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.

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.

Effect of a Low-Glycemic Index Nutritional Intervention on Body Weight and Selected Cardiometabolic Parameters in Children and Adolescents with Excess Body Weight and Dyslipidemia.

Excess body weight in pediatric patients and the resulting dyslipidemia, if left untreated, are a serious risk factor for cardiovascular disease in young adults. Despite this, there is still no effective and validated nutritional strategy for the treatment of overweight/obesity and comorbid dyslipidemia in children and adolescents. A low-glycemic index (LGI) diet may be recommended, but evidence for its effectiveness in the pediatric population is limited. The aim of this study was to evaluate the effectiveness of nutritional intervention in children and adolescents with excess body weight and dyslipidemia. The study was conducted in patients aged 8-16 with overweight or obesity and lipid disorders (n = 64), of which 40 participants who completed the entire 8-week study were included in the analysis. Patients were randomly selected and allocated to one of the two dietary groups: the LGI diet or the standard therapy (ST) diet. Both diets were based on the principal recommendation of Cardiovascular Health Integrated Lifestyle Diet-2 (CHILD-2). This study showed that both LGI and ST diets were equally beneficial in reducing body weight, body fat, blood pressure, total cholesterol (TC), and triglyceride (TG) levels. The LGI diet, compared to the ST diet, was less effective in reducing blood TG levels but more effective in reducing diastolic blood pressure (DBP). Therefore, the choice of the type of diet in the treatment of children and adolescents with excess body weight and dyslipidemia may be individual. However, it should be based on the recommendation of CHILD-2. Further long-term, larger-scale studies are needed.

Obesity: Post-Pandemic Weight Management.

Societal changes secondary to the coronavirus disease 2019 pandemic led to increased prevalence of adolescents with obesity and heightened awareness of weight stigma and size bias. During this time the American Academy of Pediatrics published its first clinical practice guidelines, and the Food and Drug Administration approved new weight loss drugs for adolescents, but insurance coverage is largely unavailable.

Mental health and BMI in children and adolescents during one year in obesity treatment.

BACKGROUND: Mental health plays a major role in children and adolescents with obesity. The aim of this study was (1) to compare mental health in children with obesity with the background population and (2) to investigate if mental health changed during one year in an obesity treatment program. METHODS: Data on self-reported mental health was collected in 107 children and adolescents (mean age 13.2 years) with obesity at first visit in an obesity treatment program and at one year follow-up (n = 47). Mental health was assessed by eight questions from the Danish Health Behaviour in School-aged Children (HBSC) questionnaire: (1) self-rated health (2) life satisfaction (3) feeling low (4) body-image (5) loneliness (6) self-esteem (7) self-efficacy and (8) social competence. Data was compared to a reference population based on HBSC data. BMI-SDS was based on Danish reference values. RESULTS: Children and adolescents with obesity had significantly higher odds of reporting negative body image and feeling low and lower odds of reporting high self-rated health and high self-esteem compared to a reference population. There was no difference between the groups regarding life-satisfaction, social competence, self-efficacy or feeling lonely. There were no significant changes in mental health from first visit to one-year follow-up. CONCLUSION: Our findings highlight the mental health difficulties in children and adolescents with obesity, and the importance of addressing these issues in obesity treatment. The results also indicate that children with obesity have psychosocial resources that should be exploited in treatment protocols.

"A balancing act": parents' longitudinal perspectives of weight-related discussions with their children following obesity treatment.

Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.

Emotion Regulation Training as an Add-on in the Treatment of Obesity in Young Adolescents: A Randomized Controlled Superiority Trial.

In an inpatient treatment center for pediatric obesity, the effectiveness of an emotion regulation (ER) training on top of the multidisciplinary obesity treatment (MOT) was tested by means of an RCT. The ER training was evaluated on primary outcomes: ER and emotional eating, and secondary outcomes: well-being and weight loss, taking into account pre, post, and follow-up measurements. Of the 115 10- to-14-year old adolescents with obesity (52.2% girls), 65 were allocated to the ER training. Physicians measured their height and weight objectively (4 times). Participants also filled out questionnaires on ER competencies (ER abilities and ER strategies), emotional eating and well-being (3 times). Significant pre-post interactions were found for "emotional awareness," "problem solving," and "evoking a positive mood." Moreover, the positive effects of the ER training on emotion regulation strategies were maintained at follow-up. Concerning well-being, no significant pre-post interaction effects were found but a significant interaction effect was found when comparing pre with follow-up. Analyses show a significant main effect of time on weight loss, but this was not qualified by a Time × Condition interaction effect. The current RCT study shows limited but promising effects of adding an ER training to the MOT. Further research should investigate whether the positive short-term effects will be maintained.

Predictors of adherence to follow-up and treatment success in childhood obesity.

INTRODUCTION: Management of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. PATIENTS AND METHODS: We conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. RESULTS: The mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latin. We found a higher proportion of Latinla ethnicity and compulsive eating in the group of patients with early attrition from the weight management follow-up. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow-up. CONCLUSIONS: Some family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from follow-up or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

Interventions for Weight Management in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: Body mass index (BMI) of the 95th or greater percentile for age and sex is common among young people, and its prevalence has increased in recent decades. Objective: To examine the benefits and harms of weight management interventions initiated in health care settings among children and adolescents with high BMI. Data Sources: MEDLINE via Ovid, PsycINFO via Ovid, and the Cochrane Central Registry of Controlled Trials through January 12, 2023; ongoing surveillance through January 26, 2024. Study Selection: English-language studies of weight management interventions (behavioral and pharmacologic, including liraglutide, semaglutide, orlistat, and phentermine/topiramate) among children aged 2 to 18 years with high BMI (eg, ≥85th or ≥95th percentile for age and sex) conducted in or recruited from health care settings. Data Extraction and Synthesis: One investigator abstracted data; a second checked for accuracy. Outcomes with sufficient evidence for meta-analysis were pooled using random-effects models. Main Outcomes and Measures: BMI and other weight-related outcomes, cardiometabolic measures, quality of life, physical activity, dietary pattern scores, and harms. Results: Fifty-eight randomized clinical trials (RCTs) were included (N = 10 143). Behavioral interventions were associated with small reductions in BMI and other weight outcomes after 6 to 12 months (28 RCTs [n = 4494]; mean difference in change between groups, -0.7 [95% CI, -1.0 to -0.3]). Larger effects were seen in interventions with higher contact hours and that offered physical activity sessions. Reporting was sparse for outcomes other than BMI, with few significant findings. Semaglutide and phentermine/topiramate had the largest effects on BMI (eg, 1 RCT [n = 201] for semaglutide; mean difference, -6.0 [95% CI, -7.3 to -4.6]). The very few studies that evaluated outcomes after medication discontinuation showed immediate weight regain. Gastrointestinal adverse effects were common with liraglutide, semaglutide, and orlistat. Serious adverse effects were rare, but no studies had follow-up longer than 17 months. Conclusions and Relevance: In the short term, weight management interventions led to lower BMI in children and adolescents, with no evidence of serious harm. Evidence is lacking about how weight management interventions affect BMI beyond 1 year and after medication discontinuation and about longer-term effects on other outcomes.

Effectiveness and predictors of weight loss response to phentermine plus lifestyle modifications among youth in a paediatric weight management clinical setting.

BACKGROUND: Anti-obesity medications (AOMs) are promising lifestyle modification (LSM) adjuncts for obesity treatment, and phentermine is commonly prescribed in paediatric weight management clinics. Determining 'real-world' AOM effectiveness and characteristics predicting response is important. OBJECTIVES: We sought to describe phentermine plus LSM effectiveness and identify baseline characteristics predicting response. METHODS: This was a retrospective cohort study among youth seen in a US academic-based weight management clinic from 2012 to 2020. Baseline characteristics (e.g., body mass index (BMI), liver transaminases, eating-related behaviours) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, %BMI change, weight) were determined through electronic health records and intake surveys. RESULTS: Among 91 youth prescribed phentermine plus LSM over 8 years (mean %BMIp95 150%), %BMIp95 was statistically significantly reduced at 1.5, 3, 6 and 12 months (peak reduction 10.9 percentage points at 6 months; p < 0.001). Considering multiple comparisons, the presence of baseline elevated alanine aminotransferase was associated with statistically significant smaller 1.5-month %BMIp95 reductions (p = 0.001) and higher food responsiveness with smaller 3- (p = 0.001) and 6-month (p < 0.001) reductions. CONCLUSIONS: Phentermine plus LSM reduced %BMIp95 among youth in a weight management clinic, and baseline characteristics may help determine those more or less likely to respond. Prospective studies are needed to further characterize effectiveness and confirm response predictors.

The effectiveness of multidisciplinary weight loss interventions is associated with initial cardiorespiratory fitness in adolescents with obesity.

BACKGROUND: The identification of predictive parameters of the success of multidisciplinary weight loss interventions (MWLI) appears essential to optimize obesity management. The association between baseline cardiorespiratory fitness (CRF) and changes in anthropometric parameters and body composition during MWLI remains underexplored in adolescents with obesity. OBJECTIVES: To assess whether baseline CRF was associated with the effectiveness of a 16-week MWLI measured through improved body mass, body mass index (BMI) and body composition (percentage of total fat mass (FM) as the main criterion). METHODS: Cardiorespiratory fitness and body composition were respectively measured by peak oxygen consumption (VO2peak) during maximal exercise tests and dual-photon x-ray absorptiometry (DXA), before (T0) and after (T1) a 16-week MWLI in 165 adolescents (aged 13.3 ± 1.38 years, 61.2% female, BMI 35.11 ± 5.16 kg/m2). RESULTS: Reductions in BMI and total FM percentage between T0 and T1 were greater in subjects with a baseline VO2peak ≥ 3rd quartile compared to the first quartile (p < 0.001) and the interquartile range (p < 0.05 and p < 0.001, respectively). Baseline VO2peak and VO2 at the first ventilator threshold were positively correlated with the reductions in body mass, BMI and total and visceral FM percentages and with the increase in lean mass (LM) percentage between T0 and T1 after adjustment for age and gender (p < 0.001). CONCLUSION: Initial CRF is associated with the success of MWLI in adolescents with obesity. Improving their aerobic fitness before starting a MWLI might be a promising strategy to optimize its benefits.

Interventions for High BMI in Children and Teenagers.

This JAMA Patient Page describes intensive behavioral interventions for high body mass index (BMI) in children and teenagers and the US Preventive Services Task Force (USPSTF) recommendation for provision of such interventions.

Interventions for High Body Mass Index in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.

Importance: Approximately 19.7% of children and adolescents aged 2 to 19 years in the US have a body mass index (BMI) at or above the 95th percentile for age and sex, based on Centers for Disease Control and Prevention growth charts from 2000. The prevalence of high BMI increases with age and is higher among Hispanic/Latino, Native American/Alaska Native, and non-Hispanic Black children and adolescents and children from lower-income families. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the evidence on interventions (behavioral counseling and pharmacotherapy) for weight loss or weight management in children and adolescents that can be provided in or referred from a primary care setting. Population: Children and adolescents 6 years or older. Evidence Assessment: The USPSTF concludes with moderate certainty that providing or referring children and adolescents 6 years or older with a high BMI to comprehensive, intensive behavioral interventions has a moderate net benefit. Recommendation: The USPSTF recommends that clinicians provide or refer children and adolescents 6 years or older with a high BMI (≥95th percentile for age and sex) to comprehensive, intensive behavioral interventions. (B recommendation).

Prebiotics, probiotics, synbiotics and postbiotics to adolescents in metabolic syndrome.

The prevalence of childhood and adolescent obesity has globally reached alarming dimensions and many adolescents affected by obesity already present one or more obesity-related comorbidities. In recent years, emerging evidence supporting the role of gut microbiota in the pathophysiology of metabolic diseases has been reported and the use of prebiotics, probiotics, synbiotics and postbiotics as a strategy to manipulate gut microbiota has become popular. The aim of this review is to explore the relationship between gut microbiota and metabolic syndrome in adolescents and to discuss the potential use of prebiotics, probiotics, synbiotics and postbiotics for the prevention and treatment of this clinical picture in adolescence. According to the most recent literature, prebiotics, probiotics and synbiotics have no clear effect on MetS, but a possible modulation of anthropometric parameters has been observed after synbiotic supplementation. Only one study has examined the role of postbiotics in alleviating metabolic complications in children with obesity but not in adolescents. More extensive research is needed to support the conclusions drawn so far and to develop effective microbiome-based interventions that may help improving the quality of life of children and adolescents exposed to the increasing prevalence of MetS.

Clinical effectiveness and predictors of response to topiramate plus lifestyle modification in youth with obesity seen in a weight management clinical setting.

Introduction: Obesity affects approximately 20% of U.S. youth. Anti-obesity medications (AOMs) are promising lifestyle modification adjuncts for obesity treatment, and topiramate is commonly prescribed in pediatric weight management clinics. It is important to determine "real-world" effectiveness of AOMs and, given shifts towards personalized approaches, characteristics potentially predicting better or worse response. We therefore sought to describe clinical effectiveness from topiramate plus lifestyle modification, and to determine if baseline phenotypic characteristics are associated with better or worse response. Methods: We performed a retrospective cohort study (2012-2020) among youth (<18 years old) followed in a U.S. academic-based weight management clinic. Baseline characteristics (i.e., body mass index (BMI), liver function tests, eating-related behaviors) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, percent %BMI change, weight) were determined through review of electronic health records and clinic intake survey data. Results: Among 282 youth prescribed topiramate plus lifestyle modifications (mean baseline age 12.7 years, %BMIp95 144%), %BMIp95 and percent BMI change were statistically significantly reduced at each time point (1.5-, 3-, 6-, and 12-month %BMIp95 reductions: -2.2, -3.9, -6.6, and -9.3 percentage points, respectively; percent BMI reduction: -1.2%, -1.9%, -3.2%, and -3.4%, respectively; all p<0.01). Considering multiple comparisons, no baseline characteristics statistically significantly predicted response at any time point. Conclusions: We found that topiramate plus lifestyle modification reduced %BMIp95 and BMI among youth in a weight management clinical setting, and that no baseline characteristics evaluated were associated with response. These results should be considered preliminary given the observational nature of this study, and prospective studies are needed to further characterize clinical effectiveness and identify and confirm potential predictors of response.

Documentation and management of paediatric obesity: Evidence from a paediatric inpatient unit.

INTRODUCTION: The obesity epidemic is a worldwide phenomenon.1 In Australia, the prevalence of paediatric overweight or obesity is 25%.2 Children with obesity present to medical services more frequently than children with a healthy weight.3 Therefore, any hospital admission is an opportunity for clinicians to identify and manage children with overweight or obesity. Previous research has not objectively measured how frequently clinicians document a child as being above the healthy weight range and initiate weight management strategies. This study addresses this gap in the literature by demonstrating the prevalence rate and clinical characteristics of children with overweight/obesity in a non-tertiary paediatric inpatient unit and measuring the rate of clinician recognition, documentation, and initiation of weight management strategies.