Psychometrics of the modified family-centered care assessment short version for childhood obesity.

BACKGROUND: Incorporating principles of family-centered care into pediatric weight management interventions can improve the effectiveness and quality of treatment and reduce attrition rates. To assess the family-centeredness of interventions, reliable, valid, and easy-to-administer scales are needed. The purpose of the study was to develop a shortened version of the modified Family Centered Care Assessment (mFCCA) and assess its psychometric properties. METHODS: The mFCCA, a scale to assess the family-centeredness of interventions for childhood obesity, was administered to families following the Connect for Health randomized control trial evaluating the effectiveness of a primary care-based pediatric weight management intervention. We iteratively removed items from the mFCCA and used Rasch modeling to examine the reliability and validity of the shortened scale. RESULTS: We included data from 318 parents and the exploratory factor analysis showed the presence of a single factor. The results of the Rasch modeling demonstrated acceptable internal consistency of the scale (0.7) and strong validity as evidenced by the overall model fit and range of item difficulty. Following the psychometric analyses, we reduced the number of items from 24 to 8 items. CONCLUSION: The mFCCA short version demonstrates good psychometrics and can be used to evaluate the family-centeredness of childhood obesity interventions with reduced participant burden, thereby improving outcomes for children with obesity. TRIAL REGISTRATION: Clinicaltrials.gov NCT02124460 registered on April 24, 2014.

Research progress on the role of mindfulness in intervention for adolescent obesity.

In the face of the increasingly serious background of overweight and obesity rates among adolescents in China, mindfulness, as an emerging therapeutic approach, has shown its unique effectiveness. This article reviewed the research progress of mindfulness in the intervention of adolescent obesity, summarized its effects on improving physiological and psychological indicators, and listed the different options for implementing mindfulness therapy. These studies supported the preliminary effectiveness of mindfulness in the intervention of adolescent obesity, providing a basis for mindfulness to become a new approach for obesity intervention in the future.

The association between weight loss behaviors and body weight perception in Chinese adolescents: 2007-2022.

BACKGROUND: Weight misperceptions are common in children and adolescents, which is related to the engagement of weight loss behaviors. The aim of this study was to investigate the association between body weight perception and weight loss behaviors of lower-calorie diets and increased levels of physical activity (PA). METHODS: The Ningbo Youth Risk Behavior Survey was conducted from 2007 to 2022. A multistage, stratified cluster sampling procedure was utilized to draw target adolescents aged 12 to 18 years participating in each survey wave (2007, 2012, 2017, 2022). Data of anthropometry, weight perception, and weight loss behaviors were collected through self-administered questionnaires. A binary generalized linear model was used to examine associations between body weight perception and weight loss behaviors of lower calorie diets and increased levels of PA. RESULTS: The sample sizes for each survey wave were 777, 885, 1588 and 2638. The prevalence of overweight (OW)/obesity (OB), self-perception of OW/OB and overestimated perception increased from 7.6%, 27.0% and 29.1% in 2007 to 16.3%, 39.9% and 41.4% in 2022, respectively. Adolescents that perceived themselves as OW/OB had higher odds of lower-calorie diets (OR: 4.2, 3.3-5.4) and increased level of PA (OR: 3.8, 2.9-5.0), whereas adolescents that perceived themselves as underweight had lower odds of lower-calorie diets (OR: 0.371, 0.253-0.542) and increased levels of PA (OR: 0.381, 0.295-0.559). CONCLUSION: OW, self-perception of OW/OB and overestimated perception were prevalent in Chinese adolescents. Self-perception of OW/OB was positively associated with lower-calorie diets and increased levels of PA. The results can support public health specialists to promote health education of body perception and improve self-esteem in Chinese children and adolescents.

Healthcare professionals' perspectives on the barriers and facilitators of integrated childhood obesity care.

BACKGROUND: Both the causes and consequences of childhood obesity can be complex. To provide healthcare that is suitably tailored to the specific needs of children with obesity integrated care is required. The objective of this study was to explore the perceived barriers and facilitators of healthcare professionals (HCPs) in providing integrated care for children with obesity, to support them in tailoring the healthcare approach. METHODS: In this qualitative study, semi-structured in-depth interviews were conducted with 18 healthcare professionals with experience in childhood obesity care; pediatricians, youth healthcare nurses and a youth healthcare physician. A two-phased thematic content analysis was performed: an inductive analysis with open and selective coding and a deductive analysis with axial coding using the patient-centered care model by Stewart. RESULTS: Overall, the healthcare professionals defined the etiology of obesity as complex, and experienced the integrated care as complicated. The results fit into the four theme-structure of the patient-centered care model, with the integrated care system as an additional fifth theme. The main barriers were perceived within the sub-themes of illness and healthcare experiences, and sensitivity over talking about weight-related issues. The main facilitators were perceived within the sub-themes of conducting a biomedical, psychosocial and lifestyle assessment, tailoring the approach to families' situation and investing in a family-professional relationship. Weight stigma appeared to be an underlying barrier for healthcare professionals that impacted, both explicitly and implicitly, upon all themes. CONCLUSIONS: Healthcare professionals providing integrated care for children with obesity, experience this type of care as complicated and comprising many barriers and facilitators regarding the four themes of the patient-centered care model and the fifth theme of the integrated care system. This paper demonstrates the patient-centered care model could prove helpful structuring a tailored approach within integrated care. This approach supports healthcare professionals in adopting a broad perspective towards individual and environmental factors and investing in the relationship, with respect to the sensitivity and complexity of childhood obesity.

Mental health from childhood to adolescence predicts excessive weight and body composition at 18 years.

OBJECTIVE: To investigate the association of mental health in childhood and adolescence with four outcomes at 18 years: ultra-processed food (UPF) consumption, body mass index (BMI), excessive weight (EW), and body composition, including fat mass (FM) and fat free mass (FFM) in kg, FM index (FMI) and FFM index (FFMI) in kg/m2. METHODS: Cohort study in which The Development and Well-Being Assessment (DAWBA) (6 and 11 years) and the MINI International Neuropsychiatric Interview (MINI) (18 years) provided information on internalizing (INT), externalizing (EXT) and any mental disorder (ANY). The exposure was classified in: "never", "at 6 and/or 11 years", "at 18 years only" and "at 6, 11, and 18 years". Linear and logistic regression were run. All analyses were stratified by sex. RESULTS: A total of 2722 participants were analyzed. At 18 years, female with EXT disorders at 6 and/or 11 years presented higher BMI (ß: 1.70; 0.18-3.23), FM (ß: 4.74; 1.42-8.06), and FMI (ß: 1.53; 0.28-2.79) than those who never had. The odds of EW at 18 years was also higher in females with EXT disorders at 6 and/or 11 years (OR: 3.39; 1.56-7.36) and at the three time points (OR: 7.08; 1.69-29.59). Males with EXT disorders at 6 and/or 11 years presented higher FM (ß: 4.45; 1.85-7.06) and FMI (ß: 1.47; 0.63-2.31). CONCLUSIONS: Among children and adolescents showing symptoms of EXT disorders, weight should be monitored carefully, thus ultimately contributing to reduce the burden of EW in adolescence.

Weight loss trends in Korean adolescents (2005-2021): Exploring the impact of measured and self-perceived weight status.

OBJECTIVE: This study aims to assess the trends in the proportions of weight loss efforts among Korean adolescents aged 10-18 years from 2005 to 2021, examining variations based on weight status, to examine factors related to weight loss efforts by weight status, and to evaluate weight loss efforts based on the combination of measured and self-perceived weight status. METHODS: Complex sample design analyses were conducted on a dataset comprising 10,760 adolescents, utilizing information from the Korea National Health and Nutrition Examination Survey, a nationally representative dataset. Participants were categorized into non-overweight and overweight groups using a BMI percentile threshold of 85. RESULTS: 22-29 % of non-overweight adolescents and 54-77 % of adolescents with overweight engaged in weight loss efforts. Among adolescents who attempted to lose weight from 2005 to 2017, 39.5-57.1 % tried both of diet and exercise, 22.7-47.4 % tried exercise alone, and 10.2-26.7 % tried diet alone. Female gender, older age, and higher self-perceived weight status were associated with increased odds of weight loss efforts, irrespective of actual weight status. For adolescents perceiving themselves as obese, the odds of attempting weight loss were 8.32 for non-overweight boys, 2.02 for non-overweight girls, 15.28 for overweight boys, and 5.77 for overweight girls compared to controls who were non-overweight and perceived themselves as not obese. CONCLUSION: Weight loss efforts among Korean adolescents aged 10 to 18 remained consistent irrespective of their actual weight over 16 years. Throughout this period, adolescents who perceived themselves as obese were more likely to attempt weight loss, independent of their true weight status. Hence, subjective weight perception plays a significant role in influencing weight loss behaviors among adolescents.

Acute exercise might not affect subsequent appetite responses to a fixed meal in adolescents with obesity: The SMASH exploratory study.

While an intensity-dependent post-exercise decrease in energy intake (EI) has been described in adolescents with obesity, studies invariably used ad libitum meals, limiting then any conclusions regarding the effect of exercise on post-meal appetitive responses that can be also impacted by the ad libitum nature of the meal. This study analyses appetite and food-reward related responses to a fixed meal after an acute exercise, also exploring the associations between substrate use during exercise and overall daily EI in adolescents with obesity. Thirteen adolescents with obesity (12-16 years, 5 males) randomly complete 2 experimental sessions: (i) a control condition (CON); (ii) a 30-min moderate intensity (65% VO2peak) cycling condition (EX). Energy expenditure and substrate oxidation were measured during both 30 min of rest (CON) or exercise (EX). Ad libitum EI, macronutrient intake and relative EI were assessed at dinner, subjective appetite sensations taken at regular intervals and food reward measured before and after lunch as well as before dinner. Energy and macronutrient intake did not differ between conditions, as well as appetite feelings. A time effect (p = 0.012) was observed between pre and post meal for choice fat bias in both conditions but was only significant within the CON condition (p = 0.004). CHO oxidation during exercise was found correlated with both EI (r = 0.586, p = 0.045), pre-lunch hunger (r = 0.624, p = 0.030), daily AUC for hunger and DTE (r = 0.788, p = 0.002 and r = 0.695; p = 0.012 respectively). This exploratory study highlights that acute exercise might not affect subsequent appetite responses when using a fixed test meal in adolescents with obesity.

The psychosocial beliefs, experiences and expectations of children living with obesity.

BACKGROUND: Childhood obesity has been shown to impair psychological health. However, psychological factors are often overlooked in both research evaluations and treatment interventions, and children's perspectives on managing obesity are underexplored. Neglecting psychosocial factors might undermine interventions. This research explored the psychological beliefs, expectations and experiences of children living with obesity (range 7-13) and attending a weight management programme (WMP). METHODS: Thirty-four participants (19 females, 15 males, average age 9.5 years) completed a semistructured interview. Recorded interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Four overarching themes were developed: (1) defining health and self-recognition; (2) external influence; feedback, stigma and comparison; (3) recognising emotions and (4) future expectations: obesity is a reality. These themes interact to influence the children's psychosocial status. CONCLUSIONS: This study highlights a range of psychosocial and emotional difficulties that children living with obesity experience and suggests that these remain regardless of their attendance at a WMP. Interventions for children living with obesity should address psychosocial factors, including stress management, peer victimisation and handling feedback from others. PATIENT OR PUBLIC CONTRIBUTION: As proposed by the two young people acting as patient and public involvement and engagement representatives, the utilisation of scrapbooks as a preinterview tool was particularly helpful in aiding discussion during the interviews. This innovative approach could be considered a valuable methodological technique for investigating sensitive topics with children in future research.

Depression, anxiety, and development of obesity from childhood to young adulthood in China.

OBJECTIVE: To examine the cross-sectional and longitudinal bidirectional associations of depression and anxiety symptoms with the development of obesity over time among children and adolescents in different age groups from childhood to young adulthood. METHODS: This is a three-wave longitudinal study that included >200,000 school-aged children between 5 and 18 years. Participants were assessed at baseline, 6 months, and 12 months. Depression and anxiety symptoms, as well as participants' weight and height, were collected at each assessment. The cross-sectional associations between obesity and depression or anxiety were examined through ANOVA and Chi-square tests. Multivariable logistic regression analyses were performed to investigate their longitudinal bidirectional associations. RESULTS: The prevalence of obesity reached a peak in the age group between 12 and 14 years. Concurrently, higher mean BMI and obesity prevalence were associated with more severe symptoms of depression and anxiety in each age group (ps < 0.001). Longitudinally, depression and anxiety significantly increased the risk of development of obesity over time (odds ratios [ORs] = 1.08 to 1.77). Moreover, obesity significantly aggravated the risk of development of depression (ORs = 1.17 to 1.68) and anxiety (ORs = 1.25 to 1.71) over time and hindered the alleviation of depressive (ORs = 0.68 to 0.79) and anxiety symptoms (ORs = 0.73 to 0.74). CONCLUSION: Findings suggest that there were bidirectional associations between obesity and psychological distress. It may be important to continuously track BMI and psychological conditions for children and adolescents over time to avoid the reinforcement of their negative reciprocal interactions.

Childhood obesity and comorbidities-related perspective and experience of parents from Black and Asian minority ethnicities in England: a qualitative study.

Background: Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations. Methods: Following ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study's qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents' perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis. Results: Parents' perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child's weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings. Conclusion: Minority ethnic communities' perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.

Design of the FRESH-teen study: A randomized controlled trial evaluating an adapted emotion regulation weight loss program for adolescents with overweight or obesity and their parent.

Overweight and obesity affect >40% of adolescents. Family-based behavioral treatment (FBT) is the most efficacious behavioral treatment for weight management among youth and consists of nutrition and physical activity education, behavior change skills, and parent skills training. However, the efficacy of FBT decreases for youth as they get older. Increased emotional lability and limited emotion regulation skills may contribute to the reduced efficacy of FBT for adolescents. To date, there are no treatments for overweight or obesity specifically adapted for the needs of adolescents. We developed a treatment that integrates components from Dialectical Behavior Therapy and Emotion Focused Therapy with FBT (FBT+ER or FBT-ER) to address the specific needs of adolescents. The current study randomized 166 adolescents (BMI = 32.8; 14.3 years; 57% female; 32% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic and Non-White) and one of their parents (BMI = 32.9; 45.3 years; 85% female; 27% Hispanic, 57% Non-Hispanic White, 16% Non-Hispanic and Non-White) to 6 months of either standard FBT or FBT+ at 2 sites. Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). Primary outcomes are adolescent weight (BMIz/%BMIp95), emotion regulation skills, and emotional eating behaviors. Given the public health concern of adolescent obesity, FBT+ could prove extremely useful to provide more targeted and effective intervention for adolescents with overweight or obesity. CLINICAL TRIALS: # NCT03674944.

Household chaos and childhood obesity-related health outcomes.

OBJECTIVE: Household chaos, defined as a lack of organization, structure, and predictability, has been linked to deleterious childhood health outcomes and may hinder attempts to initiate and maintain healthy lifestyle changes. This study examined the associations of household chaos and obesity-related health conditions in a sample of youth being treated for obesity. METHODS: Participants were 715 patients (61.8% girls; Mage = 12.3 years; 68.7% non-Hispanic Black; M% of 95th BMI %-ile = 146.9%) enrolled in a pediatric weight management clinic. Caregiver report of household chaos was measured using the Confusion, Hubbub and Order Scale (CHAOS). Physiological obesity-related comorbidities (e.g., insulin resistance, hypertension, dyslipidemia) were assessed by a medical clinician and abstracted from electronic medical records; health conditions were dichotomized as present or not present. Psychological functioning was measured with the Pediatric Symptom Checklist, a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention concerns. RESULTS: The Wilcoxon rank-sum test was used to test differences in household chaos scores for each obesity-related health condition. Caregivers of youth diagnosed with hypertension and obstructive sleep apnea reported significantly lower levels of household chaos, while caregivers who reported clinical levels of psychological dysfunction reported higher levels of chaos. CONCLUSIONS: Traditional management of childhood obesity requires changes across multiple health domains (e.g., dietary, exercise, sleep), and such change may be facilitated by structure and consistency. Present findings suggest that psychological resources within pediatric weight management settings should address individual patient-level factors associated with physiological and mental health as well as household functioning.

The BDNF Val66Met polymorphism and health-related quality of life in youth with obesity.

The brain derived-neurotrophic factor (BDNF) Val66Met polymorphism causes functional changes in BDNF, and is associated with obesity and some psychiatric disorders, but its relationship to health-related quality of life (HRQoL) remains unknown. This study examined, in youth with obesity, whether carriers of the BDNF Val66met polymorphism Met-alleles (A/A or G/A) differed from noncarriers (G/G) on HRQoL. The participants were 187 adolescents with obesity. Ninety-nine youth were carriers of the homozygous Val/Val (G/G) alleles, and 88 were carriers of the Val/Met (G/A) or Met/Met (A/A) alleles. Blood samples were drawn in the morning after an overnight fast for genotyping. HRQoL was measured using the Pediatric-Quality of Life core version. Compared to carriers of the Val66Met Val (G/G) alleles, carriers of the Met-Alleles reported significantly higher physical -HRQoL (p = 0.02), school-related HRQoL, (p = 0.05), social-related HRQoL (p = 0.05), and total HRQoL (p = 0.03), and a trend for Psychosocial-HRQoL. Research is needed to confirm our findings and determine whether carriers of the BDNF Val66Met homozygous Val (G/G) alleles may be at risk of diminished HRQoL, information that can influence interventions in a high-risk population of inactive youth with obesity.

Parental Neglect and Childhood Obesity Amidst COVID-19: A Developmental Psychopathology Perspective on Health and Developmental Risks.

The COVID-19 pandemic has profoundly impacted the mental health and developmental trajectories of children and adolescents, catalyzing a range of psychological and behavioral issues due to enforced lockdowns and other restrictions. This text explores these impacts through the lens of developmental psychopathology, which integrates clinical psychology and developmental science to examine the emergence and evolution of psychological disorders across a lifespan. This paper highlights how pandemic-related disruptions have exacerbated conditions such as anxiety and depression and, notably, increased childhood obesity due to changes in lifestyle and reductions in physical activity. The analysis includes a discussion of how isolation has not only restricted access to educational and psychological resources but also increased the risk of parental mental illness and related familial stress, thereby intensifying issues of neglect and their consequent impact on child health. By employing a developmental psychopathology framework, this paper argues for the necessity of targeted interventions that address these complex interplays of genetic, environmental, and psychological factors. Such interventions aim to support children through structured educational and health-oriented strategies, ensuring their well-being amidst the ongoing challenges posed by the pandemic. This approach underscores the importance of early, multifaceted strategies involving parents, educators, and healthcare providers to foster healthier developmental outcomes for children facing unprecedented global health crises.

Insights from the ACTION Teens Study: a survey of adolescents living with obesity, their caregivers and healthcare professionals in the UK.

OBJECTIVES: The Awareness, Care and Treatment In Obesity maNagement (ACTION) Teens study explored attitudes, behaviours, perceptions and barriers regarding effective obesity care among adolescents living with obesity (ALwO), caregivers and healthcare professionals (HCPs). DESIGN: Cross-sectional online survey study. SETTING: Study across 10 countries; here, we report data from UK respondents. PARTICIPANTS: Overall, 416 ALwO (aged 12 to <18 years; body mass index ≥95th percentile for age and sex (WHO charts)), 498 caregivers and 250 HCPs in the UK completed the survey (August-December 2021). PRIMARY AND SECONDARY OUTCOME MEASURES: Survey questions addressed key aspects of obesity management for ALwO. RESULTS: Overall, 46% of ALwO perceived their weight as normal or below normal and 86% believed their health was at least good; 56% and 93% of caregivers responded similarly for their ALwO. Despite this, most ALwO (57%) had attempted to lose weight in the past year and 34% felt highly motivated to lose weight. YouTube and social media were most often used by ALwO for information about weight management (41% and 39%); few ALwO and caregivers sought information from a doctor (13% and 22%). Among ALwO who had discussed weight with an HCP (n=122), 49% trusted their weight-management advice. Only 10% of ALwO and 8% of caregivers were told by a doctor that they/their child had obesity. For HCPs, obesity-related comorbidities were the most common reason for initiating weight conversations with ALwO (73%), while short appointment times were the most common barrier (46%). Overall, 30% of ALwO and 11% of caregivers did not feel comfortable bringing up weight with an HCP. CONCLUSIONS: Improved education and communication are needed among ALwO, caregivers and HCPs in the UK to help improve awareness of obesity, its aetiology and its impact on health, and to support HCPs to proactively initiate weight-related conversations and build trust with ALwO and caregivers. TRIAL REGISTRATION NUMBER: NCT05013359.

Understanding experiences and perspectives in addressing unmet social needs of children and families in a paediatric weight management program: a qualitative descriptive study.

OBJECTIVE: The objective is to describe the experiences and perceptions of caregivers who participated in a community systems navigator intervention that addressed unmet social needs. DESIGN, SETTING AND PATIENTS: A qualitative descriptive study with caregivers of children enrolled in a clinical trial addressing unmet social needs of families with children cared for in a tertiary pediatric weight management clinic, through community systems navigation. Participants were asked open-ended questions related to perceptions of social needs screening in clinical settings. Interviews were recorded and analysed using Braun and Clarke's six-phase approach to thematic analysis. RESULTS: Ten parent participants were interviewed. Social needs screening perception and acceptability varied between participants. Social needs screening was comfortable for most but stressful for others. Participants noted that trusting relationships promote comfort with sharing social needs information, and this data should be shared on the electronic health record if accurate and purposeful. They found the online screening tool convenient but thought it could also limit opportunities to elaborate. Some participants noted the intervention of community systems navigation helpful; however, others described the need for more tailored resources. CONCLUSIONS: Screening for unmet social needs in clinical settings is complex and should be family centred, including the consideration of the mode of screening, data sharing in the electronic health record and ensuing interventions. Perspectives of families should drive the design of future larger scale community navigation interventions to address unmet social needs in clinical settings.

Evaluating an acceptance-based lifestyle modification program to address cardiovascular disease risk among adolescent girls with overweight and obesity: Protocol for a randomized controlled trial.

BACKGROUND: Behavioral weight loss interventions achieve only limited weight loss in adolescent samples and weight regain is common. This limited intervention success may be attributed, in part, to adolescents' lack of self-regulation skills essential for lifestyle modification and use of a one-size fits-all approach to produce weight loss in boys and girls. Interventions which teach self-regulation skills, such as Acceptance-Based Therapy (ABT), and are tailored to meet gender-specific concerns, are critical to help adolescents adapt to pervasive biological and environmental influences toward weight gain. OBJECTIVE: This trial tests the effect of an ABT intervention on cardiometabolic health, health-related behaviors, and psychological factors among adolescent girls with overweight or obesity (OW/OB). METHODS: Girls 14-19 years (N = 148; ≥ 40% racial/ethnic minorities) with OW/OB (BMI: ≥ 85th percentile) will be enrolled in the study. Participants will be randomized to one of two 6-month interventions, consisting of either 18 sessions of ABT or 9 sessions of a health education control, an augmented version of standard care for adolescent OW/OB, both led by bachelor's level interventionists. RESULTS: Recruitment is taking place in Philadelphia, USA, from January 2024 to January 2028. Cardiometabolic health markers (adiposity; blood pressure; blood lipids), health-related behaviors (dietary intake; physical activity; sleep), and psychological factors (quality of life; depression; disordered eating; psychological flexibility) will be measured at baseline, mid-treatment, post-treatment, 6-month follow-up, and 12-month follow-up. CONCLUSIONS: This study will provide valuable information on a novel intervention tailored to the needs of adolescent girls with OW/OB to address self-regulation and cardiometabolic health.

Predictors of parent self-monitoring patterns in a family-based behavioral weight loss treatment program.

OBJECTIVE: Self-monitoring dietary intake is a critical component of family-based intensive health behavior and lifestyle treatment for pediatric obesity, but adherence rates are often low. This study identifies predictors of parent self-monitoring rates during treatment. METHODS: A secondary analysis of parent self-monitoring data from a randomized controlled trial involving 150 parent-child dyads. Patterns of self-monitoring were identified using a latent class mixed model approach. Logistic regression analyses evaluated predictors of self-monitoring patterns. RESULTS: Latent class models identified two trajectory groups: a high consistent self-monitoring group and a low-decreasing self-monitoring group. When compared to parents in the low group, parents in the high group lost more weight throughout treatment. Children in the high group had a similar trajectory for weight loss; however, the groups were not statistically different. Higher levels of family chaos and poorer family problem-solving skills were associated with higher odds of being in the low group. CONCLUSION: This study identified two patterns of rates of parent self-monitoring, which were associated with parent weight loss and were differentiated by family chaos and poor problem-solving. These findings suggest that families with high levels of chaos and poor problem-solving could benefit from early intervention to improve outcomes in pediatric obesity treatment programs. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01197443.

The effects of parent-child dysfunctional interactions on early childhood weight: A serial mediation model through emotional feeding and child appetite traits.

Parent-child dysfunctional interactions (PCDI) are known to contribute to children's weight status. However, the underlying mechanisms in how dysfunctional interactions between parent and child influence child weight are not clear. This study investigates the impact of PCDI on toddlers' weight, focusing on the potential serial mediation by maternal emotional feeding and child appetite traits. We conducted a secondary analysis of longitudinal data from a larger intervention trial to prevent childhood obesity in low-income Hispanic families. A total of 241 mother-child dyads were included in these analyses. Measurements were taken at various stages: PCDI at child age 19 months, maternal emotional feeding at 28 months, and both child appetite traits and weight-for-age z-score (WFAz) at 36 months. Serial mediation analyses revealed a significant indirect effect of early PCDI on later child WFAz through maternal emotional feeding and two child food approach traits (food responsiveness, emotional overeating) out of the eight child appetite traits assessed. PCDI at 19 months was associated with increased use of emotional feeding in mothers at 28 months, which was associated with heightened food responsiveness and emotional overeating in children at 36 months, which in turn was linked to greater child WFAz at 36 months. The findings of this study expand the understanding of the mechanisms underlying PCDI and child weight, emphasizing the interplay between maternal feeding practices and child appetite in the context of adverse parent-child interactions during early childhood.

Maternal concern and perception about child overweight risk, maternal feeding practices, and child eating behaviors: A cross-sectional study.

Abundant efforts have been directed to understand the global obesity epidemic and related obesogenic behaviors. However, the relationships of maternal concern and perception about child weight with child eating behaviors in Saudi Arabia have not been investigated. Therefore, this study aimed to examine the associations of maternal concern and perception about child overweight risk with maternal feeding practices and child eating behaviors among mothers and their children in Saudi Arabia. Mothers of 115 children aged 3-5 years old were recruited from eight preschools. Child eating behaviors (enjoyment of food, responsiveness to foods, food fussiness, satiety responsiveness, and slowness in eating) and maternal feeding practices (restriction, monitoring, and using food as a reward), maternal concern about child weight, and maternal perception about child overweight risk were assessed using validated questionnaires. Multiple linear regression models, adjusted for maternal body mass index (BMI) and child's BMI-z score and sex, were tested to examine the independent associations of maternal concern and perception about child overweight risk with child eating behaviors and maternal feeding practices. Maternal concern about child weight was positively associated with food enjoyment in children (B = 0.14 [95% confidence intervals = 0.02,0.27]) and responsiveness to food (B = 0.16 [0.03,0.29]), whereas a negative association with child food fussiness was observed (B = -0.19 [-0.33, -0.04]). Maternal perception about child overweight risk and child slowness in eating were negatively associated (B = -0.72 [-0.16 to -0.28]). Maternal concern and perception about child overweight risk were not associated with maternal feeding practices. In conclusion, maternal concern and perception about child overweight risk were found to be associated with food approach eating behavior traits but not with maternal feeding practices. Mothers who are concerned about child weight or perceive their children as overweight may need guidance and support to promote healthy eating behaviors among their children. Future cross-cultural studies are needed to understand the underlying mechanisms for the influence of maternal concern and perception about child overweight risk on maternal feeding practices, child eating behaviors, and weight status of children.