COVID-19 lockdowns worsen childhood obesity, study finds

Research finds obese kids under lockdown in Italy ate more junk food, watched more TV at expense of physical activity

June 3, 2020

Science Daily/University at Buffal

Lockdowns implemented across the world due to the COVID-19 pandemic have negatively impacted diet, sleep and physical activity among children with obesity, according to University at Buffalo research.

The study, published in April in Obesity, examined 41 overweight children under confinement throughout March and April in Verona, Italy.

Compared to behaviors recorded a year prior, the children ate an additional meal per day; slept an extra half hour per day; added nearly five hours per day in front of phone, computer and television screens; and dramatically increased their consumption of red meat, sugary drinks and junk foods.

Physical activity, on the other hand, decreased by more than two hours per week, and the amount of vegetables consumed remained unchanged.

"The tragic COVID-19 pandemic has collateral effects extending beyond direct viral infection," says Myles Faith, PhD, UB childhood obesity expert and co-author on the study. "Children and teens struggling with obesity are placed in an unfortunate position of isolation that appears to create an unfavorable environment for maintaining healthy lifestyle behaviors."

"Recognizing these adverse collateral effects of the COVID-19 pandemic lockdown is critical in avoiding the depreciation of hard-fought weight control efforts among youths afflicted with excess weight," says Faith, chair and professor of counseling, school and educational psychology in the UB Graduate School of Education.

The study was led by Steven Heymsfield, MD, professor at the Louisiana State University Pennington Biomedical Research Center; and Angelo Pietrobelli, MD, professor at the University of Verona in Italy.

Children and adolescents typically gain more weight during summer vacation than during the school year, says Faith, which led the researchers to wonder if being homebound would have a similar effect on the kids' lifestyle behaviors.

"School environments provide structure and routine around mealtimes, physical activity and sleep -- three predominant lifestyle factors implicated in obesity risk," says Faith.

The researchers surveyed 41 children and teens with obesity in Verona, Italy, who were involved in an ongoing long-term study. Lifestyle information regarding diet, activity and sleep was collected three weeks into Italy's mandatory national lockdown and compared to data on the children gathered in 2019. Questions focused on physical activity, screen time, sleep, eating habits, and the consumption of red meat, pasta, snacks, fruits and vegetables.

The results confirmed the negative change in behavior, indicating that children with obesity fare worse on weight control lifestyle programs while at home compared to when they are engaged in their school curriculum.

"Depending on the duration of the lockdown, the excess weight gained may not be easily reversible and might contribute to obesity during adulthood if healthier behaviors are not re-established," says Faith. "This is because childhood and adolescent obesity tend to track over time and predict weight status as adults."

Government officials and policymakers should consider the potential harmful effects of lockdowns on youths with obesity when making decisions regarding when and how to loosen restrictions, says Faith.

There is also a need to establish and evaluate telemedicine programs that encourage families to maintain healthy lifestyle choices during periods of lockdown, he adds.

Faith and colleagues are conducting an ongoing National Institutes of Health-funded study that is testing a family-based treatment for childhood obesity using telemedicine technology that allows participants to be treated in their homes.

https://www.sciencedaily.com/releases/2020/06/200603194444.htm

Obesity could affect brain development in children

December 18, 2019

Science Daily/University of Vermont

New research found that obese children had a thinner pre-frontal cortex than normal weight children. The thinner cortex could be factor in the decreased executive function earlier studies observed among children with higher BMI. The new study confirmed that the obese subjects in the study had poorer working memory compared with normal weight children.

Published studies have long found a correlation between obesity in children and decreased executive function. New research published in JAMA Pediatrics, based on data mined from a massive national research study, suggests that a change in brain structure -- a thinner prefrontal cortex -- may help explain that interrelationship.

"Our results show an important connection; that kids with higher BMI tend to have a thinner cerebral cortex, especially in the prefrontal area," said Jennifer Laurent, an associate professor in the Department of Nursing at the University of Vermont and lead author of the study.

The findings are based on data retrieved from a National Institutes of Health-funded research project, the Adolescent Brain Cognitive Development study, or ABCD, which is following 10,000 teens over a 10 year period. Every two years, study subjects are interviewed, take a battery of tests, give blood samples and undergo brain scans.

The study analyzed results from 3,190 nine- and 10-year-olds recruited at 21 ABCD sites in 2017.

The robust study confirmed the findings of its predecessors; that subjects with higher BMI tended to have lower working memory, as measured by a list sorting test.

But it added an important component to that insight -- a physiological correlate in the brain that might help explain the connection.

"Our hypothesis going into the study was that the thickness of the cerebral cortex would 'mediate' -- or serve as an explanatory link for -- the relationship between BMI and executive function," Laurent said.

The findings did confirm the relationship, according to the study's senior author, Scott Mackey, an assistant professor of Psychiatry in the University of Vermont's Larner College of Medicine.

"We found widespread thinning of cerebral cortex" among research subjects with higher BMI, Mackey said, but especially so in the prefontal area.

"That's significant because we know that executive function, things like memory and the ability to plan, are controlled in that area of the brain," he said.

More research is needed to determine the nature of the link between the three variables.

"It could be that a thinner prefrontal cortex is affecting decision-making in some children, and they make unhealthy dietary choices as a result, which could lead to obesity," Laurent said.

Or the causal relationship could work in the opposite direction.

"We know from rodent models and adult studies that obesity can induce low grade inflammatory effects, which actually do alter cellular structure" and can lead to cardiovascular disease, Laurent said.

"With prolonged exposure to obesity, it is possible that children have chronic inflammation, and that may actually be affecting their brain in the long term," she said.

If that were the case, there would be significant public health implications, Laurent said. "We would want to proactively encourage changes in kids' diets and exercise levels at a young age with the understanding that it's not only the heart that is being affected by obesity, it is perhaps also the brain."

The decrease in working memory was a statistical observation, Laurent said, not a clinical one.

"We did not look at behavior. It's very important that this work not further stigmatize people who are obese or overweight," she said.

"What we're saying is that, according to our measures, we are seeing something that bears watching. How and if it translates to behavior is for future research to determine."

Data analysis for the study was done at the University of Vermont and Yale University. Richard Watts, director at the FAS Brain Imaging Center and research associate professor of radiology at Yale, was a co-author of the study.

https://www.sciencedaily.com/releases/2019/12/191218153444.htm

Defining obesity in children should be based on health issues, not just BMI

Mental health issues are consistent across BMI groups

April 2, 2019

Science Daily/McMaster University

A new study aims to identify what influences the success participants achieve in weight management programs and help improve these programs. The study follows participants for three years.

Physicians are told to gauge the severity of a child's problem with obesity using the body mass index (BMI) that measures weight against height. But that doesn't work well to identify health issues, especially those of mental health, in children with obesity seeking care, says a study led by McMaster University.

Other medical issues, including high blood pressure, prediabetes and non-alcoholic fatty liver disease are also common, and are only slightly more frequent in those with the most severe obesity compared to those with less severe obesity, according to the study.

The details of the study called the Canadian Pediatric Weight Management Registry (CANPWR) were published today in The Lancet Child & Adolescent Health. This study found two thirds of children entering weight management programs across Canada have severe obesity based on their BMI.

"We found that social and mechanical health issues were more common in those with the highest body mass index. However, mental health issues, for example, are consistent across the BMI groups," said Katherine Morrison, principal investigator of the CANPWR study, and professor of the Department of Pediatrics at McMaster.

"If you are only using BMI to identify the youth who need the most care, you would be presuming the kids with the lowest BMI class would be the least likely to have mental health issues or metabolic issues, but our findings suggest this is not true. This study suggests that using a clinical staging system, one that evaluates the health of the child and not just the BMI, is likely the best approach."

Morrison is also co-director of the Centre for Metabolism, Obesity and Diabetes Research at McMaster, an investigator of the Population Health Research Institute, and a pediatric endocrinologist at McMaster Children's Hospital. She said the end goal is to improve care of these children.

"There is a lot said about preventing obesity, we also really need to focus on how best to treat children with obesity. This is especially true when we see the burden of health illness that is associated with obesity in children entering weight management programs."

The CANPWR study aims to identify what influences the success participants achieve in weight management programs and help improve these programs. The study follows participants for three years.

The 10 clinics taking part in the study are in Vancouver, Edmonton, Calgary, Toronto, Hamilton, Ottawa and Montreal.

The paper used information from 847 children with obesity and the health issues were determined at their initial visit to one of the multidisciplinary weight management clinics across Canada. Participants were aged five to 17 at the time of enrolment.

In this study, researchers showed that using a clinical staging system called the Edmonton Obesity Staging System for Pediatrics, or EOSS-P, was more useful for understanding the health issues of the children in these clinics than the BMI class system. They suggest that using a clinical staging system will better assist the design of health care interventions for children with obesity.

Obesity-related health issues were common. Mental health concerns were the most common (90 per cent), followed by metabolic (85 per cent), social (65 per cent) and mechanical (62 per cent) health issues. The most common mental health issue identified was anxiety.

The most commonly identified metabolic health complication was dyslipidemia, followed by non-alcoholic fatty liver disease.

Bullying was the most commonly identified social health factor, followed very closely by low household income. More than one-third of children in the highest obesity group came from low income homes, which was significantly higher than those with lower levels of obesity.

Those with the most severe obesity by BMI were more likely to have experienced bullying, and more likely to report difficulties with peer relationships, compared to the less severe obesity groups. 

https://www.sciencedaily.com/releases/2019/04/190402215621.htm