Complexity around childhood obesity

January 6, 2020

Science Daily/University of Notre Dame

In a new study, researchers examined how various psychological characteristics of children struggling with their weight, such as loneliness, anxiety and shyness, combined with similar characteristics of their parents or guardians and family dynamics affect outcomes of nutritional intervention.

The World Health Organization has estimated more than 340 million children and adolescents ages 5-19 are overweight or obese, and the epidemic has been linked to more deaths worldwide than those caused by being underweight.

The Centers for Disease Control recently reported an estimated 1 in 5 children in the United States, ages 12-18, are living with prediabetes -- increasing their risk of developing type 2 diabetes as well as chronic kidney disease, heart disease and stroke.

Efforts to stem the crisis have led clinicians and health professionals to examine both the nutritional and psychological factors of childhood obesity. In a new study led by the University of Notre Dame, researchers examined how various psychological characteristics of children struggling with their weight, such as loneliness, anxiety and shyness, combined with similar characteristics of their parents or guardians and family dynamics affect outcomes of nutritional intervention.

What they found was a "network effect," suggesting a personalized, comprehensive approach to treatment could improve results of nutritional interventions.

"Psychological characteristics clearly have interactional effects," said Nitesh Chawla, the Frank M. Freimann Professor of Computer Science and Engineering at Notre Dame, director of the Center for Network and Data Science and a lead author of the study. "We can no longer simply view them as individualized risk factors to be assessed. We need to account for the specific characteristics for each child, viewing them as a holistic set for which to plan treatment."

The Notre Dame team collaborated with the Centre for Nutritional Recovery and Education (CREN), a not-for-profit, nongovernmental nutritional clinic in São Paulo, Brazil, where patients participate in a two-year interdisciplinary treatment program including family counseling, nutritional workshops and various physical activities. Researchers analyzed the medical records and psychological assessments of 1,541 children who participated in the program.

The study's key takeaway points to the significant impact parents and guardians have on their child's health when it comes to nutrition. Strong family dynamics, such as concern for behavior and treatment and a sense of protectiveness for the child, led to improved outcomes of nutritional interventions. A lack of authority, however, led to minimal changes in results.

"This is quantitative evidence of the success and failure of interactions as they relate to the characteristics and interactions between the child and the parent or guardian," Chawla said.

The study also highlights the need for clinics to expand their views on patient populations. For example, while treatment programs that incorporate development of interpersonal relationship -- familial and otherwise -- may improve outcomes of nutritional interventions, the same treatment plan may not have the same result for children experiencing loneliness coupled with anxiety.

"For the group without anxiety, this makes sense when you consider a treatment plan focused on strengthening a child's social circle and address issues stemming from loneliness, such as poor social network, bullying or self-imposed isolation," said Gisela M.B. Solymos, co-author of the study, former general manager of CREN and former guest scholar at the Kellogg Institute for International Studies at Notre Dame and at the Center for Network and Data Science. "But patients feeling loneliness and anxiety actually showed minimal changes to nutritional interventions, and may be more likely to benefit from additional services at clinics like CREN."

https://www.sciencedaily.com/releases/2020/01/200106161935.htm

Factors that predict obesity by adolescence revealed

October 16, 2019

Science Daily/Murdoch Childrens Research Institute

Three simple factors that predict whether a healthy weight child will be overweight or obese by adolescence have been revealed in a new study led by the Murdoch Children's Research Institute (MCRI).

The research shows three factors -- a child's and mother's Body Mass Index (BMI) and the mother's education level -- predict the onset or resolution of weight problems by adolescence, especially from age 6-7 years onwards.

Each one-unit higher BMI when the child is aged 6-7 years increased the odds at 14-15 years of developing weight problems by three-fold and halved the odds of resolution.

Similarly, every one-unit increase in the mother's BMI when the child is aged 6-7 years increased the odds at 14-15 years of developing weight problems by 5 per cent and decreased the odds of resolution by about 10 per cent.

Mothers having a university degree was associated with lower odds of a child being overweight and obese at ages 2-5 years and higher odds of resolving obesity issues by adolescence.

Study author MCRI's Dr Kate Lycett said the prevalence of being overweight/obese at the age of 14-15 years was 13 per cent among children with none of these three risk factors at age 6-7 years, compared with 71 per cent among those with all risk factors.

Dr Lycett said identifying these three factors may help clinicians predict which children will develop and resolve excess weight with about 70 per cent accuracy.

"In the case of BMI, it is an objective measure that is easily measured and reflects diet and exercise choices, but is free from the challenges of assessing physical activity and diet in a standard clinical appointment such as recall bias," she said.

The findings, published in the latest edition of the International Journal of Obesity, also found children who are overweight or obese at 2-5 years have a low chance of resolving their weight problems by adolescence when these three risk factors are present.

Data was sourced from 3469 participants at birth and 3276 participants at kinder from the Longitudinal Study of Australian Children. The child's height and weight were measured every two years.

Dr Lycett said until now most studies have overlooked the important questions around which children are likely to become overweight/obese and how it be resolved.

"Because clinicians haven't been able to tell which children will grow up to become teens with excess weight, it's been hard to target interventions for those most at risk," she said.

"The consequences of this are dire, with childhood obesity predicting premature death and being implicated in cardiovascular disease, diabetes and cancer."

The study examined how combinations of 25 potential short clinical markers such as time breastfeeding and amount of outdoor activity at various ages predict weight issues, as well as resolution, by ages 10-11 and 14-15 years.

Intriguingly, short questions about poor diet, low physical activity and other common lifestyle factors were not predictive of weight outcomes.

Lead author Professor Markus Juonala, from the University of Turku in Finland, said a simple risk score, which would be easily available to child health clinicians, could help target treatment or prevention.

"Combining data on these three easily obtainable risk factors may help clinicians make appropriate decisions targeting care to those most at risk of adolescent obesity," he said.

"The benefits of removing a focus on those unlikely to need clinical interventions for obesity has largely been ignored, despite an increasing policy emphasis on avoiding wasteful or unnecessary health care."

https://www.sciencedaily.com/releases/2019/10/191016094911.htm

Even in young children: Higher weight = higher blood pressure

June 13, 2019

Science Daily/European Society of Cardiology

Overweight four-year-olds have a doubled risk of high blood pressure by age six, raising the hazard of future heart attack and stroke. That's the finding of a study published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

"The myth that excess weight in children has no consequences hampers the prevention and control of this health problem," said study author Dr Iñaki Galán, of Carlos III Health Institute, Madrid, Spain. "Parents need to be more physically active with young children and provide a healthy diet. Women should shed extra pounds before becoming pregnant, avoid gaining excess weight during pregnancy, and quit smoking, as these are all established risk factors for childhood obesity."

According to the World Health Organization, childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and the prevalence has increased at an alarming rate. In 2016, more than 41 million children under the age of five were overweight.

This study, based on the ELOIN cohort, examined the link between excess weight and high blood pressure in 1,796 four-year-olds who were followed up two years later. Blood pressure was measured at both time points, as was body mass index (BMI in kg/m2) and waist circumference.

Compared to children maintaining a healthy weight between ages four and six, those with new or persistent excess weight according to BMI had 2.49 and 2.54 higher risks of high blood pressure, respectively. In those with new or persistent abdominal obesity, the risks for high blood pressure were 2.81 and 3.42 greater, respectively. Children who lost weight did not have an increased risk of high blood pressure. The findings applied to all children regardless of sex or socioeconomic status.

"There is a chain of risk, whereby overweight and obesity lead to high blood pressure, which heightens the chance of cardiovascular disease if allowed to track into adulthood," said Dr Galán. "But the results show that children who return to a normal weight also regain a healthy blood pressure."

The best way to maintain a healthy weight and lose excess kilos is to exercise and eat a healthy diet, said Dr Galán. In addition to the central role of parents, the school curriculum needs to include three to four hours of physical activity every week. Teachers should supervise activities during breaks, while schools can offer games and sports after classes and provide nutritionally balanced meals and snacks.

Doctors should routinely assess BMI and waist circumference at early ages, added Dr Galán. "Some paediatricians think the harms of overweight and obesity begin in adolescence but our study shows they are mistaken," he said. "We need to detect excess weight as soon as possible so the damaging impact on blood pressure can be reversed."

Overweight children should have their blood pressure measured. Three consecutive elevated readings constitute high blood pressure. In young children, the most common cause is excess weight, but doctors will rule out other reasons such as heart defects, kidney disease, genetic conditions, and hormonal disorders. If the cause is overweight, more activity and dietary improvements will be advised. If lifestyle changes don't help, blood pressure lowering medication may be prescribed.

Dr Galán noted that overweight in children is most accurately assessed using both BMI and waist circumference. In the study, using either measurement alone would have missed 15% to 20% of cases.

https://www.sciencedaily.com/releases/2019/06/190613095224.htm

Childhood obesity linked to poor school performance and coping skills

November 2, 2018

Science Daily/American Academy of Pediatrics

Study suggests that childhood obesity, now at epidemic levels in the United States, may affect school performance and coping skills for challenging situations.

Researchers analyzed responses from 22,914 parents and caregivers of children aged 10-17 years who participated in the 2016 National Survey of Children's Health. The goal was to determine the independent association between body mass index (BMI) and five markers of "flourishing," or overall well-being as it relates to the development of positive psychosocial and coping skills.

"Childhood obesity is one of the biggest public health challenges we face today," said Natasha Gill, MD, FAAP, a Pediatric Emergency Medicine Fellow at the Alpert Medical School of Brown University and Hasbro Children's Hospital. "We know that children with obesity are at a greater risk for long-term health conditions that can last into adulthood, and we wanted to see whether obesity affects a child's immediate well-being as it relates to development of psychosocial skills and other signs of flourishing."

Adjusting for several confounding variables, including gender, child depression status, average sleep hours per night, average digital media exposure per day, highest parental education level, and household poverty status, Dr. Gill and her colleagues analyzed parents' responses to questions about whether their child:

·     "Shows interest and curiosity in learning new things"

·     "Works to finish tasks he or she starts"

·     "Stays calm and in control when faced with a challenge"

·     "Cares about doing well in school"

·     "Does all required homework"

Researchers found that only 27.5 percent of children with obesity, defined as a BMI at or above the 95th percentile for children and teens of the same age and sex, were reported to have all five flourishing markers. This compares with 36.5 percent of those in the overweight range, with BMI at or above the 85th percentile, and 39 percent of children with normal BMI.

"The negative relationship between obesity and flourishing markers suggests that when compared to children with a normal BMI, obese youth may be less likely to develop healthy relationships, positive attitudes, a sense of purpose and responsibility, and interest in learning," Dr. Gill said. "Individual markers of flourishing have been shown to stay the same over time like a person's personality," she said, "so it may be important to monitor these markers in childhood to ensure optimal development into adulthood."

"We want all children to reach their maximum potential," she said. "If we can intervene early enough, we can promote positive physical, mental, and social development for these at-risk children and help them become responsible, hard-working members of society." She said her study's findings support the need for focused and coordinated efforts and resources from schools and health care providers that target obesity to improve overall well-being.

https://www.sciencedaily.com/releases/2018/11/181102083441.htm