Pediatric Overweight Research Articles

Treatment of Pediatric Overweight and Obesity: Assessing the Options.

Obesity in the United States has been identified as one of the most prevalent health epidemics affecting both adults and children, and it has become the focus of a variety of primary, secondary, and tertiary healthcare interventions. To summarize and assess the efficacy of current practices in the management and treatment of pediatric overweight and obesity. An extensive review of the literature was performed. This review examined five areas of intervention most commonly used to manage and treat pediatric overweight and obesity: physical activity, nutritional and behavioral interventions, pharmaceutical management, and surgical procedures. Of 82 sources, 43 studies met our inclusion and exclusion criteria. However, after evaluating study strength using the PEDro, 24 were included in this systematic review. The studies, which included RCTs and cohort studies of levels I and II evidence, respectively, were evaluated for methodological quality using the PEDro scale. Programs that combined decreased sedentary behaviors and nutritional modifications had the most significant results in changes in body mass index (BMI) and weight gain or weight loss. To ensure successful management and treatment of pediatric obesity, the most successful paradigm of intervention is through a multidisciplinary approach: physical activity, nutrition, and behavioral strategies. Behavioral interventions should support and reinforce physical activity and nutritional modifications. Because of the potential health risks involved to the child, pharmaceutical and surgical approaches are considered only when all other interventions have failed.

"C.H.A.M.P. Families": Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study.

Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.

Volumetric gray matter measures of amygdala and accumbens in childhood overweight/obesity.

ObjectivesNeuroimaging data suggest that pediatric overweight and obesity are associated with morphological alterations in gray matter (GM) brain structures, but previous studies using mainly voxel-based morphometry (VBM) showed inconsistent results. Here, we aimed to examine the relationship between youth obesity and the volume of predefined reward system structures using magnetic resonance (MR) volumetry. We also aimed to complement volumetry with VBM-style analysis.MethodsFifty-one Caucasian young subjects (32 females; mean age: 13.8±1.9, range: 10.2–16.5 years) were included. Subjects were selected from a subsample of the I.Family study examined in the Hungarian center. A T1-weighted 1 mm3 isotropic resolution image was acquired. Age- and sex-standardized body mass index (zBMI) was assessed at the day of MRI and ~1.89 years (mean±SD: 689±188 days) before the examination. Obesity related GM alterations were investigated using MR volumetry in five predefined brain structures presumed to play crucial roles in body weight regulation (hippocampus, amygdala, accumbens, caudate, putamen), as well as whole-brain and regional VBM.ResultsThe volumes of accumbens and amygdala showed significant positive correlations with zBMI, while their GM densities were inversely related to zBMI. Voxel-based GM mass also showed significant negative correlation with zBMI when investigated in the predefined amygdala region, but this relationship was mediated by GM density.ConclusionsOverweight/obesity related morphometric brain differences already seem to be present in children/adolescents. Our work highlights the disparity between volume and VBM-derived measures and that GM mass (combination of volume and density) is not informative in the context of obesity related volumetric changes. To better characterize the association between childhood obesity and GM morphometry, a combination of volumetric segmentation and VBM methods, as well as future longitudinal studies are necessary. Our results suggest that childhood obesity is associated with enlarged structural volumes, but decreased GM density in the reward system.

Mobile Game–Based Digital Vaccine for Reducing Risk of Lifestyle Diseases

Background: There is a rising epidemic of pediatric obesity in the United States and worldwide. While many factors contribute to pediatric overweight and obesity, dietary decisions are a leading cause. Children spend many hours a day playing video games, mostly on mobile devices. Hence, personalized gamification and learnification on mobile devices have great potential to influence children’s dietary-lifestyle behaviors during the habit formation stage of early childhood. In fact, video games on mobile devices have become a platform through which children learn in a fun and enjoyable way. While there is some early evidence of the positive impact of neuropsychology-based, cartoon-styled, immersive video games on healthy eating behaviors in children, the mechanisms underlying these improved outcomes are yet to be understood. Objective: To design appropriate interventions in the game environment for children’s behavior formation and change, we need to learn more about the underlying patterns of player behaviors evidenced during gameplay through techniques of machine learning and stochastic optimization. Building on prior descriptive work, this study examines the impact of a diet and lifestyle focused mobile game on children’s game play patterns and associate these patterns with their actual food choices using machine learning and statistical models. Methods: Our dataset was generated from an IRB-approved, informed consent–based randomized controlled trial (RCT) with pre- and post-treatment measurements of almost 100 school children using fooya!, a novel mobile gaming, iOS/Android based App that is being developed as a low-risk and non-invasive “digital vaccine” for lifestyle diseases, for 2 exposures of 20 minutes each. Based on artificial intelligence, neuropsychology and cognitive behavior therapy, fooya! has been shown to deliver positive outcomes with respect to food choices, self-reported dietary choices, and healthy eating intentions. We first model the process of game playing at any level across all students as a discrete, time-homogeneous, first-order Markov chain with multiple states, each representing a status of the game. Process mining identifies distinct patterns in the game sequences and statistical models establish the relationship between game patterns combined with demographic and behavioral data with actual food choices at the end of the game. Results: We find strong evidence of the positive effect of the mobile game on actual food choices, just after 40 minutes of intervention exposure (T: 2.46; C: 1.10; P<.001). Analysis of children’s play patterns shows significant variations in game play mechanics among players. Regression analyses further reveal that more engaged, dynamic, and strategic game play patterns are associated with better actual food choices. Conclusions: This study adds to the growing body of evidence that learning about healthy eating in a fun and exciting way via mobile games, acting as Digital Vaccines, can positively impact children’s actual food choices. While promising, additional RCTs in varied settings and deeper analysis of the resulting data are needed to confirm Digital Vaccines’ potential to reduce the long-term risk of nutrition related non-communicable diseases such as diabetes and cardiovascular disease, as well as health risks from the double burden of overweight vs malnutrition and under-nutrition by educating children regarding healthy lifestyle choices using mobile games.

Family-Based Treatment for Pediatric Obesity: Case Study of an Adaptation for a Non-Psychiatric Adolescent Population.

Pediatric overweight and obesity, a highly prevalent condition posing risks extending into adulthood, is considered a major public health concern. Findings from the pediatric obesity treatment literature support the efficacy of parental involvement across multiple formats. Family-based treatment is an outpatient intervention for adolescents with eating disorders that enlists parents as the primary agents of symptom management during the acute stages of illness, titrating down their involvement as severity of the disorder decreases. We adapted family-based treatment for pediatric obesity, modifying the original model to recognize that children and adolescents with obesity do not exhibit the developmental regression seen in eating disorders and to reflect the non-psychiatric nature of obesity. Thus, family-based treatment for pediatric obesity modulates the degree of parental involvement as a function of chronological developmental stage, not severity of the condition. To illustrate the implementation of this treatment, we present a case report of a 15-year old with an eight-year history of overweight and a greater than 30-pound weight gain prior to treatment. Through this case study, the three phases of family-based treatment for pediatric obesity and six-month post treatment follow-up results are presented through the lens of response from this adolescent and her family. We present this case report to illustrate the implementation of the intervention's adolescent module, and the potential impact of the approach in the treatment of adolescents with obesity and their families.

Obstructive Sleep Apnea and Sleep Architecture in Adolescents With Severe Obesity: Effects of a 9-Month Lifestyle Modification Program Based on Regular Exercise and a Balanced Diet.

Physical exercise and lifestyle modification are recognized as adjunct therapy for obstructive sleep apnea (OSA) in overweight adults. The objectives of this study were to investigate the effects of long-term physical exercise combined with a balanced diet on sleep architecture, sleep duration, and OSA in adolescents with severe obesity. This interventional study was conducted in a nursing institution. Participants were aged 14.6 ± 1.2 years with obesity (body mass index (BMI) = 40.2 ± 6.5 kg/m2). At admission and at 9 months, participants underwent ambulatory polysomnography and incremental maximal exercise testing to determine cardiorespiratory fitness. Twenty-four subjects completed the study. Analyses were performed on the whole population and on a subgroup of subjects with OSA (OSA-subgroup). OSA, defined as obstructive apnea-hypopnea index (OAHI) ≥ 2 events/h, was diagnosed in 58.3% of the population. OAHI was only associated with fat mass in males (r = .75, P < .05). At 9 months postintervention, weight loss (-11.1 kg, P < .0001) and improved cardiorespiratory fitness (VO2peak: +4.9 mL/min/kg, P < .001) were found in the whole population. Sleep duration was increased (+34 minutes, P < .05) and sleep architecture was changed with an increase of rapid eye movement sleep (+2.5%, P < .05) and a decrease of stage N3 sleep (-3.1%, P < .001). Similar results were found in the OSA subgroup. However, OAHI remained unchanged (P = .18). A combination of supervised aerobic exercise and a balanced diet led to weight loss, improved aerobic capacity, and modified sleep architecture without changes in OSA. A commentary on this article appears in this issue on page 907. Registry: ClinicalTrials.gov, Title: Exercise and Venous Compression on Upper Airway Resistance in Obese Teenagers With OSA (OBESOMAC), URL: https://clinicaltrials.gov/ct2/show/NCT02588469, Identifier: NCT02588469.

WOW Summer Day Camp: Extension of an AAP Stage 3 Weight Management Program Emphasizing Cooking Skills, Enjoyable Activity, and Self-esteem.

Background: Pediatric overweight and obesity pose a serious health risk, affecting approximately 32% of US youth aged 2-19 years. Potential contributing factors include unhealthy weight gain in summer due to less structured activity and a decline in cooking skills potentially leading to poor food choices. To address these potential needs, as well as concerns around food insecurity, we initiated a pilot study that added a 5 day summer day camp to our AAP Stage 3 weight management program on the college campus that hosts our clinic. Methods: 13 children, enrolled …

The Relationship between Obesity, Sleep and Physical Activity in Chinese Preschool Children.

Background: Pediatric overweight and obesity has become a major public health problem in China. The goal of this study is to understand overweight and obesity in preschool children in Changsha City in the context of their sleep and physical activity. These results offer feasible proposals to reduce levels of overweight and obesity among preschool children. Methods: A total of 112 preschoolers aged three to six years old were investigated using multiple stage stratified cluster sampling and simple random sampling. Questionnaires were used to collect general information about children and their families. Body mass index (BMI) was used as an indicator of overweight and obesity. Age- and sex-specific cutoff values for Chinese children and adolescents were used to determine child weight status. Children’s sedentary time was reported by caregivers, while physical activity and sleep were recorded using fitness bracelets (Misfit Shine 2). Results: The prevalence of childhood overweight and obesity were 15.2% and 9.8% respectively. Preschool-aged children travelled 11,111 ± 3357 and 10,350 ± 2973 steps per day on weekdays and weekends respectively. The number of daily steps was not statistically different between weekdays and weekends. The amount of time spent daily doing vigorous activity on weekdays and weekends was significantly different, with an average time of 20.5 ± 31.6 min and 10.3 ± 15.3 min respectively (p = 0.002). Furthermore, 10.7% and 50.9% of children used screens for more than two hours on weekdays and weekends respectively (p < 0.001). Children slept for significantly longer on weekends (8.3 ± 0.9 h) than on weekdays (8.1 ± 0.7 h) (p = 0.037). A significantly higher proportion of students also fell asleep before 10:00 p.m. on weekends (26.8%) compared to weekdays (15.2%) (p < 0.001). Parent’s BMI values were positively correlated with child BMI, the monthly household income was negatively associated with child BMI. Male children were more likely to have a higher BMI than female children. Children who were obese were also more likely to have shorter sleep times compared to children of normal weight (p = 0.047). Conclusions: There was a high prevalence of overweight and obesity among the Chinese preschool children in this study. Students also demonstrated poor sleep and physical activity habits. Future research is necessary to explore the relationship between sleep, physical activity and weight status for young children in China.

Lipid profile pattern in pediatric overweight population with or without NAFLD in relation to IDF criteria for metabolic syndrome: a preliminary study.

The aim of this study is to assess the lipid profile pattern of pediatric overweight and/or obese patients with Non-Alcoholic Fatty Liver Disease (NAFLD) in relation to IDF Consensus Criteria for Metabolic Syndrome (MetS). We conducted a cross-sectional preliminary study on 45 consecutive pediatric patients. Overweight or obese children aged from 3 to 18 years were included. Standardized measurement of blood pressure and anthropometric parameters were performed. Biological evaluation included inflammatory status, lipid profile, glycemic profile, full blood count and liver function tests. Abdominal ultrasound was performed in all patients. Prevalence of MetS was 44.4%. A number of 21 patients (46.7%) had NAFLD. MetS patients had higher risk for NAFLD (OR = 9.5, 95% CI = 2.42-37.24). Also patients with positive familial history of type 2 diabetes had a 6.61 fold higher risk for NAFLD (OR = 6.61, 95% CI = 1.74-25.1). We performed a subgroup analysis in patients under ten years old. Patients under the age of ten which had both NAFLD and MetS met more frequently the hypertriglyceride criterion. After adjusting for age and MetS presence, triglyceride levels independently associated with NAFLD (adjusted R square = 0.46, unstandardized B coefficient = 34.51, 95% CI = 4.01-65.02, p = 0.02). NAFLD obese patients had higher prevalence of MetS, higher BMI and particular lipid profile pattern. Triglyceride levels independently associated with NAFLD after adjusting for age and MetS presence. According to our findings we suggest early triglyceride testing (even below the age of ten) in selected patients.

Embedding weight management into safety-net pediatric primary care: randomized controlled trial

BackgroundImplementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States).MethodsIn a 12-month trial, families of children (age 7–12 years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n = 360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions.ResultsThe mean body mass index Z-score declined in both arms (P < 0.01) with no significant difference between the Standard Care Alone (0.12 kg [SE: 0.03]) and Standard Care + Enhanced Program (0.15 kg [SE: 0.03]) arm (P = 0.15). Compared to the Standard Care Alone, the Standard Care + Enhanced Program resulted in significantly greater improvements in total cholesterol (P = 0.05), low-density lipoprotein cholesterol (P = 0.04), aspartate aminotransferase (P = 0.02), and alanine transaminase (P = 0.03) concentrations.ConclusionsSafety-net primary care settings can provide efficacious pediatric weight management services. Targeted family-based behavioral counseling helps overweight/obese children achieve a modest body mass index Z-score improvement. A more intensive lifestyle intervention program may improve some metabolic parameters.Trial registrationClinicalTrials.gov Identifier: NCT00851201. Registered 23 February 2009.

Improved assessment of arterial stiffness using corrected cardio-ankle vascular index (CAVI0) in overweight adolescents with white-coat and essential hypertension

Arterial stiffness is a marker of vascular damage. Although adiposity increases cardiovascular risk, the relationship between paediatric overweight and arterial stiffness is unclear. The study aimed to evaluate the simultaneous effect of hypertension and overweight on arterial stiffness using cardio-ankle vascular index (CAVI) and related novel, theoretically blood pressure (BP)-independent, index CAVI0. CAVI and CAVI0 were measured in 140 adolescent boys (16.0 ± 1.9 years) divided into age-matched groups: normal-weight normotensives, overweight normotensives, overweight white-coat hypertensives, and overweight essential hypertensives. Overweight normotensives had significantly lower CAVI and CAVI0 compared to normal-weight normotensives (4.81 ± 0.64 vs. 5.33 ± 0.66, p < .01; 7.10 ± 0.99 vs. 7.81 ± 1.00, p < .01, respectively). CAVI and CAVI0 in overweight essential hypertensives showed no significant difference compared to normal-weight normotensives and were significantly higher compared to overweight normotensives (5.32 ± 0.77 vs. 4.81 ± 0.64, p < .01; 7.77 ± 1.19 vs. 7.10 ± 0.99, p < .01, respectively). CAVI, but not CAVI0, was associated positively with diastolic pressure (0.022 mmHg−1, p = .002) and negatively with pulse pressure (−0.022 mmHg−1, p = .001), and it was significantly higher in overweight white-coat hypertensives compared to overweight normotensives (5.20 ± 0.63 vs. 4.81 ± 0.64, p < .05). The lowering effect of overweight on arterial stiffness indexed by CAVI and CAVI0 in hypertensive adolescents seems to counterbalance the early arteriosclerotic effect of essential hypertension. The increase in CAVI, but not CAVI0, in overweight white-coat hypertensives could be attributable to residual BP dependence of CAVI, which is not present in CAVI0. Under certain conditions, CAVI0 may offer a clinically relevant improved assessment of arterial stiffness superior to CAVI.

Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity.

Paediatric obesity rates remain high despite extensive efforts to prevent and treat obesity in children. We investigated the quality of the methodology and reporting within systematic reviews (SRs) underpinning paediatric content in US clinical practice guidelines (CPGs). In June 2016 we searched guideline clearinghouses and professional organization websites for guidelines published by national or professional organizations in the United States from January 2007 onwards. In our primary, a priori analysis, we used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) instruments to score SRs and meta-analyses that included paediatric populations and were cited by included CPGs. In a secondary, post hoc analysis, we determined the extent to which US CPGs use available, relevant SRs and meta-analyses compared with non-US CPGs. Eight US-based CPGs with 27 references to 22 unique SRs were found. AMSTAR and PRISMA scores were low overall, with only three SRs having 'high' methodological quality. Items dealing with bias assessments and search strategies had especially low scores. US CPGs were also older on average and cited fewer SRs than their international counterparts. Low quality scores and dated guidelines should be a cause for concern among practicing clinicians and a call to action for future guideline developers, publishers and research institutions.

Health Promotion in Primary Schools- Evaluation of Side-Effects on Cognitive and Academic Performance in a Randomized Trial

Background: School-based lifestyle interventions are a cost-effective way to prevent pediatric overweight. The program “Join the Healthy Boat” focuses on physical activity, healthy diet and screen media use in German primary school children, implemented by regular classroom teachers including teaching units, physical activity exercises, and work with parents. Objective of the study was to measure potential side-effects on children’s cognitive and academic performance. Methods: The program was evaluated in a RCT design, measurements took place before and after one year of intervention. Stratification of randomization was carried out for number of classes and grade level. Participants were 1st and 2nd graders of primary schools. Intervention and assessment took place on site at school; questionnaires were issued. N=442 children performed a computer based test battery measuring inhibitory control, cognitive flexibility and sustained attention. Academic achievement was assessed via parental questionnaire. Results: Multiple regression analyses controlling for age, gender and parental education and Mann-Whitney-Utests revealed no significant differences between intervention and control group in cognitive changes or academic development from baseline to follow up. In Cognitive Flexibility, however, the number of children who improved was higher in the intervention group. Conclusion: Taking time from the regular school curriculum for health promotion had no negative impacts on children’s cognitive or academic development. To obtain more positive effects a longer period of time and a more intense intervention are presumably necessary. The findings are in line with a recent review indicating no negative effects of school health programs. Eventually there is a positive impact of physical activity interventions on specific cognitive functions but findings regarding academic outcomes are still inconclusive. Weak evidence is reported for nutrition services.

Change in health-related quality of life in the context of pediatric obesity interventions: A meta-analytic review.

To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities. (PsycINFO Database Record

Outpatient evaluation, recognition, and initial management of pediatric overweight and obesity in U.S. military medical treatment facilities.

As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines.

The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review.

This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l’ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.

Correlation between Obesity, Diet, Physical Activity and Sedentary Behaviour among School-aged Children and Young Adolescents in Macedonia

Diet and physical activity education in school-aged children and young adolescents are in the focus of the modern healthcare and education system. The aims of our cross-section study were to estimate the prevalence of obesity in youth, and the significant correlation between nutrition status, health behavioural and biological markers. The sample size was 400 randomly selected school-aged children and adolescent from 14 to 18 years old. They were divided into two population groups of school-aged children (12-13 years old) and young adolescent (17-18 years). Standardized, non-quantitative Food Frequency Questionnaire (FFQ) and the International Questionnaire for assessment of Physical Activity (IPAQ-short version) were used as well as the anthropometric measurements: body weight and height, body mass index (BMI kg/m2) presented in percentile using the WHO Child Growth Standards. Statistical analysis was included descriptive statistics, Pearson Chi-square test and Logistic regression analysis using SPSS Statistics 17.0. In accordance with the distribution of Pearson Chi-square=16.94 (p<0.001), there was statistical significance between nutritional status of study participants in both, first and second study groups. Also, there was significant difference in high intensity sports activity between two groups (Pearson Chi-square=26.59; p<0.001). Sedentary behaviour had the highest influence on development of childhood obesity (Wald=2.81; p=0.09). Significant correlation was estimated between obesity and sweetness food (pasta, rise and potatoes), soft drinks, but drinking water had a protective effect. Prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, sports coaches as well as consistent and integrated messages and environmental support across all sectors of society, especially educational sector. The next step is to develop an innovative “Skills for health” model including nutrition and physical activity education program in Macedonia.

Can we Introduce an Effective Lifestyle Modification Intervention among Children at Risk of Overweight and Obesity in the Conditions of Family Practice?

Background: Diet and physical activity are crucial in management of pediatric overweight and obesity, however family involvement has not been adequately studied in primary care. Goal: Assessment of the effectiveness of lifestyle modification intervention among overweight and obese children, addressing parental adherence. Methods: During the period of the study (from October 2013 until June 2014) 588 children have visited the family practice involved in the study because of many different reasons. Each child of this group of 588 children was screened for the risk of abdominal obesity. 106 children have matched the criteria of the risk of abdominal obesity. An intervention - “3-color signaling diet and increased physical activity was implemented for 24 weeks in a group of 106 subjects, aged 2-17, with waist circumference (WC) ≥ 75 percentile (in industrial region of Poland). Anthropometric parameters (BM, BMI and WC), blood pressure, fasting lipid fractions (TG, HDL-C) and plasma glucose (FPG) levels were measured before and after the intervention, and parents were filling out the survey, assessing their adherence to the program. Results: After 24 weeks, in all the subjects, regardless of their age and gender, the mean values of BMI, WC, and BP were statistically significantly lower (p<0.01) than their baseline parameters, and the HDL-C levels were higher. The parental survey revealed that 77.3% were adherent to the dietary (20.7% for 24 weeks), and 55.7% – to the physical activity recommendations (25.5% continuously). Conclusions: Lifestyle modification intervention that targets overweight and obese children and adolescents and their families, reinforcing weight loss goals is helpful in improving anthropometric and HDL-C results. The whole family needs to accept and adhere to the recommended diet and physical activity changes for at least 6 months. A parental perspective of barriers to compliance needs to be considered in designing an effective weight management intervention in primary care.

The moderating role of body dissatisfaction in the relationship between ADHD symptoms and disordered eating in pediatric overweight and obesity

ABSTRACTBackground: Identifying factors linked to disordered eating in overweight and obesity (OV/OB) may provide a better understanding of youth at risk for disordered eating. This project examined whether ADHD symptoms and body dissatisfaction were associated with disordered eating. Methods: ADHD symptoms, disordered eating, and body dissatisfaction were assessed in 220 youth ages 7–12 who were OV/OB. Results: Multiple linear regressions showed that body dissatisfaction and ADHD symptoms were associated with disordered eating. Discussion: Children with ADHD symptoms and OV/OB may be at greater risk for disordered eating when highly dissatisfied with their bodies. Health care providers should assess body image and disordered eating in youth with comorbid OV/OB and ADHD.

Using weight-for-age percentiles to screen for overweight and obese children and adolescents

There are relatively low rates of screening for overweight and obesity among children and adolescents in primary care. A simplified method for such screening is needed. The study objective was to examine if weight-for-age percentiles are sufficiently sensitive in identifying overweight and obesity in children and adolescents.We used data from two distinct sources: four consecutive cycles of the National Health and Nutrition Examination Surveys (NHANES) from the years 2005 to 2012, using participants aged 2–17.9years for whom data on age, sex, weight, and height were available (n=12,884), and primary care clinic measurements (n=15,152). Primary outcomes were the threshold values of weight-for-age percentiles which best discriminated between normal weight, overweight, and obesity status.Receiver operating characteristic analyses demonstrated that weight-for-age percentiles well discriminated between normal weight and overweight and between non-obese and obese individuals (area under curve=0.956 and 0.977, respectively, both p<0.001). Following Classification and Regression Trees analysis, the 90th and 75th weight-for-age percentiles were chosen as appropriate cutoffs for obesity and overweight, respectively. These cutoffs had high sensitivity and negative predictive value in identifying obese participants (94.3% and 98.6%, respectively, for the 90th percentile) and in identifying overweight participants (93.2% and 95.9%, respectively, for the 75th percentile). The sensitivities and specificities were nearly identical across race and sex, and in the validation data from NHANES 2011 to 2012 and primary care.We conclude that weight-for-age percentiles can discriminate between normal weight, overweight and obese children, and adolescents. The 75th and 90th weight-for-age percentiles correspond well with the BMI cutoffs for pediatric overweight and obesity, respectively.