Potential pathways to the onset and development of eating disorders in people with overweight and obesity: A scoping review.

OBJECTIVE: To describe pathways to eating disorder (ED) development that have been evaluated in people with overweight and obesity. METHODS: Four databases were searched to identify studies testing ED development models in adolescents (10-19 years) or adults (>19 years) with overweight and obesity. Explanatory variables were thematically grouped into constructs to describe pathways to each ED outcome. RESULTS: Of 2226 studies screened, 46 (10 adolescent; 36 adult) were included. Study samples were predominantly female, ranging from 22 to 2236 participants and mean age 12.3 to 56.0 years. In total, 207 explanatory variables were grouped into 18 constructs to summarize 107 pathways that were identified. The most common ED outcome was binge eating (n = 24 studies), followed by global ED psychopathology (n = 10 studies). Across pathways to ED development, negative affect was the most proposed construct, followed by preoccupation with weight/shape and weight stigma. CONCLUSION: Pathways to ED development in people with overweight and obesity are complex and may include more than 18 different explanatory factors of which negative affect, preoccupation with weight/shape, and weight stigma are the most common. More research on adolescents, males, and the spectrum of ED in diverse populations is required for early identification and intervention.

Economic benefits of reducing childhood and adolescent overweight and obesity in Australia.

OBJECTIVES: The Australian Government, through the National Obesity Strategy 2022-2032, has set an aspirational goal of reducing the prevalence of childhood and adolescent overweight and obesity by 5% by 2030 (from 25% to 20%). Our objective was to quantify the long-term economic benefits of achieving this goal. METHODS: Using a microsimulation model and a synthetic cohort of Australian children and adolescents aged 4-17 years, we estimated the excess per capita lifetime costs of overweight and obesity. Using these results and population projections for 2030, we estimated the potential lifetime cost savings that could be achieved through attaining the National Obesity Strategy goal. RESULTS: Compared with their peers of a healthy weight, children and adolescents with overweight and obesity were estimated to incur, per capita, excess lifetime costs (discounted) of approximately $19 700 and $46 700, respectively (in 2030 Australian dollars). Achieving the National Obesity Strategy's goal was estimated to save approximately $7.44 billion, predominantly through reductions in lifetime obesity-related healthcare costs and premature mortality. CONCLUSION: Our results demonstrate the considerable economic benefits that could be achieved by reducing the current prevalence of childhood and adolescent overweight and obesity in Australia; they provide justification for investment in prevention and treatment for this demographic.

Efficacy, Safety and Acceptability of a Very-Low-Energy Diet in Adolescents with Obesity: A Fast Track to Health Sub-Study.

The aim of this study was to determine the efficacy, safety and acceptability of a 4-week very-low-energy diet (VLED) program for adolescents with obesity. Adolescents (13-17 years) with obesity and ≥1 obesity-related complication were Fast Track to Health 52-week randomized controlled trial participants. Adolescents undertook a 4-week micronutrient-complete VLED (800 kcal/day), with weekly dietitian support. Anthropometric data were recorded at baseline and week-4 and side-effects at day 3-4, week-1, -2, -3 and -4. Adolescents completed an acceptability survey at week-4. A total of 134 adolescents (14.9 ± 1.2 years, 50% male) had a 5.5 ± 2.9 kg (p < 0.001) mean weight loss at week-4: 95% experienced ≥1 and 70% experienced ≥3 side-effects during the VLED program, especially during the first week. Hunger, fatigue, headache, irritability, loose stools, constipation and nausea were most common. Reporting more side-effects at day 3-4 correlated with greater weight loss at week-4 (r = -0.188, p = 0.03). Adolescents reported 'losing weight' (34%) and 'prescriptive structure' (28%) as the most positive aspects of VLED, while 'restrictive nature' (45%) and 'meal replacement taste' (20%) were least liked. A dietitian-monitored short-term VLED can be implemented safely and is acceptable for many adolescents seeking weight loss, despite frequent side-effects. Investigating predictors of acceptability and effectiveness could determine adolescents most suited to VLED programs.

Responsive feeding practices among Arabic and Mongolian speaking migrant mothers in Australia: A qualitative study.

Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi-structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian-speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic-speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian-speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic-speaking mothers often supplemented with formula top-ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic-speaking mothers used food-based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure-feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds.

Symptoms of Depression, Eating Disorders, and Binge Eating in Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial.

Importance: Depression and eating disorders are heightened for adolescents with obesity. Clinical reviews alongside self-report questionnaires are important to ensure appropriate intervention. Objective: To evaluate changes in self-report symptoms of depression, eating disorders, and binge eating in adolescents with obesity during the Fast Track to Health trial. Design, Setting, and Participants: This was a randomized clinical trial conducted from 2018 to 2023. It was a multisite trial conducted at children's hospitals in Sydney, New South Wales, and Melbourne, Victoria, Australia, and included adolescents (13-17 years) with obesity (defined as adult equivalent body mass index ≥30; calculated as weight in kilograms divided by height in meters squared) and 1 or more related complications. Interventions: Duration was 52 weeks including a very low energy diet for 4 weeks followed by intermittent energy restriction (IER) or continuous energy restriction (CER). Main Outcomes and Measures: Self-report symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised 10-Item Version for Adolescents [CESDR-10]; scores 0-30), eating disorders (Eating Disorder Examination Questionnaire [EDE-Q]; scores 0-6), and binge eating (Binge Eating Scale [BES]; scores 0-46) were assessed. Adolescents were screened for depression and eating disorders (weeks 0, 4, 16, and 52) and monitored for the onset of new symptoms of disordered eating during dietetic consults. Results: Of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) enrolled, median baseline EDE-Q score was 2.28 (IQR, 1.43-3.14), median baseline CESDR-10 score was 9.00 (IQR, 4.00-14.50), and median baseline BES score was 11.00 (IQR, 5.00-17.00). There were no differences between groups for change in CESDR-10 (mean difference at week 52, 0.75; 95% CI, -1.86 to 3.37), EDE-Q (mean difference at week 52, 0.02; 95% CI, -0.41 to 0.45), or BES (mean difference at week 52, -2.91; 95% CI, -5.87 to 0.05). The within-group reductions at week 4 were maintained at week 52, for CESDR-10 and EDE-Q, indicating reduced symptoms of depression and eating disorders. Within-group reductions on the BES were maintained in the IER group only. Seventeen adolescents (12.1%) required support or referral for depression and/or disordered eating, including 7 (5%; 5 IER, 2 CER) adolescents who experienced the onset or reemergence of symptoms during the intervention. Conclusions and Relevance: Results suggest that many treatment-seeking adolescents with obesity self-reported symptoms of depression and eating disorders. Although symptoms reduced for most, some required additional support. Obesity treatment is an opportune time to screen and monitor for depression and disordered eating. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12617001630303.

Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial.

Importance: Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management. Objective: To examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity. Design, Setting, and Participants: This multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included. Interventions: Intensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52). Main Outcomes and Measures: The primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed. Results: A total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, -0.28 [95% CI, -0.37 to -0.20] for IER and -0.28 [95% CI, -0.36 to -0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, -9.56 [95% CI, -12.36 to -6.83] for IER and -9.23 [95% CI, -11.82 to -6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups. Conclusions and Relevance: These findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice. Trial Registration: http://anzctr.org.au Identifier: ACTRN12617001630303.

"What concerns me or what is most interesting to me": A qualitative study about what influences adolescent engagement with public health issues.

ISSUES ADDRESSED: Promoting public health messages in adolescence may influence future health outcomes. A better understanding of what influences adolescent engagement with public health issues is needed. METHODS: Adolescents aged 13-19 years from New South Wales, Australia, were recruited via study advertisements to participate in an online focus group. All provided informed consent and completed a short survey including demographics and selection of leading public health issues of concern. Participants attended a 75-90 min focus group conducted through Zoom teleconference that explored top public health issues of concern to participants, and barriers/enablers to engage with these issues. Qualitative data was thematically analysed using NVivo. A working group reached consensus on final themes. RESULTS: Out of 18 participants (mean 15.4 [SD: 2.2] years; 50% female), most attended high school (83%), spoke predominantly English at home (89%), and resided in metropolitan areas (94%). The top public health issues of concern selected were mental health (56%) and the environment/climate change (56%). From the thematic analysis, underlying drivers of adolescent engagement with public health issues included: personal connection to these issues, broader societal impact, and exposure to public health issues on digital media. Barriers included feeling unempowered, and a lack of support and opportunities. CONCLUSIONS: This study provides insights on the barriers and enablers of adolescents engaging with public health issues of concern to them. SO WHAT?: Understanding this may help health professionals and researchers to design more influential public health campaigns and interventions, including through co-design processes, which may improve future health outcomes.

An international multidisciplinary consensus on pediatric metabolic dysfunction-associated fatty liver disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in children and adolescents, particularly those with obesity. NAFLD is considered a hepatic manifestation of the metabolic syndrome due to its close associations with abdominal obesity, insulin resistance, and atherogenic dyslipidemia. Experts have proposed an alternative terminology, metabolic dysfunction-associated fatty liver disease (MAFLD), to better reflect its pathophysiology. This study aimed to develop consensus statements and recommendations for pediatric MAFLD through collaboration among international experts. METHODS: A group of 65 experts from 35 countries and six continents, including pediatricians, hepatologists, and endocrinologists, participated in a consensus development process. The process encompassed various aspects of pediatric MAFLD, including epidemiology, mechanisms, screening, and management. FINDINGS: In round 1, we received 65 surveys from 35 countries and analyzed these results, which informed us that 73.3% of respondents agreed with 20 draft statements while 23.8% agreed somewhat. The mean percentage of agreement or somewhat agreement increased to 80.85% and 15.75%, respectively, in round 2. The final statements covered a wide range of topics related to epidemiology, pathophysiology, and strategies for screening and managing pediatric MAFLD. CONCLUSIONS: The consensus statements and recommendations developed by an international expert panel serve to optimize clinical outcomes and improve the quality of life for children and adolescents with MAFLD. These findings emphasize the need for standardized approaches in diagnosing and treating pediatric MAFLD. FUNDING: This work was funded by the National Natural Science Foundation of China (82070588, 82370577), the National Key R&D Program of China (2023YFA1800801), National High Level Hospital Clinical Research Funding (2022-PUMCH-C-014), the Wuxi Taihu Talent Plan (DJTD202106), and the Medical Key Discipline Program of Wuxi Health Commission (ZDXK2021007).

Barriers and enablers to accessing child health resources and services: Findings from qualitative interviews with Arabic and Mongolian immigrant mothers in Australia.

BACKGROUND: Over the past two decades, there has been an increase of immigrants in Australia. Despite this, the availability of culturally responsive resources and services that cater to their needs remains insufficient. OBJECTIVE: The aim of this study was to explore the resources used and trusted by Mongolian- and Arabic-speaking migrant mothers in Australia for child health information and examine how they navigate and overcome challenges they encounter accessing this information. DESIGN: Semi-structured telephone interview. METHODS: A theory informed semi-structured 60-min telephone interview was conducted in Arabic and Mongolian with 20 Arabic- and 20 Mongolian-speaking migrant mothers of children younger than 2 years or currently pregnant and living in Australia. Data were analysed thematically using the framework method. RESULTS: The reliance on digital platforms such as google emerged as a common trend among both groups of mothers when seeking child health information. Notably, there were differences in resources selection, with Mongolian mothers showing a preference for Australian-based websites, while Arabic-speaking mothers tended to opt for culturally familiar resources. There were various barriers that hindered their access to health services and resources, including language barriers, cost, and limited knowledge or familiarity with their existence. Negative encounters with healthcare professionals contributed to a perception among many mothers that they were unhelpful. Both groups of mothers employed a cross-checking approach across multiple websites to verify trustworthiness of information. Acculturation was shown only among the Mongolian-speaking mothers who adapted their cultural practices in line with their country of residence. CONCLUSION: The findings of this study highlight the importance of addressing the needs of migrant mothers in accessing child health information. Health professionals, government agencies, and researchers have an opportunity to provide culturally responsive support by fostering a culturally inclusive approach to developing and promoting equitable access to services and resources, ultimately enhancing the wellbeing of migrant families.

Barriers and enablers to accessing child health resources and services: Findings from qualitative interviews with Arabic and Mongolian immigrant mothers in AustraliaMothers may experience barriers accessing resources and services related to child health behaviours after migration to Australia. Studies have found that parents actively seek health information and have a significant impact on their child's health behaviours, which can have long-term effects. Various factors influence parental decision-making regarding child health, including the socio-cultural environment, life experiences, and access to services and resources.This study reveals that both Arabic- and Mongolian-speaking migrant mothers heavily depend on online sources for accessing health information, primarily due to various barriers they face when accessing in person services, such as language constraints, financial limitations, and challenges in accessing healthcare services. This article also provides recommendations for future research and initiatives to be considered addressing the challenges faced by migrant mothers in accessing healthcare resources and services.

Differences in weight status among Australian children and adolescents from priority populations: a longitudinal study.

BACKGROUND AND SIGNIFICANCE: Australia has a high level of cultural and linguistic diversity, including Aboriginal and Torres Strait Islander peoples. Children from specific cultural and ethnic groups may be at greater risk of overweight and obesity and may bear the additional risk of socioeconomic disadvantage. Our aim was to identify differences in body-mass index z-score (zBMI) by: (1) Cultural and ethnic groups and; (2) Socioeconomic position (SEP), during childhood and adolescence. SUBJECTS/METHODS: We used data from the Longitudinal Study of Australian children (n = 9417) aged 2-19 years with 50870 longitudinal measurements of zBMI. Children were classified into 9 cultural and ethnic groups, based on parent and child's country of birth and language spoken at home. These were: (1) English-speaking countries; (2) Middle East & North Africa; (3) East & South-East Asia; (4) South & Central Asia; (5) Europe; (6) Sub-Saharan Africa; (7) Americas; (8) Oceania. A further group (9) was defined as Aboriginal and Torres Strait Islander from self-reported demographic information. Longitudinal cohort analyses in which exposures were cultural and ethnic group and family socioeconomic position, and the outcome was zBMI estimated using multilevel mixed linear regression models. We stratified our analyses over three periods of child development: early childhood (2-5 years); middle childhood (6-11 years); and adolescence (12-19 years). RESULTS: Across all three periods of child development, children from the Middle East and North Africa, the Americas and Oceania were associated with higher zBMI and children from the two Asian groups were associated with lower zBMI, when compared to the referent group (English). zBMI was socioeconomically patterned, with increasingly higher zBMI associated with more socioeconomic disadvantage. CONCLUSIONS: Our findings identified key population groups at higher risk of overweight and obesity in childhood and adolescence. Prevention efforts should prioritize these groups to avoid exacerbating inequalities in healthy weight in childhood.

Changing the global obesity narrative to recognize and reduce weight stigma: A position statement from the World Obesity Federation.

Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public-facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.

Parental smoking in the first two years of a child's life and its associations with breastfeeding.

BACKGROUND: Exclusive breastfeeding for the first 6 months followed by ongoing breastfeeding to 12 months and beyond is associated with multiple benefits for both mother and child. Maternal smoking is associated with a reduction in breastfeeding. Little is known about the effect of partner smoking on breastfeeding. AIMS: This study explores the smoking behaviour of mothers and their partners in the first two years of a child's life and its associations with breastfeeding practice. MATERIALS AND METHODS: We performed a secondary data analysis using survey data on 1155 mothers from their third trimester of pregnancy and at six, 12 and 24 months after delivery. Survey questions included smoking status of both mother and partner and breastfeeding intention and practice. Logistic regression models were conducted at each time point. FINDINGS: Where the mother or both parents smoke, babies were less likely to be breastfed at six months of age (adjusted odds ratio (aOR) 0.29, 95% CI: 0.13-0.66) compared with families where neither parent smoked. Non-smoking mothers with smoking partners were less likely to intend to breastfeed (aOR 0.29, 95% CI: 0.11-0.82) and their babies were less likely to be breastfed at six and 12 months of age (aOR 0.64, 95% CI: 0.42-0.98 and 0.64, 95% CI: 0.43-0.95 respectively). There was no difference in breastfeeding behaviour between smoking and non-smoking parents at 24 months. CONCLUSION: Smoking parents are less likely to breastfeed their babies at ages six and 12 months. Breastfeeding promotion should target both smoking mothers and smoking partners.

Mothers' sociodemographic factors and use of health professionals for child feeding advice.

This study examined sociodemographic factors associated with mothers seeking child feeding advice from health professionals (HPs). Cross-sectional analysis of survey data from linked randomized controlled trials was conducted. Surveys asked which sources of feeding information mothers used when their child was 6 months and 5 years old. Logistic regression was used to examine associations between sociodemographic characteristics and use of information from HPs. Here, 947 and 405 mothers completed 6-month and 5-year surveys, respectively. At 6 months, multiparous mothers were less likely to seek advice from child and family health nurses (CFHNs) (adjusted odds ratio [AOR]: 0.558, 95% confidence interval [95% CI]: 0.416-0.749) and other HPs (AOR: 0.706, 95% CI: 0.542-0.919), unmarried mothers were less likely to seek advice from other HPs (AOR: 0.582, 95% CI: 0.342-0.990). At 5 years, mothers with household income ≥$80,000 p.a. were less likely to seek advice from CFHNs (AOR: 0.514, 95% CI: 0.302-0.875) and working mothers less likely to seek advice from general practitioners (GPs) (AOR: 0.581, 95% CI: 0.374-0.905). Mothers born in Australia were less likely to seek information from CFHNs (AOR: 0.462, 95% CI: 0.257-0.833) and GPs (AOR: 0.431, 95% CI: 0.274-0.677). There was a greater likelihood that multiparous mothers (AOR: 2.114, 95% CI: 1.272-3.516) and mothers of children whose fathers had not attended university (AOR: 2.081, 95% CI: 1.256-3.449) had never sought advice from CFHNs, and that mothers who had not attended university (AOR: 1.769, 95% CI: 1.025-3.051), multiparous (AOR: 1.831, 95% CI: 1.105-3.035) and employed (AOR: 2.058, 95% CI: 1.135-3.733) mothers had never sought advice from other HPs. Understanding sociodemographic factors associated with seeking child feeding advice from HPs may inform priorities for engaging families in health promotion.

Associations of dietary and sedentary behaviours of pregnant women with their children's birth weight: findings from the CHAT trial in Australia.

OBJECTIVE: To examine the associations of pregnant women's dietary and sedentary behaviours with their children's birth weight. DESIGN: Secondary data analysis was conducted using data from a randomised controlled trial, Communicating Healthy Beginnings Advice by Telephone, conducted in Australia. Information on mothers' socio-demographics, dietary and sedentary behaviours during pregnancy was collected by telephone survey at the third trimester. Birth weight data were extracted from the child's health record book. Multinomial logistic regression models were built to examine the associations of pregnant women's dietary and sedentary behaviours with children's birth weight. SETTING: Participating families. PARTICIPANTS: Pregnant women and their children. RESULTS: A total of 1132 mother-child dyads were included in the analysis. The majority of infants (87 %, n 989) were of normal birth weight (2500 g to <4000 g), 4 % (n 50) had low birth weight (<2500 g) and 8 % (n 93) had macrosomia (≥4000 g). Mothers who ate processed meat during pregnancy were more likely to have macrosomia (adjusted risk ratio (ARR) 1·80, 95 % CI (1·12, 2·89)). The risk of macrosomia decreased as the number of dietary recommendations met by mothers increased (ARR 0·84, 95 % CI (0·71, 0·99)). Children's birth weight was not associated with mothers' sedentary time. Children's low birth weight was not associated with mothers' dietary and sedentary behaviours during pregnancy. CONCLUSION: Maternal consumption of processed meat during pregnancy was associated with an increased risk of macrosomia. Increasing number of dietary recommendations met by mothers was associated with a lower risk of macrosomia. The findings suggested encouraging pregnancy women to meet dietary recommendation will benefit children's birth weight.

Role of Pediatricians in Promoting and Supporting Breastfeeding: A Position Paper of the International Pediatric Association Strategic Advisory Group on Infant, Child, and Adolescent Nutrition.

BACKGROUND: Promoting and supporting breastfeeding is an important public health intervention with multiple benefits for both infants and mothers. Even modest increases in the prevalence and duration of breastfeeding could significantly reduce healthcare costs and improve maternal and child health outcomes. However, widespread adoption of breastfeeding recommendations remains poor in most settings, which contributes to widening health and social inequalities. Pediatricians have a duty to advocate for improving child health, including promoting and supporting breastfeeding. SUMMARY: This paper, from the International Pediatric Association Special Advisory Group on Nutrition, considers common barriers to breastfeeding and addresses how pediatricians can better promote and support breastfeeding, both at an individual level and by influencing practice and policy. All pediatricians need to understand the basics of breastfeeding, including lactation physiology, recognize common breastfeeding problems, and advise mothers or refer them for appropriate support; training curricula for general pediatricians and all pediatric subspecialties should reflect this. Even in the situation where their day-to-day work does not involve direct contact with mothers and infants, pediatricians can have an important influence on policy and practice. They should support colleagues who work directly with mothers and infants, ensuring that systems and environments are conducive to breastfeeding and, where appropriate, milk expression. Pediatricians and pediatric organizations should also promote policies aimed at promoting and supporting breastfeeding at local, regional, national, and international levels. KEY MESSAGES: Pediatricians have a duty to promote and support breastfeeding, regardless of their day-to-day role and responsibilities. Pediatric training curricula should ensure that all trainees acquire a good understanding of breastfeeding so they are able to effectively support mothers in their personal practice but also influence breastfeeding practice and policy at a local, regional, national, and international level.

Resources used and trusted regarding child health information by culturally and linguistically diverse communities in Australia: An online cross-sectional survey.

BACKGROUND: Parents' play a proactive role in seeking health information to ensure optimal growth and development for their children. To date, very little is known about the differences between information seeking behaviour for child health and engagement with resources between culturally and linguistically diverse (CALD) and non-CALD parents. OBJECTIVE: To investigate the differences in resources used and trusted for information related to child health behaviours and engagement with online features among CALD and non-CALD respondents in Australia. METHODS: An analysis of a theory informed online cross-sectional survey was conducted using data from 122 CALD and 399 non-CALD parents who had a child younger than 24 months or were currently pregnant in Australia. Descriptive statistics and chi-squared were used to compare the differences, and logistic regression models were used to identify factors associated with using health resources. RESULTS: The most trusted sources for information reported by respondents were health professionals (76.2 %), websites run by health professionals (59.5 %), and government websites (53.2 %). Social media was significantly more trusted as a source of information for child health behaviours among CALD respondents than non-CALD respondents (odds ratio (OR) 1.92, P = 0.01). In contrast, booklets/ pamphlets and friends were significantly more trusted by non-CALD parents than for CALD parents (OR 0.54, P = 0.02). General search engines were used very frequently among CALD respondents for child health information (39.3 % vs 24.1 %, p = 0.013). Overall, the most common features respondents enjoyed on websites were images (81 %), videos (40.1 %), and discussion forums (39.9 %). CALD respondents significantly favoured videos (p = 0.003) while non-CALD respondents preferred obtaining information through attachments (p < 0.001). CONCLUSIONS: Despite parents' reporting health professionals, websites run by health professionals, and government websites as trustworthy, general search engines and social media were still the most frequently used information source for parents with young children. Credible resources parents deem as trustworthy should take into account effective and engaging means of disseminating information that are accessible to both CALD and non-CALD communities.

Communication strategies and effectiveness of early childhood obesity-related prevention programs for linguistically diverse communities: A rapid review.

Children from culturally and linguistically diverse backgrounds experience higher rates of obesity and have poorer outcomes in obesity prevention studies. Interventions tailored to specific cultural groups may be limited within linguistically diverse, multicultural communities, and thus, alternative approaches to childhood obesity prevention in these communities are needed. This study aims to describe communication strategies used in interventions targeting prevention of obesity/obesity-related behaviors, among children 0-5 years, from linguistically diverse communities, and assess their effectiveness. A rapid review was conducted by systematically searching Medline, Embase, and CINAHL. The inclusion criteria are as follows: Studies reported an intervention tailored to linguistically diverse communities targeting at least one obesity-related behavior among children 0-5 years. The exclusion criteria are as follows: Interventions used simple language translations, targeted one language group, or treated obesity. A total of 4677 articles were identified with 14 studies meeting inclusion criteria. Key communication strategies included materials in multiple languages, English text written at a set readability level, and multimodal delivery. Six studies reported effectiveness data, of which five had effective primary or secondary outcomes. This is the first rapid review to identify communication strategies used in childhood obesity prevention interventions for linguistically diverse communities, highlighting a need for future research to incorporate and evaluate the communication strategies identified.

Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management.

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

Participant recruitment for paediatric research using social media: A practical 'how-to' guide for researchers.

AIM: Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies. METHODS: The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process. RESULTS: A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase. CONCLUSION: Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with, and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.

Child and adolescent obesity.

The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.