Recent Advances in Treatment of Childhood Obesity

: Childhood obesity has assumed epidemic proportions and is currently one of the most widespread public health problems. Many are the factors involved in the pathogenesis of excess weight with interactions between genetic, environmental and biological factors and therefore, also the therapeutic approach must be multidisciplinary and multidimensional. In this review of the literature, we report the contiguity of childhood obesity with eating disorders and the importance of involving the family context in order to induce stable lifestyle changes, both in relation to dietary and nutritional habits, but also in increasing physical activity. Finally, among the therapeutic options, although for selected cases, pharmacotherapy and bariatric surgery can be used as treatment strategies.

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App Technology to Support Physical Activity and Intake of Vitamins and Minerals After Bariatric Surgery (the PromMera Study): Protocol of a Randomized Controlled Clinical Trial (Preprint)

10.2196/preprints.19624 ◽

2020 ◽

Author(s):

Stephanie Erika Bonn ◽

Mari Hult ◽

Kristina Spetz ◽

Marie Löf ◽

Ellen Andersson ◽

...

Keyword(s):

Physical Activity ◽

Bariatric Surgery ◽

Controlled Trial ◽

Intervention Group ◽

Study Participant ◽

Lifestyle Factors ◽

Lifestyle Changes ◽

Control Group ◽

Controlled Clinical Trial ◽

Randomized Controlled

BACKGROUND To optimize postoperative outcomes after bariatric surgery, lifestyle changes including increased physical activity are needed. Micronutrient deficiency after surgery is also common and daily supplementation is recommended. OBJECTIVE The aim of the PromMera study is to evaluate the effects of a 12-week smartphone app intervention on promotion of physical activity (primary outcome) and adherence to postsurgery vitamin and mineral supplementation, as well as on other lifestyle factors and overall health in patients undergoing bariatric surgery. METHODS The PromMera study is a two-arm, randomized controlled trial comprising patients undergoing bariatric surgery. Participants are randomized postsurgery 1:1 to either the intervention group (ie, use of the PromMera app for 12 weeks) or the control group receiving only standard care. Clinical and lifestyle variables are assessed pre- and postsurgery after 18 weeks (postintervention assessment), 6 months, 1 year, and 2 years. Assessments include body composition using Tanita or BOD POD analyzers, muscle function using handgrip, biomarkers in blood, and an extensive questionnaire on lifestyle factors. Physical activity is objectively measured using the ActiGraph wGT3X-BT triaxial accelerometer. RESULTS A total of 154 participants have been enrolled in the study. The last study participant was recruited in May 2019. Data collection will be complete in May 2021. CONCLUSIONS Implementing lifestyle changes are crucial after bariatric surgery and new ways to reach patients and support such changes are needed. An app-based intervention is easily delivered at any time and can be a key factor in the adoption of healthier behavioral patterns in this rapidly growing group of patients. CLINICALTRIAL ClinicalTrials.gov NCT03480464; https://clinicaltrials.gov/ct2/show/NCT03480464 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19624

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Exploring associations between children’s obesogenic behaviours and local environment using big data (Preprint)

10.2196/preprints.26290 ◽

2020 ◽

Author(s):

Nicos Maglaveras ◽

Dimitris Filos ◽

Irini Lekka ◽

Vasileios Kilintzis ◽

Leandros Stefanopoulos ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Big Data ◽

Childhood Obesity ◽

Local Environment ◽

Living Environment ◽

Health Policies ◽

Major Public Health Problem ◽

European Cities ◽

Custom Made

UNSTRUCTURED Obesity is a major public health problem globally and in Europe, while the prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast-food retailers, among others. Thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems to objectively measure the effect of living environment parameters on obesogenic behaviours and obesity so that tailored policies can be planned. The H2020 project “BigO: Big Data Against Childhood Obesity” (http://bigoprogram.eu) aims to tackle childhood obesity by creating new sources of evidence based on big data. This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which can support public health authorities in formulating effective, context-specific policies and interventions addressing childhood obesity. In particular, OPdashboard allows for (i) the real time monitoring of children’s obesogenic behaviours, (ii) the extraction of associations between them and the local environment, (iii) the evaluation of an intervention in time, and (iv) the design of an action by predicting its effect. More than 3700 children, from more than 33 schools and 2 clinics, in 5 European cities have been monitored using a custom-made mobile application for the extraction of behavioural patterns through the capturing of accelerometer and geolocation data, while online databases were assessed in order to have a description of the environment. In this paper, OPdashboard functionality is described in detail, while the preliminary association outcomes in two European cities, namely Thessaloniki in Greece and Stockholm in Sweden, indicate a correlation between children’s eating and physical activity behaviours and the availability of food related places or sport facilities close to schools. In addition, OPdashboard was used to assess the modification of children’s physical activity as the result of the health policies applied for the deceleration of the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease on physical activity was statistically significant, while in the suburbs a slight increase was observed. Those findings suggest the importance of the open spaces availability on children’s behavioural change. However, additional factors must be taken into account in order to have a clearer understanding of the results. The OPdashboard is exposed as a web interface (http://bigo.med.auth.gr:3838/), while its functionality was evaluated during a focus group with experts on public health, where its usefulness on the better understanding of the interplay between children’s obesogenic behaviours and the environment was underlined.

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Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients

Journal of Physical Activity and Health ◽

10.1123/jpah.2016-0529 ◽

2017 ◽

Vol 14 (6) ◽

pp. 492-498 ◽

Cited By ~ 4

Author(s):

Dale S. Bond ◽

Hollie A. Raynor ◽

J. Graham Thomas ◽

Jessica Unick ◽

Jennifer Webster ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Bariatric Surgery ◽

Severe Obesity ◽

Moderate Intensity ◽

The Public ◽

Public Health Guideline ◽

Health Guideline

Background:This study examines whether performance of bout-related physical activity (PA) during morning hours is related to greater overall bout-related PA increases within a preoperative PA intervention for bariatric surgery (BS) patients.Methods:Participants with severe obesity (n = 33; mean age = 45.6 ± 9.6 years; BMI = 45.7 ± 7.0 kg/m2) seeking BS were randomized to and completed 6 weeks of preoperative PA counseling (retention = 82.5%). Participants were encouraged to walk daily at a moderate intensity in bouts ≥ 10 minutes during morning hours to overcome time-related obstacles and establish a PA habit. Timing and amount of bout-related moderate-to-vigorous PA (MVPA) was assessed via objective monitor at pre- and postintervention.Results:Greater proportion of bout-related MVPA performed during morning hours (4:00 AM–12:00 PM) at postintervention was associated with larger total increases in bout-related MVPA minutes/day (β = .40, P = .03). At postintervention, a greater proportion of participants whose longest MVPA bouts occurred during morning hours (n = 11) achieved the public health guideline (ie, ≥150 bout-related MVPA minutes/week) versus those whose longest MVPA bouts occurred during nonmorning hours (n = 19; 63.6% vs. 26.3%, P = .04).Conclusions:Intervention-related increases in PA tended to be greatest when PA was performed in the morning. Morning exercise may be a viable strategy for promoting habitual PA in inactive BS patients.

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Factors influencing obesity among Hungarian school-age children

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.256 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Horváth ◽

A Szabó ◽

C s Erdős ◽

G Dobi-Ágoston ◽

E Paulik

Keyword(s):

Childhood Obesity ◽

Primary Schools ◽

Dietary Habits ◽

Ecological Model ◽

Demographic Data ◽

Lifestyle Changes ◽

School Age Children ◽

Obese Children ◽

Significant Difference ◽

The Family

Abstract Background Childhood obesity has increased almost 80% worldwide in the last 30 years. According to WHO COSI data, Hungary is ranked 15th in the prevalence of overweight/obesity in 6-9 years children, with national values (27.4%) higher than the average of the participating countries. The aim of the study was to investigate the factors contributing to childhood obesity, along some components of the ecological model, and to identify factors promoting or inhibiting lifestyle changes. Methods The survey was conducted in three primary schools of Szeged, involving 9-12 years old children and their parents (N = 459). The questionnaire examined the child's physical activity, dietary habits, mood, postnatal medical history as well as parents' anthropometric, socio-demographic data, attitudes to their child's nutrition, health-related value system, lifestyle knowledge and relevant history of obesity. Results The prevalence of overweight/obesity was 22.7% in the sample, with higher proportion of boys than girls (59.6% vs. 40.4%). Overweight/obese children were significantly more dissatisfied with their shape than children with normal BMI (39.8% vs. 8.9%, p < 0.001) and fewer of them participated in out-of-school sports activities (69.1% vs. 79.1 %, p > 0.05;). Obese children were significantly more likely to eat even when they were not hungry (37.2% vs. 26.4%, p < 0.05). Frequency of meals with the family was also the lowest among overweight/obese (60.6%), and three times as many of them ate alone in their room than their nutritionally normal fellows. There was no significant difference in the diet preferences and quality of food of the two groups. Conclusions In our study, prevalence of childhood obesity was beyond than global prevalence. Parents' attitudes, and family conventions significantly influenced the success of a child's lifestyle change hence it is high priority to increase the knowledge of the parents. Funding The research is supported by the EFOP-3.6.1-16-2016-00008. Key messages Childhood obesity is a complex problem, simultaneous, positive modification of the family, community, and social environment is indispensable for effective intervention. Parents’ lifestyle influences the children’s dietary habits, therefore parent’s health education is important in the prevention of childhood obesity.

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An Investigation of Family Nutrition and Physical Activity and Affecting Factors in Primary Schools

European Journal of Public Health ◽

10.1093/eurpub/ckz186.277 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

E Ekici ◽

H Ikiişik ◽

H Ankarali ◽

E H Kozan ◽

M Yetim

Keyword(s):

Physical Activity ◽

Socioeconomic Status ◽

Childhood Obesity ◽

Primary Schools ◽

Affecting Factors ◽

The Family ◽

The Mean ◽

Nutrition And Physical Activity ◽

Middle Socioeconomic Status ◽

Family Nutrition

Abstract Background In this study, it was aimed to determine the family nutrition and physical activity status of primary school students and some affecting factors. Methods In this descriptive and correlation-seeking research, mixed sampling methods were used. The sample size was not calculated, it was aimed to reach all students in three primary schools with different socioeconomic status (high, medium, low) in Uskudar, Istanbul. Data from 727 subjects were collected through an introductory information form and The Family Nutrition and Physical Activity Screening Tool (FNPA). Results In the study, data from 294 (49.7%) girls and 297 (50.3%) boys from three primary schools who studied first grade (n = 321, 54.3%) and 4th grade (n = 270, 45.7%), a total of 591 children were used. The total FNPA score of students in schools with high or middle socioeconomic status was significantly higher than the socioeconomically low school (P < 0.001). The mean score of the scale was significantly higher in those who doesn’t eat junkfood or snacks (P = 0.001), who had regular breakfast (P = 0.001) and people with regular meal time (P = 0.001). The mean BMI of children in the middle socioeconomic status school was found to be significantly higher than that of students in the low socioeconomic status school (P = 0.013). There was also a significant correlation between the mean BMI of mothers and the total FNPA score (P < 0.001). Conclusions In the study, as the socioeconomic status of schools increased, FNPA total score increased as well. Although some studies suggest that family income and socioeconomic status are inversely related to childhood obesity, in this research the mean BMI of children in the socioeconomically middle school was significantly higher than the students in the socioeconomically low school. Key messages The evaluation of the nutritional and physical activity status of the family as an element of the obesogenic environment, may be effective on identifying the causes of childhood obesity. Studies to determine the nutritional and physical activity of the family in preventing childhood obesity are essential.

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Why are children sedentary: an examination using the International Study of Childhood Obesity, Lifestyle and the Environment

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2015-0555 ◽

2016 ◽

Vol 41 (7) ◽

pp. 790-790 ◽

Cited By ~ 2

Author(s):

Allana LeBlanc

Keyword(s):

Public Health ◽

Physical Activity ◽

Childhood Obesity ◽

Sedentary Behaviour ◽

Screen Time ◽

Weight Status ◽

Sedentary Time ◽

International Study ◽

Wide Range ◽

The World

Physical inactivity and sedentary behaviour have been independently associated with a wide range of negative health indicators including obesity, poor cardio-metabolic health, and poor psychosocial health. The overarching objective of this research was to gain a better understanding as to why children are sedentary and where we need to focus public health messages and interventions to reduce sedentary behaviour. Specifically, I aimed to provide insight on current awareness of sedentary behaviour guidelines, determine important correlates of total sedentary time (SED) and screen time (ST) in Canadian children, and understand correlates of SED and ST in a global context. The primary dataset used for this project was the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Background work was completed to review current literature on knowledge and awareness of Canadian physical activity and sedentary behaviour guidelines (in all age groups) and to understand the representativeness of the ISCOLE dataset. In addition to the 2 background papers, this dissertation includes 3 manuscripts, all prepared for submission in scientific, peer-reviewed journals: Canadian physical activity and screen time guidelines: do children know?, Correlates of objectively measured sedentary time and self-reported screen time in Canadian children, and Correlates of total sedentary time and screen time in 9–11 year-old children around the world: The International Study of Childhood Obesity, Lifestyle and the Environment. Overall, this work showed the majority of children around the world are accumulating large amounts of sedentary time, and exceeded current screen time guidelines. We found that the large majority of Canadian children are not aware of screen time guidelines; however, a greater proportion of children could identify physical activity guidelines. We also identified a number of correlates of SED and ST in Canadian children and in children around the world. The most common correlates included weight status and access to electronics in the house. Taken together, this work suggests that public health messaging should focus on increasing awareness of screen time guidelines. While increasing awareness of the guidelines, messaging can be tailored to promoting healthy weight status and reducing (or removing) children’s access to electronic devices in hopes of reducing overall time spent sedentary.

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Childhood Obesity in Developing Countries: Epidemiology, Determinants, and Prevention

Endocrine Reviews ◽

10.1210/er.2010-0028 ◽

2012 ◽

Vol 33 (1) ◽

pp. 48-70 ◽

Cited By ~ 296

Author(s):

Nidhi Gupta ◽

Kashish Goel ◽

Priyali Shah ◽

Anoop Misra

Keyword(s):

Physical Activity ◽

Developing Countries ◽

Childhood Obesity ◽

Female Gender ◽

Lifestyle Changes ◽

Dietary Practices ◽

Metropolitan Cities ◽

Therapeutic Lifestyle Changes ◽

High Risk Screening

Rapidly changing dietary practices and a sedentary lifestyle have led to increasing prevalence of childhood obesity (5–19 yr) in developing countries recently: 41.8% in Mexico, 22.1% in Brazil, 22.0% in India, and 19.3% in Argentina. Moreover, secular trends indicate increasing prevalence rates in these countries: 4.1 to 13.9% in Brazil during 1974–1997, 12.2 to 15.6% in Thailand during 1991–1993, and 9.8 to 11.7% in India during 2006–2009. Important determinants of childhood obesity include high socioeconomic status, residence in metropolitan cities, female gender, unawareness and false beliefs about nutrition, marketing by transnational food companies, increasing academic stress, and poor facilities for physical activity. Childhood obesity has been associated with type 2 diabetes mellitus, the early-onset metabolic syndrome, subclinical inflammation, dyslipidemia, coronary artery diseases, and adulthood obesity. Therapeutic lifestyle changes and maintenance of regular physical activity through parental initiative and social support interventions are the most important strategies in managing childhood obesity. Also, high-risk screening and effective health educational programs are urgently needed in developing countries.

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Family environment risk factors for overweight in childhood

European Journal of Public Health ◽

10.1093/eurpub/ckz187.036 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

V Duleva ◽

E Chikova-Iscener ◽

L Rangelova ◽

P l Dimitrov

Keyword(s):

Public Health ◽

Risk Factors ◽

Childhood Obesity ◽

Family Environment ◽

Well Being ◽

Overweight And Obesity ◽

Family Risk Factors ◽

Family Risk ◽

Co Morbidity ◽

The Family

Abstract Background One of the current public health problems in Bulgaria is the high prevalence of overweight and obesity in childhood. The family environment affects many aspects of children’s health and well-being. The unfavourable socio-economic characteristics of the family environment might be a risk for overweight and obesity in childhood. Methods A national representative survey was conducted in Bulgaria in 2016 as part of the WHO European Childhood Obesity Surveillance Initiative (COSI). 3379 schoolchildren were recruited. The average age of the sample was 7.7 years, equally distributed by gender - girls 50.11% (n = 1693) and boys 49.89% (n = 1686). The data from the filled in Family form was analysed with SPSS using descriptive statistical methods. Results The study identified the following risk factors of the family environment for the development of overweight in childhood: the proportion of parents with elementary or primary education was significant - about a quarter, nearly one third of the surveyed households were experiencing financial difficulties, 14.1% of the women and 11.6% of the men were unemployed in the last 1 year. There was a high incidence of co-morbidity among family members: hypertension - 27.7%, diabetes mellitus - 14.4% and hypercholesterolemia - 13.6%. Among the surveyed parents 28.4% of the women and 68% of the men were overweight. Only 13.5% of the parents estimated the weight status of their child as overweight (with objectively measured overweight among 29.2% of the recruited children). A significant proportion of the children were not breastfed (17.3%) or the duration of exclusive breastfeeding was not optimal for 67.8% of the exclusively breastfed children. Conclusions Identifying family risk factors associated with overweight in childhood is important for the public health and provides opportunities to develop policies for improvement of the nutritional and health status of children. Key messages To tackle the childhood obesity epidemic the family risk factors should be addressed. The awareness of the children and parents should be raised through targeted information materials and campaigns.

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Causality assessment of skyfruit-induced liver injury using the updated RUCAM: a case report and review of the literature

Journal of International Medical Research ◽

10.1177/0300060520917569 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052091756 ◽

Cited By ~ 2

Author(s):

Caixia Xia ◽

Yanning Liu ◽

Hangping Yao ◽

Weihong Zhu ◽

Jiexia Ding ◽

...

Keyword(s):

Public Health ◽

Case Report ◽

Liver Injury ◽

Causality Assessment ◽

Public Health Problem ◽

Assessment Method ◽

Review Of The Literature ◽

Asian Countries ◽

Hepatocellular Injury ◽

The Family

In many Asian countries, herbs are used to treat disease. However, herbs also have adverse effects. Herb-induced liver injury has become a serious public health problem requiring urgent attention. The seeds of Swietenia macrophylla, a member of the family Polygonaceae, are often called skyfruit. We recently encountered a case of liver injury caused by skyfruit. The patient suffered from hepatocellular injury. We applied the updated Roussel Uclaf Causality Assessment Method (RUCAM) and the results indicated a highly probable relationship with skyfruit (total score 10). Moreover, we summarize another six cases of skyfruit-induced liver injury from the literature. The aim of our report is to help clinicians become more aware of the potential hepatotoxic effects of skyfruit and to accurately describe the clinical and laboratory characteristics of skyfruit-induced liver injury.

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Effects of local authority expenditure on childhood obesity

European Journal of Public Health ◽

10.1093/eurpub/cky252 ◽

2018 ◽

Vol 29 (4) ◽

pp. 785-790

Author(s):

Dan Liu ◽

Anne Mason ◽

Linda Marks ◽

Howard Davis ◽

David J Hunter ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Childhood Obesity ◽

Negative Binomial ◽

Age Groups ◽

Sensitivity Analyses ◽

Public Health Programme ◽

Capita Expenditure ◽

Health And Social Care ◽

Health Programme

Abstract Background Under the 2013 reforms introduced by the Health and Social Care Act (2012), public health responsibilities in England were transferred from the National Health Service to local authorities (LAs). Ring-fenced grants were introduced to support the new responsibilities. The aim of our study was to test whether the level of expenditure in 2013/14 affected the prevalence of childhood obesity in 2016/17. Methods We used National Child Measurement Programme definitions of childhood obesity and datasets. We used LA revenue returns data to derive three measures of per capita expenditure: childhood obesity (<19); physical activity (<19) and the Children’s 5–19 Public Health Programme. We ran separate negative binomial models for two age groups of children (4–5 year olds; 10–11 year olds) and conducted sensitivity analyses. Results With few exceptions, the level of spend in 2013/14 was not significantly associated with the level of childhood obesity in 2016/17. We identified some positive associations between spend on physical activity and the Children’s Public Health Programme at baseline (2013/14) and the level of childhood obesity in children aged 4–5 in 2016/17, but the effect was not evident in children aged 10–11. In both age groups, LA levels of childhood obesity in 2016/17 were significantly and positively associated with obesity levels in 2013/14. As these four cohorts comprise entirely different pupils, this underlines the importance of local drivers of childhood obesity. Conclusions Higher levels of local expenditure are unlikely to be effective in reducing childhood obesity in the short term.

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