Childhood Obesity Research Articles

Changes in systems thinking and health equity considerations across four communities participating in Catalyzing Communities.

Childhood obesity is a persistent public health concern, and community-based interventions have become crucial for addressing it by engaging local communities and implementing comprehensive evidence-based strategies. The Catalyzing Communities intervention takes a "whole-of-community"approach to involve leaders from diverse sectors in thinking systematically about child healthy weights and implementing evidence-based solutions. Using systems thinking and the Getting to Equity framework to guide interview analysis, this study examines changes in participants' use of systems thinking concepts and health equity in 43 participants across four U.S. communities involved in the Catalyzing Communities intervention. Our findings reveal significant shifts in systems thinking concepts, as participants develop a deeper understanding of childhood obesity as a complex adaptive system, and system insights, as participants increasingly recognize the interconnections and leverage points within the system driving childhood obesity. Participants also experienced increases in health equity thinking and action, particularly when discussing social and structural determinants of health, commitment to targeted actions, and a focus on addressing barriers and enhancing resources. The intersection between systems insights and health equity action, such as explaining leverage points and interventions to reduce deterrents to health behaviors, suggests the need for systems thinking activities to be integrated into health equity planning. Future research is needed to develop measures to connect systems thinking concepts to health equity, and the impact of these to community-level policy, systems, and environmental changes in public health.

Conceptualizing bias in EHR data: A case study in performance disparities by demographic subgroups for a pediatric obesity incidence classifier.

Electronic Health Records (EHRs) are increasingly used to develop machine learning models in predictive medicine. There has been limited research on utilizing machine learning methods to predict childhood obesity and related disparities in classifier performance among vulnerable patient subpopulations. In this work, classification models are developed to recognize pediatric obesity using temporal condition patterns obtained from patient EHR data in a U.S. study population. We trained four machine learning algorithms (Logistic Regression, Random Forest, Gradient Boosted Trees, and Neural Networks) to classify cases and controls as obesity positive or negative, and optimized hyperparameter settings through a bootstrapping methodology. To assess the classifiers for bias, we studied model performance by population subgroups then used permutation analysis to identify the most predictive features for each model and the demographic characteristics of patients with these features. Mean AUC-ROC values were consistent across classifiers, ranging from 0.72-0.80. Some evidence of bias was identified, although this was through the models performing better for minority subgroups (African Americans and patients enrolled in Medicaid). Permutation analysis revealed that patients from vulnerable population subgroups were over-represented among patients with the most predictive diagnostic patterns. We hypothesize that our models performed better on under-represented groups because the features more strongly associated with obesity were more commonly observed among minority patients. These findings highlight the complex ways that bias may arise in machine learning models and can be incorporated into future research to develop a thorough analytical approach to identify and mitigate bias that may arise from features and within EHR datasets when developing more equitable models.

Economic benefits of reducing childhood and adolescent overweight and obesity in Australia

Economic benefits of reducing childhood and adolescent overweight and obesity in Australia

Early Life Energy Balance: The Development of Infant Energy Expenditure and Intake in the Context of Obesity.

This review aims to provide a summary of the current knowledge on measurement tools and most recent evidence for prenatal and postnatal modulators of energy balance in young infants. The prevention of pediatric obesity depends upon curating the perfect imbalance of energy intake to energy expenditure, taking into consideration the energy needs for healthy growth. We summarize the recent evidence for the programming of fetal and infant metabolism influenced by maternal preconception health, prenatal metabolic milieu, and physical activity behaviors. In the early postnatal environment, caregiver feeding behaviors shape the extent of energy imbalance through dictating quantity and modality of infant energy intake. There are biological and behavioral contributors to improper infant energy imbalance. Furthermore, caregiver and clinician education on overfeeding and clinical tools to prescribe and monitor infant overgrowth are absent. Ultimately, the lack of high-quality and modern research of infant energy expenditure underpins the lack of advancement in clinical guidelines and the needed prevention of pediatric obesity.

Evaluation of retinal nerve fiber layer and choroidal structure in obese children and adolescents

Aim: Obesity-related vascular damage and endothelial dysfunction have deleterious effects on the ocular vasculature. It was aimed to examine optical coherence tomography (OCT) parameters in obese and overweight children and to define their relationship with metabolic markers in this study. Methods: The patient group consisted of 26 obese, 24 overweight patients aged between 8 and 18 years. The control group consisted of 25 healthy children with normal body mass index (BMI). This was a cross-sectional observational study. Serum glucose, lipid parameters, and homeostasis model assessment of insulin resistance (HOMA-IR) were investigated. Measurement of choroidal thickness was performed with Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA). Retinal nerve fiber layer (RNFL) thickness was determined by an automatic computer algorithm without the need for user measurement. Results: There were no differences in subfoveal, nasal, temporal choroidal thickness, and RNFL between obese, overweight, and control groups (p>0.05). A positive (linear) moderate relationship was found between RNFL and the HOMA-IR of 26 patients in the obese group (r=0.389) (p=0.049). A positively weak correlation was found between height and RNFL in obese patient group (r=0.264, p=0.028). Conclusion: In the study, RNFL thickness increased as HOMA-IR level increased in obese children and adolescents. RNFL decreased as the height increased in obese children and adolescents. We believe that more comprehensive data about the effect of obesity on RNFL and choroidal thickness will be obtained with prospective studies in which the obese patient group with insulin resistance is taken separately and disease durations are defined, and long-term patient follow-up is performed.

Evaluation of antibodies to oxidized low-density lipoprotein in children with obesity of different degrees

Introduction. The interest in the study of anti-oxidized low-density lipoproteins (anti-oxLDL) is due to their association with the development and progression of atherosclerosis and metabolic syndrome. Purpose of the study. To study the level of antibodies of oxidized low-density lipoproteins (anti-oxLDL) in serum in obese children. Materials and Methods. 76 children aged 5 to 17 years participated in the study. A standard objective and laboratory examination was performed, including physical and sexual development, lipidogram and anti-oxLDL levels. To assess anthropometric data, the standard deviation coefficient was calculated using the Auxology application. The parameters of fat metabolism were determined according to the data of blood biochemical analysis. The content of anti-oxLDL was determined by immuno-enzymatic analysis using test kits “Biomedica”. Results. According to the results of the examination the patients were divided into three groups: group 1 included 36 children with constitutional-exogenous obesity and increased level of anti-oxLDL, group 2-30 patients with constitutional-exogenous obesity and normal level of anti-oxLDL, group 3-10 healthy children. The level of antibodies to oxidized low density lipoproteins (oxLDL) in obese children is 11.6 times higher compared to healthy children. The antibody titer in prepubertal children is 2206 [1809;2603] IU/mL, and in adolescents it is 1505.5 [1109;1902] IU/mL. The highest values of anti-oxLDL levels were observed in patients with 1st degree obesity 2623 [2245;3001] IU/mL and 3rd degree obesity 2914.5 [2678;3151] IU/mL. Conclusion. High of anti-oxLDL levels were found in pre-pubertal children with obesity, especially in 1st and 3rd degree obesity. In obese children, the level of anti-oxLDL has a direct correlation with the duration of the underlying disease and the increase in low-density lipoprotein (LDL) levels. Further studies are needed on the role of anti-OCOLDL as an early predictor of atherosclerosis in clidren with obesity.

Syndromic obesity in children (using the example of clinical cases)

Obesity is a heterogeneous group of hereditary and acquired diseases associated with excessive accumulation of adipose tissue in the body. One example of syndromic obesity in children is Bardet-Biedl syndrome. This is a rare autosomal recessive disease from the group of ciliopathies, characterized by retinal dystrophy, obesity, polydactyly, mental retardation, hypogonadism, and renal dysfunction. The article presents two clinical cases of Bardet-Biedl syndrome. Diagnostic criteria for the disease are given, and the need for molecular genetic research methods in the early stages of the diagnostic search is shown. Promising directions in the treatment of the syndrome are considered.

Iron deficiency and obesity in children: is there a relationship?

A close relationship between obesity and iron metabolism has been proven. Aim. To study the features of iron metabolism in obese children by evaluating dietary iron intake and the level of laboratory markers of iron status, with the goal of improving prevention and correction of identified disorders in this cohort of children. Materials and methods. The actual dietary iron intake was assessed in 75 obese children aged 7-17 years using the Optimal Nutrition 5.0 software. A set of clinical and laboratory research methods was performed in 30 children to identify iron deficiency, as well as a questionnaire on the symptoms of iron deficiency. Results. One third of children have insufficient iron intake with food. Most of the examined children complained and had clinical symptoms characteristic of iron deficiency in the body. 86.7% of obese children had one or more signs of iron deficiency. Laboratory diagnostics using only a general clinical blood test showed insufficient detection of iron deficiency: only in 13.3% of children this analysis showed the presence of abnormalities characteristic of iron deficiency. In the other children, it was detected after a biochemical blood test. Conclusions. The majority of obese children show both clinical and laboratory evidence of iron deficiency, which may contribute to the pathogenesis of obesity-related conditions. Biochemical blood tests are essential for accurate diagnosis of iron deficiency, as standard clinical blood test may not always show the presence of iron deficiency. The high prevalence of iron deficiency indicates the need for targeted nutritional iron support for obesity in children.

Associations of Neighborhood Food Retail Environments with Weight Status in a Regional Pediatric Health System.

Background: There have been mixed findings on the relationships between childhood obesity and macroscale retail food environments. The current study investigates associations of the neighborhood retail food environment with changes in children's weight status over 6 years in the Kansas City Metropolitan area. Methods: Anthropometrics and home addresses were collected during routine well-child visits in a large pediatric hospital (n = 4493; >75% were Black or Latinx children). Children had measures collected during two time periods ([Time 1] 2012-2014, [Time 2] 2017-2019). Establishment-level food environment data were used to determine the number of four types of food outlets within a 0.5-mile buffer from the children's residence: supermarkets/large grocery stores, convenience stores/small grocery stores, limited-service restaurants, and full-service restaurants. Children who moved residences between periods were "movers" (n = 1052). Associations of baseline and changes in food environment status with Time 2 weight status were assessed using mixed-effects models. Results: Movers who experienced no change in the number of convenience stores or small grocery stores within a 0.5-mile of their home had increased likelihoods of having overweight/obesity and less favorable BMIz changes, compared with movers who experienced a decrease in convenience stores/small grocery stores within a 0.5-mile distance. No associations were observed among nonmovers. Conclusion: Findings suggest that moving to an area with fewer unhealthy retail food outlets (e.g., convenience stores) is associated with a lower risk of obesity in children. Future research is needed to determine whether larger-scale changes to the retail food environment within a neighborhood can support children's healthy weight.

Association of childhood obesity or weight change with early-onset follicular occlusion triad among children.

The effects of childhood obesity or weight gain on the development of early-onset follicular occlusion triad (FOT) among children, which includes hidradenitis suppurativa (HS), acne conglobata (AC), and dissecting cellulitis of the scalp (DCS), remain unknown. To investigate the association between body mass index (BMI) or its changes and early-onset FOT development. This nationwide population-based longitudinal cohort study included a cohort of 2,012,928 Korean children who underwent two consecutive health examinations at 30-36 months and 42-48 months of age between 2009 and 2020. The BMI and its changes derived during health screenings at 30-36 and 42-48 months. We performed multivariate Cox proportional hazards regression analyses to estimate the risk of early-onset FOT, including HS, AC, and DCS. During the follow-up, 1,283 FOT, including 143 HS, 1,068 AC, and 72 DCS, events were identified. Children with obesity were at an elevated risk of early-onset FOT compared to those with a normal weight (FOT: adjusted hazard ratio [aHR] 1.49, 95% confidence interval [CI] 1.21-1.84; HS: aHR 2.30, 95% CI 1.39-3.82; AC: aHR 1.36, 95% CI 1.07-1.73). BMI gain was correlated with an elevated risk of early-onset FOT, particularly HS, whereas BMI loss was linked to a decreased risk of early-onset FOT, especially HS. Children who became obese had an increased early-onset FOT risk (aHR 1.51, 95% CI 1.07-2.14) compared to those who maintained a normal weight. Children who reduced from obese to normal weight exhibited a decreased risk of early-onset FOT (FOT: aHR 0.41, 95% CI 0.17-0.96, P for trend=0.02; HS: P for trend=0.05) compared to obese children who retained their weight. Childhood obesity was associated with an elevated risk of early-onset FOT, including HS and AC. Weight gain was correlated with an increased risk of early-onset FOT, especially HS, while weight loss was associated with a decreased risk of early-onset FOT, particularly HS. Implementing purposeful weight-reduction strategies may be helpful in preventing early-onset FOT development.

Nutrition nurturers: Empowering primary school children through innovative dietary education and parental engagement

Purpose: This research aims to examine effective pedagogical methods for promoting healthy dietary practices among elementary students. By reviewing the literature, the study will identify key factors influencing children's eating habits, assess treatment impacts on eating patterns and metabolism in obese children, and explore how breakfast quality affects the health of children and teenagers. Method: This study analyses pertinent literature on encouraging healthy eating habits in primary school students using a systematic review and meta-analysis methodology. Comprehensive searches of electronic databases, such as PubMed, PsycINFO, and Web of Science, are part of the systematic review process to find pertinent research published in peer-reviewed journals. The inclusion criteria cover research on instructional methods, tactics, and interventions intended to encourage primary school students to eat healthily. Result: The outcomes of the meta-analysis and systematic review point to several successful instructional methods and tactics for encouraging primary school students to eat healthily. Children's eating habits are influenced by several factors, and treatments that focus on diet and metabolic responses, especially in obese kids, seem to be working well. The study also emphasizes how important a healthy breakfast is to kids' and teens' overall health and well-being. Conclusions: The study concludes that raising lifelong good eating habits in primary school students requires comprehensive strategies incorporating nutritional education, parental involvement, and community support. The results have significant ramifications for educators, legislators, and medical professionals who work to encourage children to adopt healthy habits. To investigate the long-term impacts of interventions and create specialized tactics for a range of populations, more study is necessary.

Treatment of OSA beyond adenotonsillectomy.

Pediatric obstructive sleep apnea (OSA) is a common syndrome in children. While an adenotonsillectomy is effective for most, it may not be the treatment of choice for all, and possible alternative treatment options are briefly discussed herein. In obese children, in whom OSA is more prevalent, and has high rates of persistence after surgery, weight loss interventions may be recommended. Anti-inflammatory therapies, such as nasal steroids and montelukast, reduce the size of the adenoids and tonsils and are considered part of the stepwise treatment approach. Functional orthodontic therapies may improve OSA as well as orthopedic interventions in children in whom orthodontic indications exist. Positive airway pressure and high flow nasal cannula, stent the airway open and alleviate the obstruction, but adherence may be challenging. Tongue surgery, as well as several additional interventions are further discussed. In conclusion, multiple therapeutic options are available for pediatric OSA. Further studies are required to better identify the children most likely to benefit from these therapies.

Demographic and Socioeconomic Disparities in Adolescent Obesity: Insights From the National Survey of Children’s Health Database

Demographic and Socioeconomic Disparities in Adolescent Obesity: Insights From the National Survey of Children’s Health Database

Association between rs8192678 C/T polymorphism of the PPARGC1A gene and metabolically associated fatty liver disease in obese children living in the Moscow region

Over the past 30 years, the incidence of childhood obesity has quadrupled, leading to a rise in metabolically associated fatty liver disease (MAFLD), which has multifactorial genesis. Numerous studies highlight a significant genetic contribution to the development and severity of MAFLD. Purpose of the study. Тo determine the distribution of alleles and genotypes of the rs8192678 C/T polymorphism of the PPARGC1A gene and its relationship with the development of MAFLD in obese children living in the Moscow region. Materials and methods. The study included 87 children with exogenous constitutional obesity. The children were divided into two groups: group I - obesity without MAFLD (n = 43), group II - obesity with MAFLD (n = 44). The association of genotypes with the risk of developing MAFLD was studied in various genetic models. Results. 43 (49.4%) children had genotypes containing the T allele: 4 (4.6%) - homozygous TT genotype, 39 (44.8%) - heterozygous CT genotype. The CC genotype was detected in 44 (50.6%) children. The frequency of allele C was 73%. Carriers of the T allele have almost twice the risk of developing MAFLD than сarriers of the C allele (OR = 2.08 (95% CI: 1.05-4.24), p = 0.041). Conclusion. Тhe rs8192678 polymorphism increases the risk of developing MAFLD already in childhood, and with the homozygous TT genotype, this risk more than doubles. Studying the genetic contribution to the development of MAFLD enables a comprehensive approach to assessing individual risks of each patient.

Use of Biomarkers in Nutrition Intervention Studies of Children: A Scoping Review.

Obesity in youth is an increasingly prevalent public health concern worldwide. Lifestyle interventions aim to help participants establish healthy habits and reduce obesity-related disease risk by targeting physical activity and dietary habits. Most studies assess weight loss, but biomarkers may enable more rapid and comprehensive assessment of intervention success. This scoping review aims to synthesize the published literature on which biomarkers are assessed during interventions for pediatric obesity to inform future use. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search of five databases conducted in February 2022 returned 1579 unique and relevant articles published between 2006 and 2021. After screening titles, abstracts, and full text, four reviewers determined that 43 studies met eligibility requirements. Quality screening was conducted, and 97.7% of papers were of fair or good quality. Of the 43 studies, 47% reported measures of adipose-related signaling molecules inclusive of adipokines, 74% included insulin-related biomarkers, 63% reported lipid-related biomarkers, 40% reported proinflammatory cytokine biomarkers, 12% reported measures of skin and/or plasma carotenoids, 40% measured blood pressure, and 21% included liver enzymes. Sixty-seven percent of studies measured biomarkers in whole blood, 40% measured biomarkers in plasma, 56% measured biomarkers in serum, and 2% measured biomarkers in urine. This work summarizes the current use of biomarkers in lifestyle intervention studies enrolling children. These biomarkers could be clinically relevant for pediatric weight management interventions.

Association of psychological distress with health-related quality of life in Asian adolescents seeking obesity treatment.

There is limited research on the psychosocial health of Asian adolescents undergoing obesity treatment. Our study examined the predictors of psychological distress, disordered eating and poor health-related quality of life (HRQoL) in these adolescents and the associations between them. A total of 82 adolescents aged 11-17 years were recruited from the Weight Management Clinic in KK Women's and Children's Hospital between June 2022 and January 2023. Participants completed the following questionnaires: (a) Young Person's Clinical Outcomes in Routine Evaluation (YP-Core) assessing for psychological distress, (b) Children's Eating Attitude Test (ChEAT) evaluating for disordered eating behaviours, and (c) Pediatric Quality of Life Inventory (PedsQL) measuring HRQoL. Participating adolescents had a mean body mass index of 31.9 ± 5.1 kg/m2. Of the participants, 40% reported significantly symptomatic psychological distress (YP-Core score ≥14) and 16% were at risk of eating disorders (ChEAT score ≥20). A higher YP-Core score was the only significant determinant of poorer HRQoL, after controlling for demographic variables and ChEAT scores. Malay (regression coefficient: 6.6, 95% confidence interval [CI]: 0.6-12.6, P = 0.031) and Indian (regression coefficient: 8.9, 95% CI: 3.8-14.0, P = 0.001) adolescents were more likely to report disordered eating and psychological distress, respectively, as compared to Chinese adolescents. Adolescents whose parent(s) had obesity (regression coefficient: 3.4, 95% CI: 0.1-6.7, P = 0.043) were also more likely to experience greater psychological distress. Understanding the determinants of psychological distress, disordered eating and HRQoL will facilitate targeted screening and management of the psychosocial complications of adolescent obesity.

The development of a tool for GPs to manage overweight and obesity in children: A Delphi study

Background General practitioners (GPs) could play an important role in the management of overweight and obesity in children. However, GPs experience different barriers and are in need of supportive tools. In order to support GPs to identify, address and refer these children, new tools should be developed. Objective To establish consensus among GPs about the content topics of a supportive tool to identify, address and refer children with overweight and obesity in general practice. Methods A two-round Delphi study was conducted with GPs identified as experts. A concept of a supportive tool was constructed based on focus-group interviews with GPs, practice nurses and parents of children with and without overweight and literature. The tool was categorised into five topics: identifying, initiating and continuing weight-related conversations, referring and evaluating a tool manual. GPs evaluated statements on the tool’s topics in terms of importance. All statements were rated on a 5-point Likert scale and consensus was set at ≥70% of respondents agreeing with the statements. Results GPs agreed that a supportive tool must contain a child’s specialised BMI calculator; examples to initiate and to continue weight-related conversations with parents and children; a map with available interventions; and a manual including information and resources about health risks of overweight and obesity during childhood. Conclusion The content topics of a supportive tool for GPs to identify, discuss and refer children with overweight and obesity were determined through a consensus-driven process. Further validation and assessment are required through a feasibility and implementation study.

Research advances of food addiction and obesity in children

Research advances of food addiction and obesity in children

Overnutrition among the School Students in Dhaka City: A Cross-sectional Study

Background: The study focuses on childhood obesity and its rise due to fast food and reduced physical activity.Objective: The aim of this study is to investigate the nutritional assessment, knowledge, attitude and practice of English medium School students aged 11-15 years in Dhaka city. Methodology: This cross-sectional study was conducted among randomly selected 280 school students with anthropometric measurement and using a semi-structured questionnaire with the permission of the student’s guardian/s. Results: The overall prevalence of overweight/obesity in this study found 51.43% where 11.43% were obese and 40.0% were overweight. The students have eaten pizza, burger and pastry according to 20%, 28% and 15% respectively at their tiffin time. About 68% respondents have not played any outdoor games (only computer games regularly). 61% normal BMI students did physical activity regularly and 91% risk BMI respondents didn’t physical activity regularly. The energy intake in last 24 hours of respondents according to their BMI also is statistically significant (p<0.01); the average energy intake of 49% male of normal BMI respondent was about 1576 kJ and the average energy intake of 48% female of normal BMI respondent was about 1455 kJ. On the other hand, the average energy intake of 51% male of risk BMI respondent was about 1819 kJ and the average energy intake of 52% female of risk BMI respondent was about 1707 kJ. Conclusion: Overweight/obesity is a public-health concern among English medium school students, especially in high-income group in Dhaka. From the key finding of the current study, awareness program regarding overweight or obesity along with prevention measures were particularly focus on the English medium school students from their school as well as their family. Keywords: Obesity, Overweight, BMI, Energy Intake, Food consumption, Nutritional value.

Corneal nerve loss in adolescents with obesity and acanthosis nigricans.

Obesity and related metabolic abnormalities in adults are associated with peripheral neuropathy. Acanthosis nigricans (AN) is associated with insulin resistance, fatty liver, hyperlipidemia and glucose intolerance, all of which are risk factors for neuropathy. The aim of this study was to investigate if obese adolescents with AN have evidence of small nerve fiber damage. Adolescents with obesity with and without AN underwent body composition analysis, assessment of vibration perception threshold (VPT), monofilament sensitivity and corneal confocal microscopy (CCM) to quantify corneal nerve fiber density (CNFD), branch density (CNBD), length (CNFL) and inferior whorl length (IWL). Forty-six participants with obesity with (n = 31) and without (n = 15) AN aged 15(14-17) years were compared to 20 healthy controls aged 13(12-14) years. There was no difference in VPT, monofilament sensitivity and CCM measures between adolescents with obesity and controls. However, adolescents with AN had a significantly higher weight (P = 0.022), fat% (P = 0.029) and fat-muscle ratio (P = 0.012) with a lower CNFD (P = 0.045) compared to those with obesity without AN. Adolescents with obesity and acanthosis nigricans have a higher fat mass and small nerve fibre loss, indicative of a sub-clinical neuropathy.