OBJECTIVE:This study examined the association between maternal postpartum weight retention (PPWR) and child BMI z-score, assessed whether this relationship was modified by in utero exposure to maternal overweight/obesity or gestational diabetes mellitus (GDM), and evaluated the relative contributions of gestational weight gain (GWG) and postdelivery weight change (PDWC). METHODS:This secondary analysis used data from the Health After Pregnancy (HAPi) Study and included 219 mother-child dyads. Dyads were classified into three groups based on maternal weight status and GDM during the index pregnancy: normal weight without GDM (NW-No GDM), overweight/obese without GDM (Ow/Ob-No GDM), and overweight/obese with GDM (GDM). PPWR was defined as maternal weight measured 4-10 years postpartum minus baseline pregnancy weight. GWG and PDWC were examined as components of PPWR. Adjusted moderation models tested whether associations between maternal weight change measures and child BMI z-score differed by exposure group, overall and stratified by child sex. RESULTS:Maternal PPWR was associated with child BMI z-score (p = 0.012), and this association differed by exposure group (interaction p = 0.030). Greater PPWR was associated with higher child BMI z-score in the NW-No GDM and Ow/Ob-No GDM groups, but not in the GDM group. GWG, but not PDWC, showed a similar pattern. The PPWR-exposure interaction was significant among girls (interaction p = 0.005), but not boys. CONCLUSIONS:The association between maternal PPWR and child BMI z-score differed by in utero exposure group and was driven primarily by GWG, highlighting pregnancy as a potential intervention window.
BACKGROUND:Previous comparison of obesity prevalence from the National Survey of Children's Health (NSCH) and the National Health and Nutrition Examination Survey (NHANES) found differences between measured and parent-reported estimates for children and adolescents. The NSCH has undergone major methodological changes prompting re-examination of the correspondence between NSCH and NHANES obesity prevalence among children/adolescents ages 6-17 years. OBJECTIVE:To compare obesity prevalence estimates among children/adolescents ages 6-17 years derived from parent-reported height/weight in NSCH (2016-2018) and measured height/weight in NHANES (2015-2018). METHODS:Obesity prevalence, height, weight, and body-mass-index for age among children/adolescents ages 6-17 years from both surveys were compared by age, sex, and race/ethnicity using absolute and relative measures of difference. RESULTS:Overall obesity prevalence was lower using parent-reported data than measured data (16.9% vs. 20.1%, p < 0.01). Estimates were similar for children ages 6-11 years (19.1% vs. 19.5%) but reported estimates were lower for adolescents ages 12-17 years (14.8% vs. 20.8%), particularly among females ages 12-13 and males ages 14-15 years. Reported prevalence was generally similar or lower across racial/ethnic groups, except among non-Hispanic Black children ages 6-9 years. Reported height, weight, and body-mass-index were typically lower than measured values. CONCLUSIONS:Parent-reported data produced similar obesity estimates for children ages 6-11 years but underestimated adolescent obesity and should be interpreted cautiously, especially for detailed subgroups.
BACKGROUND:This systematic review synthesized existing research about associations between sidewalk availability and quality and children's physical health outcomes. METHODS:Google Scholar, PubMed, Scopus, and Web of Science were searched. The initial search strategy was intentionally broad, encompassing all age groups and physical health outcomes in relation to sidewalk access, quality, and connectivity. One hundred and eighty-four eligible studies were identified among 17,726; the retained studies were categorized by age group. This review focuses on 39 articles that specifically examined associations between sidewalk infrastructure and physical health outcomes in children. Eligible studies included both observational and experimental designs, were published in English through March 2025, and reported at least one physical health metric in relation to some aspect of sidewalk characteristics. RESULTS:The included studies (n = 39) were conducted in diverse geographic regions, with the majority based in North America. Most studies employed cross-sectional designs, and both objective and subjective measures for sidewalk metrics and health outcomes were common. The most frequently analyzed health outcomes were physical activity (PA), active transportation, and outdoor play (n = 23), followed by BMI or weight-related measures (n = 11), or both (n = 5). Overall, sidewalk presence and quality were consistently associated with higher levels of various forms of PA, while associations with weight-related outcomes were inconsistent. CONCLUSIONS:Current evidence indicates that sidewalk availability and quality are more consistently linked to children's PA behaviors. Computer vision, deep learning, and automated image-based environmental audits should be used to assess sidewalk attributes that increase children's PA. Future research should also prioritize longitudinal and quasi-experimental approaches to improve causal inference.
BACKGROUND:Gaps in knowledge about youth in pediatric weight management programs (PWMPs) include family and program factors related to retention and youth weight loss, specifically for Black families. The objective of this study was to identify family and program factors associated with retention and weight loss among Black youth in a PWMP. METHODS:A total of 49 parent-child (ages 6-15) dyads who identified as Black at a PWMP had youth weight/height recorded through 12 months, program factors (total encounters and early weight loss), retention (at 6 months and total days retained), and completed assessments of family factors (family functioning, weekly family dinners) at their initial visit. Logistic regression, Wilcoxon rank-sum, and repeated-measure ANOVA were conducted to assess associations between family and program factors with retention at 6-months and weight loss at 6 and 12-months. RESULTS:A total of 42.9% of dyads were retained; each additional unique provider encounter resulted in 1.78 times greater odds of being retained. Youth who lost weight within 3 months were retained in the PWMP for more days compared to children who did not (p < 0.001). Dyads who participated in family dinners >4 days per week were more likely to be retained (p < 0.027). Youth in families with healthy family functioning were more likely to have a lower BMI at 6 months (p = 0.030). CONCLUSIONS:Black youth who experienced earlier weight loss, more provider encounters, and family dinners most of the week were more likely to be retained. Youth in families with healthy family functioning were more likely to have lower BMI at 6 months.
Accurate anthropometric measurement is essential for monitoring child growth, yet access to in-person measurement collection can be limited. This study examines the reliability and repeatability of height and weight measurements taken at home by a single parent compared to those taken by a trained researcher team in a clinical setting. Thirty children aged 2-5 years enrolled in the TARGet Kids! cohort were measured by two trained researchers working in a pair and by their parent at home using standardized instructions. Technical error of measurement (TEM), relative TEM (%TEM), and the coefficient of reliability (R) were used to assess measurement reliability. Results demonstrated high reliability and repeatability of parent-reported measurements, particularly for weight. Bland-Altman plots showed slightly greater variation in height measurements collected by the parent at home, though still within acceptable limits. These findings support the use of parent-collected anthropometry at home, which may enhance accessibility for research and clinical care when in-person measurement is not feasible.
Glucagon-like peptide-1 receptor agonists (GLP-1s), including semaglutide and liraglutide, are effective pharmacologic options for pediatric obesity, producing significant weight loss, cardiometabolic improvements, and reductions in barriers to physical activity. By alleviating pain, mechanical load, and psychosocial burden, these agents can also create a window to initiate sustainable health behaviors in adolescents. However, use during critical developmental periods raises concerns regarding long-term effects on musculoskeletal maturation. Adolescence is marked by rapid accrual of muscle and bone mass, and GLP-1-associated weight loss may attenuate this process, potentially reducing peak musculoskeletal capacity and increasing future frailty risk. This perspective piece advocates for integration of tailored exercise prescription with GLP-1 medication therapy. Given limited longitudinal pediatric data, a balanced approach is necessary. GLP-1s should be integrated within a multimodal framework emphasizing resistance training, weight-bearing activity, and optimized nutrition particularly adequate protein intake to preserve lean mass. Exercise may also synergize with GLP-1-mediated metabolic improvements to enhance functional outcomes. Clinicians should provide individualized, developmentally appropriate guidance that addresses access barriers and patient preferences while reinforcing that pharmacotherapy is not a substitute for lifestyle intervention. Integrated care models that prioritize musculoskeletal integrity and functional health are essential to maximizing long-term outcomes, underscoring the need for longitudinal research in pediatric populations.
BACKGROUND:This cross-sectional study examined how mothers of young children ranked their children's consumption of a healthy diet relative to other social, health, and academic priorities and assessed the associations between these rankings and mothers' engagement in specific food parenting practices. METHODS:Predominantly highly resourced, highly educated mothers (N = 328) ranked "My child eats a healthy diet" among 13 common parenting goals (1 = highest priority; 13 = lowest priority). Sociodemographic and food parenting practices were assessed via questionnaires. Logistic and linear regression models were used to estimate the associations between prioritization of a healthy diet and food parenting practices. RESULTS:In this sample, mothers ranked "My child eats a healthy diet" as the fifth most important parenting priority. Older mothers and mothers without a co-parent ranked children's healthy diets as a higher parenting priority. Adjusting for potential confounders, mothers who rated children's healthy diets as a higher priority were more likely to provide their child with guidance for healthy eating [B (95% confidence interval) = -0.03 (-0.06, -0.01), p = 0.009] and monitor their child's dietary intake [-0.06 (-0.10, -0.02), p = 0.008] and provide their child with more fruits and vegetables [-0.02 (-0.04, -0.0002), p = 0.048] and fewer snacks and sweets at home [0.03 (0.001, 0.06), p = 0.04]. CONCLUSIONS:Mothers who prioritize children's healthy diets are more likely to use supportive food parenting practices and shape the home food environment. Public health efforts should move beyond deficit-based narratives and empower parents by reinforcing their priorities.
PURPOSE:Examine existing rural-urban disparities in the utilization of counseling services by pediatric patients with obesity. METHODS:Based on 3 years (2017-2019) of data from the Merative MarketScan Commercial Claims and Encounters database, we used logistic regression to study rural-urban differences in the likelihood of utilizing counseling services among pediatric patients (aged 2-17 years) diagnosed with obesity. Covariates in the model included age, gender, geographic region, health insurance plan type, and the Charlson Comorbidity Index. Second-order effects of these covariates were included as necessary according to a forward stepwise selection procedure based on the Akaike Information Criterion. RESULTS:Only 8.1% of the pediatric enrollees diagnosed with obesity received at least one obesity counseling service. Nutrition counseling was the most common type of counseling service utilized. Further, we observed significantly lower odds among rural participants than their urban counterparts for patients with insurance plan types comprehensive (odds ratio [OR]: 0.123 [0.017, 0.902]), health maintenance organization (OR: 0.703 [0.530, 0.933]), preferred provider organization (OR: 0.459 [0.374, 0.564]), partially capitated point-of-service (OR: 0.062 [0.015, 0.259]), and consumer-driven health plan (OR: 0.655 [0.514, 0.835]). These are all plans under which patients may incur costs for using treatment outside the network. CONCLUSIONS:This study found a geographical disparity in obesity counseling services utilization and suggests that the need to seek services outside the network is a contributing factor to the rural-urban disparity. Health system approaches to address existing disparities are needed to prevent their spillover effect on disparities in access to modern pharmacotherapies such as glucagon-like peptide-1.
BACKGROUND:Engaging in moderate-to-vigorous physical activity (MVPA) in early childhood can have both immediate and long-term health benefits. Strategies for consistently supporting this are currently unknown, largely due to the vast number of potentially interrelated and dynamic contributing factors that may also be heterogenous across children. METHODS:We developed an agent-based model (ABM) that represents children ages 3-9 who can engage in MVPA in a variety of settings in which they spend time. Our model incorporates key theoretical constructs identified in the literature and is grounded in high-quality empirical evidence, primarily participant data from a cohort-based randomized controlled trial with extensive longitudinal accelerometry measurement. We assess the ABM's ability to reproduce patterns of MVPA observed in the cohort. RESULTS:We uncovered a specific model representation of key pathways and settings involved in MVPA for this age group that can closely reproduce real-world MVPA across multiple a priori assessment metrics. This specification provides new insights into modeled contributors to MVPA. Within our model, the most important within-model pathway driving MVPA for girls is the quality of the built environment, while, for boys, it is the social environment; given the relative availability of the two, this might explain observed differences in MVPA in real-world settings. CONCLUSIONS:In addition to immediate insights, this article provides proof of principle for a powerful tool that can further explore the etiology of childhood MVPA and inform practices and policies to positively affect early childhood PA, setting the stage for lifelong health.
BACKGROUND:Sugar-sweetened beverage (SSB) consumption among young children can be associated with obesity and other adverse health outcomes. Consumption varies by socioeconomic factors such as household income and geographic region, although how these factors might jointly affect SSB consumption is unknown. We evaluated state-level associations between income-to-poverty ratio (IPR) and SSB consumption among children aged 1-5 years in the United States. METHODS:We conducted a pooled cross-sectional study of 55,399 children aged 1-5 years using 2021-2023 National Survey of Children's Health data. We estimated the prevalence of SSB consumption ≥4 times per week by household IPR (<130%, 130%-349%, ≥350%) and state. Multivariable logistic regression evaluated the association between IPR and SSB consumption after adjusting for age, sex, and race and ethnicity. RESULTS:Nationally, 21.1% (95% confidence interval [CI]: 20.2%-21.9%) of children consumed SSBs ≥4 times per week, and this varied significantly by IPR (<130%: 33.1% [95% CI: 30.7%-35.6%], 130%-349%: 22.4% [95% CI: 21.0%-23.9%], ≥350%: 12.1% [95% CI: 11.2%-13.0%]). Substantial geographic variation was observed; SSB consumption ranged from 8.6% (95% CI: 6.4%-11.3%) in Vermont to 33.7% (95% CI: 28.9%-38.8%) in Mississippi. In multivariable models, children from households with a lower IPR (<130% compared with ≥350%) had significantly higher SSB consumption for most states, although the magnitude of this association differed by state. CONCLUSIONS:To reduce SSB consumption among young children, findings highlight the need for potential interventions tailored to the needs of those residing in low-income households.
Background: The Starting Early Program (StEP) promotes healthy nutrition during early life and leads to healthier child weight, but whether dietary patterns contribute to weight or mediate StEP weight outcomes has not been studied. Objectives: This secondary analysis identified infant dietary patterns in StEP, determined associations between dietary patterns and child weight outcomes, and examined whether dietary patterns mediated the relationship between StEP and child weight. Methods: Data were from 377 mother-infant dyads in a randomized trial testing the efficacy of StEP. Dietary patterns at 10 months were identified using latent class analysis. Child weights were abstracted from medical records at 12, 24, and 36 months. Associations between infant dietary patterns and weight-for-age z -score (WFAz) and likelihood of being classified as overweight (WFA ≥85th percentile) were assessed using linear and logistic multivariable regression models. Mediation was used to assess intervention effects on WFAz via impacts on infant dietary patterns. Results: Four classes of infant dietary patterns were identified: Breastfed-High variety, Formula fed-High variety, Formula fed-Low variety, and Mixed fed-Low variety. Compared to the Breastfed-High variety class, infants in the Formula fed-Low variety class had higher WFAz and were more likely to be classified as overweight at 24 and 36 months. Participation in StEP increased membership in Breastfed-High variety, which mediated the association between StEP and lower WFAz at 24 months. Conclusions: Infant dietary patterns were identified, and some were associated with child overweight. StEP was associated with a dietary pattern most consistent with guidelines, which mediated intervention effects on child weight.
OBJECTIVE:To examine changes in weight status after initiating zonisamide in children with epilepsy and elevated body mass index (BMI). STUDY DESIGN:Retrospective chart review of children aged 2 to ≤18 years with epilepsy treated with zonisamide, assessing BMI changes over 2 years. RESULTS:A total of 140 children were included; mean age (SD) at initiation was 9.60 years (3.93). BMI categories included 28 children with severe obesity, 28 with mild-moderate obesity, 28 with overweight, and 56 with healthy weight. Participants were 56.6% female, 91.4% non-Hispanic/Latino, and 88.6% White. At 2 years, BMI z score decreased significantly across all BMI groups: severe obesity -0.38 (N = 13, 95% CI -0.64 to -0.13; p = 0.003), mild-moderate obesity -0.39 (N = 15, 95% CI -0.62 to -0.16; p = 0.001), overweight -0.60 (N = 14, 95% CI -0.84 to -0.36; p < 0.001), and healthy weight -0.46 (N = 21, 95% CI -0.63 to -0.28; p < 0.001). Significant BMI z score reductions were also observed across age groups: 2-10 years -0.48 (N = 40, 95% CI -0.62 to -0.34), >10-13 years -0.27 (N = 15, 95% CI -0.50 to -0.04), and ≥13 years -0.63 (N = 12, 95% CI 0.89 to -0.36). CONCLUSIONS:BMI reduction persisted up to 2 years following zonisamide initiation in children with epilepsy. Further prospective studies are needed to evaluate the weight loss effect and safety of zonisamide in children with epilepsy and elevated BMI.
BACKGROUND:Neighborhood food access is considered a structural determinant of childhood obesity, yet prior studies report inconsistent findings, and longitudinal weight trajectories are understudied. This study sought to examine the association between neighborhood food access and obesity risk across the COVID-19 pandemic, which exacerbated pediatric obesity disparities. METHODS:We conducted a retrospective longitudinal cohort study of 13,832 children aged 2-11 years receiving primary care in eastern Massachusetts between 2019 and 2024. Baseline residential addresses were geocoded to classify a child's residence in low-income, low-food access neighborhoods with low vehicle availability (LILV). Mixed-effects models examined associations between LILV residence and repeated BMI z-scores and obesity risk over follow-up, adjusting for insurance type. Secondary analyses among publicly insured children (n = 3548) explored the association between LILV residence and obesity risk, adjusting for household food insecurity. RESULTS:At baseline, 26.1% of children resided in LILV neighborhoods. No significant differences in BMI z-scores or obesity risk were observed at age 5 years. By age 10, LILV residence was associated with higher BMI z-scores [β = 0.08; 95% confidence interval (CI): 0.01-0.16] and increased obesity risk [risk ratio (RR) = 1.55; 95% CI: 1.01-2.39]. By age 15, associations strengthened [BMI z-score β = 0.14; 95% CI: 0.05-0.22; obesity RR = 1.94; 95% CI: 1.17-3.23]. Among the subset of children with public insurance, these associations were not observed. CONCLUSIONS:Residence in low-income, low-food access neighborhoods is associated with higher BMI and obesity risk across childhood and adolescence, independent of insurance type. These findings highlight neighborhood food access as a potentially modifiable structural determinant of pediatric obesity disparities.
BACKGROUND:This clinical trial evaluated hepatic fat content and weight loss in adolescents with severe obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) following short-term meal replacement therapy (MRT). METHODS:Adolescents aged 12-17 years with severe obesity (BMI ≥1.2 × 95th percentile or ≥35 kg/m2) and magnetic resonance imaging-confirmed MASLD (hepatic fat fraction [HFF] ≥5%) completed a 4- to 8-week MRT program (∼500 kcal/day deficit) targeting ≥5% BMI reduction. Participants underwent 1H-magnetic resonance spectroscopy at baseline and at follow-up, along with 2-hour mixed-meal tolerance testing. RESULTS:Seventeen adolescents [baseline mean (standard deviation or SD) BMI = 39.9 (4.1) kg/m2; age = 16.0 (1.6) years; 65% male; HFF = 15.6 (5.1)%] demonstrated a mean absolute decrease in BMI of 5.6% [-2.23 kg/m2; 95% confidence interval (CI): -2.45, -2.02; p < 0.001] and a 37.3% relative reduction (95% CI: 26.4%, 48.1%; p < 0.001) in HFF. Despite HFF reduction, 13 out of 17 had MASLD at study conclusion. Decrease in HFF corresponded to significant reductions in triglycerides [difference (95% CI): -5.8 mg/dL (-9.4, -2.1); p = 0.012], glucose area under the curve (AUC) [-2.2 mg/dL (-3.2, -1.3); p = 0.021], and leptin AUC [-40.5 pg/mL (-57.1, -23.9); p = 0.009]. No significant difference in alanine aminotransferase was observed. CONCLUSIONS:Short-term MRT was associated with reductions in liver fat and improvements in metabolic biomarkers among adolescents with MASLD. Large-scale trials are needed to evaluate the implementation of MRT as part of a multimodal treatment strategy in this population. [Clinical Trial Registration: Enhancing Weight Loss Maintenance with GLP-1 RA (BYDUREON™) in Adolescents With Severe Obesity, NCT02496611, https://clinicaltrials.gov/study/NCT02496611].
BACKGROUND:This study leveraged a novel Missouri Medicaid (MOHealthNet) benefit to adapt and implement evidence-based family-based behavioral treatment (FBT) within health care settings in alignment with policy requirements. METHODS:In a nonrandomized matched-comparison trial, 108 parent-child dyads participated in FBT, and 92 dyads attended at least one session. Licensed Clinical Social Workers or Registered Dietitian Nutritionists offered 26-33 FBT hours delivered virtually over 6-12 months to Medicaid-insured patients in an urban and rural pediatric health system in Missouri. The matched-comparison group included 186 participants. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) framework was used to evaluate effectiveness (primary) and reach (secondary) and explore adoption, implementation, and maintenance. RESULTS:Children in the FBT group reduced their percent over median body mass index (BMI) compared with the matched comparison group (mean reduction: -3.9 ± 1.4, d = -0.42). Within the FBT group, participants also demonstrated improvements in coping with teasing, health-related quality of life, and family health habits (all p < 0.05). Families rated the program as highly acceptable. Reach data indicated enrolled patients had similar BMI, sex, and ethnic backgrounds compared with eligible but non-enrolled patients (ps > 0.301). CONCLUSIONS:Data demonstrate the feasibility of adopting and implementing FBT within health care systems and inform efforts to support maintenance. FBT reached a diverse population of families receiving Medicaid in pediatric primary care settings and was associated with greater improvements in youth weight outcomes compared with a matched comparison group. Adaptations made to align with the benefit may have reduced the magnitude of effects; however, this policy provides an opportunity to deliver FBT within primary care settings and expand access.
BACKGROUND:Children spend 33-35 hours per week in family child-care homes and may consume up to five meals and snacks there, making these settings important for understanding how food especially fruits and vegetables are prepared and served. The purpose was to examine frequency and variety, preparation styles by meal, and identify predictors of fresh and frozen fruit and vegetable service in Oklahoma family child care homes (FCCH). METHODS:Ninety-six FCCHs participated in two cohorts (n = 51 in-person; n = 45 virtual). Frequency, variety, and preparation styles of fruits/vegetables were recorded for both in-person and virtual cohorts. The average frequency and variety of fruits and vegetables, and the frequency of their preparation styles were calculated. The association of FCCH characteristics with fresh/frozen fruits and vegetables service score was examined. RESULTS:All FCCH providers identified as female (mean age 43.9 ± 15.1 years). At breakfast, whole fruits and juice were served by 88.6% and 6.8% of providers, respectively. At lunch, whole fruits and juice were served by 86.6%-94.1% and 2.0%-4.4%, and vegetables by 94.1%-97.8%. At snack, fruits, fruit juice, and vegetables were served by 60%, 13.3%, and 11.1%, respectively. Bananas and apples/applesauce were the most common fruits, and carrots and green beans were the most common vegetables served. Fresh fruit was most common at breakfast (77.3%), lunch (53%-61%), and snack (63%). Fresh and frozen vegetables were equally prevalent (50%) at breakfast, canned vegetables (44-57%) at lunch, and fresh vegetables (100%) at snack. No provider/program characteristics were associated with fresh/frozen service scores. CONCLUSIONS:Opportunities exist to improve fruits/vegetables service in Oklahoma FCCHs by serving vegetables at breakfast and snacks and reducing juice and canned options.
Background: Inadequate care access may exacerbate the childhood obesity epidemic. Obesity treatments are recommended for adolescents, but the health-economic impacts of unequal treatment access are unclear. This study aims to evaluate the cost-effectiveness of improving access levels to adolescent obesity care and treatment. Methods: In this economic evaluation, we used a decision-analytic model to simulate a synthetic cohort of 1000 US adolescents from ages 12 to 26 on an annual basis. Modeled treatment strategies included phentermine-topiramate, semaglutide, bariatric surgery, and lifestyle modification (usual care). Primary analysis modeled perfect care access for reproducibility with prior studies. Secondary analyses modeled imperfect access to primary care visits, specialty visits, and treatment initiation among distinct groups by insurance coverage or race and ethnicity. Uncertainty analyses tested model parameter estimates. Outcomes were costs, health effects [averted obesity cases, quality-adjusted life years (QALYs)], and incremental cost-effectiveness ratios (ICERs) from health care sector and limited societal perspectives, including caregiver time. Results: Phentermine-topiramate (vs. lifestyle) yielded an ICER of 2025 US$112,141/QALY, and semaglutide (vs. phentermine-topiramate) yielded $166,513/QALY under perfect access. Under imperfect access, cost-effectiveness and health gains were reduced. Cost-effectiveness was reduced by 11%, and averted obesity cases decreased from 57% to 3% for semaglutide. Health gains were lowest in Medicaid-insured, Black, or Hispanic youth. ICERs were sensitive to medication characteristics (costs, efficacy, discontinuation) and health utilities. Conclusions: In this economic evaluation, phentermine-topiramate and semaglutide were cost-effective under $200,000/QALY, using 2025 pricing. Care access disparities limit health-economic gains for adolescents. Improving care access is critical to addressing the childhood obesity epidemic.
Background: Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for adolescents with severe obesity; however, some health care providers are hesitant to refer adolescents due to concerns regarding decisional capacity. Structured educational materials provided prior to MBS have the potential to improve informed decision-making. The objective of this study was to characterize topics that may not be adequately addressed in existing structured educational materials for adolescents seeking MBS. Methods: Semi-structured, qualitative interviews were conducted with adolescents who had undergone MBS and with parents or guardians of postoperative adolescents. Thematic saturation was assessed by considering properties from a base number of interviews (n = 7) and a run length (n = 2). Interrater reliability was established at the theme level. An adolescent citizen scientist was approached to provide feedback on the codebook. Results: In total, six adolescents and six parents or guardians diverse in race and ethnicity were interviewed. For adolescents, the average age at the time of the procedure was 16 years (standard deviation = 2.37). Most participants (n = 5) underwent vertical sleeve gastrectomy. Five key themes were identified that provide additional information on the preferred format of delivery (interactive materials, teen-specific materials) and topics that may not be adequately addressed (physical aspects of surgery, psychosocial well-being, and specific resources for parents or guardians). Conclusions: This current study identified gaps in the format of delivery and topics covered in structured preoperative educational materials. Future work should determine if these gaps are widespread across accredited MBS centers. Furthermore, the development of additional materials should be considered.
Few studies have characterized metabolically healthy (MHO) and unhealthy obesity (MUO) in pediatric populations over time. The objective of this study was to determine the prevalence of MHO in children and adolescents enrolled in a weight management program and examine changes in cardiometabolic indicators over 1 year. Methods: Participants from the CANadian Pediatric Weight management Registry were stratified by age (6-11-year-olds; 12-17-year-olds) and sex to determine MHO/MUO status at baseline and 1-year follow-up. Results: In this sample (n = 387), the baseline and 1-year follow-up prevalence of MHO were 35% and 34%, respectively. Obesity status remained stable in 72% of participants. Of the 387 participants, n = 55 transitioned from MHO to MUO, while n = 53 transitioned from MUO to MHO by 1 year. Patterns of change in MHO were generally similar across sexes and age groups. Conclusion: In this study, MHO was present in approximately one-third of children and adolescents, with one-quarter changing MHO to MUO or MUO to MHO status from baseline to 1-year follow-up.
BACKGROUND:Responsive feeding supports healthy growth and may reduce obesity risk, yet bottle-feeding can promote nonresponsive feeding practices such as pressuring infants to finish their bottle. Because the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves many U.S. infants and bottle-feeding is common, scalable strategies are needed. We tested feasibility, acceptability, and preliminary effectiveness of GrowWell, an automated text-messaging program to support responsive bottle-feeding. METHODS:We conducted a 12-week randomized attention-control trial among mothers of bottle-fed infants ≤7 weeks old enrolled in WIC (n = 60; intervention n = 31; control n = 29). Participants received weekly goals, twice-weekly self-monitoring prompts with tailored feedback, and daily skills training; controls received texts focused on infant safety. Feasibility was assessed by response to self-monitoring prompts; acceptability by postintervention satisfaction surveys; and preliminary effectiveness by change in Infant Feeding Style Questionnaire (IFSQ) scores. Intervention participants completed semistructured interviews analyzed using rapid qualitative methods. RESULTS:Mean response rate to self-monitoring prompts was 71.9% and did not differ by group. Satisfaction survey responses (n = 56, 30 intervention, 26 control) indicated high acceptability (≥80% agreement across items), with consistently higher ratings in the intervention group. Overall changes in IFSQ scores did not differ between groups (n = 58, 31 intervention, 27 control); however, within-group analyses showed reductions in pressuring to finish (p = 0.012) and pressuring to soothe (p = 0.002) among intervention participants at 12 weeks. Exploratory interaction analyses suggested heterogeneity by select sociodemographic characteristics. Interviews among intervention participants (n = 16) indicated high satisfaction, increased awareness of cues, and adoption of responsive practices. CONCLUSIONS:GrowWell was feasible and highly acceptable, with promising preliminary signals for reducing pressuring bottle-feeding practices.
