Weight Status Outcomes Research Articles

Infants’ Dietary Pattern Characterized by Ultraprocessed Foods Is Associated With Rapid Weight Gain and Overweight/Obesity Risk: National Health and Nutrition Examination Survey 2009-2018

BackgroundGlobal trends toward childhood obesity have been associated with several factors, including suboptimal infant feeding practices, the increasing availability of ultraprocessed foods in the world's food supply, and the corresponding changes in children's dietary patterns. ObjectiveTo describe infants’ dietary patterns and assess their associations with weight status outcomes in a nationally representative sample of US infants. DesignCross-sectional analyses were performed on data collected from infants participating in the 2009-2018 National Health and Nutrition Examination Survey. Participants/settingParticipants included 744 infants aged 6 to 12 months who had data from at least 1 day of valid 24-hour dietary recall data. Main outcome measuresRapid weight gain and overweight/obesity risk. Statistical analyses performedPrincipal component analysis was used to identify dietary patterns considering the energy intake of 39 Nova food subgroups (expressed in calories per day), including breast milk. Associations were evaluated using logistic regression adjusted for potential confounders. ResultsA total of 42% infants experienced rapid weight gain, and 33% were at risk of overweight/obesity. Most infants (65.5%) were started on solid foods early. Three main dietary patterns were derived. The first pattern, labeled Natural or Minimally Processed Foods, had positive loadings for a variety of natural or minimally processed foods, some processed culinary ingredients, and a few processed and ultraprocessed foods. The second pattern, labeled Infant Formula, had high negative loading for breast milk, and high positive loading for infant formula and breakfast cereal. The third pattern, labeled Ultraprocessed Foods, had negative loadings for natural or minimally processed foods and processed culinary ingredients, positive loadings for other processed foods and for a variety of ultraprocessed foods, and negative loading for infant formula. Infants who adhere to the Ultraprocessed Foods dietary pattern were more likely to present rapid weight gain (adjusted odds ratio 1.3, 95% CI 1.1 to 1.5) and overweight/obesity risk (adjusted odds ratio 1.2, 95% CI 1.0 to 1.4). ConclusionsHigher adherence to a dietary pattern characterized by ultraprocessed foods was associated with a greater likelihood of both rapid weight gain and overweight/obesity risk early in life. Promoting breastfeeding and increasing consumption of unprocessed/minimally processed foods during early infancy while restricting ultraprocessed foods are key components to reducing the growing burden of childhood obesity.

A long-term follow-up of treatment for young children with obesity: a randomized controlled trial

BackgroundEarly childhood obesity interventions supporting parents have the largest effects on child weight status. However, long-term follow-ups are lacking.ObjectiveTo examine weight status 48 months after obesity treatment initiation for 4- to 6-year-olds.Methods177 families were recruited to the More and Less study, a 12-month randomized controlled trial (RCT) conducted in Sweden (2012–2017); 6 children were excluded due to medical diagnoses. Thus, 171 families (non-Swedish origin 59%, university degree 40%) were eligible for this 48-month follow-up with modified intention-to-treat (n = 114 had 48-month data, n = 34 dropped out, n = 23 lost to follow-up). The RCT compared 3 treatment approaches: a 10-week parent support program (1.5 h/w) with follow-up booster sessions (PGB) or without (PGNB), and standard outpatient treatment (ST). Treatment effects on primary outcome (BMI-SDS) and secondary outcomes (BMI, %IOTF25 i.e., the distance, in percent, above the cut-off for overweight) were assessed. Clinically significant reduction of BMI-SDS (≥0.5) was assessed with risk ratio. Sociodemographic factors and attendance were examined by three-way interactions.ResultsAfter 48 months (mean 50 months, range 38–67 months) mean (95% CI) BMI-SDS was reduced in all groups: PGB −0.45 (−0.18 to −0.73, p < 0.001), PGNB −0.34 (−0.13 to −0.55, p < 0.001), ST −0.25 (−0.10 to −0.40, p < 0.001), no significant difference between groups. A clinically significant reduction of BMI-SDS ≥ 0.5 was obtained in 53.7% of PGB which was twice as likely compared to ST, 33.0%, RR 2.03 (1.27 to 3.27, p = 0.003), with no difference to PGNB, 46.6% (p = 0.113). %IOTF25 was unchanged from baseline for PGB 4.50 (−1.64 to 10.63), and significantly lower compared to ST 11.92 (8.40 to 15.44) (p = 0.043). Sociodemographics or attendance had no effect.ConclusionThe intensive parent-support early childhood obesity intervention led to better weight status outcomes over time, though BMI-SDS alone did not reflect this. Further research should investigate how to assess weight changes in growing children.Clinical trial registrationClinicaltrials.gov, NCT01792531.

Longitudinal associations between sleep and weight status in infants and toddlers.

The limited research assessing relationships between sleep duration and weight status in infants and toddlers relies primarily on parent-reported sleep and cross-sectional studies. Examine whether average sleep duration and changes in sleep duration among 6-24-month-old children were associated with weight-for-length z-scores, and whether these associations varied by race/ethnicity, socioeconomic status and sex. Data were collected when children were approximately 6, 12, 18 and 24 months old (N = 116). Sleep duration was measured using actigraphy. Weight-for-length z-scores were calculated using children's height and weight. Physical activity was assessed using accelerometry. Diet was assessed using a feeding frequency questionnaire. Demographic characteristics included sex, race/ethnicity and socioeconomic status. Separate associations of between- and within-person changes in sleep duration were estimated with weight-for-length z-score treated as the outcome variable in linear mixed model analyses. Additional models were assessed that included interactions between sleep and demographic characteristics. At time points where children slept longer at night compared to their own average, their weight-for-length z-score was lower. This relationship was attenuated by physical activity levels. Increasing sleep duration can improve weight status outcomes in very young children who have low physical activity levels.

Urban foodscape and its relationships with diet and health outcomes.

Environmental features such as the 'foodscape' defined as the physical, sociocultural and economic space in which people encounter meals and foods, might be associated with dietary intake and health outcomes. This review focuses mainly on the spatial approach of the foodscape, i.e. all the local shops, markets, restaurants and sales outlets that provide food supplies in a given area. This review aims to explore the evidence on relationships of urban foodscape with diet and health outcomes and to highlight the limitations in studying these relationships as well as suggestions for future studies. Many systematic reviews on characteristics of the foodscape in relation to weight status outcomes emerged over the last decade and results are equivocal. There is not a direct association between the foodscape and weight status of the individual, rather any association is a distant one. Therefore, it is more appropriate to focus on associations between foodscape and intermediate, more proximal outcomes, such as dietary behaviours. Research on the role of the foodscape in promoting or hindering healthy dietary behaviours are also numerous, and results are again mixed. The diversity of methodologies might partly explain the heterogeneity of these results. Focusing on overall diet quality rather than fruit and vegetable consumption, taking into account multiple characteristics of the foodscape, as well as socioeconomic and contextual differences, might be part of the solution for more consistent results. Consequently, results of such studies could help shape foodscapes, which present a great opportunity for promoting healthier and eventually more sustainable diets.

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Childhood Obesity and the Food Environment: A Population-Based Sample of Public School Children in New York City.

This study aimed to examine the relationship between proximity to healthy and unhealthy food outlets around children's homes and their weight outcomes. A total of 3,507,542 student-year observations of height and weight data from the 2009-2013 annual FitnessGram assessment of New York City public school studentswere used. BMI z scoreswere calculated, studentobesity or obesity/overweight was determinedusing Centers for Disease Control and Prevention growth charts, and these datawere combined with the locations of four food outlet types (fast-food restaurants, wait-service restaurants, corner stores, and supermarkets) to calculate distance to the nearest outlet. Associations between weight status outcomes and distance to these food outlet types were examinedusing neighborhood (census tract) fixed effects. Living farther than 0.025 mile (about half of a city block) from the nearest fast-food restaurant was associated with lower obesity and obesity/overweight risk and lower BMI z scores. Results ranged from 2.5% to 4.4% decreased obesity. Beyond this distance, there were generally no impacts of the food environment and little to no impact of other food outlet types. Proximity to fast-food restaurants was inversely related to childhood obesity, but no relationships beyond that were seen. These findings can help better inform policies focused on food access, which could, in turn, reduce childhood obesity.

Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER

To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US. This multicenter prospective observational cohort study, established in 2013, includes youth (2-18years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling. We included 6454 children and adolescents (median age, 11years; IQR, 9-14years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P<.05). Older age (≥12years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors. Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity. ClinicalTrials.gov: NCT02121132.

Postoperative outcomes based on patient participation in a presurgery education and weight management program

BackgroundThe benefits of presurgery weight management programs (WMPs) for bariatric patients are mixed; some show a positive impact on percent excess weight loss (%EWL) at 12 months postsurgery, while others show no effect. ObjectivesThe purpose of this study was to compare pre- and postoperative 6- and 12-month outcomes between patients who attended a 12-week presurgery WMP and patients who did not participate. SettingOhio State Wexner Medical Center, University Hospital, United States. MethodsA retrospective medical record analysis was conducted to compare preoperative and 6- and 12-month postoperative outcomes for patients who attend the presurgery WMP (n = 56) and patients who did not (n = 441) within a 2-year time period (N = 497). Descriptive statistics and independent t tests were conducted to determine mean differences between groups, while controlling for surgery type, for weight status outcomes (%EWL, change in body mass index) preoperatively and 6 and 12 months postsurgery, and length of stay and readmission rate. ResultsPatients who attended the preoperative WMP had significantly higher %EWL at 12 months postsurgery compared with patients who did not attend the WMP. Additional findings indicated a positive, but nonsignificant effect, from the WMP on presurgery body mass index, and postsurgery %EWL at 6 months and body mass index change at 6 and 12 months postsurgery. ConclusionsPatients attending the WMP had better 12-month %EWL and outcomes compared with those who did not attend the WMP, though this was not true for 6-month outcomes and differed based on surgery type.

The neighborhood environment and obesity: Understanding variation by race/ethnicity

Neighborhood characteristics have been associated with obesity, but less is known whether relationships vary by race/ethnicity. This study examined the relationship between soda consumption – a behavior strongly associated with obesity – and weight status with neighborhood sociodemographic, social, and built environments by race/ethnicity. We merged data on adults from the 2011–2013 California Health Interview Survey, U.S. Census data, and InfoUSA (n=62,396). Dependent variables were soda consumption and weight status outcomes (body mass index and obesity status). Main independent variables were measures of three neighborhood environments: social (social cohesion and safety), sociodemographic (neighborhood socioeconomic status, educational attainment, percent Asian, percent Hispanic, and percent black), and built environments (number of grocery stores, convenience stores, fast food restaurants, and gyms in neighborhood). We fit multi-level linear and logistic regression models, stratified by individual race/ethnicity (NH (non-Hispanic) Whites, NH African Americans, Hispanics, and NH Asians) controlling for individual-level characteristics, to estimate neighborhood contextual effects on study outcomes. Lower neighborhood educational attainment was associated with higher odds of obesity and soda consumption in all racial/ethnic groups. We found fewer associations between study outcomes and the neighborhood, especially the built environment, among NH African Americans and NH Asians. While improvements to neighborhood environment may be promising to reduce obesity, null associations among minority subgroups suggest that changes, particularly to the built environment, may alone be insufficient to address obesity in these groups.

The Role of Perceived Discrimination in Obesity Among African Americans.

African Americans, especially those in the South, suffer a disproportionate burden of obesity and are at high risk for perceived discrimination (PD). This study investigates the association between PD and weight status among African Americans and clarifies the role of perceived stress and health behaviors in this relationship. Data came from the Jackson Heart Study, Examination 1 (2000-2004; analyses conducted in 2016 using Stata, version 14). African Americans from Jackson, Mississippi, aged 21-95 years were recruited (N=5,301). Weight status was measured using anthropometric data with BMI; waist circumference (in centimeters); and obesity class (I, II, III). Survey instruments were used to measure PD, perceived global stress, and health behaviors. Multivariate regression was used to model weight status outcomes as a function of PD, perceived stress, and health behaviors. After controlling for sociodemographic factors and health status, perceived everyday discrimination was associated with higher BMI (b=0.33, p<0.01); higher waist circumference (b=0.70, p<0.01); and higher relative risk of Class III obesity versus non-obesity (relative risk ratio, 1.18; p<0.001). Global perceived stress was linked to higher BMI (b=0.42, p<0.05) and higher waist circumference (b=1.18; p<0.01) and partially mediated the relationships between PD and these weight status outcomes. Health behaviors led to suppression rather than mediation between PD and weight status and between stress and weight status. PD and perceived stress are potential risk factors for higher weight status. They should be considered as a part of a comprehensive approach to reduce obesity among African Americans.

The timing of solid introduction in an ‘obesogenic’ environment: a narrative review of the evidence and methodological issues

Objective:To evaluate the evidence for association between obesity risk outcomes >12 months of age and timing of solid introduction in healthy term infants in developed countries, the large majority of whom are not exclusively breastfed to six months of age. Methods:Studies included were published 1990 to March 2013. Results:Twenty‐six papers with weight status or obesity prevalence outcomes were identified. Studies were predominantly cohort design, most with important methodological limitations. Ten studies reported a positive association. Of these, only two were large, good‐quality studies and both examined the outcome of early (<4 months) introduction of solids. None of the four good‐quality studies that directly evaluated current guidelines provided evidence of any clinically relevant protective effect of solid introduction from 4–5 versus ≥6 months of age. Conclusion:The introduction of solids prior to 4 months of age may result in increased risk of childhood obesity but there is little evidence of adverse weight status outcomes associated with introducing solids at 4–6 rather than at six months. Implications:More and better quality evidence is required to inform guidelines on the ‘when, what and how’ of complementary feeding.

Circumstances, Resources, and Weight Status Outcomes Among Middle School Students

Obesity continues to plague U.S. school-age populations. A number of individual/structural circumstances have been identified as increasing the risk of poor health among children. The article’s aim is to examine some of these circumstances and their relationship to students being overweight/obese, while highlighting resource variables as potential mediators to these negative circumstances. Using a sample of fifth- to seventh-grade students ( n = 334) attending a middle school in Northwest Arkansas, logistic regression models assessed the odds of students being overweight/obese compared with students of normal weight for their age and gender. Overall, students with higher depressive symptomatology and lower perceived social class were more likely (higher odds) to be overweight/obese. Students reporting higher levels of social and psychological resources were less likely (lower odds) to be overweight/obese; an inspection of changes in the circumstance’s coefficients found once resources were introduced, resources appeared to play some mediating role in the final model.

A Review of Associations Between Family or Shared Meal Frequency and Dietary and Weight Status Outcomes Across the Lifespan

To summarize the research literature on associations between family meal frequency and dietary outcomes as well as weight status across the lifespan. Reviewed literature of family or shared meals with dietary and weight outcomes in youth, adults, and older adults. Across the lifespan, eating with others, particularly family, is associated with healthier dietary outcomes. Among children and adolescents, these findings appear to be consistent for both boys and girls, whereas mixed findings are seen by gender for adult men and women. The findings of associations between family or shared meals and weight outcomes across the lifespan are less consistent and more complicated than those of dietary outcomes. Now is the time for the field to improve understanding of the mechanisms involved in the positive associations seen with family meal frequency, and to move forward with implementing interventions aimed at increasing the frequency of, and improving the quality of, food served at family meals, and evaluating their impact. Given the more limited findings of associations between family or shared meals and weight outcomes, capitalizing on the positive benefits of family and shared meals while addressing the types of foods served, portion sizes, and other potential mechanisms may have a significant impact on obesity prevention and reduction. Future research recommendations are provided.

Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme

ObjectivesTo assess the behavioural and weight status outcomes in English children in a feasibility study of a novel primary school-based obesity prevention programme.DesignExploratory cluster randomised controlled trial of the Healthy...

Learning to Eat in an Obesogenic Environment: A Developmental Systems Perspective on Childhood Obesity

Abstract— Currently, children are developing in an obesity‐promoting, or obesogenic, environment, which has emerged within the past 3 decades. This rapid change provides a rare opportunity to investigate the phenotypic outcomes that result from the expression of human genetic predispositions in a new environment. Unfortunately, the environmental changes that have occurred are associated with epidemic obesity rates in all age groups. Using a developmental perspective, this article argues that this probabilistic outcome is not predetermined, however. The article also provides examples of learning paradigms—familiarization and associative and observational learning—that present opportunities for parents and caregivers to restructure children’s environments in early life, increasing the likelihood of healthy weight‐status outcomes in the context of the current obesogenic environment.