Prevalence of the metabolic syndrome by household food insecurity status in the United States adolescent population, 2001-2020: a cross-sectional study.

BACKGROUND: Household food insecurity (FI) is a modifiable social determinant of health linked to chronic health outcomes. Little is known, however, about the prevalence of metabolic syndrome (MetS) in pediatric population-based studies by household FI status. OBJECTIVES: The objective of the study was to estimate the prevalence of the MetS by household FI status over the past 2 decades. METHODS: This cross-sectional study used data from the 2001-2020 National Health and Nutrition Examination Survey (NHANES). Participants were nonpregnant adolescents ages 12- 18 y in United States. The prevalence of MetS [elevated waist circumference and >2 of the following risk factors: elevated blood pressure, and fasting glucose, triglyceride, and/or low high-density lipoprotein (HDL) cholesterol concentrations] by FI status was evaluated using chi-square and logistic regression analyses. RESULTS: The estimated prevalence of MetS was 2.66% [95% confidence interval (CI): 2.28%, 3.09%] in the final analytical sample (unweighted N = 12,932). A total of 3.39% (95% CI: 2.53%, 4.53%) of adolescents from FI households had MetS compared to 2.48% (95% CI: 2.11%, 2.9%) among adolescents with no household FI. Hispanic adolescents had the highest prevalence of MetS (3.73%, 95% CI: 3.05, 4.56) compared with adolescents who identified as non-Hispanic White (2.78%, 95% CI: 2.25, 3.43), non-Hispanic Black (1.58%, 95% CI: 1.19, 2.10). Adolescents with household FI (23.20%) were more likely to have MetS [odds ratio (OR): 1.38; 95% CI: 1.02, 1.88; I=0.039) compared with adolescents with no household FI, but in fully adjusted models this was not significant (OR: 1.13; 95% CI: 0.75, 1.72). CONCLUSIONS: Using the most current NHANES data, the estimated prevalence of MetS in adolescents in United States was slightly higher among those from FI households. However, after adjusting for potential confounders, the relationship between household FI and MetS was nonsignificant, highlighting the complexity of factors contributing to MetS in this population. Hispanic adolescents share a disproportionate burden of MetS compared with their non-Hispanic counterparts.

Successful Virtual Delivery of a Group Childhood Healthy Weight Program.

Because of the COVID-19 pandemic, the Get Up & Go program, an established effective 10-week healthy weight program for children ages 6-14 years provided free to families, has offered the option of a synchronous virtual delivery. Pre- and postassessments include a parental questionnaire about child's health behaviors, and weight and height measurements of children. Over 3 cycles, 116 and 107 families registered for virtual and in-person delivery, respectively, with 70 (60.3%) and 84 (78.5%) attending ≥1 session (p = 0.003). More families in virtual delivery spoke Spanish (41.4% vs. 22.6%, p = 0.01), but children did not differ in age, gender, and severe obesity status, and baseline behavior scores and graduation rates were similar. Improvement from baseline in BMIp95 was -3.71 [standard deviation (SD) 5.26] for virtual delivery and -1.95 (3.69) (p = 0.06) for in-person. Behavior questionnaire improvement [+15.9 (12.9) vs. +14.2 (12.0), p = 0.51] did not differ. The virtual implementation demonstrated good effect and may be useful in nonpandemic environments.

The Implementation and Five-Year Evolution of a Childhood Healthy Weight Program: Making a Health Care-Community Partnership Work.

Background: Sustained implementation of moderate to high-intensity interventions to treat childhood obesity meets many barriers. This report uses the Centers for Disease Control and Prevention's (CDC's) Replicating Effective Programs framework to describe and evaluate the implementation of a 5-year health care-community collaborative program. Methods: Interviews with program leadership provided information on setting, organizational culture, program creation and adaptation, and costs. Administrative data were used for number of sessions and their characteristics; referrals; and 2018-2019 participant enrollment, attendance, completion numbers, and completer outcomes. Results: Preconditions for this program were high childhood obesity prevalence, and the complementary strengths of the health care organization (primary care treatment referral stream, population health orientation, alternative Medicaid funding) and the community organization (accessible space and time, staffing model, and organization mission). Preimplementation steps included collaborative design of a curriculum and allocation of administrative tasks. Implementation led to simultaneous deployment in as many as 17 community locations, with sessions offered free to families weekday evenings or weekends, delivered in English or Spanish. From 2018 to 2019, 2746 children were referred from nearly 300 providers, 832 (30.3%) enrolled, and 553 (66.3%) attended at least once, with 392 (70.8% of attenders and 47.1% of enrolled) completing the program. Outcomes in completers included improvement in %BMIp95 [-2.34 (standard deviation, SD 4.19)] and Progressive Aerobic Cardiovascular Endurance Run (PACER) laps [2.46 (SD 4.74)], p < 0.0001 for both. Evolution, including in referral process, Spanish program material and delivery, and range of ages, occurred continuously rather than at discrete intervals. Major system disruptions also affected the implementation. Maintenance of the program relied on the health care organization's administrative team and the collaboration with the community organization. Conclusion: This program's collaboration across organizations and ongoing adaptation were necessary to build and sustain a program with broad reach and positive health outcomes. The lessons learned may be helpful for other programs.