Obesity Prevention Research Articles

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention.

Primary prevention targets development of overweight in individuals with healthy weight and is a great challenge. This paper summarizes the main findings of a working group of the Danish Council on Health and Disease Prevention that reviewed the literature on primary prevention of overweight and obesity among children and adolescents. The results were presented in a Danish report, in which a 2019 Cochrane review on childhood obesity prevention was complemented by searches in PubMed to include all relevant subsequent studies published from January 2018 until March 2020. In this paper, the review was updated until June 2023. Numerous childhood overweight prevention interventions have been developed during the past decades, primarily targeting diet and/or physical activity. Several of these interventions showed positive effects on diet and physical activity level but did not show effects on risk of developing overweight. The evidence foundation is inconsistent as four out of five interventions did not show positive effects. Previously observed intervention effects may not reflect excessive weight gain prevention among children with healthy weight but rather bodyweight reduction among those with overweight or obesity. We do not have sufficient knowledge about how to prevent children with healthy weight from developing overweight, and creative solutions are urgently needed.

Conducting formative research during a pandemic threat to inform the development of an obesity prevention social and behaviour change communication strategy in Tonga.

The global epidemic of obesity is overtaking many parts of the world with the Pacific Islands at particular risk. Tonga population surveys identify significant increases in overweight and obesity with Social and Behaviour Change Communication (SBCC) offering opportunities for curbing the rise in non-communicable diseases. Formative research was conducted during the Covid-19 pandemic to assess stakeholder and program beneficiary needs and wants toward an obesity prevention SBCC strategy in Tonga. Semi-structured interviews with 17 key informants and 18 focus group discussions (N = 168) were conducted in Tongatapu. Data analysis was conducted on Nvivo 2020 qualitative software with desk research of secondary data supporting in-field findings. Potential barriers to behavioural compliance included social/cultural norms, poor attitudes; low motivation and capability; and vulnerabilities of gender and other social determinants. Opportunities included the Tongan collective mindset and the desire for greater social interaction and fun. Strong political will to affect change was apparent with the need to consider targeting to youth, social mobilisation of communities through empowering messaging, and an integrated range of activities. Co-design in the formative research process was able to be fostered via online communication processes to overcome the challenges of Covid-19 travel restrictions. The innovative approach provided a number of learnings including identification of national and regional priorities and improved efficiencies in SBCC planning, implementation and evaluation. SO WHAT?: Formative research adopting co-design approaches with stakeholders and program beneficiaries can provide optimal engagement and ownership in the SBCC strategy including insights into messaging approaches.

Rural-Urban Differences in Overweight and Obesity, Physical Activity, and Food Security Among Children and Adolescents.

Childhood obesity has been associated with numerous poor health conditions, with geographic disparities demonstrated. Limited research has examined the association between rurality and food security, physical activity, and overweight or obesity among children. We examined rates of food security, physical inactivity, and overweight or obesity among rural and urban children and adolescents, and associations between rurality and these 3 outcomes. We used cross-sectional data from a nationally representative sample of children and adolescents aged 10 to 17 years from the 2019-2020 National Survey of Children's Health (N = 23,199). We calculated frequencies, proportions, and unadjusted associations for each variable by using descriptive statistics and bivariate analyses. We used multivariable logistic regression models to examine the association between rurality and food security, physical activity, and overweight or obesity. After adjusting for sociodemographic factors, rural children and adolescents had higher odds than urban children and adolescents of being overweight or obese (adjusted odds ratio = 1.30; 95% CI, 1.11-1.52); associations between rurality and physical inactivity and food insecurity were not significant. The information from this study is timely for policy makers and community partners to make informed decisions on the allocation of healthy weight and obesity prevention programs for children and adolescents in rural settings. Our study provides information for public health programming and the designing of appropriate dietary and physical activity interventions needed to reduce disparities in obesity prevention among children and adolescents.

Maternal distress and body mass index in preschoolers living in families experiencing low‐income

AbstractHealth disparities among children living in poverty underscore the importance of identifying risk and protective factors for childhood obesity. By applying a family stress framework with an equity lens, this study aimed to test the differential associations between maternal distress and child body mass index (BMI) in preschool‐age children living in low‐income families. Pre‐intervention data from an obesity prevention randomized controlled trial were used to assess mother‐reported parental distress and anthropometry collected from children and mothers in a diverse sample of 450 families enrolled in Head Start. Analyses examined associations between maternal distress and child BMI z‐score (BMIz) and moderation by child sex. The sample of children was 49% female, 42% White, 25% Black, 11% Hispanic and 33% had overweight status or obesity. Results indicated higher BMIz for girls compared to boys (β = 0.10, p = 0.03). Child sex modified the association between maternal distress and child BMIz (β = 0.12, p = 0.01). Greater maternal distress was associated with higher BMIz among girls but not boys. Among preschoolers, the maternal distress–BMIz association differed by child sex. Understanding individual differences in how maternal distress relates to childhood obesity may have important implications for obesity prevention efforts.

The role of chicken eggs in modulating sarcopenic obesity and gut microbiota in db/db mice.

Sarcopenia obesity, in which loss of muscle mass and fat accumulation occur simultaneously, is the pathological basis of type 2 diabetes mellitus. The usefulness of chicken eggs in sarcopenia prevention has been reported in several previous studies. The purpose of this study was to determine the beneficial effects of chicken eggs in the prevention of sarcopenic obesity in db/db mice. We raised 8-week-old db/db male mice, a model of sarcopenia obesity, for 8 weeks and fed them a diet mixed with dried whole eggs. The fecal microbiota transplant (FMT) group was treated with antibiotics for 2 weeks, starting at 6 weeks of age, followed by FMT twice a week until 16 weeks of age. Eggs administered to db/db mice showed increased grip strength (p = 0.022) and muscle mass (p = 0.013), decreased visceral fat mass (p = 0.005), and significantly increased physical activity (p < 0.001). The FMT group of egg-fed mice showed a significant improvement in glucose intolerance and sarcopenic obesity. Sequencing of gene expression in the small intestine showed that the gene expression of amino acid transporters such as Slc6a18, Slc6a19, and Slc38a6 was increased in egg-fed mice. 16S rRNA sequencing of the gut microbiota showed an increase in the genus Vampirovibrio in both the egg-fed and FMT groups compared to that in egg-fed mice. The results of this study indicate that egg consumption not only increases the intake of amino acids and other nutrients but also alters the intestinal microbiota and increases amino acid absorption from the intestinal tract, suggesting that eggs might contribute to the ameliorative mechanism of sarcopenic obesity.

Does yoga training relate to health-promoting modifications of anthropometric indicators of overweight and quality of life in young women? Preliminary observations.

Background: Overweight and obesity are global civilization problems affecting all age groups, including in Poland. The prevalence of excessive body weight among young women in 2022, according to the Central Statistical Office (GUS), was 20%. Overweight leads to numerous complications and increases the risk of chronic diseases. There is also a confirmed link between obesity and low self-acceptance, leading to a decrease in quality of life, especially among women. Health-promoting modifications of lifestyle, including physical activity and diet, play a crucial role in the prevention and treatment of obesity. Regular physical activity like yoga is also associated with improved quality of life, particularly in the psychological domain. Aim of the study: The aim of this study was to assess the changes in anthropometric indicators of body weight (BMI, WC, WHR) and quality of life (SF-36) after 8 weeks of yoga training, conducted 3 times a week, with each session lasting 45 minutes.Material and methods: The study included 27 women with an average age of 31.48 years 10.98, who were not undergoing any medical therapy or engaging in other physical training, and were not pregnant. The participants did not make any changes to their diet during the study. The obtained results were subjected to statistical analysis using IBM SPSS Statistics 24. The normal distribution of variables was assessed using the Kolmogorov-Smirnov test, and the difference between variables was analyzed using either the Student's t-test or the Wilcoxon test. The relationships between variables were examined using the Spearman's rank correlation test.Results: The analysis of the obtained results showed that in the study group, the conducted yoga training led to a statistically significant increase in the level of quality of life in all domains (PCS, MCS, PF, RP, BP, GH, VT, SF, MH). There were no statistically significant changes observed in BMI, WC, and WHR before and after the training, which may be attributed to the small sample size and requires further research.Conclusion: Based on the preliminary results, it can be inferred that an 8-week yoga training may be recommended as a method to improve the quality of life in women.

Sweetness preference and its impact on energy intake and body weight - a review of evidence.

In the last few years, several approaches have been postulated for tackling the global increase in overweight and obesity rates, including different dietary macronutrient compositions or the timing of meals. Recently, taste modulation has come into focus as a possible approach for influencing dietary behavior. The perception of sweet taste is innate and an evolutionary protection mechanism to prevent primates from eating poisonous plants. It is hypothesized that this innate sweetness preference could be modulated by dietary sweetness, including sweet foods and beverages, which results in a learned sweetness preference that affects energy intake and body weight. However, this hypothesis is not supported by unanimous scientific evidence. This review provides an update of the current literature, regarding the modulation of sweetness preference as a possible new approach in the prevention of overweight and obesity. In general, results from observation as well as interventional studies in all age groups are heterogeneous. The majority showed no effect of dietary sweetness modulation on sweetness preference, energy intake or anthropometric measures. Therefore, the modulation of sweetness preference due to diet, foods or beverages is still a hypothesis and not scientifically proven. However, due to the lack of data, more research is necessary.

Randomized-controlled trial of a whole-family obesity prevention and treatment intervention designed for low-income Hispanic families: HeLP the healthy living program

BackgroundLow-income Hispanic families face marked disparities in obesity, but interventions for obesity prevention and treatment have rarely been designed with this population as a focus. Hispanic culture is characterized by Familism, a value that prioritizes familial respect, cooperation, and togetherness. We describe the rationale and design of a trial of the Healthy Living Program (HeLP), a bilingual whole-family behavioral obesity prevention and treatment intervention designed around the value Familism and addressing food insecurity. Methods/designThis two-group randomized comparative effectiveness trial will compare the effects of HeLP versus a primary care counseling intervention (Recommended Treatment of Obesity in Primary Care, or RTOP) on decreasing body mass index (BMI; kg/m2) in Hispanic children 2–16 years of age with obesity and preventing BMI increase among siblings without obesity. 164 families per arm will be recruited from primary care practices. Families randomized to HeLP will participate in 12 two-hour sessions, followed by booster sessions. HeLP sessions include family meals and instruction in parenting skills, nutrition, culinary skills, fitness, and mindfulness delivered at community recreation centers by bilingual health educators and athletic trainers. Families randomized to RTOP will be offered individual visits in primary care every 3 months throughout the 18-month follow-up period. Secondary outcomes include changes to objectively measured child fitness, the home environment related to nutrition, physical activity, and media usage, food insecurity, child eating behaviors, quality of life, parent BMI and waist circumference, and implementation outcomes. DiscussionThis protocol paper describes the rationale and planned methods for the comparative effectiveness trial. Trial registrationClinicaltrials.gov Identifier NCT05041855 (6/13/2023).

Enhanced in vivo absorption and biodistribution of curcumin loaded into emulsions with high medium-chain triglyceride content

The health benefits of curcumin have been demonstrated by several clinical studies, but its low bioavailability compromises its functionality. In this regard, emulsions have proven to be effective encapsulation systems for curcumin. Nevertheless, emulsions with a high oil content (50%) may offer some advantages due to the large amount of compound they can incorporate. Therefore, the aim of this work was to study the pharmacokinetics and biodistribution of curcumin when carried in optimized emulsions containing 50% MCT oil and a plant-based emulsifier (soybean lecithin) at 2 h or 4 h post-oral administration to rats. The most stable emulsion was obtained using 50% of oil and a surfactant-oil-ratio 0.1, through a microfluidization process. After the oral administration of the systems (150 mg curcumin/kg body weight), curcumin glucuronide was the main compound present in plasma (AUC0-t = 1556.3 ng·h·ml−1), especially at 2–4 h post-administration. The total curcuminoid bioavailability was increased by 10.6-fold when rats were fed with the curcumin emulsion rather than with a control suspension. Moreover, rats fed with the emulsion showed the highest accumulation of free curcuminoids, which present the highest biological activity, in the liver (129 ng curcumin/g tissue) and brown adipose tissue (193 ng curcumin/g tissue). The obtained results are of great interest since the presence of curcumin in the brown adipose tissue has been shown to play a relevant role in the prevention of obesity and its related metabolic disorders.

Obese people are more likely to exhibit unhealthy food decisions when sated

Food decision-making plays a key role in weight loss and obesity prevention. It involves the value and integration of food attributes, such as health and taste. However, how homeostatic status affects the value and integration of food attributes, especially in obese people, remains unknown. To address this question, we investigated how metabolic states (sated vs. fasting) may affect food decision-making and brain response. This study encompassed a multifaceted approach, investigating hormone levels, decision-making processes relating to food, and fNIRS data. We recruited 20 obese and 20 normal-weight subjects. We found that there were no differences between obese and normal weights in health and taste ratings. However, the weight of health ratings was higher in sated normal weight people than sated obese people. The dlPFC activity showed a similar pattern with the weight of health ratings. The functional connectivity between the vmPFC and dlPFC was lower in obese people when sated than during fasting, while this connectivity remained relatively constant in counterparts. Sated normal weight people had stronger associations between ghrelin levels and the dlPFC activation than sated obese people. Our results highlight the role of the dlPFC with regard to the homeostatic signaling regulation of food decision-making and suggest that obese people are more likely to exhibit unhealthy eating behavior when sated, which may be related to the reduced ability of the dlPFC to downregulate the vmPFC.

Nutrition Education “SAGARI” (Check Your Waist Circumference) as an Attempt to Prevent Adolescents’ Obesity

The incidence of obesity at all ages in Indonesia, including adolescents, has increased. Obesity has a negative impact on physical and social health in adolescents. Excessive food consumption and lack of physical activity are risk factors for obesity in adolescents. Based on this urgency, it is necessary to prevent obesity in adolescents. The purpose of this Community Service activity was to increase adolescents’ understanding of the importance of the 4 pillars of balanced nutrition in efforts and to change attitudes by measuring waist circumference regularly to prevent obesity. Increasing knowledge and attitudes to prevent obesity was obtained by providing a Nutrition Education Program named "SAGARI" (Check Your Own Waist Circumference). The program activities included counseling on the 4 pillars of balanced nutrition with lecture method, demonstration for measuring waist and hip circumferences, measuring nutritional status for SMK students consisting of measuring waist circumference (WC) and body mass index (BMI), and providing measuring tape "SAGARI". The results of this activity were an increase in the median knowledge score from 70.00 to 80.00 and an average attitude score from 3.00 to 3.91 related to obesity prevention in adolescents. These results showed that the "SAGARI" nutrition education program can increase students' knowledge and attitudes regarding obesity prevention which is expected to be implemented through daily behavior. Keywords: Balance nutritional, waist circumference, obesity, adolescent, nutritional status.

Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study.

Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe. Families from low socio-economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety-seven children 4-12 years old and their parents were selected using the FINDRISC-questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent-reported questionnaires. Regarding parental practices, it was revealed that being sometimes (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.10-1.43) or rarely (OR = 1.43; 95% CI = 1.21-1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67-0.98) and sometimes (OR = 0.77; 95% CI = 0.68-0.88) or rare (OR = 0.77; 95% CI = 0.66-0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13-1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17-1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24-1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09-1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age. These findings emphasize the necessity of family-centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.

Demographic and Minority Stress Risk Factors for Obesity Among Sexual Minority Youth Assigned Female at Birth.

Purpose: Sexual minority youth (adolescents and young adults) assigned female at birth (SM-AFAB) are at disproportionate risk of developing obesity compared with heterosexual cisgender youth AFAB. Grounded in minority stress theory, this study aimed to identify potential risk factors for obesity among SM-AFAB youth to inform the development of prevention and intervention efforts for this high-risk population. Methods: Data were collected in 2017 from 367 SM-AFAB youth (ages 16-20 years). Multinominal logistic regression was used to assess cross-sectional associations of race/ethnicity, sexuality, gender identity, household income, and sexual minority (SM) stressors (internalized stigma, microaggressions, and victimization) with weight status (normal, overweight, and obese). Results: Roughly half (53.1%) of participants' body mass index were in the normal weight range, with 24.8% in the overweight range and 22.1% in the obese range. Rates of obesity in Black and Latinx participants were 3-4.5 times those of White participants. Bisexual, pansexual, and queer individuals were at greater risk for obesity than gay/lesbian participants; only bisexual participants were at higher risk for overweight. Participants with a household income <$20,000 and between $20,000 and $39,000 were at greater risk for obesity than participants with household income >$80,000. Microaggressions were positively associated with obesity. Conclusion: Findings highlight risk for obesity among SM-AFAB youth, particularly for those who identify as racial minority, as low income, as being attracted to more than one gender, and for those who experience high levels of anti-SM microaggressions. Targeted obesity prevention and treatment programs should consider the unique needs, challenges, and strengths of SM-AFAB youth.

Investigation of the relationships between mindfulness, emotional eating, weight control self-efficacy, and obesity in adolescents

PurposeThis research was conducted to examine the relationships between mindfulness, emotional eating, weight control self-efficacy, and obesity in adolescents. Design and methodsThe research was conducted with 198 adolescents aged 13–18 years in three high schools in the central county of a province in Türkiye. Data were collected using a sociodemographic information form, the Mindful Attention Awareness Scale–Adolescents, the Emotional Eating Scale for Children and Adolescents, and the Weight-Efficacy Lifestyle Questionnaire for Adolescents–Short Form. In this study, adolescents' height and weight were measured to determine the effects of the study variables on their body mass indexes (BMIs). ResultsThe variables were analyzed according to BMI. The mean age of the adolescents participating in the research was 15.25 ± 1.01 years; 52% were female, and 85% were ninth-grade high school students. Their mean height was 170.33 ± 8.59 cm, and their mean weight was 62.24 ± 12.84 kg. The adolescents' BMI was found to have a low-level, significant negative correlation with their mindfulness, a low-level, significant positive correlation with their emotional eating, and a low-level significant negative correlation with their weight control self-efficacy. Adolescents' mindfulness, emotional eating, and weight control self-efficacy scores significantly predicted their BMI and explained 14.1% of the variance in their BMI levels. ConclusionsMindfulness, emotional eating, and weight control self-efficacy in adolescents have a facilitating effect on the management of obesity. Implications to practiceMultidimensional programs should be developed that take into account the interaction of parents, children, and the environment, which will pave the way for the development of healthy nutrition behaviors and contribute to the prevention of obesity.

Southern California Asian Americans and the Obesity Epidemic: A Qualitative Study to Improve Understanding and Cultural Competence

ABSTRACT Background Obesity continues to be a public health concern in the United States, yet limited research exists on the impact of obesity and weight gain among Asian Americans. Purpose The purpose of this study was to illuminate the lived realities and physical, mental, and social impacts of obesity on overweight and obese Asian Americans in Southern California. Methods A basic qualitative exploratory approach was used. Twenty-five participants were interviewed, leveraging a protocol derived from the health belief model (HBM). Results Six themes highlight obesity’s impact among Asian Americans in Southern California: physical and mental health disadvantages, motivation and consistency, taboo nature of being overweight or obese, model minority misnomer, cultural incongruence, and perception of BMI as an outdated measure. Discussion Findings reveal obesity’s impact among Asian Americans to be complex, linked to both internal and external factors, and suggest that this population is as important as others when discussing obesity prevention. Translation to Health Education Practice Health Educators and health professions need to improve their understanding of the complexities and impact obesity has among Asian Americans and increase cultural competence to develop more responsive obesity and weight interventions and Health Education content. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us.

Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.

Prevalence of metabolic syndrome among Vietnamese adult employees

Background and aimsMetabolic syndrome (MtS) is associated with increased risk of many health disorders, especially cardiovascular diseases. In Vietnam, study examining MtS is meager and especially lacking for the workforce. We estimated the prevalence of MtS and its associated factors among Vietnamese employees. Methods and resultsWe analyzed secondary data of annual health check of employees of 300 Vietnamese companies from the Vinmec Healthcare System. We used three definitions for MtS: International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and NCEP ATP III-Asia. Of 57,997 participants evaluated, 48.5 % were males and 66.2 % were younger than 40 years old. The unadjusted MtS prevalence was 8.4 % (IDF), 10.2 % (NCEP ATP III), and 16.0 % (NCEP ATP III-Asia). The age-sex adjusted prevalence of MtS (NCEP ATP III-Asia) was 21.8 % (95 % confidence interval (CI): 21.4 %, 22.2 %). MtS prevalence increased with age, reached 49.6 % for age ≥60. The aging related increase was more remarkable in females than males (prevalence ratio (PR) (95 % CI) for age ≥60 comparing to age <30 years old in males vs. females was 4.0 (3.6, 4.3) vs. 20.1 (17.7, 22.9)). High blood triglyceride (83.4 %) and abdominal obesity (74.5 %) were the predominant contributors to MtS. ConclusionIn this relatively young Vietnamese working population, 16 % had MtS with high triglyceride and abdominal obesity being the predominant contributors. These findings emphasize the need for developing effective high triglyceride and abdominal obesity prevention and control programs to curb the emerging epidemic of metabolic disorders in the workforce.

SAT419 Characteristics Of Trans Male Children And Adolescents Care Followed Up In A Children Hospital

Abstract Disclosure: M. Esposito: None. V.G. Gonzalez: None. J. Pasqualotto: None. A. Morin: None. Introduction Transgender and gender diverse (TGD) people are those whose gender identity do not correspond with their sex assigned at birth. Gender identity law was approved in 2012, guarantees access to health care including hormones and surgical procedures reassignment without any requirement except "informed consent by the individual concerned". Last years the number of youth with TGD seeking gender affirming care has increased, resulting in the formation of multidisciplinary care teams to respond to the growing demand. Objective To characterize the population of transgender male(TM) attended in a Pediatric Endocrinology Service. Method Medical records of the Pediatric Endocrine Service were reviewed for youth with TGD seen from December 2017 to November 2022. Results We received 92 TGD individuals in our care team, of which 64 (69.6%) consulted in Endocrinology Service, 52 trans-male (TM) (81.3%) and 12 trans-female (TF) (18.7%). We describe TM group. Median age was calculated for first medical advice: 14 (9-16) years; self-perception TGD: 9 (3-14) years; and gender affirmation: 13 (6-16) years. Obesity and overweight was present in 22 (42.3%), normoweight in 25 (48%) and underweight in 5 (9.7%). Vitamin D levels (N: 35) were insufficient in 30 children (85.7%). At first visit 45 (86%) were in Tanner stage 5. Gonadotropin releasing hormone agonists (Gnrh) were used in 27 TM (51.9 %) to prevent the progression of biological puberty, median age at start of treatment was 14 (11-15) years. Testosterone (T) was used in 18 (34.6%) to develop sex characteristics of the self-identified gender, median age of beginning was 16 (14-17) years of which 12 have previously used GnRH. In 4 adolescents (7.7%) thoracic masculinization surgery was performed at a median age of 16 years. Conclusion Most of the TGD children and adolescents were TM with a median age at first visit of 14 years and tanner stage 5. Overweight and obesity rates were higher than international norms and are a common problem among TGD youth. They should be considered a high-risk group and targeted in obesity prevention and treatment efforts. The majority of transgender youth had vitamin D insufficiency, so we recommend sun exposure and physical activity. Although they consulted in the Pediatric Endocrinology Service, only 63.5% started some hormonal therapy. Gender affirmation require multidisciplinary approach in which endocrinologists play an important role. Presentation: Saturday, June 17, 2023

FRI448 Mother Versus Daughter Attitudes Toward Breastfeeding In American Indians: Implications For Reproductive Health Education

Abstract Disclosure: E.W. Seely: None. J.R. Demirci: None. L.E. Hebert: None. E. Kelty: None. M. heydarpour: None. K. Moore: Consulting Fee; Self; Novo Nordisk. D. Charron-Prochownik: None. Background: Breastfeeding has well established health benefits for mothers and their children, being associated with a reduction in incidence of type 2 diabetes and childhood overweight/obesity. Accordingly, the American Academy of Pediatrics recommends 6 months of exclusive breastfeeding, followed by 1-2 years of continued breastfeeding. American Indian and Alaska Native (AIAN) women have among the lowest rates of breastfeeding of all races/ethnicities in the United States. The low rate is striking given the high rates of type 2 diabetes and obese/overweight AIAN children and young adults. To explore the low breastfeeding rates, we examined breastfeeding attitudes among AIAN mother-daughter dyads at 5 sites (Southwest, Northeast, Plains, and Northwest Coast, U.S.) in data from the Stopping GDM randomized controlled trial (NCT02723266). Methods: We used data collected among 149 mother-daughter dyads, who were asked 7 questions from the CDC’s Infant Feeding Practices Survey II focusing on the importance of breastfeeding and its potential health benefits. An additional question was asked: “If a child was breastfed, he/she will be less likely to get diabetes.” We compared mother/daughter attitudes using Chi-square tests. Results: Mean age + standard deviation of mothers was 44.1 + 9.3 and daughters 16.7 + 3.0 years. Eighty percent of both mothers and daughters agreed or strongly agreed that “Infant formula is not as good as breast milk.” However, attitudes that the best way to feed a baby is breastfeeding and that babies should be exclusively breastfed for the first 6 months were both statistically higher in mothers than daughters (74% vs. 59% and 68% vs. 40%, respectively). Mothers also had significantly higher agreement with the statements that breastfeeding was beneficial for prevention of ear infections (66% vs. 18%), respiratory illness (67% vs. 27%), diarrhea (48% vs. 22%), obesity (42% vs. 12%) and diabetes (35% vs. 13%) than daughters. Conclusion: Significant agreement between mothers/daughters exists for the belief that infant formula is not as good as breast milk. However, daughters’ attitudes toward the benefits of breastfeeding differ significantly from mothers with daughters endorsing weaker beliefs in infant health benefits of breastfeeding. This information is important to design early interventions to increase breastfeeding in AI women by increasing awareness of benefits and eliciting maternal support for adolescents and young adult women prior to planning a pregnancy. Presentation: Friday, June 16, 2023

Optimizing intervention components for sleep promotion in children in the context of obesity prevention: the SLEEPY 2.0 study protocol

BackgroundInsufficient sleep duration is highly prevalent in childhood and is associated with obesity, especially among middle school-aged children. The primary care setting has enormous potential to promote sleep, but limited time and sleep resources at in person appointments are key barriers. Digital health innovations offer solutions to these barriers. Mobile health platforms can be developed to deliver behavioral sleep promotion remotely in the home setting, with tailoring to individual and contextual factors to help ensure equitable effectiveness across sociodemographic groups. This paper presents the protocol for a randomized optimization trial using the Multiphase Optimization Strategy (MOST) to develop a mobile health platform for the pediatric care setting to promote longer sleep duration for childhood obesity prevention.MethodsThis is a single-site study being conducted at the Children's Hospital of Philadelphia. We will randomize 325 children, aged 8–12 y, with a body mass index (BMI) between the 50th−95th percentile, and who sleep &amp;lt;8.5 h per night. The Way to Health mobile platform will facilitate remote communication and data collection. A sleep tracker will estimate sleep patterns for 12-months (2-week run-in; 6-month intervention; ≈5.5-month follow-up). A randomized 24 factorial design will assess four components: sleep goal (≥9 h or ≥30 min above baseline sleep duration), digital guidance (active or active with virtual study visits), caregiver incentive (inactive or active), and performance feedback (inactive or active). Fat mass will be measured at baseline, 6-, and 12-months using dual energy X-ray absorptiometry. Total energy intake and the timing and composition of meals will be measured using 24-h dietary recalls at baseline, 6-, and 12-months. Sociodemographic data (e.g., sex, race, ethnicity) will be measured using self-report and home addresses will be geocoded for geospatial analyses.DiscussionWe anticipate that this innovative optimization trial will identify optimal component settings for sleep promotion in children, with clinically meaningful improvements in fat mass trajectories. Importantly, the platform will have broad impact by promoting sleep health equity across sociodemographic groups. With the optimal settings identified, we will be able to determine the effectiveness of the final intervention package under the evaluation phase of the MOST framework in a future randomized controlled trial. Our proposed research will greatly advance the field of behavioral sleep medicine and reimagine how insufficient sleep duration and obesity are prevented in pediatric healthcare.Trial registrationClinicalTrials.gov NCT05703347 registered on 30 January 2023.