childhood obesity research

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• Preventing Childhood Obesity
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• Obesity Data and Statistics

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Childhood Obesity Facts

At a glance.

• Approximately 1 in 5 U.S. children and adolescents have obesity.
• Obesity affects some groups more than others, including adolescents, Hispanic and non-Hispanic Black children, and children in families with lower incomes.
• Health care for obesity is expensive for patients and the health care system.

Many U.S. children have obesity

From 2017 to March 2020, the prevalence of obesity among U.S. children and adolescents was 19.7% 1 . This means that approximately 14.7 million U.S. youths aged 2–19 years have obesity.

For children, obesity is defined as having a body mass index (BMI) at or above the 95th percentile for age and sex.

Obesity affects some groups more than others

The prevalence of obesity increased with age. From 2017 to March 2020, obesity prevalence was 12.7% among U.S. children 2–5 years old, 20.7% among those 6–11, and 22.2% among adolescents 12–19. [1]

Race and ethnicity

Overall, obesity prevalence was highest in Hispanic children (26.2%) and non-Hispanic Black children (24.8%) followed by non-Hispanic white (16.6%) and non-Hispanic Asian (9.0%) children. [1]

Among U.S. girls, obesity prevalence was highest among non-Hispanic Black girls (30.8%). Among U.S. boys, obesity prevalence was highest among Hispanic boys (29.3%). [1]

Family income

Obesity prevalence increased as family income decreased. Obesity prevalence was:

• 11.5% among U.S. children with family income more than 350% of the Federal Poverty Level (FPL).
• 21.2% among children with family income 130% to 350% of FPL.
• 25.8% among children with family income 130% or less of FPL. [1]

Obesity data among young children‎

Health care for obesity is expensive.

Health care for obesity is expensive for patients and the health care system. In 2019 dollars, the estimated annual medical cost of obesity among U.S. children was $1.3 billion. Medical costs for children with obesity were $116 higher per person per year than for children with healthy weight. Medical costs for children with severe obesity were $310 higher per person per year than for children with healthy weight. [2]

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• Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey 2017–March 2020 prepandemic data files development of files and prevalence estimates for selected health outcomes . Natl Health Stat Report . 2021;158.
• Ward ZJ, Bleich S, Long MW, Gortmaker SL. Association of body mass index with health care expenditures in the United States by age and sex. PLoS One . 2021;16(3):e0247307.

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Childhood obesity: A review of current and future management options

Affiliations.

• 1 Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK.
• 2 Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK.
• 3 Department of Paediatric Dietetics, Alder Hey Children's Hospital, Liverpool, UK.
• 4 Department of Paediatric Clinical Psychology, Alder Hey Children's Hospital, Liverpool, UK.
• PMID: 34750858
• DOI: 10.1111/cen.14625

Obesity is becoming increasingly prevalent in paediatric populations worldwide. In addition to increasing prevalence, the severity of obesity is also continuing to rise. Taken together, these findings demonstrate a worrying trend and highlight one of the most significant challenges to public health. Childhood obesity affects multiple organs in the body and is associated with both significant morbidity and ultimately premature mortality. The prevalence of complications associated with obesity, including dyslipidaemia, hypertension, fatty liver disease and psychosocial complications are becoming increasingly prevalent within the paediatric populations. Treatment guidelines currently focus on intervention with lifestyle and behavioural modifications, with pharmacotherapy and surgery reserved for patients who are refractory to such treatment. Research into adult obesity has established pharmacological novel therapies, which have been approved and established in clinical practice; however, the research and implementation of such therapies in paediatric populations have been lagging behind. Despite the relative lack of widespread research in comparison to the adult population, newer therapies are being trialled, which should allow a greater availability of treatment options for childhood obesity in the future. This review summarizes the current evidence for the management of obesity in terms of medical and surgical options. Both future therapeutic agents and those which cause weight loss but have an alternative indication are also included and discussed as part of the review. The review summarizes the most recent research for each intervention and demonstrates the potential efficacy and limitations of each treatment option.

Keywords: BMI; childhood obesity; lifestyle interventions; paediatrics; pharmacotherapy.

© 2021 John Wiley & Sons Ltd.

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The overall mission of the Duke Center for Childhood Obesity Research (DCCOR) is to advance effective and equitable obesity prevention and treatment by conducting innovative interdisciplinary research to achieve optimal health for all children.

DCCOR conducts groundbreaking research that seeks to change practice and policy to help children lead healthier lives. Three pillars form the foundation for our research:

• Causes, consequences, and correlates of childhood obesity
• Prevention of obesity and its related morbidities
• Treatment of childhood obesity across the lifespan

Across all pillars, we approach research relative to the following intersecting themes, in order to achieve optimal obesity-related health outcomes: 

• Reducing stigma and bias
• Improving health equity
• Establishing policy
• Training the next generation of researchers

In support of our overarching mission, the center’s goals are to:

• Embrace  innovative research strategies and support interdisciplinary collaboration  by intentionally seeking out collaborators across different departments.
• Discover and deliver  effective obesity prevention and treatment to populations of children across the age spectrum from pre-conception through early adulthood  by identifying the physical, mental, social, and economic factors that affect parents and/or children in ways that lead to weight gain.
• Close disparities in optimal nutrition and activity that exist for children from diverse racial, ethnic, and economic diverse backgrounds  by developing culturally-sensitive intervention materials and focus on reducing barriers and facilitating access to opportunities for healthy eating and activity.
• Combat stigma and bias  against those affected by obesity by exploring implicit attitudes and their effects on beliefs, behaviors, and health.
• Educate learners at all levels about obesity --its causes and effects, weight stigma, and healthy lifestyles by developing a curriculum for children and/or parents that can be used in schools or other settings.
• Train future leaders in the field of child obesity research  by offering training opportunities and mentorship of junior researchers.
• Engage with schools and local health partners to ensure research efforts are community-based  by involving non-university and non-academic collaborators at various steps of the research process.
• Encourage the development of policies that will benefit child health and promote healthy lifestyle habits  by collaborating with legislators and key decision-makers and providing them with expertise and advice.
• Publicize our research and disseminate the findings to a wide audience  through rigorous scientific channels, center-created newsletters and informational resources, and social media platforms.

With the creation of the Duke Center for Childhood Obesity Research (DCCOR) in January 2017 under the leadership of Eliana Perrin, MD, MPH, the Department of Pediatrics and School of Medicine strengthened its commitment to the multidisciplinary research necessary to develop effective and efficient evidence-based behavioral interventions to prevent childhood obesity. Additional Center revenue and project funding is generated by grant awards from sources such as The Duke Endowment and the National Institutes of Health (NIH). The Center is currently co-directed by  Sarah Armstrong, MD , director of the Duke Healthy Lifestyles clinical and research programs and Division Chief of General Pediatrics and Adolescent Health in the Department of Pediatrics, and  Asheley Skinner, PhD , Professor of Population Health Sciences and Director of Graduate Studies for Population Health Sciences. The Center is conducting impactful, multidisciplinary research on the causes, consequences, correlates, prevention and treatment of childhood obesity.

Research Environment

DCCOR, which is an integral part of the Department of Pediatrics in the Duke University School of Medicine, is strategically positioned to conduct innovative and groundbreaking research in pediatric obesity. Duke University has a strong reputation as one of the top research institutions in the country. In 2021, the Duke School of Medicine received more than $608 million in NIH funding, ranking third in the nation. Ranking first nationally in NIH research grant funding for pediatrics clinical science departments, Duke’s Department of Pediatrics received nearly $210 million in NIH grants in 2021.

Duke University is highly supportive of research collaboration among faculty members across disciplines, departments, and schools. With the introduction of the 2006 strategic plan “Making a Difference,” Duke began to build university-wide interdisciplinary institutes, initiatives, and centers with the intention of taking novel approaches to problem-focused research. These interdisciplinary entities are supported with core funding from the Office of the Provost, sharing infrastructures that facilitate the work being accomplished by the faculty and students within them. Further evidence of Duke’s support of facilitating interdisciplinary partnerships is the School of Medicine’s interdisciplinary colloquia awards, which aim to connect faculty members from a variety departments to share knowledge and collaborate on common interests.

Duke’s expansive research infrastructure and history of supporting interdisciplinary collaborations will provide DCCOR with a strong foundation to successfully engage in innovative research, make critical advancements and discoveries, and become a leader in the field of pediatric obesity research and prevention.

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Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015–2021

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Interpretation

• Childhood obesity
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• Review Article
• Published: 23 September 2024

Early life factors that affect obesity and the need for complex solutions

• Kylie D. Hesketh   ORCID: orcid.org/0000-0002-2702-7110 1 ,
• Miaobing Zheng 1 &
• Karen J. Campbell 1  

Nature Reviews Endocrinology ( 2024 ) Cite this article

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• Risk factors

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

A large proportion of obesity risk originates in early life, making this life phase an opportune time for primary prevention.

Obesity risk factors occur across individual and biological, sociocultural, and environmental and system levels; some are unique to early childhood (such as breastfeeding) whereas others are relevant across the life cycle (such as diet and movement behaviours).

The interplay of risk factors contributes to the complexity of obesity and its development and highlights the need for complex solutions.

Focusing the narrative on supporting health behaviours rather than on obesity and weight might be more palatable and result in greater engagement from practitioners and families.

It is time to move beyond single behaviour interventions, which have limited effectiveness in early childhood, to focus on more complex multi-behaviour interventions, tailored to individual or specific population needs, to tackle the multiple influences on obesity.

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K.D.H. is supported by a Heart Foundation Future Leader Fellowship (105929). M.Z. is supported by a National Health Medical Research Council Early Career Fellowship (GNT1124283).

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Hesketh, K.D., Zheng, M. & Campbell, K.J. Early life factors that affect obesity and the need for complex solutions. Nat Rev Endocrinol (2024). https://doi.org/10.1038/s41574-024-01035-2

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Childhood Overweight and Obesity During and After the COVID-19 Pandemic

• 1 Child and Health Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
• 2 Institute of Clinical Sciences, Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Excessive childhood weight gain has been associated with the COVID-19 pandemic globally, attributed to its negative effects on diet and physical activity caused by social restrictions and reduced access to preschools. 1 Children from low socioeconomic backgrounds and with preexisting overweight were particularly affected. Childhood obesity increases the risk of obesity in adulthood, with greater risk of cardiovascular diseases, cancer, and lower quality of life. 2

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Fäldt A , Nejat S , Durbeej N , Holmgren A. Childhood Overweight and Obesity During and After the COVID-19 Pandemic. JAMA Pediatr. 2024;178(5):498–500. doi:10.1001/jamapediatrics.2024.0122

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Childhood Research in Obesity Prevention - Assistant Program Director

🔍 school of medicine, stanford, california, united states.

The Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition and The Childhood Research in Obesity Prevention (CROP) research program at Stanford University is seeking an Assistant Program Director (Academic Program Professional 2, hybrid) to work under the general direction of the program Principal Investigator (PI) to develop, implement, and administer the vision, strategy, and goals of the program. The CROP research program’s goal is to advance child health equity. To achieve this goal, the program seeks to translate clinical, community, and epidemiologic research findings into innovative population-level interventions during pregnancy, infancy, and early childhood to prevent and treat childhood obesity and chronic diseases particularly among health disparity populations. The culture of the program is one that values growth, teamwork, and inclusion. Current research projects are funded by NIH, PCORI, and Foundations amounting to over $20M total costs between 2024-2030 in addition to endowed program funding. These include the Food FARMacia randomized trial of an infant food security intervention; the LINC mixed methods study of social risk factors, navigation, and neighborhoods; and the PCORI-funded CHIME (Comparing Health Interventions for Maternal Equity) program. The CHIME program focused on maternal- infant health equity through a comparative effectiveness research study, broader partnership network, partner learning network, and research mentorship program. This position will also oversee the PCORI-funded CHIME research mentorship program for fellows and early-stage investigators in community based participatory research and implementation science focused on maternal-infant health equity, including development of the curriculum, coordinating meetings, and overseeing the application procedures.

The position will report to the research program PI and will oversee senior research program staff. The Assistant Program Director will participate in program strategy development, long-range planning, and partnership development by overseeing implementation of multiple multi-site research projects to promote food security, nutrition, and reduction of obesity and related chronic diseases starting early in life.

The Assistant Program Director will have documented expertise in nutrition and/or pediatric research, including clinical trials research experience. We are looking for someone who can collaborate with other researchers and external partners. The ability to manage multiple tasks and timelines and community clearly with collaborators will be central to success in this position. Strong analytic and writing skills, as well as the ability to take initiative and complete appropriate tasks independently, are required. Prior experience with managing large research grants and teams is required. Prior experience with assisting in the development and submission of extramural funding (e.g., NIH, CDC, AHRQ, PCORI)] applications is required.

Duties include:

·        Develop and manage research program including multi-site investigator grants and contracts, by conducting research activities, including outreach to varied stakeholders within the program, assigning resources and making program improvement recommendations that impact policies and programs, and completing quarterly, semi-annual, and annual reporting.

·        Collaborate with external projects PIs and stakeholders to ensure successful completion of projects, timely data sharing, and reporting.

·        Identify, recommend and implement opportunities for new research.

·        Source, collect and analyze data, create reports, review and explain trends; formulate and evaluate alternative solutions and/or recommendations to achieve the goals of the program or function. Oversee revisions and trainings on new program policies and procedures.

·        Teach and/or assist in the teaching and administration of research mentorship and career development programs, including oversight of the PCORI-funded CHIME Research Mentorship Program. Develop curriculum and application process. Develop curriculum-rating survey, detailed feedback on courses and make recommendations for preliminary overview and changes.

·        Write and/or edit complex content for proposals, research grants, peer-reviewed publications, and other program activities.

·        Contribute to and inform on strategic program/entity planning and related funding and financial sustainability.

·        . Write and/or edit complex content for proposals, research grants, peer-reviewed publications, and other program activities.

·        Develop or contribute to outreach strategy related to program communications, development, partnerships, and fundraising/funding.

·        Coach and mentor program staff. This includes development and implementation of our annual strategic and team-building retreat.

• - Other duties may also be assigned

All members of the Department of Pediatrics are engaged in continuous learning and improvement to foster a culture where diversity, equity, inclusion, and justice are central to all aspects of our work. The Department collectively and publicly commits to continuously promoting anti-racism and equity through its policies, programs, and practices at all levels.

Stanford University provides pay ranges representing its good faith estimate of what the University reasonably expects to pay for a position. The pay offered to a selected candidate will be determined based on factors such as (but not limited to) the scope and responsibilities of the position, the qualifications of the selected candidate, departmental budget availability, internal equity, geographic location, and external market pay for comparable jobs. The pay range for this position working in the California Bay area is $95,000. to $139,000.

DESIRED QUALIFICATIONS:

Master’s or PhD degree and three or more years of relevant experience in nutrition and/or pediatrics. Experience with nutrition research, community partnered research, clinical trials research, mixed methods research, and ability to communicate well with community partners, researchers, funders, and philanthropists.

EDUCATION & EXPERIENCE (REQUIRED):

Bachelor's degree and three or more years of relevant experience or combination of education, training, and relevant experience. Advanced degree may be required for some programs. Experience managing a budget and developing financial plans.

KNOWLEDGE, SKILLS AND ABILITIES (REQUIRED):

·        Ability to develop program partnerships and funding sources.

·        Excellent oral, written, and analytical skills, exhibiting fluency in area of specialization.

·        Ability to oversee and direct staff.

·        Basic knowledge of managing budgets and developing financial plans.

CERTIFICATIONS & LICENSES:

PHYSICAL REQUIREMENTS*:

·        Frequently stand/walk, sitting, grasp lightly/fine manipulation, perform desk-based computer tasks.

·        Occasionally use a telephone, writing by hand, lift/carry/push/pull objects that weigh up to 40 pounds.

·        Rarely sort/file paperwork or parts, lift/carry/push/pull objects that weigh >40 pounds.

·        Ability to use voice to present information/communicate with others.

·        On-campus mobility.

* - Consistent with its obligations under the law, the University will provide reasonable accommodation to any employee with a disability who requires accommodation to perform the essential functions of his or her job.

WORKING CONDITIONS:

·        May work extended hours, evenings or weekends.

·        May travel locally.

Occasional overnight travel.

• Schedule: Full-time
• Job Code: 4112
• Employee Status: Regular
• Department URL: http://pediatrics.stanford.edu/
• Requisition ID: 104651
• Work Arrangement : Hybrid Eligible

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September 24, 2024

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Research suggests obesity in moms doubles the risk of autism in babies

by University of South Australia

Children born to mothers with obesity both before and during pregnancy have an increased risk of neuropsychiatric and behavioral conditions, including autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), according to new research from the University of South Australia.

The paper is published in the journal Psychiatry Research .

Conducted in partnership with Curtin University, Monash University, SAHMRI and a team of national institutions, the systematic review and meta-analysis of more than 3.6 million mother-child pairs across 42 epidemiological studies found that obesity during pregnancy:

• increases the risk of ADHD in children by 32%
• doubles the risk of developing ASD in children (by 2.23 times)
• increases the risk of conduct disorders by 16%

The study also found that maternal pre-conception obesity or overweight was linked with an increased risk of ADHD, ASD, conduct disorder and psychotic disorder as well as a 30% increased risk in both externalizing symptoms, and peer relationship problems.

Lead researcher UniSA's Dr. Bereket Duko says the study provides new insights into the long-term impact of maternal body weight on child mental health.

"Maternal obesity has long been associated with a range of adverse perinatal outcomes, including preterm birth , low birthweight, stillbirth, and it is also linked with macrosomia, or high birthweight," Dr. Duko says.

"In this study, we examined maternal overweight and obesity before and during pregnancy, finding that both are significantly linked with psychiatric and behavioral problems in children later in life, specifically ASD, ADHD and peer relationship problems.

"Given the rising global obesity rates among women of reproductive age, and the growing numbers of children identified with neurodiverse conditions, it's important that we acknowledge the potential long-term consequences of maternal adiposity on child mental health."

In Australia, about one in 150 people have ASD with more than 8% of children aged 4–11 diagnosed with ADHD. Globally, one in eight people live with obesity .

Dr. Duko says the study's results underscore the need for interventions targeting maternal weight management before and during pregnancy.

"Public health efforts that target improving maternal health could help mitigate some of the risks of neuropsychiatric and behavioral disorders in children," Dr. Duko says.

"While further research is needed to explore the biological mechanisms underlying these associations, the findings do stress the need for health interventions that promote healthy living and weight among parents-to-be."

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Childhood Obesity’s Unexpected Impact on Skin

A STRONG link between childhood obesity and the development of immune-mediated skin diseases (IMSDs), such as alopecia areata, atopic dermatitis, and psoriasis, has been highlighted in new research.

Researchers found that obese children were significantly more likely to develop these common skin conditions compared to their normal-weight peers. Among the IMSDs studied, atopic dermatitis showed the most pronounced association with weight changes: children who gained weight (from normal to overweight) had a higher risk of developing the condition, while those who lost weight (from overweight to normal) had a reduced risk. The study analyzed data from 2.16 million Korean children from 2009 to 2020, making it one of the largest studies of its kind.

Co-lead investigator Seong Rae Kim from Seoul National University College of Medicine, South Korea, noted, “Many previous studies have examined the link between childhood obesity and IMSDs, but our long-term approach with a large sample size allows for a better understanding of how body weight changes over time affect the development of these diseases.”

The study underscores the importance of weight management in children, not only for overall health but also to reduce the risk of chronic skin conditions that impact quality of life. Despite advancements in biologic treatments, there are still limited options for managing these conditions in children, making prevention through weight maintenance and healthy lifestyle choices crucial.

Hyunsun Park, another co-lead investigator, emphasized the role of diet and lifestyle in influencing both gut health and skin conditions, suggesting a complex interplay between obesity and immune function. “Our findings suggest that preventing excessive weight gain and encouraging purposeful weight loss in children, especially before school age, can reduce the risk of developing atopic dermatitis and other IMSDs,” said Park. This research supports the need for targeted interventions to promote healthy weight and potentially prevent debilitating skin diseases in children.

Reference: Kim SR et al. Childhood obesity, weight change, and pediatric immune-mediated skin diseases. JID Innov. 2024;144(9):1984.e10.

Anaya Malik | AMJ

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Childhood Research in Obesity Prevention - Assistant Program Director

Job Details

Organization.

Occasional overnight travel.

• Schedule: Full-time
• Job Code: 4112
• Employee Status: Regular
• Department URL: http://pediatrics.stanford.edu/
• Requisition ID: 104651
• Work Arrangement : Hybrid Eligible

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Extra nutrients during pregnancy may reduce childhood obesity risk

• 31 January 2024

Taking a nutritional supplement before and during pregnancy could promote healthy weight in childhood, an NIHR-supported study has found.

The research is part of the international NiPPeR study . The study is a collaboration between the NIHR Southampton Biomedical Research Centre (BRC), the University of Southampton, the Liggins Institute at the University of Auckland, the National University of Singapore and the Agency for Science, Technology and Research (A*STAR) in Singapore.

How the study worked

Rates of childhood obesity are rising in many countries, particularly in less advantaged groups. Obesity increases the risk of many health diseases. These include type 2 diabetes, heart disease and some types of cancer.

Around 500 women from the UK, New Zealand and Singapore took part in this study. They were randomly allocated to two groups.

One group received an enriched supplement - including vitamins B2, B6, B12, D, probiotics and myoinositol - alongside a standard pregnancy supplement.

The other group received a standard pregnancy supplement alone. Neither the women nor their medical teams knew which group they were in.

The researchers checked in on the children when they were two years old. There were half as many obese children in the cohort whose mothers were in the enriched group (9% versus 18%). These children were almost 25% less likely to have experienced “rapid weight gain”, which often leads to obesity.

The new analysis by researchers in the UK, New Zealand and Singapore has been published in BMC Medicine .

A ‘special opportunity’

Professor Keith Godfrey from the University of Southampton (UoS) and the NIHR Southampton BRC is the study’s Chief Investigator. He said: “Preventing obesity is one of the most important things we can do, as treating obesity is much more difficult. The new findings suggest the period before and during pregnancy may provide a ‘special opportunity’. Supporting better nutritional status for the mother at this time could have lasting benefits for her child.”

Professor Wayne Cutfield is a professor of paediatric endocrinology at the Liggins Institute in Auckland, and one of the leaders of the research. He said: “In a world of obesity, our data suggests supplementing mums before and during pregnancy can have benefits way beyond the pregnancy and for the women involved. It can impact their baby into childhood and potentially beyond.”

Professor Marian Knight, NIHR Scientific Director for Infrastructure said: "These latest findings are a step towards beginning to understand and prevent childhood obesity. Pioneering nutrition, lifestyle and metabolism research is at the heart of our NIHR Southampton Biomedical Research Centre. Working closely with global partners, the aim of this ambitious study is to continue making discoveries that will help give every child the best start in life.”

Future research

The enhanced supplement contained seven additional micronutrients.

More research is needed to identify which of the nutrients in the supplement are most beneficial. Any of them - or a combination - could have impacted the metabolism and development of the children and the likelihood of obesity.

Professor Cutfield said: “We do not yet know the precise mechanism, but there’s evidence some of the micronutrients are associated with body metabolism in pregnancy. We have started analysing the data and we hope to be able to drill down into which component or components are most critical.”

Associate Professor Shiao Yng Chan from the National University of Singapore was a co-author on the paper. She says the effects of a mother's nutrition during pregnancy might not show in the baby right away.

“As the child grows, the things that happened in the baby's body while in the womb become apparent. These early events, sometimes called ‘foetal programming’, can influence how the child reacts to an unhealthy lifestyle, like eating lots of fatty foods and not getting enough exercise. This can make some children more likely to become overweight."

Read the full paper in BMC Medicine .

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Obesity effects on child health.

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• Continuing Education Activity

Obesity in childhood is the most challenging public health issue in the twenty-first century. Childhood obesity is associated with increased morbidity and premature death. Prevention of obesity in children is a high priority in the current situation. This activity reviews the etiology, pathophysiology, and consequence of childhood obesity and also highlights the role of the interprofessional team in the prevention and management of childhood obesity.

• Outline the definition of childhood obesity.
• Describe the etiology and pathophysiology of childhood obesity.
• Summarize the consequences of childhood obesity.
• Explain how interprofessional teamwork can improve effective management interventions for childhood obesity.
• Introduction

Obesity in childhood is the most challenging public health issue in the twenty-first century. It has emerged as a pandemic health problem worldwide. The children who are obese tend to stay obese in adulthood and prone to increased risk for diabetes and cardiac problems at a younger age. Childhood obesity is associated with increased morbidity and premature death. [1] Prevention of obesity in children is a high priority in the current situation.

Epidemiology

The prevalence of childhood obesity has alarmingly increased. The overall burden of obesity has almost tripled since 1975. However, an eightfold increase in obesity burden in the 5 to 19 years age group has been noted between 1975 and 2016. [2] Though childhood obesity is more prevalent in developed countries, the prevalence is increasing even in developing countries. [3] Currently, about 18.5% of US children present with obesity. Among boys, obesity is more prevalent in the school-age group (6 to 11 years), whereas in girls, it is more prevalent in adolescents (12 to 19 years). The prevalence of childhood obesity among boys and girls was not significantly different overall or by age groups. [4]

The word obesity infers the deposition of excessive fat in the body. Different methods can directly measure body fat like skinfold thickness, hydro densitometry, bioelectrical impedance, and air displacement plethysmography. [5] These methods are not readily available in the clinical setting and are expensive. Body mass index (BMI) provides an economical method to assess body fat indirectly. BMI is measured using a formula [BMI = weight (kg)/ height (m)^2]. [6] [7] As growth in children varies with age and sex, so do the norms for BMI. The following definitions are used to classify weight status based on BMI for children from 2 to 20 years of age. [8] [9]

• Overweight – 85th to less than the 95th percentile.
• Obese (class 1) – 95th percentile or greater
• Severe (class II) obesity – ≥ 120% of 95th percentile (99th percentile) or ≥ 35 kg/m^2 (whichever is lower)
• Class III obesity is a subcategory of severe obesity and is defined as BMI ≥140 % of 95th percentile or ≥ 40 kg/m^2. 

The World Health Organization (WHO) recommends using BMI Z-score cut-offs of >1, > 2, and > 3 to define at risk of overweight, overweight, and obesity, respectively. [7] Z-score is measured in terms of standard deviations from the mean.

• Issues of Concern

Etiology and Pathophysiology

The complex interaction of individual and environmental factors plays a crucial role in developing obesity. The most important factors contributing to childhood obesity are summarized below. 

Environmental Factors

Changes in the environment in the past few decades in terms of easy access/ affordability of high-calorie fast food, increased portion size, increased intake of sugary beverages, and sedentary lifestyles are associated with increased incidence of obesity. [10] Increasing use of electronic devices [television, tablets, smartphone, videogames] by children has led to limited physical activity, disruption of the sleep-wake cycle, depression of metabolic rate, and poor eating patterns. [11]

Feeding patterns in infancy have a long-term effect on developing obesity later on in life. It has been shown that breastfeeding in the first year of life is inversely associated with weight gain and obesity. [12] This association was much more significant if the child was exclusively breastfed compared to having added formula or solid food. Despite concerns about the risk for obesity in preterm and SGA infants receiving calorie and protein supplementation, it has been shown to improve catch-up growth without increasing the risk of obesity. [13] High protein intake in the initial two years of life has also been postulated to increase weight gain later in childhood. 

Biological Factors

There is a complex interaction between the neural, hormonal, and gut-brain axis affecting hunger and satiety. Hypothalamus regulates appetite and is influenced by key hormones, ghrelin, and leptin. Ghrelin is released from the stomach and stimulates hunger (orexigenic), whereas leptin is mainly secreted from adipose tissue and suppresses appetite (anorexigenic). Several other hormones like neuropeptide Y and agouti-related peptide stimulate hunger, while pro-melanocortin and α-melanocyte-stimulating hormone suppress hunger. [14] These hormones control energy balance by stimulating the hunger and satiety centers in the arcuate nucleus of the hypothalamus through various signaling pathways. Stress-related psychiatric disorders with associated abnormal sleep-wake cycles can also lead to increased ghrelin levels and, in turn, increase appetite.

The gut microbiome includes the trillions of microorganisms that inhabit the human gut. Alterations in the gut microbiome can lead to weight gain through numerous pathways. [15] The dominant gut florae are Firmicutes and Bacteroidetes (90%), Proteobacteria , Actinobacteria , and Fusobacteria . These bacteria have a symbiotic relationship with their host. They can be affected by various factors, such as gestational age at birth, premature rupture of membranes, mode of delivery of the infant, type of feeding, feeding practices, and antibiotics usage. The maturation of gut flora occurs from birth to adulthood and is determined by various genetic factors, diet, lifestyle, and environment. Gut microbiota helps maintain the mucosal barrier, nutrient digestion (especially the synthesis of short-chain fatty acids), and immune response against pathogens. The imbalance of the gut microbiome (dysbiosis), leading to increased production of short-chain fatty acids, has been linked to developing obesity and other medical conditions, such as type 2 Diabetes Mellitus, Metabolic syndrome, anxiety, and depression. [16]

Genetic Factors

Obesity can be either monogenic, syndromic, or polygenic types. Monogenic obesity is uncommon, occurring in 3% to 5% of obese children. [17] Mutations in genes for leptin, leptin receptor, proopiomelanocortin, and melanocortin-4 receptor can lead to obesity. Monogenic type presents in early childhood with unusual feeding behaviors and severe obesity.

Genetic syndromes causing severe obesity include

• Prader Willi syndrome:  Early growth faltering followed by hyperphagia and increased weight gain by 2 to 3 years. The mild or moderate cognitive deficit, microcephaly, short stature, hypotonia, almond-shaped eyes, high-arched palate, narrow hands/feet, delayed puberty are common features.
• Alstrom syndrome:  Blindness, deafness, acanthosis nigricans, chronic nephropathy, type 2 diabetes, cirrhosis, primary hypogonadism in males, and normal cognition are common features in Alstrom syndrome.
• Bardet Biedl syndrome: Intellectual disability, hypotonia, retinitis pigmentosa, polydactyly, hypogonadism, glucose intolerance, deafness, and renal disease are the features in Bardet Biedl syndrome.
• Other syndromes include Beckwith-Weideman syndrome and Cohen syndrome.

Polygenic obesity is much more common and is caused by a complex interaction between multiple genetic variants and the environment known as gene-environment interaction (GEI). When a child with genotype variants conferring risk for obesity interacts with various environmental factors predisposing to obesity, there is a tendency for decreased physical activity, increased food intake, and body fat storage. Early life environment starting with maternal nutrition during the prenatal or early postnatal period and early childhood adverse environmental or psychosocial stressors can lead to epigenetic changes leading to obesity.

Endocrine Factors

Endocrine causes constitute less than 1% of cases of obesity in children. [18] It is usually associated with mild to moderate obesity, short stature, or hypogonadism. These include cortisol excess [steroid medications or Cushing syndrome], hypothyroidism, growth hormone deficiency, and pseudohypoparathyroidism.

Medications

Numerous medications can cause weight gain. These include antiepileptics, antidepressants, antipsychotics, diabetes medications [insulin, sulfonylureas, thiazolidinediones], glucocorticoids, progestins, antihistamines [cyproheptadine], alpha-blockers [terazosin], and beta-blockers [propranolol]. Close monitoring for excessive weight gain should be done when any of these medications are used in children.

Endocrine-disrupting chemicals, such as bisphenol A and dichlorodiphenyltrichloroethane, have been hypothesized to predispose to obesity by modulating estrogen receptors and possibly metabolic programming. [19]

Few studies in animal models have proven that obesity can be triggered by infection with adenovirus. However, human studies have found conflicting results.

• Clinical Significance

Childhood obesity significantly impacts both physical and psychological health. Obesity can lead to severe health conditions, including non-insulin-dependent diabetes, cardiovascular problems, bronchial asthma, obstructive sleep apnea (OSA), hypertension, hepatic steatosis, gastroesophageal reflux (GER), and psychosocial issues. The preventive and therapeutic interventions in childhood obesity are crucial in decreasing the burden of comorbid health conditions.

Metabolic Syndrome

Metabolic syndrome, also named syndrome X, is a cluster of risk factors specific for cardiovascular diseases such as hypertension, glucose intolerance, dyslipidemia, and abdominal obesity that commonly occur in obese children or adolescents. Insulin resistance, hyperinsulinemia, and oxidative stress are the underlying factors contributing to metabolic syndrome. [20]  

Dyslipidemia

Atherogenic dyslipidemia is common in obese children and adolescents. A fasting lipoprotein level needs to be obtained in all children with obesity. Elevated triglycerides (TG) and Free fatty acid (FFA) levels, decreased HDL (high-density lipoprotein) cholesterol levels, and normal or mildly increased serum LDL (low-density lipoprotein) cholesterol levels are common findings in childhood obesity. [21] Hyperinsulinemia and insulin resistance in childhood obesity promotes hepatic delivery of FFA for triglyceride synthesis and sequestration into TG-rich lipoproteins. [22]  

Glucose Intolerance

Childhood obesity quadruples the risk of developing glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM or Type 2 diabetes). Over 85% of children with NIDDM are either overweight or obese at diagnosis. [23] Acanthosis nigricans is an increased pigmentation and thickness of the skin in intertriginous folds, and it is usually associated with glucose intolerance in children and adolescents. Fasting insulin and glucose should be included in the evaluation of childhood obesity. The risk factors for type 2 non-insulin-dependent diabetes and metabolic syndrome include, 

• children with BMI 85th to 95th percentile along with,
• immediate family history of type 2 diabetes 
• signs of insulin resistance such as acanthosis nigricans, dyslipidemia, hypertension, and polycystic ovarian syndrome.
• Children with BMI >95th percentile regardless of family history or associated features. [24]  

Hypertension

The most significant risk factor for pediatric hypertension is the high body mass index. One-fourth of obese children can have hypertension. Adipocyte is not only a storage depot for fat but is also an active endocrinological cell. The pro-inflammatory adipokines (leptin, resistin, and IL-6) lead to an increase in sympathetic nervous system (SNS) activation, which preferentially impacts the renal vascular beds. [25] Hypertension risk in childhood obesity can also be explained due to hyperinsulinemia. Hyperinsulinemia causes hypertension through secondary mechanisms such as increased renal sodium retention, increased intracellular free calcium, and increased SNS activity. [26] Dietary therapy, along with exercise, effectively decreases blood pressure. 

Hepatic Steatosis  

Pediatric liver disease is a severe complication of childhood obesity. Obesity-related non-alcoholic fatty liver disease (NAFLD) spectrum includes fatty liver, steatohepatitis, cirrhosis, and hepatocellular carcinoma. [27] Hyperinsulinemia in childhood obesity plays a significant role in contributing to hepatic steatosis. Gradual weight loss with regular exercise and diet with less refined carbohydrates and low-fat help normalize hepatic enzymes and resolve hepatic steatosis. [28]   

Cholelithiasis

The prevalence of cholelithiasis is high among adolescents with obesity, and the association is more robust in girls than in boys. Increased cholesterol synthesis and cholesterol saturation of bile contribute to cholelithiasis among adolescents with obesity. [29] [29]  Cholelithiasis occurs even more frequently with weight reduction. Almost half of the cases of cholecystitis in adolescents may be associated with obesity. 

Overweight or obese children have been observed to have a higher prevalence of asthma and asthma exacerbations. The link between asthma and obesity is mediated through abnormal inflammatory and oxidant stress, chest restriction with airway narrowing, and obesity-related comorbidities such as obstructive sleep apnea and gastroesophageal reflux. [30]  

Idiopathic Intracranial Hypertension 

Idiopathic intracranial hypertension (IIH) is an uncommon disease of childhood and adolescence characterized by increased intracranial pressure without any identifiable cause. Almost half of the children who present with this syndrome may be obese and also have more IIH symptoms at onset. [31]  The disease is characterized by elevated intracranial pressure. IIH presents with headaches and may lead to severe visual impairment or blindness. The potential for visual impairment indicates the need for aggressive treatment of obesity in patients with IIH.

Sleep Apnea

Obesity and overweight are crucial risk factors for obstructive sleep apnea (OSA). Neurocognitive deficits and excessive daytime sleepiness are common among obese children with sleep apnea. [32] Obesity hypoventilation syndrome may represent a long-term consequence of sleep apnea and is associated with a high mortality rate. Aggressive therapy is warranted for obese children with this syndrome. Obesity management such as increased physical activity and a healthy diet are recommended for OSA treatment, as well as surgical procedures, if appropriate. 

Orthopedic Complications

Fractures, musculoskeletal discomfort, and lower extremity malalignment such as Blount disease and slipped capital femoral epiphyses are more common in overweight than non-overweight children and adolescents. [33]  Blount disease is a disorder of the proximal tibial growth plate, which results in progressive bowing of the tibia. Although the prevalence of Blount disease is low, approximately two-thirds of Blount disease patients may be obese. Slipped capital femoral epiphysis occurs due to epiphyseal plate disruption. Between 30% and 50% of patients with slipped capital femoral epiphysis are overweight.  

Polycystic Ovary Disease 

Obesity is frequently associated with polycystic ovary disease (PCOD). Up to 30% of women with PCOD may be obese. Hyperandrogenism and hyperinsulinemia often accompany PCOD. Obesity increases the risk of PCOD through insulin resistance and compensatory hyperinsulinemia, which increases androgen production and decreases sex hormone-binding globulin, thereby increasing the bioavailability of androgen. Adolescents with PCOD are at increased risk for metabolic syndrome and glucose intolerance. Weight loss represents an important therapeutic target in obese adolescents with PCOD.  

Persistence of obesity into adulthood

About 15% to 30% of adults with obesity were also obese in their childhood or adolescence. [34]  The cardiovascular risk factors present in obese children or adolescents usually persist into adulthood. The change in body fat in obese adolescents can be a reasonable mediator contributing to the excess morbidity and mortality in later adulthood. 

Psychosocial impact 

Children with obesity or overweight are more likely to experience low self-esteem and depression during adolescence. Negative psychological experiences trigger emotional eating, leading to an ongoing obesity-depression cycle. Children who are overweight or obese face bullying at school and are excluded from competitive physical activities. Overall, children with obesity have less social interaction and spend more time in sedentary activities. Numerous studies have confirmed the association of childhood obesity with ADHD and anxiety disorders. [35]

Eating Disorders

Children with overweight or obesity have a high prevalence of disordered eating behaviors, increasing the risk of developing eating disorders. The majority of adolescents with restrictive eating disorders report a history of obesity in the past. Binge eating increases the risk of obesity and type 2 diabetes. [36]  Appropriate evaluation for eating disorders should be performed during the treatment planning of childhood obesity. 

Academic Performance 

Children who are obese and have comorbid health problems like diabetes, asthma, or sleep apnea miss school more frequently, thereby affecting their school performance negatively.

• Enhancing Healthcare Team Outcomes

Prevention is the best intervention to decrease the prevalence of obesity. The pediatrician should explore the risk of obesity and overweight during every clinical visit for all children.  

• Both bottle-fed and breastfed infants are at risk of overfeeding. However, overfeeding is more prevalent among bottle-fed infants. Exclusive breastfeeding and delayed initiation of solid foods may reduce the future risk of overweight. 
• Skim milk is a safe replacement for whole milk after two years of age. Parents or caretakers should never use food like sweets for a reward. The entire family should have a balanced diet that comprises less than 30 percent of calories from fat. AAP recommends consuming a variety of vegetables and fruits, whole grains, proteins, low-fat dairies and decreasing the intake of sodium, saturated fats, and refined sugars beginning at the age of two years. [37]
• An essential step in preventing obesity is reducing sedentary time. Limit the screen time, including television, video games, or mobile, not more than 2 hours per day for more than six-year-old children and not more than 1 hour per day for 2-6 years of age group. AAP strongly recommends not allowing kids less than two years to have screen time. [38]
• Encourage physical activity for children. Children aged 3 to 5 years should be active throughout the day. Children and adolescents ages 6 to 17 years should be physically active for at least 60 minutes every day. [39]
• As per CDC, 60% of middle school kids and 70% of high school kids do not meet the standard sleep recommendations. AAP recommends that children aged 1 to 2 years sleep 11 to 14 hours per day, children 3 to 5 years sleep 10 to 13 hours, children 6 to 12 years sleep 9 to 12 hours, and adolescents aged 13 to 18 years should regularly sleep 8 to 10 hours. [40]  Avoiding heavy meals close to bedtime, being physically active throughout the day, and removing electronic devices in the bedroom will help to get better sleep.  

The pediatrician should explore for associated morbidity in all obese children. The detailed assessment in obese children should include assessing cardiac comorbidities, orthopedic complications, and psycho-social complications.

• Reasonable weight-loss goals should be initially 5 to 10 pounds (2 kg to 4.5 kg) or a rate of 1 to 4 pounds (0.5 to 2 kg) per month.
• Dietary management:  Dieticians provide dietary prescriptions mentioning the total calories per day and recommended percentage of calories from carbohydrates, protein, and fat. The Traffic Light Plan is one method of providing dietary management. The Traffic Light Plan classifies foods as green (low energy density), yellow (moderate energy density), and red (high energy density). These categories help children in adopting healthier eating patterns.[41] The dietician plays a significant role in guiding the diet plan for the patients.
• Physical activity:  As per the fitness level, begin the physical activity with the goal of 30 minutes/day in addition to any school activity. Treatment should target gradually increasing the activity to 60 minutes per day. An exercise physiologist, along with the physician, can help the patients to achieve their target physical activity.
• Behavior modification:  Primary care-based behavioral interventions such as self-monitoring, nutritional education, improvement of eating habits, increasing physical activity, attitude change, and rewards help manage childhood obesity.
• Family involvement:  Review overall family activity and television viewing patterns and always involve parents in nutrition counseling. Family-based behavioral treatment is the most robust intervention for childhood obesity. [41]
• Psychotherapy:   Behavioral therapy and Cognitive therapy are commonly used by the psychologist in the management of obesity. Behavioral therapy trains patients to act differently around food, and cognitive therapy trains patients how to change their thoughts and emotions related to food.
• None of the anorexiant medications are FDA approved for use in childhood obesity. Orlistat is the only FDA-approved medication for use in adolescents. 
• Surgical procedures like gastric bypass have not been studied sufficiently in children to advise their use. 

An interprofessional team that provides a holistic and integrated approach can help achieve the best possible outcomes. Collaboration, shared decision making, and communication are key elements for a good outcome. Multidisciplinary teams include a primary physician, a dietician, a nurse or nurse practitioner, a clinical exercise physiologist, and a psychologist. The interprofessional team can provide a comprehensive weight loss program that benefits the patients.

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Disclosure: Palanikumar Balasundaram declares no relevant financial relationships with ineligible companies.

Disclosure: Sunil Krishna declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Balasundaram P, Krishna S. Obesity Effects on Child Health. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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