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Current Obesity Reports Mar 2024Obesity rates continue to rise among children and have shown persistent racial disparities. Racism plays a potentially essential and actionable role in these... (Review)
Review
PURPOSE OF REVIEW
Obesity rates continue to rise among children and have shown persistent racial disparities. Racism plays a potentially essential and actionable role in these disparities. This report reviews some mechanisms through which racism may shape childhood obesity.
RECENT FINDINGS
From the youngest ages, disparities in childhood obesity prevalence are already present. Racism may shape intergenerational and prenatal factors that affect obesity and various stressors and environments where children grow up. The relationships between clinicians and patients may also be shaped by everyday racism and legacies of past racism, which may affect obesity prevalence and treatment efficacy. Comprehensive data on the extent to which racism shapes childhood obesity is limited. However, compelling evidence suggests many ways through which racism ultimately does affect childhood obesity. Interventions to address racism at multiple points where it shapes childhood obesity, including intergenerational and prenatal mechanisms, may help to close disparities.
Topics: Female; Pregnancy; Humans; Child; Racism; Pediatric Obesity; Health Status Disparities; Prevalence
PubMed: 38172479
DOI: 10.1007/s13679-023-00538-9 -
JAMA Pediatrics Aug 2023Despite strong evidence linking place and obesity risk, the extent to which this link is causal or reflects sorting into places is unclear.
IMPORTANCE
Despite strong evidence linking place and obesity risk, the extent to which this link is causal or reflects sorting into places is unclear.
OBJECTIVE
To examine the association of place with adolescents' obesity and explore potential causal pathways, such as shared environments and social contagion.
DESIGN, SETTING, AND PARTICIPANTS
This natural experiment study used the periodic reassignment of US military servicemembers to installations as a source of exogenous variation in exposure to difference places to estimate the association between place and obesity risk. The study analyzed data from the Military Teenagers Environments, Exercise, and Nutrition Study, a cohort of adolescents in military families recruited from 2013 through 2014 from 12 large military installations in the US and followed up until 2018. Individual fixed-effects models were estimated that examined whether adolescents' exposure to increasingly obesogenic places over time was associated with increases in body mass index (BMI) and probability of overweight or obesity. These data were analyzed from October 15, 2021, through March 10, 2023.
EXPOSURE
Adult obesity rate in military parent's assigned installation county was used as a summary measure of all place-specific obesogenic influences.
MAIN OUTCOMES AND MEASURES
Outcomes were BMI, overweight or obesity (BMI in the 85th percentile or higher), and obesity (BMI in the 95th percentile or higher). Time at installation residence and off installation residence were moderators capturing the degree of exposure to the county. County-level measures of food access, physical activity opportunities, and socioeconomic characteristics captured shared environments.
RESULTS
A cohort of 970 adolescents had a baseline mean age of 13.7 years and 512 were male (52.8%). A 5 percentage point-increase over time in the county obesity rate was associated with a 0.19 increase in adolescents' BMI (95% CI, 0.02-0.37) and a 0.02-unit increase in their probability of obesity (95% CI, 0-0.04). Shared environments did not explain these associations. These associations were stronger for adolescents with time at installation of 2 years or longer vs less than 2 years for BMI (0.359 vs. 0.046; P value for difference in association = .02) and for probability of overweight or obesity (0.058 vs. 0.007; P value for difference association = .02), and for adolescents who lived off installation vs on installation for BMI (0.414 vs. -0.025; P value for association = .01) and for probability of obesity (0.033 vs. -0.007; P value for association = .02).
CONCLUSION AND RELEVANCE
In this study, the link between place and adolescents' obesity risk is not explained by selection or shared environments. The study findings suggest social contagion as a potential causal pathway.
Topics: Adult; Adolescent; Humans; Male; Female; Pediatric Obesity; Overweight; Body Mass Index; Socioeconomic Factors; Military Personnel
PubMed: 37273213
DOI: 10.1001/jamapediatrics.2023.1329 -
Pediatric Research Dec 2023Studies have reported the relationship between functional constipation and obesity in pediatric population. However, the results are contradictory. The purpose of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Studies have reported the relationship between functional constipation and obesity in pediatric population. However, the results are contradictory. The purpose of this study is to evaluate the possible association between these two disorders in pediatric population.
METHODS
Four databases including PubMed, Embase, CENTRAL, and Web of Science were searched until 30 September 2022. The review was done in accordance with PRISMA guidelines and registered in PROSPERO (CRD42022328992) RESULTS: Nine studies met the eligibility criteria, including 7444 participants. Studies showed the risk of obesity was significantly increased in boys with functional constipation (CI: 1.12, 3.07; P = 0.016). Such an association was also observed in girls (CI: 1.42-4.47; P = 0.00). A statistically significant association was observed between overweight/obesity and increased risk of functional constipation in children and adolescents (CI: 1.14-3.97; P = 0.02). Especially in developed countries (CI: 1.49-3.46; P = 0.00); however, no significant association was observed in developing countries (CI: 0.81-5.3; P = 0.13).
CONCLUSIONS
There is a risk of obesity in either boys or girls with functional constipation. An association exists between the risk of functional constipation and children/adolescents with obesity, especially in developed countries, but not in developing countries.
IMPACT
Our study encourages further research in this field because early detection and intervention are crucial for both functional constipation and overweight/obesity in children, to better identify its complex biology and possibly optimize the treatment approaches.
Topics: Male; Adolescent; Female; Humans; Child; Overweight; Pediatric Obesity; Constipation
PubMed: 37422494
DOI: 10.1038/s41390-023-02711-1 -
Current Obesity Reports Dec 2023Review latest data regarding the intersection of pediatric obesity epidemic with telemedicine expansion to meet the need of equitable obesity care in children. (Review)
Review
PURPOSE OF REVIEW
Review latest data regarding the intersection of pediatric obesity epidemic with telemedicine expansion to meet the need of equitable obesity care in children.
RECENT FINDINGS
Prevalence of pediatric obesity in the USA continues to worsen particularly in rural, underserved areas. Although there is an increasing number of obesity medicine specialists over the last decade, availability varies by geographic location. Pre-pandemic centers were limited, rarely located in rural areas, and required in-person visits for reimbursement. Telemedicine changes, responding to pandemic needs, provided increase in telemedicine utilization and acceptance with similar or improved obesity care outcomes. Given pediatric obesity prevalence and need for chronic, effective obesity care, leveraging telemedicine to expand reach and decrease access barriers provides a critical and creative remedy. Data cites similar outcomes between telemedicine and in-person care. The time to reimagine a full spectrum of care delivery for pediatric obesity is now.
Topics: Child; Humans; Pediatric Obesity; Telemedicine; Pandemics
PubMed: 37940835
DOI: 10.1007/s13679-023-00537-w -
Current Obesity Reports Jun 2024To review the current medical therapies available for treatment of obesity in children and adolescents less than 18 years old in the United States and outline the... (Review)
Review
PURPOSE OF REVIEW
To review the current medical therapies available for treatment of obesity in children and adolescents less than 18 years old in the United States and outline the approach to their use.
RECENT FINDINGS
Obesity is a chronic disease with increasing prevalence in children and adolescents in the United States. Over the past few years, more FDA-approved medical treatments for obesity, such as GLP-1 receptor agonists, have emerged for patients less than 18 years old. Furthermore, there are medications with weight loss effects that can be used off-label for obesity in pediatric patients. However, access to many of these medications is limited due to age restrictions, insurance coverage, and cost. Medical options are improving to provide treatment for obesity in pediatric populations. FDA and off-label medications should be considered when appropriate to treat children and adolescents with obesity. However, further studies are needed to evaluate the efficacy and long-term safety of FDA-approved and off-label medications for obesity treatment in pediatric patients.
Topics: Humans; Anti-Obesity Agents; Pediatric Obesity; Child; Adolescent; United States; Off-Label Use; Weight Loss
PubMed: 38689134
DOI: 10.1007/s13679-024-00566-z -
Complementary Therapies in Medicine Dec 2023
Topics: Child; Humans; Adolescent; Public Health; Pediatric Obesity; Health Promotion; Educational Status
PubMed: 37949416
DOI: 10.1016/j.ctim.2023.103004 -
Pediatric Obesity Oct 2023Obesity in paediatrics has become one of the most serious public health concerns worldwide. Paediatric obesity leads to increased adult obesity and is associated with... (Review)
Review
Obesity in paediatrics has become one of the most serious public health concerns worldwide. Paediatric obesity leads to increased adult obesity and is associated with several comorbidities, both physical and psychological. Within gastroenterology, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of paediatric liver disease and the most common cause of liver transplantation in young adults. Treatment for NAFLD largely focuses on treatment of obesity with weight loss strategies. Unfortunately, the traditional method of weight loss using multicomponent lifestyle modification (dietary changes, increased exercise and behavioural modification) has often led to disappointing results. In adult patients with obesity, treatment strategies have evolved to include bariatric surgery and, more recently, bariatric endoscopy. In paediatrics, the obesity and NAFLD epidemics will likely require this variety of treatment to address children in a personalized manner. Here, we present a review of paediatric obesity, paediatric NAFLD and the various treatment strategies to date. We focus on non-pharmacologic and emerging therapies, including bariatric surgery and bariatric endoscopy-based treatments. With such a large population of children and adolescents with obesity, further development of these treatments, including paediatric-focused clinical trials, is essential for these emerging modalities.
Topics: Adolescent; Young Adult; Humans; Child; Pediatric Obesity; Non-alcoholic Fatty Liver Disease; Bariatric Surgery; Behavior Therapy
PubMed: 37602954
DOI: 10.1111/ijpo.13067 -
Pediatric Cardiology Aug 2023The prevalence of obesity in children with congenital heart disease (CHD) is greater than 25%, putting these patients at-risk for increased surgical morbidity and...
The prevalence of obesity in children with congenital heart disease (CHD) is greater than 25%, putting these patients at-risk for increased surgical morbidity and mortality. Our goal was to determine the association between CHD complexity, sociodemographic factors, and obesity. Our hypothesis was that among CHD patients, the odds of obesity would be highest in older children with simple CHD, and in all children with a lower socioeconomic status. We conducted a retrospective cohort study, reviewing electronic medical records of children aged 2-17 years from over 50 outpatient pediatric clinics in Houston, TX. Children were classified as simple or moderate/complex CHD, and obesity was defined by BMI ≥ 95th percentile for age and sex. Logistic regression was used to determine the association between sociodemographic factors and CHD complexity with obesity. We identified 648 CHD and 369,776 non-CHD patients. Children with simple CHD had a similar odds of obesity as non-CHD children. Children with CHD had a higher prevalence of obesity if they were older, male, Black, Hispanic, and publicly insured. Children with moderate/complex CHD had lower odds of obesity [OR 0.24 (95% CI 0.07-0.73)], however their predicted probability of obesity approached that of the general population as they aged. Additionally, there was an incremental relationship with poverty and obesity [1.01 (1.01-1.01)]. Awareness of which patients with CHD are at highest risk of obesity may help in targeting interventions to assist at-risk patients maintain a healthy lifestyle.
Topics: Child; Humans; Male; Heart Defects, Congenital; Hispanic or Latino; Pediatric Obesity; Prevalence; Retrospective Studies; Risk Factors; Black or African American
PubMed: 36964218
DOI: 10.1007/s00246-023-03148-3 -
Bulletin of Experimental Biology and... Jan 2024Obesity is associated with chronic persistent inflammation due to a pool of tissue macrophages that can penetrate the blood-brain barrier and cause neuroinflammation....
Obesity is associated with chronic persistent inflammation due to a pool of tissue macrophages that can penetrate the blood-brain barrier and cause neuroinflammation. The analysis of the association of CD14CD163 monocytes in the peripheral blood with cognitive functions in 56 obese children (mean age 11.95 (9.45; 14.45) years) was carried out. The control group consisted of 10 children (mean age 10.4 (9.3; 13.8) years). Standard deviation of the body mass index (SDS BMI) and height (SDS height) were calculated using WHO AnthroPlus software (for children of 6-19 years). Body composition was assessed using bioimpedance measurement. Mononuclear cells were isolated from whole blood by centrifugation on a Ficoll-Urografin density gradient (ρ=1.077 g/ml). The content of CD14CD163 monocytes in the peripheral blood was assessed by flow cytometry. To analyze cognitive functions, the intelligence coefficient (IQ) was calculated and a Russian adaptation of the Rey test was performed. We found an increase in the number of M2-polarized CD14CD163 monocytes in the peripheral blood with an increase in the obesity degree and in the presence of cognitive decline, as well as a negative correlation of the level of M2-polarized monocytes and IQ, taking into account the excess of visceral fat. The revealed data on the relationship of M2-polarized CD14CD163 peripheral blood monocytes with obesity in children and the development of neuropsychological deficiency confirm the role of peripheral visceral obesity and neuroinflammation.
Topics: Humans; Child; Pediatric Obesity; Neuroinflammatory Diseases; Monocytes; Antigens, Differentiation, Myelomonocytic; Flow Cytometry; Inflammation
PubMed: 38340199
DOI: 10.1007/s10517-024-06029-8 -
Jornal de Pediatria 2024To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from... (Review)
Review
OBJECTIVE
To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from the earliest stages of life. To clarify whether there is an interaction between genetic and epigenetic factors, and how they shape eating habits.
DATA SOURCE
A narrative review based on research in PubMed and Web of Science electronic databases was carried out over the last 10 years, searching the title and summary fields using the keywords Children OR adolescents Feeding Behavior eating OR Dietary Habits OR Eating Behavior OR Eating Habits OR Children obesity.
DATA SYNTHESIS
The generational transmission of eating habits is related to the home, community, and school environments, mainly during the first years of life, and can exert the modulation of habits during all stages of life. During childhood, the family's role in consolidating eating habits is very broad and ranges from choosing foods to prioritizing family meals, including the lifestyle.
CONCLUSIONS
Eating habits are transmitted from parents to children in different ways: environmental, emotional, social, and educational. In cases of obesity, a greater association of genetic influence can be observed.
Topics: Child; Adolescent; Humans; Feeding Behavior; Parents; Life Style; Pediatric Obesity; Surveys and Questionnaires
PubMed: 38142715
DOI: 10.1016/j.jped.2023.11.007