Associations between parental and child overweight and obesity

Results of the analysis showed that parents and children overweight/obesity were significantly correlated. The sample includes 318 pairs of mothers and children, and 336 pairs of fathers and children at the age 11.3 +/- 0.4 years in Trogir, Croatia. Child overweight and obesity were defined according to body mass index (BMI) 25 and 30 equivalents (kg/m2). The prevalence of total overweight in girls was 25.6% and among boys was 20.5%. Mother's weight (p = 0.003) and BMI (p = 0.006) were greater in obese than in other groups of children. Overweight/obese children were more often found among overweight/obese mothers (p = 0.009) and fathers (p = 0.039). Correlation between overweight/obese children and their father (odds ratio 3.2, 95% CI 1.5-6.8) was stronger than between overweight/obese children and their mothers (odds ratio 2.2, 95% CI 1.2-3.9). Associations with mothers' and daughters' overweight/obesity were stronger (p = 0.017) than mothers' and sons'(p = 0.12). Correlations between children's BMI and fathers' BMI (r = 0.265, p < 0.0001) and between children's BMI and mothers' BMI (r = 0.173, p = 0.002) were significant. Children whose parents are overweight/obese look for greater attention in future preventive programme.     

The Microbiota of the Gut in Preschool Children With Normal and Excessive Body Weight

The aim of this study was to investigate the gut microbiota in preschool children with and without overweight and obesity. Twenty overweight or obese children and twenty children with BMI within the normal range (age: 4–5 years) were recruited from the south of Sweden. The gut microbiota was accessed by quantitative PCR (qPCR) and terminal restriction fragment length polymorphism and calprotectin was measured in feces. Liver enzymes were quantified in obese/overweight children. The concentration of the gram‐negative family Enterobacteriaceae was significantly higher in the obese/overweight children (P = 0.036), whereas levels of Desulfovibrio and Akkermansia muciniphila‐like bacteria were significantly lower in the obese/overweight children (P = 0.027 and P = 0.030, respectively). No significant differences were found in content of Lactobacillus, Bifidobacterium or the Bacteroides fragilis group. The diversity of the dominating bacterial community tended to be less diverse in the obese/overweight group, but the difference was not statistically significant. Concentration of Bifidobacterium was inversely correlated to alanine aminotransferase (ALT) in obese/overweight children. The fecal levels of calprotectin did not differ between the study groups. These findings indicate that the gut microbiota differed among preschool children with obesity/overweight compared with children with BMI within the normal range.     

Cortisol and its relation to insulin resistance before and after weight loss in obese children

BACKGROUND: Insulin resistance occurs both in obesity and in Cushing's syndrome suggesting a pathogenetic role of cortisol in insulin-resistant obese subjects. METHODS: We examined serum cortisol in 81 insulin-resistant (homeostasis model assessment (HOMA) >4) obese children (age in median 12 years) and 151 obese children without insulin resistance (HOMA < or = 4) (age in median 10 years) and compared these to cortisol of 83 healthy children of normal weight (age in median 12 years). Multivariate linear regression analysis was conducted for the dependent variable insulin resistance (HOMA), including weight status (BMI), age, gender, pubertal stage and cortisol concentration as independent variables. Furthermore, we analyzed cortisol and insulin resistance in 45 obese children with significant weight loss (reduction in SDS-BMI > or = 0.5) and in 109 obese children without significant weight loss (reduction in SDS-BMI <0.5) over the time period of 1 year. RESULTS: Cortisol was significantly (p = 0.006) higher in obese insulin-resistant children (median 14.6 microg/dl) compared to those of normal weight (median 11.4 microg/dl) or obese without insulin resistance (median 11.7 microg/dl). Insulin resistance was significantly influenced by weight status (BMI), age and cortisol using multivariate linear regression analysis. A reduction in overweight showed a significant decrease in cortisol (p = 0.005) and insulin resistance (p = 0.002) in insulin-resistant children, whilst there were no significant changes in children not reducing their overweight and in non-insulin-resistant children. CONCLUSIONS: Cortisol was moderately increased in insulin-resistant, obese children and related to insulin resistance. Weight reduction led to a decrease in cortisol and insulin resistance. These facts point to an association between cortisol and insulin resistance in obesity.     

Prevalence of overweight and obesity among the affluent adolescent school children of Amritsar, Punjab

In the present study, an attempt has been made to assess the prevalence of overweight and obesity in adolescent children (between 10-15 years of age) of the affluent families of Amritsar district of Punjab, a state in rapid economic and epidemiological transition. A total of 640 children (323 boys and 317girls) were measured for height and weight. Overweight and obesity were assessed using age and sex-specific body mass index (BMI) cut-off points. 9.91% boys and 11.99% girls were overweight, and 4.95% boys and 6.31% girls were obese. The prevalence of overweight and obesity among the affluent children in Amritsar was as high or higher as in some industrialized countries.     

BMI and health status among adults with asthma

Background: A convincing body of literature links obesity with a higher risk for developing adult‐onset asthma. The impact of obesity on asthma severity among adults with pre‐existing asthma, however, is less clear. Methods and Procedures: In a prospective cohort study of 843 adults with severe asthma, we studied the impact of BMI on asthma health status. Results: The prevalence of obesity and overweight were 44% (95% confidence interval (CI) 41–47%) and 28% (95% CI 25–32%). The obese BMI group was associated with a higher risk for daily or near daily asthma symptoms than was the normal BMI group (odds ratio (OR) 1.81; 95% CI 1.10–2.96). Compared to the normal BMI group, generic physical health status was worse in the overweight (mean score decrement ?2.42 points; 95% CI ?4.39 to ?0.45) and the obese groups (?6.31 points; 95% CI ?8.14 to ?4.49). Asthma‐specific quality of life was worse in the underweight (mean score increment 8.66 points; 95% CI 2.53–14.8) and obese groups (4.51 points; 95% CI 2.21–6.81), compared to those with normal BMI. Obese persons also had a higher number of restricted activity days that past month (5.05 days; 95% CI 2.90–7.19 days). Discussion: It appears that obesity has a substantive negative effect on health status among adults with asthma. Further work is needed to clarify the precise mechanisms. Clinicians should counsel dietary modification and weight loss for their overweight and obese patients with asthma.     

Utility of Childhood BMI in the Prediction of Adulthood Disease: Comparison of National and International References

Objective: To determine whether the U.S. Centers for Disease Control and Prevention (CDC; CDC Reference) or International Obesity Task Force (IOTF; IOTF Reference) BMI cut‐off points for classifying adiposity status in children are more effective at predicting future health risk. Research Methods and Procedures: The sample (N = 1709) included 4‐ to 15‐year‐old (at baseline) boys and girls from the Bogalusa Heart Study. Overweight and obesity status were determined using both the CDC Reference and IOTF Reference BMI cut‐off points at baseline. The ability of childhood overweight and obesity, determined from the two BMI classification systems, to predict obesity and metabolic disorders in young adulthood (after a 13‐ to 24‐year follow‐up) was then compared. Results: Independently of the classification system employed to determine adiposity based on childhood BMI, the odds of being obese and having all of the metabolic disorders in young adulthood were significantly (p < 0.05) higher in the overweight and obese groups by comparison with the nonoverweight groups. Childhood overweight and obesity, determined by both the CDC Reference and IOTF Reference, had a low sensitivity and a high specificity for predicting obesity and metabolic disorders in young adulthood. Overweight and obesity as determined by the CDC Reference were slightly more sensitive and slightly less specific than the corresponding values based on the IOTF Reference. Discussion: Overweight and obesity during childhood, as determined by both the CDC and IOTF BMI cut‐off points, are strong predictors of obesity and coronary heart disease risk factors in young adulthood. The differences in the predictive capacity of the CDC Reference and IOTF Reference are, however, minimal.     

Secular trends in prevalence of overweight and obesity from 2006 to 2009 in urban asian Indian adolescents aged 14-17 years

The present study examines the secular trends in prevalence of overweight and obesity among urban Asian Indian adolescents in New Delhi (North India). The data were derived from cross-sectional sampling of children, 3493 in year 2006 and 4908 in year 2009, aged 14-17 years studying in privately-funded and government-funded schools. Age, gender and Asian Indian-specific cut offs of body mass index (BMI) were used to define overweight and obesity. The prevalence of obesity increased significantly from 9.8% in 2006 to 11.7% in 2009 (p<0.01), whereas underweight decreased from 11.3% to 3.9% (p<0.001). There was a significantly higher risk of being overweight (OR 1.28; 95% CI, 1.15-1.42) and obese (OR 1.44; 95% CI, 1.24-1.66) in year 2009 than 2006, after adjusting for age, gender and type of school. Males and privately-funded school children had significantly higher increase in prevalence and risk of being overweight and obese over the three years. In conclusion, this study showed an increasing trend in prevalence of overweight and obesity in urban Asian Indian adolescents. More specifically, the study showed the association of this increasing trend of overweight and obesity prevalence with male gender and high socio-economic status, calling for an urgent need for immediate and targeted preventive measures.     

The lifetime medical cost burden of overweight and obesity: implications for obesity prevention

This study quantifies age-specific and lifetime costs for overweight (BMI: 25-29.9), obese I (BMI: 30-34.9), and obese II/III (BMI: >35) adults separately by race/gender strata. We use these results to demonstrate why private sector firms are likely to underinvest in obesity prevention efforts. Not only does the existence of Medicare reduce the economic burden that obesity imposes on private payers, but, from the perspective of a 20-year-old obese adult, the short-term costs of obesity are small. This suggests that legislation that subsidizes wellness programs and/or mandates coverage for obesity treatments might make all firms better off. Ironically, Medicare has a greater incentive to prevent obesity because when an obese 65 year old enters the program, his/her costs are immediate and higher than costs for normal weight individuals.     

High childhood obesity in an Australian population

Objective: The objective was to determine the prevalences of overweight and obesity in regional Australian children and to examine the association between BMI and indicators of socioeconomic status (SES). Research Methods and Procedures: Regionally representative cross‐sectional survey of 2184 children, 4 to 12 years of age, was conducted, and the socio‐demographic characteristics of their parents from regional Victoria, Australia, 2003 to 2004, were obtained. Results: The prevalences of overweight and obesity were 19.3 ± 0.8% (proportion ± standard error) and 7.6 ± 0.6%, respectively, using international criteria, and the proportion of overweight/obese girls was significantly higher than that of boys (29.6 ± 1.4% vs. 23.9 ± 1.3%, χ² = 9.01, p = 0.003). Children from households of lower SES had higher odds of being overweight/obese; lower SES was defined by lower paternal education (adjusted odds ratio, 1.18; 95% confidence interval, 1.08 to 1.30) and lower area‐level SES (adjusted odds ratio, 1.13; 95% confidence interval, 1.02 to 1.25), adjusted for age, gender, height, and clustering by school. Discussion: The prevalences of overweight and obesity are increasing in Australian children by about one percentage point per year. This equates to ～40,000 more overweight children each year, placing Australian children among those at highest risk around the world. In addition, girls are more likely to be overweight, and there is a general trend for children of lower SES to be at even greater risk of overweight and obesity.     

Regional white matter volumes correlate with delay discounting

A preference for immediate gratification is a central feature in addictive processes. However, the neural structures underlying reward delay tolerance are still unclear. Healthy participants (n = 121) completed a delay discounting questionnaire assessing the extent to which they prefer smaller immediate rewards to larger delayed reward after undergoing magnetic resonance imaging (MRI) scanning. Whole brain voxel-based morphometric analysis shows that delay discounting severity was negatively correlated with right prefrontal subgyral white matter volume and positively correlated with white matter volume in parahippocampus/hippocampus, after whole brain correction. This study might better our understanding of the neural basis of impulsivity and addiction.     

Delay of gratification and delay discounting in rats

Delay discounting (DD) and delay of gratification (DG) are two measures of impulsive behavior often viewed as reflecting the same or equivalent processes. However, there are some key differences in the contingencies of reinforcement between the procedures that may have implications for understanding impulsivity. This study used DD and DG procedures to determine if differences in contingencies of reinforcement specified by DD and DG alters how much organisms discount the value of delayed reinforcers. Twenty-four water-deprived rats performed one of two Adjusting Amount procedures, which consisted of repeated choices between a fixed amount of water (250 &mgr;l) delivered after a delay (0, 4, 8, 16, or 32 s) and an adjusting, usually lesser amount delivered immediately. Half of the rats (n=12) performed a DD procedure designed to assess preference for immediate over delayed reinforcers in which they had discrete choices between the immediate and delayed amounts of water. A DG procedure was used for the other half of the rats (n=12). In the DG procedure rats also selected between immediate and delayed alternatives, but if they chose the delayed alternative they could switch to and receive the immediate alternative at any time during the delay to the larger reward. In the DD procedure switching responses were not reinforced but were still recorded and used for analyses. The DD functions of the two groups did not differ significantly. However, at the longer delays, the DG group made significantly fewer switching responses than the DD group. A possible role of response inhibition in the DG procedure is discussed.     

The Effect of Obesity on Pediatric Tibia Fractures

BackgroundChildhood obesity affects nearly one fifth of all children in the United States. Understanding the unique injury characteristics and treatment of tibia fractures in this population has become increasingly important. This study aims to explore the different injury characteristics between tibia fractures in obese and non-obese children.Methods215 skeletally immature children aged 2-18 who sustained tibia fractures between 2007.2019 were retrospectively reviewed. Patients were analyzed by weight group: underweight, normal weight, overweight, and obese as defined by body mass index (BMI) percentile based upon age. Analyses were performed on dichotomized groups: underweight and normal weight versus overweight and obese. Chi-square or Fisher’s exact test was used to compare differences in categorical outcome between the 2-category BMI class variables; Wilcoxon test was used to compare continuous outcomes. A multivariate logistic regression model was used to evaluate BMI associations while controlling for age, sex, race, and mechanism of injury.ResultsDistribution of BMI in the cohort included 6.5% underweight, 45.6% normal weight, 16.7% overweight and 31.2% obese. Overweight and obese children sustained fractures from low energy mechanisms at more than double the rate of normal and underweight children (20.5% versus 9.7%, p=0.028). Overweight and obese children sustained physeal fractures at a rate of 54.4% in comparison with 28.6% in their normal and underweight peers (p<0.0001, OR 2.50 (95% CI, 1.26-4.95)). Overweight and obese children sustained distal 1/3 tibia fractures at a higher rate of 56.9% compared to under and normal weight children at 33.9% (p=0.003, OR 2.24 (95% CI, 1.17-4.30)). Overweight and obese children underwent unplanned changes in treatment at a lower rate than normal and underweight children at 1% versus 8% rates of treatment change, respectively (p=0.013, OR 0.076 (95%CI, 0.009-0.655)). No significant differences were found in the rates of operative treatment, repeat reduction, post treatment complications, or physical therapy.ConclusionOverweight children sustain tibia fractures from low energy mechanisms at higher rates than their peers. Similarly, obese and overweight patients have higher rates of physeal injuries and higher rates of distal 1/3 tibia fractures. Complication rates are similar between obese and non-obese children undergoing treatment for tibia fractures. Level of Evidence: III     

Impact of physician BMI on obesity care and beliefs

Using a national cross-sectional survey of 500 primary care physicians conducted between 9 February and 1 March 2011, the objective of this study was to assess the impact of physician BMI on obesity care, physician self-efficacy, perceptions of role-modeling weight-related health behaviors, and perceptions of patient trust in weight loss advice. We found that physicians with normal BMI were more likely to engage their obese patients in weight loss discussions as compared to overweight/obese physicians (30% vs. 18%, P = 0.010). Physicians with normal BMI had greater confidence in their ability to provide diet (53% vs. 37%, P = 0.002) and exercise counseling (56% vs. 38%, P = 0.001) to their obese patients. A higher percentage of normal BMI physicians believed that overweight/obese patients would be less likely to trust weight loss advice from overweight/obese doctors (80% vs. 69%, P = 0.02). Physicians in the normal BMI category were more likely to believe that physicians should model healthy weight-related behaviors-maintaining a healthy weight (72% vs. 56%, P = 0.002) and exercising regularly (73% vs. 57%, P = 0.001). The probability of a physician recording an obesity diagnosis (93% vs. 7%, P < 0.001) or initiating a weight loss conversation (89% vs. 11%, P ≤ 0.001) with their obese patients was higher when the physicians' perception of the patients' body weight met or exceeded their own personal body weight. These results suggest that more normal weight physicians provided recommended obesity care to their patients and felt confident doing so.     

Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic

We projected future prevalence and BMI distribution based on national survey data (National Health and Nutrition Examination Study) collected between 1970s and 2004. Future obesity-related health-care costs for adults were estimated using projected prevalence, Census population projections, and published national estimates of per capita excess health-care costs of obesity/overweight. The objective was to illustrate potential burden of obesity prevalence and health-care costs of obesity and overweight in the United States that would occur if current trends continue. Overweight and obesity prevalence have increased steadily among all US population groups, but with notable differences between groups in annual increase rates. The increase (percentage points) in obesity and overweight in adults was faster than in children (0.77 vs. 0.46-0.49), and in women than in men (0.91 vs. 0.65). If these trends continue, by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034. In children, the prevalence of overweight (BMI >/= 95th percentile, 30%) will nearly double by 2030. Total health-care costs attributable to obesity/overweight would double every decade to 860.7-956.9 billion US dollars by 2030, accounting for 16-18% of total US health-care costs. We continue to move away from the Healthy People 2010 objectives. Timely, dramatic, and effective development and implementation of corrective programs/policies are needed to avoid the otherwise inevitable health and societal consequences implied by our projections .     

Multi-Institutional Sharing of Electronic Health Record Data to Assess Childhood Obesity

Objective

To evaluate the validity of multi-institutional electronic health record (EHR) data sharing for surveillance and study of childhood obesity.

Methods

We conducted a non-concurrent cohort study of 528,340 children with outpatient visits to six pediatric academic medical centers during 2007–08, with sufficient data in the EHR for body mass index (BMI) assessment. EHR data were compared with data from the 2007–08 National Health and Nutrition Examination Survey (NHANES).

Results

Among children 2–17 years, BMI was evaluable for 1,398,655 visits (56%). The EHR dataset contained over 6,000 BMI measurements per month of age up to 16 years, yielding precise estimates of BMI. In the EHR dataset, 18% of children were obese versus 18% in NHANES, while 35% were obese or overweight versus 34% in NHANES. BMI for an individual was highly reliable over time (intraclass correlation coefficient 0.90 for obese children and 0.97 for all children). Only 14% of visits with measured obesity (BMI ≥95%) had a diagnosis of obesity recorded, and only 20% of children with measured obesity had the diagnosis documented during the study period. Obese children had higher primary care (4.8 versus 4.0 visits, p<0.001) and specialty care (3.7 versus 2.7 visits, p<0.001) utilization than non-obese counterparts, and higher prevalence of diverse co-morbidities. The cohort size in the EHR dataset permitted detection of associations with rare diagnoses. Data sharing did not require investment of extensive institutional resources, yet yielded high data quality.

Conclusions

Multi-institutional EHR data sharing is a promising, feasible, and valid approach for population health surveillance. It provides a valuable complement to more resource-intensive national surveys, particularly for iterative surveillance and quality improvement. Low rates of obesity diagnosis present a significant obstacle to surveillance and quality improvement for care of children with obesity.     

Inhibiting food reward: delay discounting, food reward sensitivity, and palatable food intake in overweight and obese women

Overeating is believed to result when the appetitive motivation to consume palatable food exceeds an individual's capacity for inhibitory control of eating. This hypothesis was supported in recent studies involving predominantly normal weight women, but has not been tested in obese populations. The current study tested the interaction between food reward sensitivity and inhibitory control in predicting palatable food intake among energy-replete overweight and obese women (N = 62). Sensitivity to palatable food reward was measured with the Power of Food Scale. Inhibitory control was assessed with a computerized choice task that captures the tendency to discount large delayed rewards relative to smaller immediate rewards. Participants completed an eating in the absence of hunger protocol in which homeostatic energy needs were eliminated with a bland preload of plain oatmeal, followed by a bogus laboratory taste test of palatable and bland snacks. The interaction between food reward sensitivity and inhibitory control was a significant predictor of palatable food intake in regression analyses controlling for BMI and the amount of preload consumed. Probing this interaction indicated that higher food reward sensitivity predicted greater palatable food intake at low levels of inhibitory control, but was not associated with intake at high levels of inhibitory control. As expected, no associations were found in a similar regression analysis predicting intake of bland foods. Findings support a neurobehavioral model of eating behavior in which sensitivity to palatable food reward drives overeating only when accompanied by insufficient inhibitory control. Strengthening inhibitory control could enhance weight management programs.     

Additive Interactions of Maternal Prepregnancy BMI and Breast‐feeding on Childhood Overweight

Objective: To examine the interactions of maternal prepregnancy BMI and breast‐feeding on the risk of overweight among children 2 to 14 years of age. Research Methods and Procedures: The 1996 National Longitudinal Survey of Youth, Child and Young Adult data in the United States were analyzed (n = 2636). The weighted sample represented 51.3% boys, 78.0% whites, 15.0% blacks, and 7.0% Hispanics. Childhood overweight was defined as BMI ≥95th percentile for age and sex. Maternal prepregnancy obesity was determined as BMI ≥30 kg/m². The duration of breast‐feeding was measured as the weeks of age from birth when breast‐feeding ended. Results: After adjusting for potential confounders, children whose mothers were obese before pregnancy were at a greater risk of becoming overweight [adjusted odds ratio (OR), 4.1; 95% confidence interval (CI), 2.6, 6.4] than children whose mothers had normal BMI (<25 kg/m²; p < 0.001 for linear trend). Breast‐feeding for ≥4 months was associated with a lower risk of childhood overweight (OR, 0.6; 95% CI, 0.4, 1.0; p = 0.06 for linear trend). The additive interaction between maternal prepregnancy obesity and lack of breast‐feeding was detected (p < 0.05), such that children whose mothers were obese and who were never breast‐fed had the greatest risk of becoming overweight (OR, 6.1; 95% CI, 2.9, 13.1). Discussion: The combination of maternal prepregnancy obesity and lack of breast‐feeding may be associated with a greater risk of childhood overweight. Special attention may be needed for children with obese mothers and lack of breast‐feeding in developing childhood obesity intervention programs.     

Racial Differences in the Tracking of Childhood BMI to Adulthood

Objective: The possibility that there are racial differences in the patterns of BMI (kilograms per meter squared) change throughout life has not been examined. For example, the high prevalence of obesity among black women could result from a higher prevalence of obesity among black girls or because normal‐weight black girls experience larger BMI increases in adolescence or adulthood than do their white counterparts. Therefore, we examined the tracking of childhood BMI into adulthood in a biracial (36% black) sample. Research Methods and Procedures: Five‐ to 14‐year‐old children (2392) were followed for (mean) 17 years. Childhood overweight was defined as BMI ≥ 95th percentile, and adult obesity was defined as BMI ≥ 30 kg/m². Results: The tracking of childhood BMI differed between whites and blacks. Among overweight children, 65% of white girls vs. 84% of black girls became obese adults, and predictive values among boys were 71% (whites) vs. 82% (blacks). These racial differences reflected contrasting patterns in the rate of BMI change. Although the initial BMI of black children was not higher than that of white children, BMI increases with age were larger among black girls and overweight black boys than among their white counterparts. In contrast, relatively thin (BMI < 50th percentile) white boys were more likely to become overweight adults than were their black counterparts. Discussion: These findings emphasize the black/white differences in BMI changes with age. Because of the adult health consequences of childhood‐onset obesity, early prevention should be given additional emphasis.