Diabetes screening outcomes in youth presenting for paediatric weight management: A report of the Paediatric Obesity Weight Evaluation Registry.

OBJECTIVE: Rising prevalence of obesity has led to increased rates of prediabetes and diabetes mellitus (DM) in children. This study compares rates of prediabetes and diabetes using two recommended screening tests (fasting plasma glucose [FPG] and haemoglobin A1c [HbA1c]). STUDY DESIGN: Data were collected prospectively from 37 multi-component paediatric weight management programs in POWER (Paediatric Obesity Weight Evaluation Registry). RESULTS: For this study, 3962 children with obesity without a known diagnosis of DM at presentation and for whom concurrent measurement of FPG and HbA1c were available were evaluated (median age 12.0 years [interquartile range, IQR 9.8, 14.6]; 48% males; median body mass index 95th percentile [%BMIp95] 134% [IQR 120, 151]). Notably, 10.7% had prediabetes based on FPG criteria (100-125 mg/dL), 18.6% had prediabetes based on HbA1c criteria (5.7%-6.4%), 0.9% had DM by FPG abnormality (≥126 mg/dL) and 1.1% had DM by HbA1c abnormality (≥6.5%). Discordance between the tests was observed for youth in both age groups (10-18 years [n = 2915] and age 2-9 years [n = 1047]). CONCLUSION: There is discordance between FPG and HbA1c for the diagnosis of prediabetes and DM in youth with obesity. Further studies are needed to understand the predictive capability of these tests for development of DM (in those diagnosed with prediabetes) and cardiometabolic risk.

Treating Children and Adolescents With Obesity: Characteristics of Success.

Background: Factors related to clinically meaningful outcomes for pediatric patients seeking care for severe obesity are not well known. Examining patient-level and program-level characteristics related to success may inform future care. Objectives: To determine factors associated with a clinically significant reduction in weight status measured by %BMIp95 after 6 months of treatment. Study Design: This is a retrospective study of youth 5-17 years of age seeking multicomponent weight management care to determine if patient characteristics, treatment recommendations, reported adherence, and additional program-affiliated class participation are associated with 6-month change in %BMIp95. Results: Among 170 children with obesity, higher reductions in %BMIp95 were seen in those with medium-high dietary adherence compared to low-none (-10.8 vs. -4.0, p = 0.002). Post hoc analysis showed higher dietary adherence among those with private insurance than public insurance (59% vs. 41%, respectively, p = 0.04). Conclusion: Children receiving multidisciplinary multicomponent weight management, who achieve clinically meaningful outcomes, are more likely to be adherent to dietary recommendations regardless of the type. Further study is needed of how best to address social determinants of health to improve dietary adherence. Clinical Trial Registration Number: NCT02121132.

Seasonal variability in body mass index change among children enrolled in the Pediatric Obesity Weight Evaluation Registry: A step in the right direction.

BACKGROUND: Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs. OBJECTIVE: To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). METHOD: Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter. RESULTS: Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26). CONCLUSION AND RELEVANCE: Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time.

Challenges and solutions to sustaining paediatric weight management programs in the United States.

Paediatric weight management (PWM) programs in the United States (US) face challenges in providing sustainable multidisciplinary care for patients. The aim of this study was to report PWM program approaches to sustaining program delivery. A survey of 39 PWM programs was administered to identify challenges and solutions to program sustainability. Common and useful strategies for optimizing reimbursement for services included the use of applicable reimbursable diagnostic codes and management, billing for assessments and non-medical personnel services, and the use of hospital outpatient department clinic billing. Increasing clinical breadth and capacity was achieved by offering telemedicine and other services, such as psychotherapy, pharmacotherapy, and metabolic and bariatric surgery, as well as active management of schedules. Securing institutional and extramural funding was also reported. One of the positive changes during the pandemic was the fast adoption of telemedicine services. Although delivering sustainable evidence-based multidisciplinary PWM under the current US payment models has its challenges, PWM programs implement practical operational strategies to support this work.

Patient Retention in Pediatric Weight Management Programs in the United States: Analyses of Data from the Pediatrics Obesity Weight Evaluation Registry.

Objective: Meeting recommended provider contact hours in multicomponent pediatric weight management (PWM) programs is difficult when patient retention is low. Our objective was to examine associations between individual patient characteristics, program characteristics, and patient retention. Methods: Using the Pediatric Obesity Weight Evaluation Registry, a prospective longitudinal study of 32 PWM programs, we included children (≤18 years; n = 6502) enrolled for a full year. We examined associations between retention (any follow-up visit) and patient and program characteristics using multivariable models with site-clustering random effects. Results: Sixty-seven percent of children had at least one follow-up visit, whereas 12% had four or more visits. Compared with non-Hispanic white children, non-Hispanic black children were less likely to have a follow-up visit [adjusted odds ratio (aOR) = 0.79], whereas Hispanic children (any race) were more likely (aOR = 1.22). Children with Medicaid had similar retention to those with private insurance. Retention did not differ by age, gender, weight status, or comorbidities, nor by program characteristics. Conclusions: Few characteristics of PWM programs are clearly associated with retention, indicating that a variety of formats can support continued treatment and likely reflect the influence of unmeasured characteristics. Clearer ways to identify and overcome barriers for individual patients will be needed to improve retention in PWM.

The Impact of Obesity on Disease Severity and Outcomes Among Hospitalized Children With COVID-19.

OBJECTIVE: To describe the impact of obesity on disease severity and outcomes of coronavirus disease 2019 (COVID-19) among hospitalized children. METHODS: This retrospective cohort study from the Society of Critical Care Medicine Viral Respiratory Illness Universal Study registry included all children hospitalized with COVID-19 from March 2020 to January 2021. Obesity was defined by Centers for Disease Control and Prevention BMI or World Health Organization weight for length criteria. Critical illness definition was adapted from National Institutes of Health criteria of critical COVID. Multivariate mixed logistic and linear regression was performed to calculate the adjusted odds ratio of critical illness and the adjusted impact of obesity on hospital length of stay. RESULTS: Data from 795 patients (96.4% United States) from 45 sites were analyzed, including 251 (31.5%) with obesity and 544 (68.5%) without. A higher proportion of patients with obesity were adolescents, of Hispanic ethnicity, and had other comorbidities. Those with obesity were also more likely to be diagnosed with multisystem inflammatory syndrome in children (35.7% vs 28.1%, P = .04) and had higher ICU admission rates (57% vs 44%, P < .01) with more critical illness (30.3% vs 18.3%, P < .01). Obesity had more impact on acute COVID-19 severity than on multisystem inflammatory syndrome in children presentation. The adjusted odds ratio for critical illness with obesity was 3.11 (95% confidence interval: 1.8-5.3). Patients with obesity had longer adjusted length of stay (exponentiated parameter estimate 1.3; 95% confidence interval: 1.1-1.5) compared with patients without obesity but did not have increased mortality risk due to COVID-19 (2.4% vs 1.5%, P = .38). CONCLUSION: In a large, multicenter cohort, a high proportion of hospitalized children from COVID-19 had obesity as comorbidity. Furthermore, obesity had a significant independent association with critical illness.

Cross-sectional comparisons of gut microbiome and short-chain fatty acid levels among children with varied weight classifications.

BACKGROUND: Limited studies associate changes in microbiota composition and metabolites among children and adolescents with obesity. Decreases in compositional diversity, increases in the proportion of Firmicutes and Bacteroidetes (F/B ratio) and increases in short-chain fatty acids (SCFAs) have been proposed as contributing factors in the pathophysiology of obesity. OBJECTIVES: The aim of the current study was to characterize the faecal microbiota composition, diversity, F/B ratio and SCFA levels in different weight categories (lean, overweight, obesity classes 1-3) of children ages 5 to 12 years. METHODS: We collected and processed 83 samples from different weight categories (27.7% lean, 11% overweight, 15%, 17% and 17% of obesity classes 1, 2, and 3, respectively). Microbiota content was determined by sequencing the V4 region of the 16S rRNA gene, and SCFA content was analyzed. RESULTS: Microbiota compositions showed no significant differences in diversity or F/B ratios between weight categories. However, a relative abundance of Proteobacteria and lack of Verrucomicrobia were demonstrated when comparing severe obesity to the leaner groups. Faecal butyrate, propionate and isopentanoate concentrations increased progressively with weight category demonstrating significance in the class 3 obesity group. CONCLUSIONS: Our results show that severe childhood obesity in our study population was associated with changes in gut microbiome composition correlated to previously reported cardiometabolic disease states in obesity. Increased SCFA levels correlate with obesity-related microbiome metabolic function without a reduction in diversity characterized at a phyla level. Further characterization of these specimens at a species level and longitudinal studies are needed to elucidate these relationships.

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

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

Electronic Gaming Characteristics Associated with Class 3 Severe Obesity in Youth Who Attend the Pediatric Weight Management Programs of the COMPASS Network.

BACKGROUND: The prevalence of severe obesity and electronic game use among youth has increased over time. METHODS: We administered a survey assessing gaming and psycho-demographic characteristics to youth aged 11-17 attending five weight management programs. We conducted chi-square and logistic regression analyses to describe the association between class 3 severe obesity and gaming characteristics. RESULTS: Four hundred twelve youth (51% female, 26% Black, 25% Hispanic, 43% White, and 44% with class 3 severe obesity) completed the survey. There was a stepwise relationship between time spent gaming and class 3 severe obesity, with 28% of those playing 2 to <4 hours a day, 48% of those playing 4 to <6 hours a day, and 56% of those playing ≥6 hours a day having class 3 severe obesity (p = 0.002). Compared to youth without class 3 severe obesity, youth with class 3 severe obesity were more likely to have a TV in the bedroom (76% vs. 63%, p = 0.004) and play games on a console (39% vs. 27%, p = 0.03) and were less likely to report parental limit setting on type of games played (7% vs. 16%, p = 0.006). Youth who played games ≥4 hours a day were 1.94 times (95% confidence interval 1.27-3.00) more likely to have class 3 severe obesity than those who played <4 hours a day, after adjustment for demographic, behavioral, and academic variables. CONCLUSIONS: Our study demonstrates a clear association between gaming characteristics, especially time spent gaming, and severe obesity in youth. Further research testing family-based interventions that target gaming behaviors in youth are needed.

Application of the Medical Neighborhood to Children with Severe Obesity.

BACKGROUND: Growth in the prevalence of severe pediatric obesity and tertiary care pediatric weight management programs supports the application of chronic disease management models to the care of children with severe obesity. One such model, the medical neighborhood, aims to optimize care coordination between primary and tertiary care by applying principles of the Patient-Centered Medical Home to all providers. METHODS: An exploration of the literature was performed describing effective programs, approaches, and coordinated care models applied to pediatric weight management and other chronic conditions. RESULTS: Though there was a paucity of literature discovered with applications specific to pediatric weight management, relevant disease management and care coordination approaches were found. Proposed applications to the care of children with severe obesity can be made. CONCLUSION: The application of the medical neighborhood framework, with its inclusion of healthcare and community partners, may optimize the management of children with severe obesity.

Community Healthcare and Technology to Enhance Communication in Pediatric Obesity Care.

Childhood obesity continues to be a critical healthcare issue and a paradigm of a pervasive chronic disease affecting even our youngest children. When considered within the context of the socioecological model, the factors that influence weight status, including the social determinants of health, limit the impact of multidisciplinary care that occurs solely within the medical setting. Coordinated care that incorporates communication between the healthcare and community sectors is necessary to more effectively prevent and treat obesity. In this article, the Expert Exchange authors, with input from providers convened at an international pediatric meeting, provide recommendations to address this critical issue. These recommendations draw upon examples from the management of other chronic conditions that might be applied to the treatment of obesity, such as the use of care plans and health assessment forms to allow weight management specialists and community personnel (e.g., school counselors) to communicate about treatment recommendations and responses. To facilitate communication across the healthcare and community sectors, practical considerations regarding the development and/or evaluation of communication tools are presented. In addition, the use of technology to enhance healthcare-community communication is explored as a means to decrease the barriers to collaboration and to create a web of connection between the community and healthcare providers that promote wellness and a healthy weight status.

Dehydration: A Multidisciplinary Case-Based Discussion for First-Year Medical Students.

Introduction: As many medical school curricula shift to integrated learning of multiple basic science topics as well as clinical concepts, there is an increasing need for instructional materials that incorporate multiple topics yet are targeted to the knowledge basis of first-year medical students. This interactive case-based session for first-year medical students centers on the clinical presentation and initial evaluation of a patient experiencing dehydration after running a marathon in a high-altitude city. Methods: After completion of assigned out-of-class preparation, students followed the patient from a healthy state to moderate dehydration over the course of two 2-hour class sessions. Throughout discussion of the case, students answered questions requiring them to integrate elements of cell biology, biochemistry, physiology, and clinical reasoning with minimal faculty involvement. The learning activity was administered at University of Illinois College of Medicine campuses in both a small-group setting (10 students, one faculty facilitator) and a large-group format (55-90 students, multiple faculty facilitators). Following the activity, we assessed student perceptions of the design and implementation of the materials as well as effectiveness at meeting the learning goals. Results: Of 198 students who participated in the case discussions on dehydration, the majority rated the case positively, indicated by a rating of good or excellent. Discussion: This multidisciplinary case on dehydration can be used early in medical education to introduce students to clinical scenarios while learning fundamental science content. An integrated approach to medical content and versatility with regard to class size make this case a valuable teaching tool.

Weight Loss Surgery in Adolescents.

Childhood obesity continues to be a national health problem, with growing numbers of adolescents (8.7%) affected by severe obesity and its associated cardiometabolic risks. Since current nonsurgical methods for treating these adolescents have only modest effects, weight loss surgery (WLS) is an alternative treatment. An overview of the literature was conducted describing the selection, management, and outcomes of adolescents undergoing WLS. Adolescent guidelines require physical and emotional maturity as well as serious comorbidities associated with body mass index cutoffs higher than those used for adults. Medium-term to long-term outcomes are similar to those of adults undergoing WLS. Such outcomes depend on management by a multidisciplinary team with expertise in caring for adolescents who are still developing psychosocially and who are relatively more dependent on family supports for continued care. Future exploration is needed to elucidate optimal surgical indications for adolescents, improved adherence to postoperative care, and the impact of WLS on life expectancy. Resulting evidence can better inform the direction for healthcare delivery and policy directed toward this at-risk population.

Problem Video Gaming Among Children Enrolled in Tertiary Weight Management Programs.

Prior studies show seven percent to nine percent of children demonstrate gaming behaviors that affect a child's ability to function (e.g., problem gaming), but none have examined the association between problem gaming and weight status. The objective of this study was to determine the prevalence of problem gaming among children enrolled in tertiary weight management programs. We administered a computer-based survey to a convenience sample of children aged 11-17 years enrolled in five geographically diverse pediatric weight management (PWM) programs in the COMPASS (Childhood Obesity Multi-Program Analysis and Study System) network. The survey included demographics, gaming characteristics, and a problem gaming assessment. The survey had 454 respondents representing a diverse cohort (53 percent females, 27 percent black, 24 percent Hispanic, 41 percent white) with mean age of 13.7 years. A total of 8.2 percent of respondents met criteria for problem gaming. Problem gamers were more likely to be white, male, play mature-rated games, and report daily play. Children in PWM programs reported problem gaming at the same rate as other pediatric populations. Screening for problem gaming provides an opportunity for pediatricians to address gaming behaviors that may affect the health of children with obesity who already are at risk for worsened health and quality of life.

Expectations for Treatment in Pediatric Weight Management and Relationship to Attrition.

BACKGROUND: Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition. PATIENTS AND METHODS: A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months. RESULTS: From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 children <12 years). Of the 203 adolescents, 160 also self-reported. Attrition rate was 42.2% at 3 months. For adolescents, greater interest in family support/behavior skills was associated with decreased odds of attrition at 3 months [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.98, p = 0.04]. The more discordant the parent/adolescent dyad responses in this category, the higher the odds of attrition at 3 months (OR 1.36, 95% CI 1.04-1.78, p = 0.02). Weight loss was an important weight management goal for both adolescents and parents. For adolescents with this goal, the median weight-loss goal was 50 pounds. Attrition was associated with adolescent weight-loss goals above the desired median (50% above the median vs. 28% below the median, p = 0.02). CONCLUSIONS: Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on family-based change and realistic goal setting. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT01753063.

Exergaming for Health: A Randomized Study of Community-Based Exergaming Curriculum in Pediatric Weight Management.

OBJECTIVE: To evaluate the effectiveness and sustainable impact of a multifaceted community-based weight intervention program for children, including exergaming curriculum. METHODS: Eighty overweight or obese children, aged 8-12 years, were randomly assigned in a 2:1 ratio to an Exergaming for Health intervention group, comprising both exergaming and classroom curriculum, or to a control group with classroom curriculum alone. Outcome measures included body mass index (BMI), z-score change, and shuttle runs to assess cardiorespiratory endurance. RESULTS: Fifty-nine participants took part in the intervention and 21 in the control group, with 35 and 13 completing 6-month follow-up, respectively. Twenty-eight intervention children were followed-up at 1 year. At the end of the 6-month intervention, the intervention group reduced its BMI z-score by -0.06 (±0.12) compared to 0 (±0.09) change for the control group; additionally, intervention subjects were two shuttle runs higher than control. However, these differences were not statistically significant (P = 0.07 and P = 0.09, respectively). Over the 6-month period after the program, the intervention group did not have an increase in weight status (BMI z-score change -0.01 [95% confidence interval -0.08 to +0.06], P = 0.76). CONCLUSIONS: Use of exergaming in community pediatric weight management did not improve weight status at the end of programming, and study implementation was limited by small sample and missing data. However, there were clinically promising trends in fitness, screen time, and caloric intake. Weight status of intervention participants did not rebound 6 months after programming. Larger, longer term studies are needed to establish the impact of videogaming interventions.

Social/Electronic Media Use of Children and Adolescents Who Attend the Pediatric Weight Management Programs of the COMPASS Network.

BACKGROUND: Obesity is a major healthcare problem in youth and their social/electronic media (SEM) use has been described as a risk factor. Though much is known about the newer technologies youth use to communicate, little is known about what is used by those in weight management programs. The aim of this study was to determine what types of SEM, including sedentary and active video games, youth in weight management programs use and which they prefer for communicating with healthcare providers. METHODS/DESIGN: This was a multisite study using a 24-question online SurveyMonkey® questionnaire. Youth, 12-17 years old, attending pediatric weight management programs at seven participating centers in the Childhood Obesity Multi Program Analysis and Study System network were eligible. RESULTS: There were 292 responders with a mean age of 14.2 years. Fifty-four percent were female, 36% Caucasian, 35% African American, and 33% were Hispanic. Ninety-four percent had access to a computer, 71% had Internet access, and 63% had smartphones. Whereas 87% had at least one gaming system at home, 50% reported they never played sedentary video games (71% of females vs. 25% males; p < 0.0001) and 63% never played exercise video games during the week. The preferred method of communication with a healthcare provider was face to face (60%), with few indicating a preference for communication by texting (13%), phone (12%), or social media (6%). CONCLUSIONS: Face-to-face communication with healthcare providers is the preferred method for youth in pediatric weight management programs. They self-reported video game use less than previously described.

Pairing motivational interviewing with a nutrition and physical activity assessment and counseling tool in pediatric clinical practice: a pilot study.

BACKGROUND: Recommendations to screen and counsel for lifestyle behaviors can be challenging to implement during well-child visits in the primary care setting. A practice intervention was piloted using the Family Nutrition and Physical Activity (FNPA) Screening Tool paired with a motivational interviewing (MI)-based counseling tool during well-child visits. Acceptability and feasibility of this intervention were assessed. Its impact on parent-reported obesigenic behavior change and provider efficacy in lifestyle counseling were also examined. METHODS: This was an observational study in a pediatric primary care office. During well-child visits of 100 patients (ages 4-16 years), the FNPA tool was implemented and providers counseled patients in an MI-consistent manner based on its results. Duration of implementation, patient satisfaction of the intervention, and success of stated lifestyle goals were measured. Provider self-efficacy and acceptability were also surveyed. RESULTS: The FNPA assessment was efficient to administer, requiring minutes to complete and score. Patient acceptability was high, ranging from 4.0 to 4.8 on a 5-point scale. Provider acceptability was good, with the exception of duration of counseling; self-efficacy in assessing patient "readiness for change" was improved. Parent-reported success of primary lifestyle goal was 68% at 1 month and 46% at 6 months. CONCLUSIONS: The FNPA assessment with an MI-based counseling tool shows promise as an approach to identify and address obesigenic behaviors during pediatric well-child visits. It has the potential to improve provider efficacy in obesity prevention and also influence patient health behaviors, which can possibly impact childhood excessive weight gain. After refinement, this practice intervention will be used in a larger trial.

Exergaming for health: a community-based pediatric weight management program using active video gaming.

OBJECTIVE: To evaluate the efficacy and feasibility of a multifaceted, community-based weight intervention program for children using exergaming technology (activity-promoting video gaming). DESIGN AND METHODS: This is a prospective observational pilot study. Forty-eight children, between the ages of 8 and 16 years, who are overweight or obese, enrolled in Exergaming for Health, a multidisciplinary weight management program, which used active video gaming. Primary outcome measures were change in body mass index (BMI) z scores. RESULTS: Most children (n = 40, 83%) completed the program and participated in outcome evaluations. The average BMI change was -0.48 kg/m(2) (SD = 0.93), P < .002 (BMI z-score change was -0.072, SD = 0.14, P < .0001). The average Global Self-Worth score improved, screen time and soda intake reduced, and exercise hours per week increased. CONCLUSIONS: The Exergaming for Health program may be an effective weight management intervention that is feasible with high participation rates. A larger randomized controlled trial is needed to confirm these results.