Adaptation of a standardized lifestyle intervention to maximize health outcomes in adolescent metabolic and bariatric surgery patients.

BACKGROUND: Metabolic and bariatric surgery (MBS) is safe and efficacious in treating adolescents with severe obesity. Behavioral/lifestyle programs can support successful preparation for surgery and post-MBS weight loss, but no standardized lifestyle intervention exists for adolescents. Here we describe the process of developing and adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP/GLB) curriculum to support adolescents pre- and post-MBS. METHODS: We collected both qualitative and quantitative data from a diverse group of adolescents (N = 19, mean age 15.2 years, range 13-17, 76% female, 42% non-Hispanic Black, 41% Hispanic, 17% other). Additionally, we included data from 13 parents, all of whom were mothers. These participants were recruited from an adolescent MBS program at Children's Health System of Texas. In an online survey, we asked participants to rank their preferences and interests in DPP/GLB content topics. We complemented these results with in-depth interviews from a subset of 10 participants. This qualitative data triangulation informed the development of the TeenLYFT lifestyle intervention program, designed to support adolescents who were completing MBS and described here. This program was adapted from adolescent and parent DPP/GLB content preferences, incorporating the social cognitive model (SCM) and the socioecological model (SEM) constructs to better cater to the needs of adolescent MBS patients. RESULTS: Adolescents' top 3 ranked areas of content were: (1) steps to adopt better eating habits and healthier foods; (2) healthy ways to cope with stress; and (3) steps to stay motivated and manage self-defeating thoughts. Nearly all adolescent participants preferred online delivery of content (versus in-person). Mothers chose similar topics with the addition of information on eating healthy outside the home. Key themes from the adolescent qualitative interviews included familial support, body image and self-confidence, and comorbidities as key motivating factors in moving forward with MBS. CONCLUSIONS: The feedback provided by both adolescents and parents informed the development of TeenLYFT, an online support intervention for adolescent MBS candidates. The adapted program may reinforce healthy behaviors and by involving parents, help create a supportive environment, increasing the likelihood of sustained behavior change. Understanding adolescent/parent needs to support weight management may also help healthcare providers improve long-term health outcomes for this patient population.

Association of corticosteroid use and attention deficit/hyperactivity disorder in asthmatic children varies by age.

OBJECTIVE: We aim to examine the impact of corticosteroids use on ADHD among children with asthma by administration routes. METHODS: A population-based, cross-sectional analysis included pediatric patients ages 5-20 years old from the 2016 and 2019 Kids Inpatient Database (unweighted N = 111,702). ICD-10-CM codes were used to identify corticosteroids use, asthma, and ADHD cases. Survey logistic regression models with purposeful variable selection algorithms were built to examine the association between corticosteroids use, and ADHD by asthma severity and age. An inverse probability weighting (IPW) approach was used to help further control residual confounding. RESULTS: Among children aged 5-11 years old, the odds of ADHD were significantly higher in children with moderate to severe asthma who used inhaled corticosteroids than nonusers (moderate asthma: adjusted odds ratios [aOR] 1.46, 95% confidence interval [CI] 1.14-2.44; severe asthma: aOR 1.61, 95% CI 1.18-2.21). Although oral corticosteroid use was not independently associated with ADHD in young children, combined use of inhaled and oral corticosteroid had almost 5 times higher odds of use among ADHD in children with severe asthma vs. nonusers (aOR 4.85, 95% CI 2.07 - 11.35). No associations were found between any corticosteroid use and ADHD among asthmatic children aged 12-20 years. CONCLUSIONS: In this retrospective analysis, we found inhaled corticosteroids were positively associated with ADHD in younger children with moderate to severe asthma, but not in older children.

Cluster-randomised trial of the impact of an obesity prevention intervention on childcare centre nutrition and physical activity environment over 2 years.

OBJECTIVE: The prevalence of obesity among pre-school-aged children in the USA remains unacceptably high. Here, we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a childcare centre (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over 2 school years. DESIGN: This was a cluster-randomised trial with twelve CCC receiving the HC2 intervention arm and twelve in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over 2 school years (Fall 2015, Spring 2016 and Spring 2017). Changes in EPAO physical activity and nutrition score were analysed via a: (1) random effects mixed models and (2) mixed models to determine the effect of HC2 v. control. SETTING: The study was conducted in twenty-four CCC serving low-income, ethnically diverse families in Miami-Dade County. PARTICIPANTS: Intervention CCC received (1) teachers/parents/children curriculum, (2) snack, beverage, physical activity, and screen time policies, and (3) menu modifications. RESULTS: Two-year EPAO nutrition score changes in intervention CCC were almost twice that of control CCC. The EPAO physical activity environment scores only slightly improved in intervention CCC v. control CCC. Intervention CCC showed higher combined EPAO physical activity and nutrition scores compared to control CCC over the 2-year study period (ß = 0·09, P = 0·05). CONCLUSIONS: Obesity prevention programmes can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCC may need consistent support to improve the physical activity environment to ensure the policies remain intact.

Body mass index as a predictor of sonographic visualization of the pediatric appendix.

BACKGROUND: Appendicitis is a common condition that is often confirmed with imaging. Ultrasound (US) is recommended as the first radiologic test in the work-up of appendicitis in children. Increased body mass index (BMI) has been implicated as a limiting factor to the sensitivity of US. This has drastic public health ramifications, as pediatric obesity has been increasing at alarming rates. OBJECTIVE: The purpose of this study is to compare age-adjusted BMI z-scores to the frequency of sonographic visualization of the appendix. MATERIALS AND METHODS: A retrospective review of 500 consecutive reports of US exams ordered for appendicitis in patients with a documented BMI was performed. Patients were stratified by BMI z-score based on, and the visualization frequency of the appendix was compared to the BMI z-score group. A logistic regression analysis generated the odds of visualization of the appendix by BMI z-score group. Primary home language, ethnicity, sex and insurance status were included in the logistic regression model to assess these characteristics as potential effect modifiers. RESULTS: Of the 500 patients, 52.4% were male, 56.4% were Hispanic and 62.0% had government insurance. BMI z-score distribution groups were as follows: 4.2% were <-2, 8.0% were -2 to -1, 49.8% were -1 to 1, 26.4% were 1 to 2 and 11.6% were >2. The visualization frequency was 61.1% for boys and 46.2% for girls (P<0.05). Visualization frequency by BMI z-score group was as follows: 85.7% for <2, 72.5% for -2 to -1, 57.4% for -1 to 1, 47.7% for 1 to 2 and 29.3% for >2. Children with a BMI z-score greater than 2 were less likely to have a US with visualization of the appendix compared to children with a BMI z-score between -1 and 1 (adjusted odds ratio [aOR]: 0.21, 95% CI: 0.11-0.40, P<0.0001). Boys were more likely than girls to have a US with visualization of the appendix (aOR: 1.90, 95% CI: 1.29-2.80, P=0.001). There was no effect from insurance status, ethnicity or primary home language. CONCLUSION: Findings show that as the BMI z-score increased, sonographic visualization of the appendix decreased even after adjusting for demographic differences. These findings have implications for pediatric radiology practice in light of the worsening obesity epidemic.

The Feasibility of Collecting Longitudinal Cardiovascular and Fitness Outcomes From a Neighborhood Park-Based Fitness Program in Ethnically Diverse Older Adults: A Proof-of-Concept Study.

This proof-of-concept study examined feasibility of assessing longitudinal changes in body mass index, strength, mobility, and cardiovascular health outcomes in older, racial/ethnic minority adults participating in a park-based physical activity program. Study feasibility was based on follow-through data collection procedures and ability to manage and implement data collection, enrollment, and repeated measures data collection in older adults (≥50 years; n = 380; 45% Hispanic, 41% non-Hispanic Black) over a 28-month period. Mixed models were developed to estimate the effects of program participation over time on participant cardiovascular and fitness outcomes and across poverty and age subgroups. Model estimates adjusted for individual-level sociodemographics showed improvements across each 4 month time point in arm strength (0.55 arm curl; 95% confidence interval [0.33, 0.77]) and systolic (-0.68 mmHg; 95% confidence interval [-1.22, -0.13]) and diastolic (-0.47 mmHg; 95% confidence interval [-0.79, -0.16]) blood pressure. An Age × Poverty interaction found greater improvements in systolic and diastolic blood pressure among younger participants living in low poverty (vs. older in higher poverty). Study of the longitudinal association between fitness class participation and health outcomes was feasible in park-based settings.

Comparison of Early Life Obesity-Related Risk and Protective Factors in Non-Hispanic Black Subgroups.

OBJECTIVES: Previous obesity prevention studies in preschool-age children have included non-Hispanic Black (NHB) children, but few have investigated between-subgroup differences even though there may be cultural risk and protective practice differences, challenging the generalizability of findings. The purpose of this study was to examine differences in early childhood obesity-related factors in NHB subgroups (Haitian, other Caribbean Islander and African-American [AA]) children. METHODS: Baseline data from two randomized controlled trials in 52 childcare centers of which 35 had data to test a preschool-based obesity prevention intervention was analyzed. The sub-sample included 370 caregiver-child dyads; 209 self-identified as AA, 120 as Haitian and 41 as Caribbean Islander/West Indian or mixed race. Multilevel regression models generated outcome estimates for group differences in body mass index (BMI) percentile, birthweight, breastfeeding initiation and duration, bottle feeding duration and age when solid foods were introduced. RESULTS: Mean BMI percentile was similar for AA, Haitian and Caribbean Islander/West Indian/Multiracial (60.1th percentile, 60.8th percentile, 62.8th percentile, respectively) as was birthweight (6.3, 6.8, and 6.6 lb, respectively). Children of US-born caregivers had significantly lower BMI percentiles (9.13 percentile points) versus foreign-born caregivers. Haitian women were significantly more likely to initiate breastfeeding (64.9%) versus AA (47.6%) and Caribbean Islander/West Indian/Multiracial (62.2%) (p < .01). No significant group differences were found in breastfeeding or bottle feeding duration or age solid foods were introduced. CONCLUSIONS: Findings here suggest that NHB race classification can identify important subgroup behavioral similarities which in turn may inform culturally sensitive strategies to promote early childhood healthy weight. Foreign-born caregivers may benefit from healthy weight promotion information, and as early as possible in their child's development.

The Interprofessional/Family-Centered-Care Observation Rubric (I-FOR): Results of a Multicenter Study of a New Measure of Educational Outcomes.

Introduction The ability to provide family-centered care (FCC) and the ability to work in interprofessional care teams (IPC) are essential educational outcomes in graduate training programs. Lack of standardized measures leave programs to rely on idiosyncratic methods to monitor outcomes. We developed a faculty observation tool as part of an effort to create a national quality improvement database. We present evidence for the feasibility and validity of the faculty observation tool. Methods Trainees and faculty at four independent training programs participated. Nineteen maternal and child health disciplines were represented. Faculty supervisors rated trainees using the new measure (I-FOR), and trainees completed related subscales of a previously developed self-report measure, the core competency measure (CCM). Faculty provided qualitative feedback regarding the I-FOR in a separate questionnaire. Results Faculty (n = 78) completed the I-FOR on 86 trainees (86/92 = 93%) and reported satisfaction with completing the measures. The I-FOR demonstrated good internal consistency (Cronbach's alpha > 0.930) and test-retest reliability (IPC r = 0.862, FCC r = 0.823, p < 0.001). Greater than 95% of participants reported that the I-FOR accurately addressed the relevant skills for each practice domain. The I-FOR showed no correlation with the CCM. Significant improvements over time in the I-FOR ratings were demonstrated in three out of four programs. Discussion The I-FOR demonstrated good internal consistency and test-retest reliability. Faculty responses provide evidence for the feasibility and validity of the instrument. Self-report and faculty-observation measures both increased with training but were not correlated with each other.

Longitudinal Impact of a Park-Based Afterschool Healthy Weight Program on Modifiable Cardiovascular Disease Risk Factors in Youth.

Community-based programs hold significant potential to prevent cardiovascular disease (CVD) risk in youth. We describe here the longitudinal change in several modifiable CVD risk factors after participation in up to 3 years of Fit2Play™, a park-based afterschool program. Children ages 6-15 years old (N = 2261, mean age 9.0 years, 50% Hispanic, 47% non-Hispanic black, 54% male) who participated in Fit2Play™ for either 1-3 school years between 2010 and 2016 had height, weight, 4-site skinfold thicknesses, systolic and diastolic blood pressure, the progressive aerobic cardiovascular endurance run test, and health/wellness knowledge and behavior scores collected at the beginning and end of the school year(s). Effects of length of Fit2Play™ participation on CVD outcomes were assessed via 2-level repeated measures analysis adjusted for child sociodemographics, park, area poverty, and year. Adjusted models showed overweight/obese children who participated in up to 3 years of Fit2Play™ had a mean reduction of 8 mm in skinfold thicknesses; almost 0.5 SD's in BMI z-score; 5 DBP %ile points; 17% reduction in probability of developing hypertension; and a mean increase of 6.4 PACER laps and 17% increase in health/wellness assessment compared to baseline. A dose-response trend was found for years of Fit2Play™ participation and improved CVD risk profile in participating youth. In conclusion, park-based afterschool programs that promote preventive CVD risk strategies can be an equitable, low-cost, high value tool for addressing our national epidemics of obesity, heart disease and diabetes and a rapidly changing healthcare system in need of evidence-based prevention programs.

The Effect of a Park-Based Physical Activity Program on Cardiovascular, Strength, and Mobility Outcomes Among a Sample of Racially/Ethnically Diverse Adults Aged 55 or Older.

INTRODUCTION: Many older adults are not physically active despite the well-documented health benefits of regular exercise. We examined cardiovascular, strength, and mobility outcomes among a sample of racially/ethnically diverse adults aged 55 or older participating in a community park-based physical activity program. METHODS: We assessed the following among adults aged 55 or older who attended a 1-hour park-based fitness class 2 or 3 times per week for 21 weeks: 1) 3 fitness outcomes, 2) systolic and diastolic blood pressure, 3) height and weight (to assess body mass index), and 4) pulse. We collected data at baseline (August-September 2016) and follow-up (January-February 2017). Linear regression analysis, adjusting for sex, age, and race/ethnicity, examined the association between program participation and changes in outcomes. RESULTS: Adjusted models showed a mean decrease in systolic blood pressure (-3.80 mm Hg; 95% CI, -6.75 to -0.84 mm Hg) and diastolic blood pressure (-1.54 mm Hg; 95% CI, -3.01 to -0.06 mm Hg) and a mean increase in number of arm curls completed in 30 seconds (1.66; 95% CI, 0.71-2.61) from baseline to follow-up among all participants. Hispanic participants, compared with non-Hispanic white and non-Hispanic black participants, showed greater improvements in mean body mass index (-2.48; 95% CI, -4.60 to -0.34), systolic blood pressure (8.59 mm Hg; 95% CI, -16.82 to -0.36 mm Hg), diastolic blood pressure (-7.06 mm Hg; 95% CI, -11.16 to -2.97 mm Hg), and pulse (-6.53 beats per minute; 95% CI, -11.38 to -1.67 beats per minute). CONCLUSION: Park-based fitness classes tailored to older, racially/ethnically diverse adults can improve cardiovascular health and strength.

Participation Rates and Perceptions of Caregiving Youth Providing Home Health Care.

Little is known about the population of caregiving youth in the United States. We sought to describe the participation rates, demographics, and caregiving tasks among sixth graders served by the American Association of Caregiving Youth (AACY) in its Caregiving Youth Project (CYP) in Palm Beach County, FL and evaluate the perceived benefit of AACY services. Sixth grade enrollment data from eight middle schools between 2007 and 2013 were obtained from The School District of Palm Beach County and the AACY. Data were obtained using a retrospective review of AACY program participant files. These files contained responses to evaluative questions from both students and family members. Overall, 2.2 % of sixth graders enrolled and participated in the program. Among the 396 caregiving sixth graders studied, care recipients were predominantly a grandparent (40.6 %) or parent (30.5 %). Common activities included providing company for the care recipient (85.6 %), emotional support (74.5 %), and assistance with mobility (46.7 %). Youth reported a median of 2.5 h caregiving on weekdays and 4 h on weekend days, while families reported fewer hours (1.6 and 2.3, respectively). At the end of the school year, the sixth graders reported improvement in school (85.5 %), caregiving knowledge (88.5 %), and self-esteem (89.5 %). Slightly over 2 % of sixth graders participated in the CYP. While support services may mitigate the negative effects of the time spent by caregiving youth, more prospective research is needed to better define the true prevalence, tasks, and time spent caregiving among this subpopulation.

Disparities in Patient Family Social Determinants of Health in a Large Urban Pediatric Health System.

INTRODUCTION: This analysis sought to identify disparities in social determinants of health (SDOH) outcomes at a Texas pediatric hospital. METHODS: This retrospective study used electronic health records of pediatric patients families surveyed August -December 2022. Outcomes for health literacy, social support, food, transportation, energy, digital, and housing insecurity, and tobacco exposure were analyzed across demographic categories. RESULTS: Among 15,294 respondents to the survey (mean child age, 8.73 years; 43.68% Hispanic, 29.73% non-Hispanic White, 18.27% non-Hispanic Black, 6.79% other race/ethnicity; 53.95% male), 50.25% of respondents reported at least one SDOH, whereas 23.39% reported two or more SDOH. The most prevalent SDOH was lack of social support (3,456, 23.91%). Hispanic, non-Hispanic Black, and other race/ethnicity respondents, non-English speakers, and public insurance users had higher odds of reporting almost all SDOH in logistic regression models adjusted for age, race/ethnicity, language, gender, and insurance type. DISCUSSION: Race/ethnicity, language, and insurance type disparities were identified for all SDOH.

Anthropometry for predicting cardiometabolic disease risk factors in adolescents.

OBJECTIVE: Early screening prevents chronic diseases by identifying at-risk adolescents through anthropometric measurements, but predictive value in diverse groups is uncertain. METHODS: A cross-sectional analysis of 12- to 19-year-old individuals from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) assessed the predictive ability of BMI percentile, total body fat percentage, waist circumference (WC), and waist-hip ratio (WHR) for four cardiometabolic risk factors across race and ethnicity groups using receiver operating characteristic curves. RESULTS: The unweighted sample (N = 1194; 51.2% male individuals; 23.7% Hispanic, 13.2% non-Hispanic Black [NHB], 51.1% non-Hispanic White [NHW], 12.0% other/multirace) had a weighted prevalence of elevated blood pressure of 2.7%, hyperglycemia of 36.8%, hypertriglyceridemia of 4.8%, and low high-density lipoprotein (HDL) cholesterol of 15%. WHR (area under the curve [AUC] = 0.77), WC (AUC = 0.77), and BMI percentile (AUC = 0.73) outperformed total body fat percentage (AUC = 0.56) in predicting elevated blood pressure (p < 0.001 for all). BMI percentile was more accurate than total body fat percentage in predicting hypertriglyceridemia (AUC = 0.70 vs. 0.59; p = 0.02) and low HDL cholesterol (AUC = 0.69 vs. 0.59; p < 0.001). Race and ethnicity-based predictions varied: NHW adolescents had the highest AUC (0.89; p < 0.01) for elevated blood pressure prediction compared with Hispanic and NHB adolescents (AUC = 0.77 for both). Total body fat percentage was more accurate in predicting low HDL cholesterol among Hispanic versus NHW adolescents (AUC = 0.73 vs. 0.58; p = 0.04). CONCLUSIONS: WHR, WC, and BMI percentile are better predictors of cardiometabolic risk factors in adolescents than total body fat percentage. Predictive abilities differed by race and ethnicity, highlighting the importance of tailored risk assessment strategies.

Association of Social Support and Metabolic and Bariatric Surgery Completion Among Racially and Ethnically Diverse Patients.

PURPOSE: Metabolic and bariatric surgery (MBS) is presently the most evidence-based, effective treatment of obesity. Nevertheless, only half of the eligible individuals who are referred for this procedure complete it. This study aims to investigate the association between social support and MBS completion, considering race and ethnicity. METHODS: In this prospective cohort study, 413 participants were enrolled between 2019 and 2022. Using the 19-item Brief Family Relationship Scale, which comprises three subscales (eight-item Cohesion subscale, four-item Expressiveness subscale, and seven-item Conflict subscale), the quality of family relationship functioning was assessed. Multivariable logistic regression models were used to determine the association between MBS completion and social support status, adjusting for variables including race, ethnicity, age, gender, body mass index, and insurance. RESULTS: The mean age of the sample was 47.55 years (SD 11.57), with 87% of the participants being female and 39% non-Hispanic White. Nearly 35% of participants (n = 145) completed MBS. Multivariable logistic regression analysis showed overall cohesion (adjusted odds ratio [aOR], 1.52 [95% CI, 1.15-2.00]; p = .003) and overall expressiveness (aOR, 1.58 [95% CI, 1.22-2.05]; p < .001) were associated with higher odds of pursuing MBS. There was no significant interaction between overall cohesion, expressiveness, conflict, and race/ethnicity (p = .61, p = .63, p = .25, respectively). CONCLUSION: The findings indicated that there is a link between family-based social support and MBS completion, regardless of race and ethnicity. Future research should continue to explore the complex interplay between family dynamics and MBS outcomes, considering cultural variations to enhance the effectiveness of obesity interventions within diverse communities.

Factors Associated with the Decision to Complete Bariatric Metabolic Surgery among a Racially and Ethnically Diverse Sample of Adults: A Classification and Regression Tree Analysis.

BACKGROUND: Less than 50% of eligible candidates who are referred complete Bariatric Metabolic Surgery (BMS). The factors influencing the decision to complete BMS, particularly how these factors vary across different racial and ethnic groups, remain largely unexplored. METHODS: This prospective cohort study included adult patients referred to a bariatric surgeon or obesity medicine program between July 2019-September 2022. Sociodemographic characteristics, body mass index (BMI), anxiety, depression, body appreciation, and patient-physician relationship information were collected via survey and electronic health records. The association between BMS completion and potential decision-driving factors was examined using Classification and Regression Tree (CART) analysis. RESULTS: A total of 406 BMS -eligible patients participated in the study (mean [SD] age: 47.5 [11.6] years; 87.2% women; 18.0% Hispanic, 39% non-Hispanic Black [NHB], and 39% non-Hispanic White [NHW]; mean [SD] BMI: 45.9 [10.1] kg/m2). A total of 147 participants (36.2%) completed BMS. Overall, the most influential factor driving the decision to complete BMS was younger age (< 68.4 years), higher patient satisfaction, and BMI (≥ 38.0 kg/m2). Hispanic participants prioritized age (< 55.4 years), female sex, and body appreciation. For NHB participants, the highest ranked factors were age < 56.3 years, BMI ≥ 35.8 kg/m2, and higher patient satisfaction. For NHW patients, the most influential factors were age (39.1 to 68.6 years) and higher body appreciation. CONCLUSION: These findings highlight racial and ethnic group differences in the factors motivating individuals to complete BMS. By acknowledging these differences, healthcare providers can support patients from different backgrounds more effectively in their decision-making process regarding BMS.

Health status of childcare center providers in a COVID-19 hotspot.

BACKGROUND: Childcare center providers in Miami-Dade County, Florida a COVID-19 hotspot, are made up almost entirely of ethnic minority women. This is a critical frontline staff that is now encountering the triple threat of respiratory illnesses from respiratory syncytial virus (RSV), influenza viruses (or the seasonal flu), and COVID-19. OBJECTIVE: To examine sociodemographic characteristics, anthropometrics, and health behaviors that were collected from a sample of CCC teachers in Miami Dade County, a COVID-19 hotspot. METHODS: Cross-sectional data were used from Healthy Caregivers, Healthy Children (HC2), a randomized controlled intervention trial (#NCT02697565) for healthy weight maintenance among children 2-to-5 years old, conducted in 24 subsidized childcare centers in MDC in 2015-2018. Prevalence was determined by frequency or mean/standard deviation of each variable. Chi-squared analyses were performed to test for differences in BMI categories. RESULTS: In this sample of childcare center providers (n = 255), the majority (61%) had an elevated body mass index. Positive health behaviors such as regular exercise and eating fruits and vegetables were only reported in about a third of the sample. CONCLUSION: It is vital that we encourage the uptake of regular vaccination schedules as a means to protect our community, especially the critical frontline workers that have been caring for our young children.

Quality of Life Among Caregivers of Children with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder: A Cross Sectional Study.

Caregivers of children with attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) experience more stress than caregivers of typically developing children but there is limited research evaluating caregivers' quality of life (QoL). This study aimed to describe the association of caregiver QoL in children with ASD and/or ADHD. This study included patients with ADHD and/or ASD seen in one pediatric specialty clinic between September 2018-August 2020. Caregivers were classified as those caring for children with ASD-only, ADHD-only, or youth with both conditions (ADHD + ASD). An adapted version of the PedsQL Family Impact Module was used to measure caregiver QoL. The sample included caregivers of 931 children. The majority of these children were male (74.7%), non-Hispanic white (63.3%), and aged 6 to 12 years (57.8%). Across the groups, significant differences were observed in patient age (p < 0.0001), preferred language (p = 0.005), and insurance (p = 0.001). Caregivers of non-Hispanic Black children had 4-times the odds of reporting feeling isolated from others (OR 4.36, 95% CI 1.19-16.00 p = 0.03). Those caring for children with ADHD-only had significantly lower odds of reporting helplessness or hopelessness (OR 0.45, 95% CI 0.26-0.80, p = 0.004), and difficulty talking about their child's health with others (OR 0.30, 95% CI 0.17-0.54, p < 0.0001). Similarly, caregivers of children who had ADHD + ASD reported higher odds of difficulty making decisions together as a family (OR 14.18, 95% CI 1.15-17.91, p=0.04) and difficulty solving family problems together (OR 45.12, 95% CI 2.70-752.87), p = 0.008). Caring for children with ADHD and/or ASD may affect caregiver QoL.

Telehealth utilization among multi-ethnic patients with obesity during the COVID-19 pandemic.

INTRODUCTION: The science of telemedicine has shown great advances over the past decade. However, the field needs to better understand if a change in care delivery from in-person to telehealth as a result of the COVID-19 pandemic will yield durable patient engagement and health outcomes for patients with obesity. The objective of this study was to examine the association of mode of healthcare utilization (telehealth versus in-person) and sociodemographic factors among patients with obesity during the COVID-19 pandemic. METHODS: A retrospective medical chart review identified patients with obesity from a university outpatient obesity medicine clinic and a community bariatric surgery practice. Patients completed an online survey (1 June 2020-24 September 2020) to assess changes in healthcare utilization modality during subsequent changes in infection rates in the geographic area. Logistic regression analysis examined the association of mode of healthcare utilization and key sociodemographic characteristics. RESULTS: A total of 583 patients (87% female, mean age 51.2 years (standard deviation 13.0), mean body mass index 40.2 (standard deviation 6.7), 49.2% non-Hispanic white, 28.7% non-Hispanic black, 16.4% Hispanic, 7% other ethnicity, 33.1% completed bariatric surgery) were included. Adjusted logistic regression models showed older age was inversely associated with telehealth use (adjusted odds ratio = 0.58, 95% confidence interval 0.34-0.98) and non-Hispanic black were more likely to use telehealth compared to non-Hispanic white (adjusted odds ratio = 1.72, 95% confidence interval 1.05-2.81). CONCLUSIONS: The COVID-19 pandemic is impacting access to healthcare among patients with obesity. Telehealth is an emerging modality that can maintain healthcare access during the pandemic, but utilization varies by age and ethnicity in this high-risk population.

Effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery weight recurrence.

OBJECTIVE: The aim of this study was to compare the effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery (MBS) weight recurrence. METHODS: A retrospective analysis of 207 adults with post-MBS weight recurrence treated with semaglutide 1.0 mg weekly (n = 115) or liraglutide 3.0 mg daily (n = 92) at an academic center from January 1, 2015, through April 1, 2021, was conducted. The primary end point was percentage body weight change at 12 months of treatment with regimens containing semaglutide or liraglutide. RESULTS: The mean sample age was 55.2 years; mean BMI was 40.4 kg/m2 ; 89.9% were female; and 50% completed sleeve gastrectomy, 29% completed Roux-en-Y gastric bypass, and 21% completed adjustable gastric banding. Least-squares mean weight change at 12 months was -12.92% versus -8.77% in the semaglutide and liraglutide groups, respectively (p < 0.001). The adjusted odds ratios were 2.34 (95% CI: 1.28-4.29) for ≥10% weight loss and 2.55 (95% CI: 1.22-5.36) for ≥15% weight loss over 12 months in the semaglutide group versus liraglutide group, respectively. Weight-loss efficacy of semaglutide (vs. liraglutide) did not differ by subgroups explored, including age, sex, and MBS procedure. CONCLUSIONS: These results show that treatment regimens including semaglutide 1.0 mg weekly lead to superior weight loss compared with liraglutide 3.0 mg daily for treating post-MBS weight recurrence, regardless of procedure type or the magnitude of weight recurrence.

Impact of employment status and work setting on body weight and health behaviors among people with obesity.

BACKGROUND: The impact of employment and the work-from-home (WFH) setting on body weight among people with obesity is unknown. OBJECTIVE: This study examined the relationship between employment status, WFH setting, and change in body weight among adults with obesity during the COVID-19 pandemic. METHODS: Patients from an obesity medicine clinic completed an online survey in 2022 to assess health, work, and lifestyle behaviors. Multiple regression models examined the association between WFH status and change in body weight. RESULTS: The analytical sample included 380 patients (81.9% female, mean age 52.5 years, mean body mass index 43.25, 50.0% non-Hispanic White, 25.7% non-Hispanic Black, 18.7% Hispanic, 5.7% other ethnicity). During the pandemic, 28.7% were employed in a WFH setting (73.4% of this subgroup were in a WFH setting only), 36.1% were employed but not in a WFH setting, 11.8% were unemployed, and 23.4% were retired. Mean body weight change for participants who partially WFH during the pandemic was +5.4 (±7.2) % compared to those completely WFH -0.3 (±9.8) % (P = 0.006). After adjusting for key demographics, participants who were partially WFH gained 7.8% more weight compared to those completely WFH (ß= 7.28, SE = 1.91, p <  0.001). The most significant predictors for weight gain after adjusting for WFH frequency (partially vs. completely) included overeating (aOR 11.07, 95% CI 3.33-36.77), more consumption of fast food (aOR 7.59, 95% 2.41-23.91), and depression (aOR 6.07, 95% CI 1.97-18.68). CONCLUSION: These results show that during the COVID-19 pandemic, the WFH hybrid (combination of office and WFH) setting is associated with greater weight gain compared to those who completely WFH in people with obesity. Risk factors include overeating, higher fast food consumption, and depression.

The Role of Body Appreciation in the Decision to Complete Metabolic and Bariatric Surgery Among Ethnically Diverse Patients.

PURPOSE: Metabolic and bariatric surgery (MBS) is an evidence-based safe, effective treatment for obesity. However, only half of referred or eligible persons complete the procedure for unknown reasons. The proposed study examined the association between the degree of body appreciation and the decision to complete MBS by ethnicity. METHODS: This prospective cohort study included 409 participants who had been referred to a bariatric surgeon or an obesity medicine program between August 2019 and May 2022. Participants completed a survey about health behaviors and psychosocial characteristics, including body appreciation by MBS completion status (Y/N). Multivariate logistic regression models generated adjusted odd ratios (aOR) and 95% confidence intervals (CIs) of body appreciation among MBS completers vs. non-completers. RESULTS: The sample mean age was 47.18 years (SD 11.63), 87% were female. 39.6% identified as non-Hispanic White (NHW), 38.5% as non-Hispanic Black (NHB), and 17.6% as Hispanic. Over a third of the sample (31.05%, n = 127) completed MBS. "Often" experiencing body appreciation was the most significant predictor of MBS completion (aOR: 28.19, 95% CI: 6.37-124.67, p-value < 0.001), followed by "Sometimes" (aOR: 20.47, 95% CI: 4.82-86.99, p-value < 0.001) and "Always" (aOR: 13.54, 95% CI: 2.55-71.87, p-value < 0.01) after controlling for sex, age, and race/ethnicity. There was not a significant interaction between body appreciation and race/ethnicity (p-value = 0.96). CONCLUSION: Results showed a significant association between body appreciation and MBS completion, controlling for sex, age, and race/ethnicity. MBS clinical settings may want to assess body appreciation as a pre-operative screener among ethnically diverse patients.