Pediatric Obesity Pharmacotherapy: State of the Science, Research Gaps, and Opportunities.

Pediatric obesity is a major public health problem, affecting nearly 20% of children and adolescents living in the United States. In 2023, the American Academy of Pediatrics released its first clinical practice guideline for the evaluation and management of child and adolescent obesity and recommended integrating health behavior and lifestyle interventions with pharmacological treatment when medically indicated. However, there is a limited evidence base to guide antiobesity medication treatment decisions in clinical practice and limited data on long-term safety during this critical period of growth and development in youth. Thus, in November of 2023, the National Institute of Diabetes and Digestive and Kidney Diseases sponsored a workshop to identify knowledge gaps and opportunities for research on the use of pharmacotherapy for obesity in children and adolescents. Leading scientific and clinical experts in obesity pathophysiology and treatment, pharmacotherapy, clinical trial design, and health equity and disparities, among others, identified gaps in clinical trial design, guidance for clinical use of medications in children and adolescents, additional treatment outcomes beyond body fat or weight, and improvement in care delivery. Adolescent patients and caregivers with lived experience of obesity and weight management were also invited to participate in a panel discussion, providing personal perspectives on living with obesity, clinical care considerations, and research needs. This article summarizes the workshop proceedings on the state of the science and identifies gaps and opportunities for future research to inform optimal and equitable medical management of children and adolescents with obesity.

Weight Bias and Stigma in Pediatric Obesity.

Weight stigma is pervasive during childhood and adolescent years. Well-established physical and psychosocial health consequences of weight stigma, like disordered eating behaviors, low self-esteem, and higher depressive symptoms, make it especially harmful during a critical period of development for youth. Lasting negative health impacts of these experiences highlight the importance of addressing weight stigma early on. The pediatric health care setting, both physical and social components, can be one of many sources of weight-stigmatizing experiences for youth. This observation has prompted calls for action in the health care setting to reduce weight biases and stigmatizing behavior among pediatric providers.

Community-based diet and obesity-related policy, system, and environmental interventions for obesity prevention during the first 1000 days: A scoping review.

Community-based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community-based diet and obesity-related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60-69%) occurred in the prenatal period and early infancy (0-3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.

Increasing disparities in obesity and severe obesity prevalence among public elementary and middle school students in New York City, school years 2011-12 through 2019-20.

Recent national trends in the United States indicate a significant increase in childhood obesity, a major public health concern with documented physical and mental comorbidities and sociodemographic disparities. We aimed to estimate the prevalence of obesity and severe obesity among youth in New York City (NYC) before the COVID-19 pandemic and examine time trends overall and by key characteristics. We included all valid height and weight measurements of kindergarten through 8th grade public school students aged 5 to 15 from school years 2011-12 through 2019-20 (N = 1,370,890 unique students; 5,254,058 observations). Obesity and severe obesity were determined using age- and sex-specific body mass index percentiles based on the Centers for Disease Control and Prevention growth charts. Analyses were performed using multivariate logistic regression models with repeated cross-sectional observations weighted to represent the student population for each year and clustered by student and school. Among youth attending public elementary and middle schools in NYC, we estimate that 20.9% and 6.4% had obesity and severe obesity, respectively, in 2019-20. While consistent declines in prevalence were observed overall from 2011-12 to 2019-20 (2.8% relative decrease in obesity and 0.2% in severe obesity, p<0.001), increasing trends were observed among Black, Hispanic, and foreign-born students, suggesting widening disparities. Extending previous work reporting prevalence estimates in this population, nearly all groups experienced significant increases in obesity and severe obesity from 2016-17 to 2019-20 (relative change = 3.5% and 6.7%, respectively, overall; p<0.001). Yet, some of the largest increases in obesity were observed among those already bearing the greatest burden, such as Black and Hispanic students and youth living in poverty. These findings highlight the need for greater implementation of equity-centered obesity prevention efforts. Future research should consider the influence of the COVID-19 pandemic and changes in clinical guidance on childhood obesity and severe obesity in NYC.

Physical activity and sleep changes among children during the COVID-19 pandemic.

Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann-Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data were collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1655 steps. Sleep onset and wake time were delayed by about an hour and 45 min, respectively, while sleep duration decreased by over 12 min as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. Trial Registration: Clinical trial registration: NCT03339440.

Physical activity and sleep changes among children with obesity during a period of school closures related to the COVID-19 pandemic.

Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data was collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1,655 steps. Sleep onset and wake time were delayed by about an hour and 45 minutes, respectively, while sleep duration decreased by over 12 minutes as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. We demonstrate the utility of wearable sensors in objectively measuring longitudinal physical activity and sleep behavior patterns in children with obesity and in quantifying changes in their health behaviors due to disruption of structured, daily routines following in-person school closures during the COVID-19 pandemic. Trial Registration: Clinical trial registration: NCT03339440.

Stay-at-Home Orders during COVID-19: The Influence on Physical Activity and Recreational Screen Time Change among Diverse Emerging Adults and Future Implications for Health Promotion and the Prevention of Widening Health Disparities.

BACKGROUND: The purpose of this study was to examine changes in physical activity (PA) and recreational screen time (RST) behaviors from pre-COVID-19 in 2018 to Spring 2020 during the mandatory stay-at-home order in an ethnically/racially, socioeconomically diverse sample of emerging adults. METHODS: Longitudinal data were analyzed from 218 participants (Mage = 24.6 ± 2.0 years) who completed two surveys: EAT 2018 (Eating and Activity over Time) and C-EAT in 2020 (during COVID-19). Repeated ANCOVAs and multiple linear regression models were conducted. RESULTS: Moderate-to-vigorous and total PA decreased (4.7 ± 0.3 to 3.5 ± 0.3 h/week [p < 0.001] and 7.9 ± 0.4 to 5.8 ± 0.4 h/week [p < 0.001], respectively), and RST increased from 26.5 ± 0.9 to 29.4 ± 0.8 h/week (p = 0.003). Perceived lack of neighborhood safety, ethnic/racial minoritized identities, and low socioeconomic status were significant predictors of lower PA and higher RST during COVID-19. For example, low SES was associated with 4.04 fewer hours of total PA compared to high SES (p < 0.001). CONCLUSIONS: Stay-at-home policies may have significantly influenced PA and RST levels in emerging adults with pre-existing disparities exacerbated during this mandatory period of sheltering-in-place. This suggests that the pandemic may have played a role in introducing or magnifying these disparities. Post-pandemic interventions will be needed to reverse trends in PA and RST, with a focus on improving neighborhood safety and meeting the needs of low socioeconomic and ethnic/racial minoritized groups.

Recreational Screen Time Behaviors during the COVID-19 Pandemic in the U.S.: A Mixed-Methods Study among a Diverse Population-Based Sample of Emerging Adults.

Understanding how screen time behaviors changed during the COVID-19 pandemic is important to inform the design of health promotion interventions. The purpose of this study was to quantify and describe changes in recreational screen time from 2018 to 2020 among a diverse sample of emerging adults. Participants (n = 716) reported their average weekly recreational screen time in 2018 and again during the pandemic in 2020. Additionally, participants qualitatively reported how events related to COVID-19 had influenced their screen time. Weekly recreational screen time increased from 25.9 ± 11.9 h in 2018 to 28.5 ± 11.6 h during COVID-19 (p < 0.001). The form of screen time most commonly reported to increase was TV shows and streaming services (n = 233). Commonly reported reasons for changes in screen time were boredom (n = 112) and a desire to connect with others (n = 52). Some participants reported trying to reduce screen time because of its negative impact on their mental health (n = 32). Findings suggest that screen time and mental health may be intertwined during the pandemic as it may lead to poorer mental health for some, while promoting connectedness for others. Health professionals and public health messaging could promote specific forms for screen time to encourage social connection during the COVID-19 pandemic and beyond.

Changes to Physical Activity during a Global Pandemic: A Mixed Methods Analysis among a Diverse Population-Based Sample of Emerging Adults in the U.S.

Emerging adults' lives have changed because of the COVID-19 pandemic. Physical activity (PA) behaviors need to be examined to inform interventions and improve health. Responses to the C-EAT (COVID-19 Eating and Activity over Time) survey (N = 720; age = 24.7 ± 2.0 yrs) were analyzed. This mixed-methods study quantitatively examined changes in self-reported PA (hours/week of mild PA, moderate-to-vigorous PA (MVPA), and total PA) from 2018 to 2020. Qualitative responses on how COVID-19 impacted PA were analyzed using a grounded theory approach. Hours of PA were lower on average for all intensity levels during COVID-19 than in 2018 (p's < 0.0001). Over half of the sample reported a decrease in MVPA (53.8%) and total PA (55.6%); 42.6% reported a decrease in mild PA. High SES were more likely to report an increase in total PA (p = 0.001) compared to those of lower SES. Most (83.6%) participants perceived that COVID-19 had influenced their PA. The most common explanations were decreased gym access, effects on outdoor PA, and increased dependence on at-home PA. Results suggest that emerging adults would benefit from behavioral interventions and health promotion efforts in response to the pandemic, with a focus on activities that can be easily performed in the home or in safe neighborhood spaces.