Nucleus accumbens cytoarchitecture predicts weight gain in children.

The prevalence of obesity in children and adolescents worldwide has quadrupled since 1975 and is a key predictor of obesity later in life. Previous work has consistently observed relationships between macroscale measures of reward-related brain regions (e.g., the nucleus accumbens [NAcc]) and unhealthy eating behaviors and outcomes; however, the mechanisms underlying these associations remain unclear. Recent work has highlighted a potential role of neuroinflammation in the NAcc in animal models of diet-induced obesity. Here, we leverage a diffusion MRI technique, restriction spectrum imaging, to probe the microstructure (cellular density) of subcortical brain regions. More specifically, we test the hypothesis that the cell density of reward-related regions is associated with obesity-related metrics and early weight gain. In a large cohort of nine- and ten-year-olds enrolled in the Adolescent Brain Cognitive Development (ABCD) study, we demonstrate that cellular density in the NAcc is related to individual differences in waist circumference at baseline and is predictive of increases in waist circumference after 1 y. These findings suggest a neurobiological mechanism for pediatric obesity consistent with rodent work showing that high saturated fat diets increase gliosis and neuroinflammation in reward-related brain regions, which in turn lead to further unhealthy eating and obesity.

Are we underestimating overweight and obesity prevalence in children?

OBJECTIVE: To objectively determine the prevalence of overweight and obesity in elementary school children in two rural counties in Vermont prior to implementing a community-based intervention. METHODS: School-based objective measures of body mass index (BMI) were obtained from 1,688 public school children in first, third, and fifth grades in two Northern Vermont counties in the Fall of 2017. RESULTS: Forty-one percentage of elementary school children were either overweight or obese, nearly double the estimated Vermont prevalence rate of 22.2%. Schools located in more rural areas showed higher levels of overweight and obesity in children than schools in less rural areas in these northern counties (p < .005). CONCLUSIONS: Indirect and self-reported measures of BMI may be underestimating the true prevalence of overweight and obesity particularly in more rural communities. POLICY IMPLICATIONS: Data presented here in which children were measured directly by trained study staff demonstrate that the prevalence of obesity among children in elementary school is alarmingly high. Accurate, ongoing BMI measurement surveillance is one tool to better understand both the current trends in childhood overweight and obesity and the effect of community and state interventions.

Psychometric properties for the Children's Power of Food Scale in a diverse sample of pre-adolescent youth.

PURPOSE: The Children's Power of Food Scale measures appetitive responsiveness across three domains, food available, food present, and food tasted but not eaten, and a total aggregate score. Although validated in adult populations it has not been tested in youth. The purpose was to establish psychometric properties for the Children's Power of Food Scale (C-PFS) for use in youth. METHODS: Six content experts were recruited to establish content validity (CVI). Reliability was established using 2-week test-retest procedures following lunch period in 47 ethnically diverse 10-14 year olds. RESULTS: CVI for the aggregate score was 0.87. Factor and aggregate score Cronbach's alphas were 0.61-0.89. Intra-class correlation factors scores were 0.28-0.68. Kappa (κ) ranged from 0.19 to 0.69 for individual questions. CONCLUSIONS: The C-PFS may serve as a useful instrument to identify youth more vulnerable to food preoccupation and overconsumption given the obesogenic food environment. Factor 2, food present not tasted, should be interpreted with caution in English language learners.

Associations Among Body Mass Index, Cortical Thickness, and Executive Function in Children.

Importance: A total of 25.7 million children in the United States are classified as overweight or obese. Obesity is associated with deficits in executive function, which may contribute to poor dietary decision-making. Less is known about the associations between being overweight or obese and brain development. Objective: To examine whether body mass index (BMI) is associated with thickness of the cerebral cortex and whether cortical thickness mediates the association between BMI and executive function in children. Design, Setting, and Participants: In this cross-sectional study, cortical thickness maps were derived from T1-weighted structural magnetic resonance images of a large, diverse sample of 9 and 10-year-old children from 21 US sites. List sorting, flanker, matrix reasoning, and Wisconsin card sorting tasks were used to assess executive function. Main Outcomes and Measures: A 10-fold nested cross-validation general linear model was used to assess mean cortical thickness from BMI across cortical brain regions. Associations between BMI and executive function were explored with Pearson partial correlations. Mediation analysis examined whether mean prefrontal cortex thickness mediated the association between BMI and executive function. Results: Among 3190 individuals (mean [SD] age, 10.0 [0.61] years; 1627 [51.0%] male), those with higher BMI exhibited lower cortical thickness. Eighteen cortical regions were significantly inversely associated with BMI. The greatest correlations were observed in the prefrontal cortex. The BMI was inversely correlated with dimensional card sorting (r = -0.088, P < .001), list sorting (r = -0.061, P < .003), and matrix reasoning (r = -0.095, P < .001) but not the flanker task. Mean prefrontal cortex thickness mediated the association between BMI and list sorting (mean [SE] indirect effect, 0.014 [0.008]; 95% CI, 0.001-0.031) but not the matrix reasoning or card sorting task. Conclusions and Relevance: These results suggest that BMI is associated with prefrontal cortex development and diminished executive functions, such as working memory.

Relationship Between Meal Plan, Dietary Intake, Body Mass Index, and Appetitive Responsiveness in College Students.

INTRODUCTION: One third of the approximately 23,000 undergraduates in the United States are overweight or obese. College students appear to be more vulnerable to disproportionate weight gain during this time. METHOD: Cross-sectional. Diet, body mass index, and appetitive responsiveness were assessed in 80 undergraduates enrolled in three different meal plans, unlimited access, points, and none. RESULTS: Appetitive responsiveness was positively correlated with fat (r = 0.34, p = .002) but not added sugars across groups. Unlimited access-plan students had higher fat consumption than no-plan students, regardless of appetitive responsiveness. Unlimited access-plan students had higher fruit and vegetable consumption and higher dairy consumption than point-plan students. There were no group differences for body mass index. All groups were below the U.S. Department of Agriculture guidelines for dairy and fruit and vegetable intake. DISCUSSION: Optimizing the college campus food environment toward healthful, affordable choices is likely to improve dietary habits and might minimize college weight gain.

Addictive-Like Eating, Body Mass Index, and Psychological Correlates in a Community Sample of Preadolescents.

INTRODUCTION: The two main objectives were to identify addictive-like eating in youth and determine the relationship between addictive-like eating, hedonic hunger, and psychological variables. METHOD: A cross-sectional design was used. Each subject's objective heights and weights were measured. Subjects completed questionnaires about anxiety, depression, appetitive responsiveness, addictive-like eating, other forms of disordered eating, and exercise patterns. RESULTS: Sixty-five children, ages 9 to 14 years, participated in the study. The mean body mass index percentile for age and gender was 69%. Thirty-eight percent of the children were either overweight or obese. Sixteen percent reported three or more addictive-like eating behaviors, and 4% met the criteria for "food addiction." Addictive-like eating was significantly correlated with appetitive responsiveness but not body mass index, anxiety, depression, or other measures of disordered eating. DISCUSSION: Addictive-like eating occurs in children as young as 9 years and appears to be a different type of disordered eating. The hedonic value and proximity of food is a contributor to addictive-like eating behaviors.

The Health Care Provider's Experience With Fathers of Overweight and Obese Children: A Qualitative Analysis.

PURPOSE: The purpose of this study was to explore the experience of health care providers (HCPs) in the outpatient setting as they work with fathers of children who are overweight and obese. METHOD: Interpretative phenomenological analysis was used for data collection and analysis. Seven HCPs were interviewed about their experiences. RESULTS: Two major themes emerged from the experiences of these HCPs: "dad in the back seat" and "paternal resistance." DISCUSSION: The theme of "dad in the back seat" captured the HCPs' experiences and perceptions of parental roles and related stereotypes with respect to fathers' lack of presence in the health-care setting, family roles that relegate fathers to the back seat in dealing with this issue, and the tendency of fathers to take a passive role and defer to mothers in the management of their child's weight. "Paternal resistance" reflected the perceived tendency of the father to resist the acceptance of his child's weight as a problem and to resist change and even undermine family efforts to make healthier choices. CONCLUSION: HCPs' experiences of fathers as having a minimal role in the management of their child's overweight and obesity may lead them to neglect fathers as agents of change with regard to this important issue.

Increases in body mass index following initiation of methadone treatment.

Despite the clear efficacy of methadone for opioid dependence, one less desirable phenomenon associated with methadone may be weight gain. We examined changes in body mass index (BMI) among patients entering methadone treatment. A retrospective chart review was conducted for 96 patients enrolled in an outpatient methadone clinic for ≥ 6 months. The primary outcome of BMI was assessed at intake and a subsequent physical examination approximately 1.8 ± 0.95 years later. Demographic, drug use and treatment characteristics were also examined. There was a significant increase in BMI following intake (p<0.001). Mean BMIs increased from 27.2 ± 6.8 to 30.1 ± 7.7 kg/m(2), translating to a 17.8-pound increase (10% increase in body weight) in the overall patient sample. Gender was the strongest predictor of BMI changes (p < 0.001), with significantly greater BMI increases in females than males (5.2 vs. 1.7 kg/m(2), respectively). This translates to a 28-pound (17.5%) increase in females vs. a 12-pound (6.4%) increase in males. In summary, methadone treatment enrollment was associated with clinically significant weight gain, particularly among female patients. This study highlights the importance of efforts to help patients mitigate weight gain during treatment, particularly considering the significant health and economic consequences of obesity for individuals and society more generally.

A qualitative exploration into parental recognition of overweight and obesity in pre-adolescents: a process of discovery.

INTRODUCTION: The purpose of this study is to describe influential factors as parents become aware that their pre-adolescent is overweight/obese. METHODS: A grounded theory approach was used, and 17 parents of obese pre-adolescents were interviewed. RESULTS: Within the concept of discovery ("How did you come to realize your pre-adolescent was overweight or obese?"), five central themes emerged. The theme of predisposition emerged as most parents believed there was some type of predisposition for their pre-adolescent to be overweight/obese. Parents avoided using the words overweight, obese, or fat to describe their pre-adolescent's body habitus, thus leading to the theme "husky build." "Compared to others" was identified as a theme since most parents described how they compared their overweight pre-adolescent with other pre-adolescents. The health care provider emerged as a theme because the role of the health care provider played a pivotal role in the discovery process for parents. Finally, parental buy-in involved acceptance that their pre-adolescent was overweight and recognition that this status signaled a problem and a potential health threat for their pre-adolescent. DISCUSSION: Parents do not rely solely on visual cues. Several factors are involved in the awareness process of parents whose pre-adolescents are clinically obese. The input from the health care provider played a significant role.