classified as children with ASD (n = 668), children with developmental delays/disorders (n = 914), or general population controls (n = 884). Using an observational cohort design, we compared the 3 groups. Children's heights and weights were measured during a clinical visit. Co-occurring conditions (medical, behavioral, developmental/psychiatric) were derived from medical records, interviews, and questionnaires. ASD severity was measured by the Ohio State University Global Severity Scale for Autism. The odds of overweight/obesity were 1.57 times (95% CI 1.24-2.00) higher in children with ASD than general population controls and 1.38 times (95% CI 1.10-1.72) higher in children with developmental delays/disorders than general population controls. The aORs were elevated for children with ASD after controlling for child co-occurring conditions (ASD vs general population controls: aOR = 1.51; 95% CI 1.14-2.00). Among children with ASD, those with severe ASD symptoms were 1.7 times (95% CI 1.1-2.8) more likely to be classified as overweight/obese compared with children with mild ASD symptoms. Prevention of excess weight gain in children with ASD, especially those with severe symptoms, and in children with developmental delays/disorders represents an important target for intervention.

Biologic agents are associated with excessive weight gain in children with inflammatory bowel disease

Children with active inflammatory bowel disease (IBD) are frequently underweight. Anti-tumor necrosis factor (anti-TNF) agents may induce remission and restore growth. However, its use in other autoimmune diseases has been associated with excess weight gain. Our aim was to examine whether children with IBD could experience excess weight gain. A centralized diagnostic index identified pediatric IBD patients evaluated at our institution who received anti-TNF therapy for at least 1 year between August 1998 and December 2013. Anthropometric data were collected at time of anti-TNF initiation and annually. Excess weight gain was defined as ΔBMI SDS (standard deviation score) where patients were (1) reclassified from “normal” to “overweight/obese,” (2) “overweight” to “obese,” or (2) a final BMI SDS >0 and ΔSDS >0.5. During the study period, 268 children received anti-TNF therapy. Of these, 69 had sufficient follow-up for a median of 29.3 months. Median age at first anti-TNF dose was 12.8 years. At baseline, mean weight SDS was −0.7 (SD 1.4), while mean BMI SDS was −0.6 (1.3). Using baseline BMI SDS, 11.6% were overweight/obese. At last follow-up (LFU), however, the mean ΔBMI SDS was 0.50 (p 0 and ΔSDS >0.5. Pediatric patients with IBD may experience excess weight gain when treated with anti-TNF agents. Monitoring for this side effect is warranted.

Infant feeding recommendations – a time of change?

Infant feeding recommendations – a time of change?

Violation of the regulation of cytokine in chronic catarrhal gingivitis in overweight children

Introduction. The development of inflammation in the periodontium is inextricably linked to the system processes in the organism, including an accompanying pathology, which is often parallel. The WHO particularly emphasizes the dissemination of overweight among children. Against the background of excessive weight gain in children there are the series metabolic disorders that provoke chronic diseases, including chronic catarrhal gingivitis.Aim. The aim of this study was to identify the dynamics of cytokines (IL-4, IL-6) in oral fluid and characterize the immune system of the oral cavity in children with overweight and obesity.Material and Methods. This study presents the results of examination of 80 children with overweight and obese patients with chronic catarrhal gingivitis (CCG), aged 12–15 years. Based on anthropometric surveys body mass index (BMI) was calculated. Also the obtained measurements and calculations were evaluated by percentile tables that were designed by the WHO in 2007 for children and adolescents 5 to 19 years for both sexes separately (WHO, 2007). The content of interleukin (IL-4; IL-6) in oral fluid in children was determined by using kits of reagents of company "Vector-Best" (Russia), based on solid-phase "sandwich" variant of immunoenzyme analysis.Results. The level of IL-4 in the oral fluid of children with chronic catarrhal gingivitis decreases (1.8 times) with increasing of age and with the deepening of violations of fat metabolism. The level of IL-6 in the oral fluid of children with chronic catarrhal gingivitis increases (2.9 times) with increasing of age and the presence of excess body weight and obesity.Conclusions. Further study of interleukin imbalance in the oral fluid of patients with chronic catarrhal gingivitis and overweight is a promising area of research to develop methods of prevention and pathogenic therapy.

Biologic Agents Are Associated with Excessive Weight Gain in Children with Inflammatory Bowel Disease.

Children with active inflammatory bowel disease (IBD) are frequently underweight. Anti-tumor necrosis factor (anti-TNF) agents may induce remission and restore growth. However, its use in other autoimmune diseases has been associated with excess weight gain. Our aim was to examine whether children with IBD could experience excess weight gain. A centralized diagnostic index identified pediatric IBD patients evaluated at our institution who received anti-TNF therapy for at least 1year between August 1998 and December 2013. Anthropometric data were collected at time of anti-TNF initiation and annually. Excess weight gain was defined as ΔBMI SDS (standard deviation score) where patients were (1) reclassified from "normal" to "overweight/obese," (2) "overweight" to "obese," or (2) a final BMI SDS >0 and ΔSDS >0.5. During the study period, 268 children received anti-TNF therapy. Of these, 69 had sufficient follow-up for a median of 29.3months. Median age at first anti-TNF dose was 12.8years. At baseline, mean weight SDS was -0.7 (SD 1.4), while mean BMI SDS was -0.6 (1.3). Using baseline BMI SDS, 11.6% were overweight/obese. At last follow-up (LFU), however, the mean ΔBMI SDS was 0.50 (p<0.0001). However, 10 (17%) patients had excess weight gain at LFU; 3 patients were reclassified from "normal" to "obese," and 7 had a final BMI SDS >0 and ΔSDS >0.5. Pediatric patients with IBD may experience excess weight gain when treated with anti-TNF agents. Monitoring for this side effect is warranted.

The Impact of a Community-Based Childhood Obesity Prevention Program on Children’s Physical Activity and Fitness

The purpose of this study is to determine the effects of South County Food, Fitness and Fun (SCFFF), a 16-week community-based obesity prevention program, on children’s moderate to vigorous physical activity (MVPA), physical fitness, body mass index (BMI), and BMI z-score. A non-randomized pre-test and post-test study design was used to assess changes in MVPA, physical fitness, BMI and BMI z-score from baseline to program end. MVPA was measured by accelerometer, physical fitness measured by Fitnessgram, and height and weight were measured by stadiometer and scale and used to calculate BMI. The analytic sample for this study included 53 children from nine SCFFF programs conducted between 2011-2016. There was a significant increase in the percentage of time children spent participating in MVPA (1.12%; p=0.022), curl-ups (p<0.001) and trunk lifts (p=0.004). BMI z-score decreased (p<0.001). Results reinforce the importance of offering community-based interventions that include caregivers to prevent excess weight gain in children.