The cost of paediatric obesity

There has been a great deal of media attention given to the rising levels of obesity and overweight in children and adolescents, but what is the real cost of pediatric obesity? This article reviews information about the recent rise in pediatric obesity and discusses the cost of this condition from medical, financial and psychological perspectives

Waist-to-height ratio and cardiometabolic risk factors in adolescence: findings from a prospective birth cohort

What is already known about this subject In adults, associations between body mass index (BMI), waist-to-height ratio (WHtR) and cardiometabolic outcomes are similar. In children and adolescents, results from cross-sectional studies examining the associations between BMI z scores, WHtR and cardiometabolic outcomes are conflicting and there is a paucity of prospective data.<p></p> What this study adds This is the first study to demonstrate the prospective association between WHtR in childhood and cardiometabolic outcomes in adolescent boys. WHtR is a simple calculation that can be used to identify children and adolescents for cardiometabolic risk without the need for reference growth charts. The WHtR cut-point of ≥0.5 was highly specific in identifying cardiometabolic risk co-occurrence but has poor sensitivity.<p></p> Objective To examine the associations between body mass index (BMI) and waist-to-height ratio (WHtR) measured in childhood and adolescence and cardiometabolic risk factors in adolescence.<p></p> Methods Secondary data analysis of the Avon Longitudinal Study of Parents and Children, a population based cohort. Data from 2858 adolescents aged 15.5 (standard deviation 0.4) years and 2710 of these participants as children aged 7–9 years were used in this analysis. Outcome measures were cardiometabolic risk factors, including triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol, insulin, glucose and blood pressure at 15 years of age.<p></p> Results Both BMI and WHtR measured at ages 7–9 years and at age 15 years were associated with cardiometabolic risk factors in adolescents. A WHtR ≥0.5 at 7–9 years increased the odds by 4.6 [95% confidence interval 2.6 to 8.1] for males and 1.6 [0.7 to 3.9] for females of having three or more cardiometabolic risk factors in adolescence. Cross-sectional analysis indicated that adolescents who had a WHtR ≥0.5, the odds ratio of having three or more cardiometabolic risk factors was 6.8 [4.4 to 10.6] for males and 3.8 [2.3 to 6.3] for females. The WHtR cut-point was highly specific in identifying cardiometabolic risk co-occurrence in male children and adolescents as well as female children (90 to 95%), but had poor sensitivity (17 to 53%). Similar associations were observed when BMI was used to define excess adiposity.<p></p> Conclusions WHtR is a simple alternative to age and sex adjusted BMI for assessing cardiometabolic risk in adolescents

Pediatric Obesity: Influence on Drug Dosing and Therapeutics

Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of US children and adolescents. Severe obesity (³120% of the 95th percentile of BMI-for-age, or a BMI of ³35 kg/m2) is the fastest growing subgroup and now approaches 6% of all US youth. Health consequences (e.g., type 2 diabetes, coronary heart disease) are related in a dose-dependent manner to severity of obesity. Since therapeutic interventions are less effective in severe obesity, prevention is a high priority. Treatment plans involving combinations of behavioral therapy, nutrition and exercise achieve limited success. Only one drug, orlistat, is FDA-approved for long-term obesity management in adolescents 12 years and older. As part of comprehensive medication management, clinicians should consider the propensity for a given drug to aggravate weight gain and to consider alternatives that minimize weight impact. Medication management must take into account developmental changes as well as pathophysiology of obesity and comorbidities. Despite expanding insight into obesity pathophysiology, there are gaps in its translation to therapeutic application. The historical construct of obesity as simply a fat storage disorder is fundamentally inaccurate. The approach to adjusting doses based solely on body size and extrapolating from therapeutic knowledge of adult obesity may be based on assumptions that are not fully substantiated. Classes of drugs commonly prescribed for comorbidities associated with obesity should be prioritized for clinical research evaluations aimed at optimizing dosing regimens in pediatric obesity

Parental stress increases body mass index trajectory in pre-adolescents.

What is already known about this subjectRates of childhood obesity have increased since the mid-1970s. Research into behavioural determinants has focused on physical inactivity and unhealthy diets. Cross-sectional studies indicate an association between psychological stress experienced by parents and obesity in pre-adolescents.What this study addsWe provide evidence of a prospective association between parental psychological stress and increased weight gain in pre-adolescents. Family-level support for those experiencing chronic stress might help promote healthy diet and exercise behaviours in children.ObjectiveWe examined the impact of parental psychological stress on body mass index (BMI) in pre-adolescent children over 4 years of follow-up.MethodsWe included 4078 children aged 5-10 years (90% were between 5.5 and 7.5 years) at study entry (2002-2003) in the Children's Health Study, a prospective cohort study in southern California. A multi-level linear model simultaneously examined the effect of parental stress at study entry on the attained BMI at age 10 and the slope of change across annual measures of BMI during follow-up, controlled for the child's age and sex. BMI was calculated based on objective measurements of height and weight by trained technicians following a standardized procedure.ResultsA two standard deviation increase in parental stress at study entry was associated with an increase in predicted BMI attained by age 10 of 0.287 kg m(-2) (95% confidence interval 0.016-0.558; a 2% increase at this age for a participant of average attained BMI). The same increase in parental stress was also associated with an increased trajectory of weight gain over follow-up, with the slope of change in BMI increased by 0.054 kg m(-2) (95% confidence interval 0.007-0.100; a 7% increase in the slope of change for a participant of average BMI trajectory).ConclusionsWe prospectively demonstrated a small effect of parental stress on BMI at age 10 and weight gain earlier in life than reported previously. Interventions to address the burden of childhood obesity should address the role of parental stress in children

The Pediatric Obesity Epidemic and the Role of the Corporation: Why Work Conditions and Faith in Meritocracy Matter

The global pediatric obesity epidemic is a “grand challenge” that will reduce quality of life and strain healthcare delivery systems for many years. The root causes and treatments of pediatric obesity are medical and social, requiring cross‐disciplinary collaboration. Research on pediatric obesity spans medicine, molecular biology, public health, and sociology and involves hospitals, clinics, community partners, and schools. However, little attention has been given to how corporations play a role in this nexus of institutions. We make the case for understanding the role of the corporation, beyond that of producer and distributor of unhealthy foods. Specifically, we consider two factors. First, we examine the work conditions that corporations create for parents and how these affect family lifestyle, differentially by socioeconomic status (SES). Second, we expose how the American tendency to “individualize” social problems is reinforced in the corporation. Faith in meritocracy directs attention to individual effort rather than structural constraints. Treating pediatric obesity as remediable by meritorious individual behaviors might obscure root causes and promising approaches based on new medical research

Cardiovascular Regulation Profile Predicts Developmental Trajectory of BMI and Pediatric Obesity

The present study examined the role of cardiovascular regulation in predicting pediatric obesity. Participants for this study included 268 children (141 girls) obtained from a larger ongoing longitudinal study. To assess cardiac vagal regulation, resting measures of respiratory sinus arrhythmia (RSA) and RSA change (vagal withdrawal) to three cognitively challenging tasks were derived when children were 5.5 years of age. Heart period (HP) and HP change (heart rate (HR) acceleration) were also examined. Height and weight measures were collected when children were 5.5, 7.5, and 10.5 years of age. Results indicated that physiological regulation at age 5.5 was predictive of both normal variations in BMI development and pediatric obesity at age 10.5. Specifically, children with a cardiovascular regulation profile characterized by lower levels of RSA suppression and HP change experienced significantly greater levels of BMI growth and were more likely to be classified as overweight/at-risk for overweight at age 10.5 compared to children with a cardiovascular regulation profile characterized by high levels of RSA suppression and HP change. However, a significant interaction with racial status was found suggesting that the association between cardiovascular regulation profile and BMI growth and pediatric obesity was only significant for African-American children. An autonomic cardiovascular regulation profile consisting of low parasympathetic activity represents a significant individual risk factor for the development of pediatric obesity, but only for African-American children. Mechanisms by which early physiological regulation difficulties may contribute to the development of pediatric obesity are discussed

Stress as a Contributing Factor for Pediatric Obesity: Literature Review and Internship Experience

This article is an examination of how stress drives diet and physical activity behaviors that contribute to pediatric obesity in the United States. An increasing rate of childhood obesity is being reported in the United States and therefore a multitude of studies and reviews have been conducted on the topic. This review of the literature systematically analyzes how stress, diet, and physical activity behaviors contribute to this rising rate of pediatric obesity. An analysis of the chosen articles for review indicates that stress and its counterpart (resilience) tend to be driving forces in how American children and adolescents participate in their diet and physical activity practices. In order for pediatric obesity rates to decrease, a more in-depth evaluation and implementation of stress-reduction amongst American youth and their family units must be obtained, thereby causing healthier nutrition and activity behaviors

Pediatric Obesity: Prevention, Assessment and Treatment in Primary Care

People of all ages deserve care for the disease of obesity. Pediatric obesity affects one in three children in the United States, and the number of obese children has tripled since the 1970s (Centers for Disease Control and Prevention (CDC), 2018a). High blood pressure, high cholesterol, type 2 diabetes, and sleep apnea are complications that pediatric patients now face, and these diseases are well known to worsen quality of, and potentially shorten life. This scholarly project addresses the question: How can family nurse practitioners effectively address pediatric obesity in the primary care setting? Interventions early in life, perhaps even pre-conception, aim to avoid development of severe health issues and diseases that are related to obesity. It is the role of the primary care provider to help families understand the impact of excess weight on health, to assess young patients for weight concerns, to promote positive behaviors and initiate effective treatment options. This scholarly project will examine nurse practitioner knowledge of pediatric obesity prevention, assessment, and treatment. Further, it will explore current approach to care delivery by nurse practitioners in a primary care practice setting. This scholarly project will demonstrate that one must be empowered with the education on best practice to most effectively engage in pediatric obesity care delivery

The Relationship between BMI & Mandated Physical Education Requirements of Elementary Schools

The physical activity policies of elementary schools in Arkansas and correlations between physical activity requirements and body mass index have been studied. Examination of the policies at the individual school, district, or state level were noted. The statewide BMI database was consulted. Interviews with physical education teachers was conducted to assess policy implementation. Results may provide schools and policy makers with insight on future physical activity policies

Where are Family Theories in Family-based Obesity Treatment?: Conceptualizing the Study of Families in Pediatric Weight Management

Family-based approaches to pediatric obesity treatment are considered the ‘gold-standard,’ and are recommended for facilitating behavior change to improve child weight status and health. If family-based approaches are to be truly rooted in the family, clinicians and researchers must consider family process and function in designing effective interventions. To bring a better understanding of family complexities to family-based treatment, two relevant reviews were conducted and are presented: (1) a review of prominent and established theories of the family that may provide a more comprehensive and in-depth approach for addressing pediatric obesity; and (2) a systematic review of the literature to identify the use of prominent family theories in pediatric obesity research, which found little use of theories in intervention studies. Overlapping concepts across theories include: families are a system, with interdependence of units; the idea that families are goal-directed and seek balance; and the physical and social environment imposes demands on families. Family-focused theories provide valuable insight into the complexities of families. Increased use of these theories in both research and practice may identify key leverage points in family process and function to prevent the development of or more effectively treat obesity. The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment