research on childhood obesity supports which of the following statements

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Published: 06 June 2024

Pediatric obesity is a complex disease. It is time we start reimbursing for care

• Sarah C. Armstrong 1  

Pediatric Research ( 2024 ) Cite this article

46 Accesses

5 Altmetric

Metrics details

Obesity is the most common chronic disease affecting youth today. As of 2020, 14.7 million US children and adolescents were living with obesity, and obesity prevalence has increased from 5% of children aged 2−17 years in 1976−1980 to 19.7% in 2017−2020. 1 Obesity in childhood leads to immediate and long-term adverse health and developmental outcomes including decreased quality of life, 2 lower educational attainment, 3 high cholesterol, 4 type 2 diabetes, 4 hypertension, 4 and depression. 5

Obesity-related heath disparities vary significantly by race, ethnicity, and economic factors; this points to significant inequity that drives and sustains excess weight gain in childhood. By age 2, Hispanic children have a higher prevalence of obesity (14%) than Non-Hispanic Black (11%), White (10%), or Asian (5%) children. By age 11, the highest prevalence of obesity is in Non-Hispanic Black (26%) and Hispanic (25%) youth, as compared with Non-Hispanic White (15%) and Asian (10%) youth. 1 Poverty prior to age 2 is strongly associated with obesity by age 15, 6 and food insecurity before age 12 months is associated with obesity by Kindergarten entry. 7

This is a preview of subscription content, access via your institution

Access options

Subscribe to this journal

Receive 14 print issues and online access

251,40 € per year

only 17,96 € per issue

Buy this article

• Purchase on Springer Link
• Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Ogden, C. L., Martin, C. B., Freedman, D. S. & Hales C. M. Trends in obesity disparities during childhood. Pediatrics ,150. https://doi.org/10.1542/peds.2022-056547 (2022).

Ciężki, S., Odyjewska, E., Bossowski, A. & Głowińska-Olszewska, B. Not only metabolic complications of childhood obesity. Nutrients, 16 https://doi.org/10.3390/nu16040539 (2024).

Cohen, A. K., Rai, M., Rehkopf, D. H. & Abrams, B. Educational attainment and obesity: a systematic review. Obes. Rev. 14 , 989–1005 (2013).

Article   CAS   PubMed   PubMed Central   Google Scholar  

Skinner, A. C., Perrin, E. M., Moss, L. A. & Skelton, J. A. Cardiometabolic risks and severity of obesity in children and young adults. N. Engl. J. Med. 373 , 1307–17 (2015).

Article   PubMed   Google Scholar  

Moradi, M., Mozaffari, H., Askari, M. & Azadbakht, L. Association between overweight/obesity with depression, anxiety, low self-esteem, and body dissatisfaction in children and adolescents: a systematic review and meta-analysis of observational studies. Crit. Rev. Food Sci. Nutr. 62 , 555–570 (2022).

Lee, H., Andrew, M., Gebremariam, A., Lumeng, J. C. & Lee, J. M. Longitudinal associations between poverty and obesity from birth through adolescence. Am. J. Public Health 104 , e70–6 (2014).

Article   PubMed   PubMed Central   Google Scholar  

Simonovich, S. D. et al. A systematic review examining the relationship between food insecurity and early childhood physiological health outcomes. Transl. Behav. Med. 10 , 1086–1097 (2020).

St Pierre C. et al. Food insecurity and childhood obesity: a systematic review. Pediatrics, 150 https://doi.org/10.1542/peds.2021-055571 (2022).

Felitti, V. J. et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study. Am. J. Prev. Med. 14 , 245–58 (1998).

Article   CAS   PubMed   Google Scholar  

Petruccelli, K., Davis, J. & Berman, T. Adverse childhood experiences and associated health outcomes: a systematic review and meta-analysis. Child Abus. Negl. 97 , 104127 (2019).

Article   Google Scholar  

Wiss, D. A. & Brewerton, T. D. Adverse childhood experiences and adult obesity: a systematic review of plausible mechanisms and meta-analysis of cross-sectional studies. Physiol. Behav. 223 , 112964 (2020).

Mahmoud, R., Kimonis, V. & Butler M. G. Genetics of obesity in humans: a clinical review. Int. J. Mol. Sci . 23 https://doi.org/10.3390/ijms231911005 (2022).

Mahmoud, A. M. An overview of epigenetics in obesity: the role of lifestyle and therapeutic interventions. Int. J. Mol. Sci . 23 https://doi.org/10.3390/ijms23031341 (2022).

Lahtinen, P. et al. Effectiveness of fecal microbiota transplantation for weight loss in patients with obesity undergoing bariatric surgery: a randomized clinical trial. JAMA Netw. Open 5 , e2247226 (2022).

Adamo, K. B., Colley, R. C., Hadjiyannakis, S. & Goldfield, G. S. Physical activity and sedentary behavior in obese youth. J. Pediatr. 166 , 1270–1275.e2 (2015).

Malik, V. S., Schulze, M. B. & Hu, F. B. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am. J. Clin. Nutr. 84 , 274–88 (2006).

Collese, T. S. et al. Role of fruits and vegetables in adolescent cardiovascular health: a systematic review. Nutr. Rev. 75 , 339–349 (2017).

Albarqouni, L. et al. Evaluation of evidence supporting NICE recommendations to change people’s lifestyle in clinical practice: cross sectional survey. BMJ Med. 1 , e000130 (2022).

Hampl S. E. et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 151 https://doi.org/10.1542/peds.2022-060640 (2023).

Grossman, D. C. et al. Screening for obesity in children and adolescents: US preventive services task force recommendation statement. Jama 317 , 2417–2426 (2017).

Skinner, A. C. et al. Appraisal of clinical care practices for child obesity treatment. Part I: interventions. Pediatrics 151 https://doi.org/10.1542/peds.2022-060642 (2023).

Kelly, A. S. et al. A randomized, controlled trial of liraglutide for adolescents with obesity. N. Engl. J. Med. 382 , 2117–2128 (2020).

Weghuber, D. et al. Once-weekly semaglutide in adolescents with obesity. N. Engl. J. Med. 387 , 2245–2257 (2022).

Kelly, A. S. et al. Phentermine/topiramate for the treatment of adolescent obesity. NEJM Evid . 1 https://doi.org/10.1056/evidoa2200014 (2022).

McDuffie, J. R. et al. Three-month tolerability of orlistat in adolescents with obesity-related comorbid conditions. Obes. Res. 10 , 642–50 (2002).

Inge, T. H. et al. Five-year outcomes of gastric bypass in adolescents as compared with adults. N. Engl. J. Med. 380 , 2136–2145 (2019).

Nunez Lopez, O., Jupiter, D. C., Bohanon, F. J., Radhakrishnan, R. S. & Bowen-Jallow, K. A. Health disparities in adolescent bariatric surgery: nationwide outcomes and utilization. J. Adolesc. Health 61 , 649–656 (2017).

Download references

Acknowledgements

Drs. Ann Reed and Tina Cheng for critical input and discussion. No financial assistance was received in the preparation of this commentary.

Author information

Authors and affiliations.

Department of Pediatrics, Duke University, Durham, NC, 27704, USA

Sarah C. Armstrong

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Sarah C. Armstrong .

Ethics declarations

Competing interests.

S.C.A. was a co-author of the 2023 American Academy of Pediatrics Clinical Practice Guideline for the Evaluation and Treatment of Obesity in Children and Adolescents. No additional disclosures or conflicts of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Armstrong, S.C. Pediatric obesity is a complex disease. It is time we start reimbursing for care. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03201-8

Download citation

Received : 21 March 2024

Accepted : 25 March 2024

Published : 06 June 2024

DOI : https://doi.org/10.1038/s41390-024-03201-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Preventing Childhood Obesity
• Health Care Strategies
• About Obesity
• What Can Be Done
• Obesity Data and Statistics

Related Topics:

• View All Home
• About Healthy Weight and Growth
• Body Mass Index (BMI)
• About Nutrition
• About Physical Activity

Childhood Obesity Facts

At a glance.

• Approximately 1 in 5 U.S. children and adolescents have obesity.
• Obesity affects some groups more than others, including adolescents, Hispanic and non-Hispanic Black children, and children in families with lower incomes.
• Health care for obesity is expensive for patients and the health care system.

Many U.S. children have obesity

From 2017 to March 2020, the prevalence of obesity among U.S. children and adolescents was 19.7% 1 . This means that approximately 14.7 million U.S. youths aged 2–19 years have obesity.

For children, obesity is defined as having a body mass index (BMI) at or above the 95th percentile for age and sex.

Obesity affects some groups more than others

The prevalence of obesity increased with age. From 2017 to March 2020, obesity prevalence was 12.7% among U.S. children 2–5 years old, 20.7% among those 6–11, and 22.2% among adolescents 12–19. [1]

Race and ethnicity

Overall, obesity prevalence was highest in Hispanic children (26.2%) and non-Hispanic Black children (24.8%) followed by non-Hispanic white (16.6%) and non-Hispanic Asian (9.0%) children. [1]

Among U.S. girls, obesity prevalence was highest among non-Hispanic Black girls (30.8%). Among U.S. boys, obesity prevalence was highest among Hispanic boys (29.3%). [1]

Family income

Obesity prevalence increased as family income decreased. Obesity prevalence was:

• 11.5% among U.S. children with family income more than 350% of the Federal Poverty Level (FPL).
• 21.2% among children with family income 130% to 350% of FPL.
• 25.8% among children with family income 130% or less of FPL. [1]

Obesity data among young children‎

Health care for obesity is expensive.

Health care for obesity is expensive for patients and the health care system. In 2019 dollars, the estimated annual medical cost of obesity among U.S. children was $1.3 billion. Medical costs for children with obesity were $116 higher per person per year than for children with healthy weight. Medical costs for children with severe obesity were $310 higher per person per year than for children with healthy weight. [2]

Related information

Adult Obesity Facts

Information about obesity among adults in the U.S.

About Child and Teen BMI

What BMI is, how it is used, and how it is interpreted.

Child and Teen BMI Calculator

Calculate BMI, BMI percentile, and BMI category for children and adolescents 2–19.

Person-first language‎

• Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey 2017–March 2020 prepandemic data files development of files and prevalence estimates for selected health outcomes . Natl Health Stat Report . 2021;158.
• Ward ZJ, Bleich S, Long MW, Gortmaker SL. Association of body mass index with health care expenditures in the United States by age and sex. PLoS One . 2021;16(3):e0247307.

CDC's obesity prevention efforts focus on policy and environmental strategies to make healthy eating and active living accessible for everyone.

For Everyone

Health care providers, public health.

Fact sheets

• Facts in pictures
• Publications
• Questions and answers
• Tools and toolkits
• HIV and AIDS
• Hypertension
• Mental disorders
• Top 10 causes of death
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• Data collection tools
• Global Health Observatory
• Insights and visualizations
• COVID excess deaths
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment in WHO
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal
• Questions and answers /

Noncommunicable diseases: Childhood overweight and obesity

The prevalence of overweight and obesity in adolescents is defined according to the WHO growth reference for school-aged children and adolescents (overweight = 1 standard deviation body mass index for age and sex, and obese = 2 standard deviations body mass index for age and sex).

Overweight and obesity are defined as ''abnormal or excessive fat accumulation that presents a risk to health''.

Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally in 2016, the number of overweight children under the age of five, is estimated to have been over 41 million. Almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa. Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases like diabetes and cardiovascular diseases at a younger age. Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity therefore needs high priority.

The most commonly used measure for overweight and obesity is the Body Mass Index (BMI) - a simple index to classify overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2).

The BMI provides the most useful population-level measure of overweight and obesity, as it is the same for both sexes and for all ages of adults. However, it should be considered as a rough guide because it may not correspond to the same body fat percentage in different individuals.

It is difficult to develop one simple index for the measurement of overweight and obesity in children and adolescents because their bodies undergo a number of physiological changes as they grow. Depending on the age, different methods to measure a body's healthy weight are available:

For children aged 0-5 years

The WHO Child Growth Standards, launched in April 2006, include measures for overweight and obesity for infants and young children up to age 5.

• The WHO Child Growth Standards
• WHO Global Database on Child Growth and Malnutrition, 0-5 years.

For individuals aged 5-19 years

WHO developed the Growth Reference Data for 5–19 years. It is a reconstruction of the 1977 National Center for Health Statistics (NCHS)/WHO reference and uses the original NCHS data set supplemented with data from the WHO child growth standards sample for young children up to age 5.

• Growth reference data for 5-19 years
• Global school-based student health survey (GSHS)

Childhood obesity is associated with a higher chance of premature death and disability in adulthood. Overweight and obese children are more likely to stay obese into adulthood and to develop noncommunicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age. For most NCDs resulting from obesity, the risks depend partly on the age of onset and on the duration of obesity. Obese children and adolescents suffer from both short-term and long-term health consequences.

The most significant health consequences of childhood overweight and obesity, which often do not become apparent until adulthood, include:

• cardiovascular diseases (mainly heart disease and stroke);
• musculoskeletal disorders, especially osteoarthritis; and
• certain types of cancer (endometrial, breast and colon).

At least 2.6 million people each year die as a result of being overweight or obese.

Many low- and middle-income countries are now facing the so-called double burden of disease. As they continue to struggle with the problems of infectious diseases and under-nutrition, at the same time they are experiencing a rapid increase in risk factors of NCDs such as obesity and overweight, particularly in urban settings.

It is not uncommon to find under-nutrition and obesity existing side by side within the same country, the same community or even within the same household in these settings.

This double burden is caused by inadequate prenatal, infant and child nutrition, which is then followed by exposure to high fat, energy dense, micronutrient poor foods and a lack of physical activity as the child grows older.

The fundamental cause of childhood overweight and obesity is an energy imbalance between calories consumed and calories expended.

Global increases in childhood overweight and obesity are attributable to several factors. First, there has been a global shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other healthy micronutrients. There is also a trend towards decreased physical activity levels due to the increasingly sedentary nature of many forms of recreation time, changing modes of transportation and increasing urbanization.

WHO recognizes that the increasing prevalence of childhood obesity results from changes in society. Childhood obesity is mainly associated with unhealthy eating and low levels of physical activity, but the problem is linked not only to children's behaviour but also, increasingly, to social and economic development and policies in the areas of agriculture, transport, urban planning, the environment, food processing, distribution and marketing, as well as education.

The problem is societal and therefore it demands a population-based multisectoral, multidisciplinary and culturally relevant approach.

Unlike most adults, children and adolescents cannot choose the environment in which they live or the food they eat. They also have a limited ability to understand the long-term consequences of their behaviour. They therefore require special attention when fighting the obesity epidemic.

Overweight and obesity, as well as related noncommunicable diseases, are largely preventable. It is recognized that prevention is the most feasible option for curbing the childhood obesity epidemic since current treatment practices are largely aimed at bringing the problem under control rather than effecting a cure. The goal in fighting the childhood obesity epidemic is to achieve an energy balance which can be maintained throughout the individual's life span.

WHO recommends the following to reduce and prevent childhood overweight and obesity:

• increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts;
• limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats;
• limit the intake of sugars; and
• be physically active and accumulate at least 60 minutes of regular, moderate- to vigorous-intensity activity each day that is developmentally appropriate.

Curbing the childhood obesity epidemic requires sustained political commitment and the collaboration of many public and private stakeholders.

Governments, international partners, civil society, NGOs and the private sector have vital roles to play in shaping healthy environments and making healthier diet options for children and adolescents affordable, and easily accessible. It is therefore WHO's objective to mobilize these partners and engage them in implementing the Global Strategy on Diet, Physical Activity and Health.

WHO supports the designation, implementation, monitoring and leadership of actions. A multisectoral approach is essential for sustained progress; the Organization mobilizes the combined energy, resources and expertise of all global stakeholders involved.

Recommendations

Public comments and nominations, about the uspstf.

• Recommendation Topics
• Recommendation: High Body Mass Index in Children and Adolescents: Interventions

Final Recommendation Statement

High body mass index in children and adolescents: interventions, june 18, 2024.

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Recommendation Summary

Pathway to Benefit

To achieve benefit, it is important that children and adolescents age 6 years or older with a high BMI receive intensive (26 or more contact hours) behavioral interventions.

Clinician Summary

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation.

• View the Clinician Summary in PDF

Additional Information

• Supporting Evidence and Research Taxonomy
• Related Resources & Tools
• Final Evidence Review (June 18, 2024)
• Evidence Gaps Research Taxonomy Table (June 18, 2024)
• Evidence Summary (June 18, 2024)
• Final Research Plan (June 30, 2022)
• Centers for Disease Control and Prevention: Obesity - Educational Tools New Resource for Clinicians and Patients
• The Community Guide: CPSTF Findings for Obesity - For Providers New Resource for Clinicians and Patients
• Physical Activity Guidelines for Americans - For Providers
• JAMA Patient Page: Interventions for High BMI in Children and Teenagers New Resource for Clinicians and Patients
• JAMA Podcast: Interventions for High BMI in Children and Adolescents New Resource for Clinicians and Patients

Recommendation Information

Full Recommendation:

The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms to improve the health of people nationwide.  

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.  

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

  The USPSTF is committed to mitigating the health inequities that prevent many people from fully benefiting from preventive services. Systemic or structural racism results in policies and practices, including health care delivery, that can lead to inequities in health. The USPSTF recognizes that race, ethnicity, and gender are all social rather than biological constructs. However, they are also often important predictors of health risk. The USPSTF is committed to helping reverse the negative impacts of systemic and structural racism, gender-based discrimination, bias, and other sources of health inequities, and their effects on health, throughout its work.

Approximately 19.7% of children and adolescents aged 2 to 19 years in the US have a body mass index (BMI) at or above the 95th percentile for age and sex, based on Centers for Disease Control and Prevention (CDC) growth charts from 2000. 1 , 2 BMI percentile is plotted on growth charts, such as those developed by the CDC, which are based on US-specific, population-based norms for children 2 years or older. 1 , 3 The prevalence of high BMI increases with age and is higher among Hispanic/Latino, Native American/Alaska Native, and non-Hispanic Black children and adolescents and children from lower-income families. 1 , 2

The USPSTF concludes with moderate certainty that providing or referring children and adolescents 6 years or older with a high BMI to comprehensive, intensive behavioral interventions has a moderate net benefit . The USPSTF concludes with moderate certainty that intensive behavioral interventions have a moderate net benefit for children and adolescents 6 years or older. Therefore, clinicians should provide those with high BMI with such interventions or refer them to appropriate health care professionals.

See Table 1 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual. 4

Patient Population Under Consideration

This recommendation applies to children and adolescents 6 years or older.

Definitions

BMI (weight in kilograms divided by the square of height in meters) is the currently accepted clinical standard measure of excess fat in the US, 1 , 5 and childhood and adolescent weight status is usually obtained by calculating BMI. Traditionally, children and adolescents are categorized as having “overweight” when their BMI is between the 85th and 95th percentile and as having “obesity” when their BMI is at or above the 95th percentile on CDC growth charts. In this recommendation, the USPSTF will use the general term “high BMI” when referring to youth considered to be above “normal” body weight status (≥95th percentile for age and sex) according to CDC standards. Specific BMI cutoffs (“≥95th percentile for age and sex” rather than “obese” and “85th to 95th percentile for age and sex” rather than “overweight”) will also be used when feasible. BMI is an imperfect measure of adiposity and is not an equivalent measure of adiposity across all racial and ethnic populations. However, most children with a BMI-for-age at or above the 95th percentile have high adiposity, while few children with a BMI-for-age below the 85th percentile have high adiposity. 1 , 6

Behavioral Counseling Interventions and Implementation Considerations

Comprehensive, intensive behavioral interventions with at least 26 contact hours or more that include supervised physical activity sessions for up to 1 year result in weight loss in children and adolescents. 1 Effective, high-intensity (≥26 contact hours) behavioral interventions result in greater weight loss than less intense interventions and result in some improvements in cardiometabolic risk factors. 1 These behavioral interventions consist of multiple components, and although components vary across interventions, many of the studied interventions include sessions targeting both the parent and child (separately, together, or both); offer group sessions in addition to individual or single-family sessions; provide information about healthy eating, safe exercising, and reading food labels; and incorporate behavior change techniques such as problem solving, monitoring diet and physical activity behaviors, and goal setting. 1 These types of interventions are often delivered by multidisciplinary teams, including pediatricians, exercise physiologists or physical therapists, dietitians or diet assistants, psychologists or social workers, or other behavioral specialists. 1

The USPSTF recognizes the challenges that the families of children and adolescents encounter in accessing effective, intensive behavioral interventions for high BMI. Identifying high BMI and how to address it are important steps in helping children and adolescents and their families obtain the support they need. The USPSTF also understands that stigma associated with high BMI can be harmful to children and adolescents. However, the USPSTF did not find evidence that behavioral interventions resulted in additional stigma. Also, none of the trials found a decrease in self-esteem or body satisfaction, or an increase in disordered eating, associated with behavioral interventions. 1

Pharmacotherapy Considerations

While several medications demonstrated greater weight loss than placebo, the totality of the evidence was found to be inadequate. An important limitation of the pharmacotherapy studies was that there was only a single trial for each effective medication (ie, phentermine/topiramate, semaglutide, and liraglutide) that lasted longer than 2 months. 1 The limited evidence on weight maintenance after pharmacotherapy discontinuation suggests that weight rebound starts soon after discontinuation, implying that long-term use will be needed to maintain weight loss. However, there is no evidence on the harms of long-term medication use. 1 In addition, pharmacotherapy is associated with moderate harms due to gastrointestinal symptoms (eg, nausea, vomiting, diarrhea, fecal incontinence, flatus, and gallstones). 1 Therefore, the USPSTF encourages clinicians to promote behavioral interventions as the primary effective intervention for weight loss in children and adolescents.

Additional Tools and Resources

The Community Preventive Services Task Force recommends several youth interventions promoting physical activity and healthy eating, access to affordable healthy food and beverages, healthy food and beverage choices, and fostering physical activity among children, reducing sedentary screen time, and using digital health interventions for weight management ( https://www.thecommunityguide.org/pages/task-force-findings-obesity.html ).

The US Department of Health and Human Services published the “Physical Activity Guidelines for Americans,” which provides recommendations for how physical activity can help promote health and reduce the risk of chronic disease for Americans 3 years or older ( https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines ).

The CDC has resources available for families and clinicians addressing high BMI at https://www.cdc.gov/obesity/ .

Other Related USPSTF Recommendations

The USPSTF has issued recommendations on screening for high blood pressure in children and adolescents, 7 screening for lipid disorders in children and adolescents, 8 and screening for prediabetes and type 2 diabetes in children and adolescents. 9 Current versions of these and other related USPSTF recommendations are available at https://www.uspreventiveservicestaskforce.org/uspstf/ .

This recommendation updates the 2017 USPSTF recommendation statement on screening for obesity in children and adolescents 6 years or older (B recommendation). 8

Scope of Review

The USPSTF commissioned a systematic evidence review 1 , 10 to update its 2017 recommendation on screening for obesity in children and adolescents. 11 Because assessing BMI is now part of routine clinical practice, it was not a focus of this review. The USPSTF reviewed evidence on interventions (behavioral counseling and pharmacotherapy) for weight loss or weight management that can be provided in or referred from a primary care setting. Interventions that did not include a weight loss or weight management component were not eligible for inclusion in this review. Surgical weight loss interventions are generally not first-line preventive interventions and are outside the scope of the review.

Effectiveness of Behavioral Counseling and Pharmacotherapy Interventions

Fifty randomized clinical trials (RCTs) (N = 8798) examined behavioral interventions. Twenty-eight trials were conducted in the US; the remaining 22 were conducted in Europe, Canada, Australia, New Zealand, Israel, and Turkey. Twenty-seven trials were conducted in primary care settings, and the remaining 23 were conducted in other health care settings (eg, various specialty outpatient clinics or research facilities). 1 , 10 Most trials (41/50) included study participants who had a BMI at or above the 85th percentile or at or above the 95th percentile for their age or sex according to CDC growth charts, country-specific norms, or International Obesity Task Force norms. The mean BMI percentile was 93 (range, 84.9-99.2). 1 , 10 Trials included children and adolescents aged 2 to 19 years. Eighteen trials were limited to elementary school–aged children (aged 6 to 8 years, up to age 12 years); 13 trials included preschool-aged or elementary school–aged children to adolescents; 12 trials evaluated adolescents only; and 7 trials targeted preschool- to kindergarten-aged children. 1 , 10

Most trials did not report on race or ethnicity or included predominantly White study participants. Trials conducted in the US had a more diverse study population; trials were mostly composed of White (52.4%), Black (20.5%), and Hispanic/Latino (25%) study participants. 1 , 10 There was limited inclusion of Asian or Native American/Alaska Native participants. Most trials described the level of patient participation in interventions. In the included trials, 31% to 93% of participants completed all sessions. The average percentage of sessions completed generally ranged from 60% to 80%. 1 , 10

Trials rarely reported health outcomes (eg, depression or social adjustment). However, pooled analyses demonstrated a statistically significant increase in global quality of life after 6 to 12 months (mean difference in change, 1.9 [95% CI, 0.2 to 3.5]; 11 RCTs; n = 1922). Among studies with more contact hours (≥26 contact hours), the mean difference in change in quality-of-life measures was 3.8 points (95% CI, 3.6 to 4.1) (most scales ranged from 0-100). 1 , 10 No studies reported longer-term benefits on health outcomes. Studies suggest that 4.4- to 5.4-point differences in the Pediatric Quality of Life Inventory (PedsQL) represent a minimal clinically important difference, and some of the included trials of higher-contact interventions did report improvement in this range on the PedsQL among children participating in the interventions. 1 , 10 , 12 , 13

Behavioral interventions were associated with reductions in BMI and other weight-related outcomes after 6 to 12 months (mean difference in change between groups, −0.7 [95% CI, −1.0 to −0.3]; 28 RCTs [n = 4494]; I 2  = 86.8%). Larger effects were seen in interventions with more contact hours (≥26) and physical activity sessions (1.4-point reduction in BMI [95% CI, −2.2 to −0.6]; 11 RCTs [n = 1087]; I 2  = 87.8%; and 2.6-kg loss in weight [95% CI, −3.8 to −1.3 kg]; 10 RCTs [n = 907]; I 2  = 58.2%).

Other weight and adiposity outcomes showed similar patterns. 1 , 10

Cardiometabolic risk factors (eg, lipid levels, blood pressure, and fasting plasma glucose level) were reported by 16 trials (n = 1700). 1 , 10 Pooled analyses of trials providing 26 or more contact hours and physical activity sessions showed improvements in blood pressure (eg, mean difference in systolic blood pressure, −3.6 mm Hg [95% CI, −5.7 to −1.5 mm Hg]; 8 RCTs [n = 773]; I 2  = 47.3%; mean difference in diastolic blood pressure, −3.0 mm Hg [95% CI, −5.7 to −1.5 mm Hg]; 8 RCTs [n = 774]; I 2  = 49.3%) and fasting plasma glucose level (mean difference, −1.9 mg/dL [95% CI, −2.7 to −1.2 mg/dL]; 4 RCTs [n = 367]; I 2  = 0%) after 6 to 12 months. 1 , 10 Pooled results of all 16 studies (including those with <26 contact hours) were not associated with improvements in systolic blood pressure.

Although the USPSTF found no evidence to determine the individual benefits of specific intervention components, effective interventions commonly included supervised physical activity sessions; provided information about healthy eating, safe exercising, and reading food labels; and incorporated behavior change techniques such as problem solving, monitoring diet and physical activity behaviors, and goal setting.

Evidence on effective interventions in children younger than 6 years is limited. 1 , 10

Eight trials assessed pharmacotherapy interventions: liraglutide (3 RCTs [n = 296]), semaglutide (1 RCT [n = 201]), orlistat (2 RCTs [n = 579]), and phentermine/topiramate (2 RCTs [n = 269]). Five trials included behavioral counseling components along with the medication or placebo. Seven of the 8 trials were either conducted entirely in the US or had study sites in the US; the remaining trial was conducted in Germany. 1 , 10 The majority of study participants were 12 years or older or 14 years or older; 1 study included children aged 7 to 11 years. 1 , 10 The evidence base for each medication was limited, consisting of only 1 trial per medication with 12 months or longer of treatment. 1 , 10

Only 1 medication, semaglutide, was associated with a greater improvement in weight-related quality of life than placebo (mean difference, 5.3 [95% CI, 0.2 to 8.3]) (scales ranged from 0-100), which is consistent with published minimal clinically important differences for the PedsQL (range, 4.4-6.3 points). 1 , 10 , 12 , 13 Three other pharmacotherapy trials found no between-group differences in change in quality of life or depression incidence compared with placebo after 6 to 13 months. 1 , 10

Pharmacotherapy was associated with larger mean BMI reductions compared with placebo in most trials. Liraglutide was associated with a 1.6-point greater reduction in BMI than placebo (mean difference, −1.6 [95% CI, −2.5 to −0.7] after 13 months), semaglutide with a 6.0-point greater reduction in BMI (mean difference, −6.0 [95% CI, −7.3 to −4.6] after 16 months), orlistat with a 0.9-point greater reduction (mean difference, −0.9 [95% CI not reported]; P  = .001; after 12 months), and phentermine/topiramate with 3.7- to 5.4-point greater reductions (15/92-mg dose mean difference, −5.4 [95% CI, −6.4 to −4.3]; 7.4/46-mg dose mean difference, −3.7 [95% CI, −5.0 to −2.5] after 13 months). 1 , 10 Group differences were not maintained in the liraglutide study after 6 months without treatment. While there was an initial reduction in BMI, longer-term maintenance after medication withdrawal was either not reported for any of the other medications or showed immediate weight increase after discontinuation. All medications showed increases in the likelihood of losing both 5% and 10% of baseline weight or BMI. 1 , 10

Cardiometabolic outcomes were reported for orlistat (2 RCTs) and 1 study each of phentermine/topiramate, liraglutide, and semaglutide. The only medication that showed a clear reduction in blood pressure was phentermine/topiramate and only at the higher dose level (mean difference, −4.0 [95% CI, −7.7 to −0.5]). 1 , 10 Semaglutide improved low-density lipoprotein cholesterol levels (mean difference in percent change, −7.1 [95% CI, −11.9 to −1.8]), and phentermine/topiramate improved high-density lipoprotein cholesterol levels (eg, mean difference in percent change, 8.8 [95% CI, 2.2 to 15.4] for 15/92-mg/d dose); other medications did not demonstrate statistically significant improvements. None of the pharmacotherapy trials found improvements in glucose-related parameters. 1 , 10

Potential Harms of Behavioral Counseling and Pharmacotherapy Interventions

Eighteen trials (n = 2539) examined the harms of behavioral interventions. Outcomes were reported 6 to 12 months after baseline assessments. None of the trials found an increased risk of any adverse event or serious adverse events, including disordered eating, or decreases in self-esteem or body satisfaction. 1 , 10

Eight trials (n = 1345) examined the adverse effects of pharmacotherapy. More than 60% of youth taking liraglutide, semaglutide, or orlistat experienced gastrointestinal adverse effects (eg, nausea, vomiting, diarrhea, gallstones, flatus with discharge, and fecal incontinence). For example, in the largest trial of liraglutide, gastrointestinal adverse effects occurred in 65% of study participants in the intervention group vs 36% in the placebo group (relative risk, 3.20 [95% CI, 1.91 to 5.36]). 1 , 10 Musculoskeletal and psychiatric adverse effects were most reported with phentermine/topiramate (at doses of 15/92 mg/d) (8.8% with intervention vs 1.8% with placebo for both categories of adverse effects). 1 , 10 Serious adverse effects were rare in all of the pharmacotherapy trials. No evidence was available on adverse effects beyond 1 month after medication discontinuation or longer than 17 months for any medication. 1 , 10

Response to Public Comment

A draft version of this recommendation statement was posted for public comment on the USPSTF website from December 12, 2023, to January 16, 2024. In response to comments, the USPSTF clarified the type of studies eligible for inclusion in the Scope of Review section. The USPSTF incorporated language in the Practice Considerations section regarding the harms associated with having a high BMI and the use of BMI for assessment/screening. The USPSTF also listed additional resources to help clinicians in the Additional Tools and Resources section.

See Table 2 for research needs and gaps related to interventions for high BMI in children and adolescents.

The American Academy of Pediatrics recommends plotting BMI on a growth chart at all pediatric visits for all patients 2 years or older. It also recommends comprehensive treatment of high BMI with improved nutrition, physical activity, behavioral therapy, and consideration of pharmacotherapy according to US Food and Drug Administration indications for children 12 years or older and consideration of bariatric surgery for adolescents. 14 , 15 The Canadian Task Force on Preventive Health recommends growth monitoring for all children and adolescents 17 years or younger at primary care visits. It also recommends that primary care clinicians offer or refer children and adolescents with high BMI to structured behavioral interventions aimed at healthy weight management. 16 The American Psychological Association recommends family-based multicomponent behavioral interventions with a minimum of 26 contact hours, initiated at an early age for children and adolescents with overweight or obesity. 17 The American College of Obstetricians and Gynecologists recommends screening for adolescent overweight and obesity and that adolescents with overweight or obesity be screened for depression and bullying and appropriately referred. It also recommends that clinicians initiate behavioral counseling or other multidisciplinary management as necessary. It does not recommend metformin for adolescent weight loss alone and recommends that bariatric surgery should only be considered after careful candidate selection by a multidisciplinary team. 18 Additionally, it recommends that clinicians caution against the use of weight loss supplements. The Society for Adolescent Health and Medicine calculating BMI percentile for all adolescents, reinforcing healthy behaviors, and counseling regarding body image, inappropriate dieting, and weight stigmatization, when indicated. For patients with a high BMI, it also recommends behavioral counseling or, if needed, referral to more intensive treatment options such as weight loss surgery. 19 The National Association of Pediatric Nurse Practitioners recommends measuring BMI in children 2 years or older and assessing family eating patterns, physical activity, sedentary time, and daily screen time in all children. It further recommends that weight loss programs be multicomponent and accessible within clinical, school, or community settings. 20 , 21

The authors of this recommendation statement include Task Force members serving at the time of publication and former members who made significant contributions to the recommendation. Any member with a level 3 conflict of interest (COI) recusal is not included as an author (see below for relevant COI disclosures for this topic).

The US Preventive Services Task Force authors of this recommendation statement include the following individuals: Wanda K. Nicholson, MD, MPH, MBA (George Washington University, Washington, DC); Michael Silverstein, MD, MPH (Brown University, Providence, Rhode Island); John B. Wong, MD (Tufts University School of Medicine, Boston, Massachusetts); David Chelmow, MD (Virginia Commonwealth University, Richmond); Tumaini Rucker Coker, MD, MBA (University of Washington, Seattle); Esa M. Davis, MD, MPH (University of Maryland School of Medicine, Baltimore); Katrina E. Donahue, MD, MPH (University of North Carolina at Chapel Hill); Carlos Roberto Jaén, MD, PhD, MS (University of Texas Health Science Center, San Antonio); Marie Krousel-Wood, MD, MSPH (Tulane University, New Orleans, Louisiana); Sei Lee, MD, MAS (University of California, San Francisco); Li Li, MD, PhD, MPH (University of Virginia, Charlottesville); Goutham Rao, MD (Case Western Reserve University, Cleveland, Ohio); John M. Ruiz, PhD (University of Arizona, Tucson); James Stevermer, MD, MSPH (University of Missouri, Columbia); Joel Tsevat, MD, MPH (University of Texas Health Science Center, San Antonio); Sandra Millon Underwood, PhD, RN (University of Wisconsin, Milwaukee); Sarah Wiehe, MD, MPH (Indiana University, Bloomington).

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://uspreventiveservicestaskforce.org/uspstf/about-uspstf/conflict-interest-disclosures . All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. Dr Wong reported publications and federal grant funding to his institution for the relationship between obesity and the potential effect of nutrition policy interventions on cardiovascular disease and cancer and for a meta-analysis of the effect of dietary counseling for weight loss. Dr Lee reported receiving grants from the National Institute on Aging (K24AG066998; R01AG079982) outside the submitted work. No other disclosures were reported.

No Task Force members had a level 3 COI recusal from this topic.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.  

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Copyright Notice: USPSTF recommendations are based on a rigorous review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs. To encourage widespread discussion, consideration, adoption, and implementation of USPSTF recommendations, AHRQ permits members of the public to reproduce, redistribute, publicly display, and incorporate USPSTF work into other materials provided that it is reproduced without any changes to the work of portions thereof, except as permitted as fair use under the US Copyright Act.

AHRQ and the US Department of Health and Human Services cannot endorse, or appear to endorse, derivative or excerpted materials, and they cannot be held liable for the content or use of adapted products that are incorporated on other Web sites. Any adaptations of these electronic documents and resources must include a disclaimer to this effect. Advertising or implied endorsement for any commercial products or services is strictly prohibited.

This work may not be reproduced, reprinted, or redistributed for a fee, nor may the work be sold for profit or incorporated into a profit-making venture without the express written permission of AHRQ. This work is subject to the restrictions of Section 1140 of the Social Security Act, 42 U.S.C. §320b-10. When parts of a recommendation statement are used or quoted, the USPSTF Web page should be cited as the source.

1. O’Connor E, Evans C, Henninger M, Redmond N, Senger C, Thomas R. Interventions for High Body Mass Index in Children and Adolescents: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis No. 237 . Agency for Healthcare Research and Quality; 2024. AHRQ publication 23-05310-EF-1. 2. Stierman B, Afflux J, Carroll MD, et al. National Health and Nutrition Examination Survey 2017–March 2020 Prepandemic Data Files—Development of Files and Prevalence Estimates for Selected Health Outcomes . National Center for Health Statistics; 2021. 3. Centers for Disease Control and Prevention. Defining childhood BMI categories. Accessed April 30, 2024. https://www.cdc.gov/growthcharts/cdc_charts.htm 4. U.S. Preventive Services Task Force. Procedure Manual. Updated May 2021. Accessed April 30, 2024. https://uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual 5. Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clin Proc . 2017;92(2):251-265. Medline:28065514 doi:10.1016/j.mayocp.2016.09.017 6. Ryder JR, Kaizer AM, Rudser KD, Daniels SR, Kelly AS. Utility of body mass index in identifying excess adiposity in youth across the obesity spectrum. J Pediatr . 2016;177:255-261. Medline:27496270 doi:10.1016/j.jpeds.2016.06.059 7. US Preventive Services Task Force. Screening for high blood pressure in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA . 2020;324(18):1878-1883. Medline:33170248 doi:10.1001/jama.2020.20122 8. US Preventive Services Task Force. Screening for lipid disorders in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA . 2023;330(3):253-260. Medline:37462699 doi:10.1001/jama.2023.11330 9. US Preventive Services Task Force. Screening for prediabetes and type 2 diabetes in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA . 2022;328(10):963-967. Medline:36098719 doi:10.1001/jama.2022.14543 10. O’Connor EA, Evans CV, Henninger M, Redmond N, Senger CA. Interventions for weight management in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA . Published June 18, 2024. doi:10.1001/jama.2024.6739 11. US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA . 2017;317(23):2417-2426. Medline:28632874 doi:10.1001/jama.2017.6803 12.  Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr . 2003;3(6):329-341. Medline:14616041 doi:10.1367/1539-4409(2003)003<0329:TPAAPP>2.0.CO;2 13. Hilliard ME, Lawrence JM, Modi AC, et al; SEARCH for Diabetes in Youth Study Group. Identification of minimal clinically important difference scores of the PedsQL in children, adolescents, and young adults with type 1 and type 2 diabetes. Diabetes Care . 2013;36(7):1891-1897. Medline:23340884 doi:10.2337/dc12-1708 14. American Academy of Pediatrics. Recommendations for preventive pediatric health care. Updated April 2023. Accessed April 30, 2024. https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf?_ga=2.231878815.1413452381.1668206139-1862393775.1661884606 15. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics . 2023;151(2):e2022060640. Medline:36622115 doi:10.1542/peds.2022-060640 16. Canadian Task Force on Preventive Health Care. Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care. CMAJ . 2015;187(6):411-421. Medline:25824498 doi:10.1503/cmaj.141285 17. American Psychological Association. Clinical Practice Guideline for Multicomponent Behavioral Treatment of Obesity and Overweight in Children and Adolescents: Current State of the Evidence and Research Needs. Published 2018. Accessed April 30, 2024. https://www.apa.org/obesity-guideline/clinical-practice-guideline.pdf 18. Committee on Adolescent Health Care. Committee opinion no. 714: obesity in adolescents. Obstet Gynecol . 2017;130(3):e127-e40. Medline:28832485 doi:10.1097/AOG.0000000000002297 19. Society for Adolescent Health and Medicine. Preventing and treating adolescent obesity: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health . 2016;59(5):602-606. Medline:27772662 doi:10.1016/j.jadohealth.2016.08.020 20. Roettger L, Shreve M, Yeager L, et al; National Association of Pediatric Nurse Practitioners, Childhood Obesity Special Interest Group. NAPNAP position statement on the identification and prevention of overweight and obesity in the pediatric population. J Pediatr Health Care . 2021;35(4):425-427. doi:10.1016/j.pedhc.2021.03.001 21. Polfuss ML, Duderstadt KG, Kilanowski JF, Thompson ME, Davis RL, Quinn M. Childhood obesity: evidence-based guidelines for clinical practice--part one. J Pediatr Health Care . 2020;34(3):283-290. Medline:32005502 doi:10.1016/j.pedhc.2019.12.003

Abbreviations: BMI, body mass index; USPSTF, US Preventive Services Task Force.

Risk factors of childhood obesity: What are they? How to prevent them? – An updated of 2019

Today’s post comes from Audrey St-Laurent. Audrey is a PhD student in the department of kinesiology at Laval University of Quebec City. She is also the communications director of the OC-SNP National Executive.

Childhood obesity is a known public health issue. In 2016, the worldwide prevalence of overweight and obesity in children and adolescents was more than four times higher than it was 40 years ago (OMS 2018). Moreover, it is known that obesity occurs at an early age (<6 years old) (Geserick et al. 2018) and that there exists a strong association between the number of years lived with obesity and the risk of cardiovascular disease mortality and all-cause mortality (Abdullah et al. 2011).

Genetics contributes substantially to the development of excessive adiposity during childhood. In fact, genetics could explain 47% to 80% of the body mass index variations during early life (Elks et al. 2012). In addition to genetic, many modifiable determinants may also be associated with the development of obesity in young children. This begs these questions: What are they? How can we prevent them?

A recent article published in Nature Reviews Endocrinology (Larqué et al. 2019) aimed to review the existing scientific evidence about the determinants of childhood obesity to provide clinically relevant strategies to prevent this issue from preconception to the end of the second year of life.

What are the modifiable risk factors of childhood obesity? 

Figure 1. Modifiable factors associated with child adiposity

Larqué et al. (2019) identified 20 potential prenatal and postnatal determinants of childhood obesity. Among them, four modifiable risk factors (breastfeeding, macronutrient intake during infancy [in particular total fat intake], supplementation with prebiotics and probiotics and complementary feeding) could need more attention considering their inconclusive effect. It is also important to note that despite the inconclusive effect of breastfeeding on reducing obesity risk later in life, there is a consensus on that breastfeeding should be promoted owing to its many beneficial effects.

How to prevent the risk factors of childhood obesity?

• During pregnancy, health care providers should support strategies to ensure healthy maternal lifestyles, including practicing regular physical activity, consuming polyunsaturated fats, avoiding malnutrition/undernutrition or overnutrition, alcohol and smoking and limiting the consumption of free sugar intake to <10% of total energy.
• Healthy paternal lifestyles, in particular, a healthy diet and a regular physical activity practice should be promoted.
• Pregnant women should take antibiotics only after identification of bacterial infection.
• Caesarean delivery should be strictly limited to medical indications.
• Infant formula with a protein content <2.05g/100ml should be avoided.
• Children aged of <2 years should sleep more than 10.5 hours per day, including naps.
• Infants’ sedentary screen time should be limited 

Table 1. Canadian guidelines of sedentary screen time during in early life (0-4 years)

Source: Tremblay et al. (2017)

To conclude, in the context of preventing childhood obesity, pediatrics and health care professionals should provide personalized, evidence-based advice and information on healthy lifestyle behaviors (e.g. nutrition, physical activity and sleep) to parents during pregnancy, but optimally even before conception. Moreover, Larqué et al. (2019) reported that specific measurements of offspring adiposity and not only body mass index are required. The authors also recommend that national and local policies and institutions adopt health promotion actions that take into account the above identified early risk factors for childhood obesity in order to support families in the short- and long-term.

Do you have any ideas for promoting a healthy lifestyle at all ages? Please share them with us by emailing Audrey @ [email protected] !

For more information, you may consult the following article: Larqué, E., Labayen, I., Flodmark, C.-E., et al. (2019). From conception to infancy—early risk factors for childhood obesity. Nature Reviews Endocrinology , 1.

Abdullah, A. et al. (2011). The number of years lived with obesity and the risk of all- cause and cause- specific mortality. Int. J. Epidemiol. 40, 985–996. 

Elks CE, den Hoed M, Zhao JH, Sharp SJ, Wareham NJ, Loos RJ, Ong KK. Variability in the heritability of body mass index: a systematic review and meta-regression. Front Endocrinol (Lausanne) 2012;3. 

Geserick, M., Vogel, M., Gausche, R., et al. (2018). Acceleration of BMI in early childhood and  Larqué, E., Labayen, I., Flodmark, C.-E., et al. (2019). From conception to infancy—early risk factors for childhood obesity. Nature Reviews Endocrinology , 1.

Tremblay, M. S., Chaput, J.-P., Adamo, K. B., et al. (2017). Canadian 24-hour movement guidelines for the early years (0–4 years): an integration of physical activity, sedentary behaviour, and sleep. BMC Public Health, 17(5), 874.

WHO. (2018). Obesity and overweight [Retrieved from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight ]. Assessed on October 3, 2019.

Share This Story, Choose Your Platform!

Related posts.

Obesity Canada Supports The Society of Gynecologic Oncology of Canada and the Alberta Cancer Foundation

Call for Nominations to the Board of Directors

INFORMAS Canada FOOD EPI-2023 Report

Conference Reflections from Jordyn Cox

Conference Reflections from Dana Lowry

• Patient Care & Health Information
• Diseases & Conditions
• Childhood obesity

As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI -for-age growth chart. The BMI helps indicate if your child is overweight for his or her age and height.

Using the growth chart, your doctor determines your child's percentile, meaning how your child compares with other children of the same sex and age. For example, if your child is in the 80th percentile, it means that compared with other children of the same sex and age, 80% have a lower BMI .

Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention, help classify the severity of a child's weight problem:

• BMI between 85th and 94th percentiles — overweight
• BMI 95th percentile or above — obesity
• BMI 99th percentile or higher — severe obesity

Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. This helps determine whether your child's weight is a health concern.

In addition to BMI and charting weight on the growth charts, the doctor evaluates:

• Your family's history of obesity and weight-related health problems, such as diabetes
• Your child's eating habits
• Your child's activity level
• Other health conditions your child has
• Psychosocial history, including incidences of depression, sleep disturbances, and sadness and whether your child feels isolated or alone or is the target of bullying

Blood tests

Your child's doctor might order blood tests that may include:

• A cholesterol test
• A blood sugar test
• Other blood tests to check for hormone imbalances or other conditions associated with obesity

Some of these tests require that your child not eat or drink anything before the test. Ask if your child needs to fast before a blood test and for how long.

More Information

• Cholesterol test

Treatment for childhood obesity is based on your child's age and whether he or she has other medical conditions. Treatment usually includes changes in your child's eating habits and physical activity level. In certain circumstances, treatment might include medications or weight-loss surgery.

Treatment for children with BMIs between the 85th and 94th percentiles (overweight)

The American Academy of Pediatrics recommends that children older than 2 whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain. This strategy allows the child to add inches in height but not pounds, causing the BMI to drop over time into a healthier range.

Treatment for children with BMIs at the 95th percentile or above (obesity)

Children ages 6 to 11 whose weight falls into the obesity category might be encouraged to modify their eating habits for gradual weight loss of no more than 1 pound (or about 0.5 kilogram) a month. Older children and adolescents who have obesity or severe obesity might be encouraged to modify their eating habits to aim for weight loss of up to 2 pounds (or about 1 kilogram) a week.

The methods for maintaining your child's current weight or losing weight are the same: Your child needs to eat a healthy diet — both in terms of type and amount of food — and increase physical activity. Success depends largely on your commitment to helping your child make these changes.

Healthy eating

Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child's health.

• Prioritize fruits and vegetables. When food shopping, cut back on convenience foods — such as cookies, crackers and prepared meals — which are often high in sugar, fat and calories.
• Limit sweetened beverages. This includes beverages that contain fruit juice. These drinks provide little nutritional value in exchange for their high calories. They can also make your child feel too full to eat healthier foods.
• Avoid fast food. Most of the menu options are high in fat and calories.
• Sit down together for family meals. Make it an event — a time to share news and tell stories. Discourage eating in front of a TV, computer or video game screen, which can lead to fast eating and lowered awareness of the amount eaten.
• Serve appropriate portion sizes. Children don't need as much food as adults do. Start with a small portion and your child can ask for more if they're still hungry. Allow your child to eat only until full, even if that means leaving food on the plate. And remember, when you eat out, restaurant portion sizes are often way too large.

Physical activity

A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. It burns calories, strengthens bones and muscles, and helps children sleep well at night and stay alert during the day.

Good habits established in childhood help adolescents maintain healthy weights And active children are more likely to become fit adults.

To increase your child's activity level:

• Limit TV time. Recreational screen time — in front of a TV, computer, tablet or smart phone — should be limited to no more than two hours a day for children older than 2. Children younger than 2 should have no screen time at all.
• Emphasize activity, not exercise. Children should be moderately to vigorously active for at least an hour a day. Your child's activity doesn't have to be a structured exercise program — the object is to get him or her moving. Free-play activities — such as playing hide-and-seek, tag or jump-rope — can be great for burning calories and improving fitness.
• Find activities your child likes. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book.

Medications

Medication might be prescribed for some children and adolescents as part of an overall weight-loss plan.

Weight-loss surgery

Weight-loss surgery might be an option for adolescents with severe obesity, who have been unable to lose weight through lifestyle changes. However, as with any type of surgery, there are potential risks and long-term complications. Discuss the pros and cons with your child's doctor.

Your doctor might recommend this surgery if your child's weight poses a greater health threat than do the potential risks of surgery. It's important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including an obesity medicine expert, psychologist and dietitian.

Weight-loss surgery isn't a miracle cure. It doesn't guarantee that an adolescent will lose their excess weight or be able to keep it off long term. And surgery doesn't replace the need for a healthy diet and regular physical activity.

• Mayo Clinic Children's Center Pediatric Weight Management Clinic
• Bariatric surgery
• Mayo Clinic Minute: Weight loss surgery for kids

Coping and support

Parents play a crucial role in helping children feel loved and in control of their weight. Take advantage of every opportunity to build your child's self-esteem. Don't be afraid to bring up the topic of health and fitness. Talk to your kids directly, openly, and without being critical or judgmental.

In addition, consider the following:

• Avoid weight talk. Negative comments about your own, someone else's or your child's weight — even if well intended — can hurt your child. Negative talk about weight can lead to poor body image. Instead, focus your conversation on healthy eating and positive body image.
• Discourage dieting and skipping meals. Instead, encourage and support healthy eating and increased physical activity.
• Find reasons to praise your child's efforts. Celebrate small, incremental changes in behavior but don't reward with food. Choose other ways to mark your child's accomplishments, such as going to the bowling alley or a local park.
• Talk to your child about his or her feelings. Help your child find ways other than eating to deal with emotions.
• Help your child focus on positive goals. For example, point out that he or she can now bike for more than 20 minutes without getting tired or can run the required number of laps in gym class.
• Be patient. Realize that an intense focus on your child's eating habits and weight can easily backfire, leading a child to overeat even more or possibly making him or her prone to developing an eating disorder.

Preparing for your appointment

Your child's family doctor or pediatrician will probably make the initial diagnosis of childhood obesity. If your child has complications from being obese, you might be referred to additional specialists to help manage these complications.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything your child needs to do in advance, such as fast before having certain tests and for how long. Make a list of:

• Your child's symptoms, if any, and when they began
• Key personal information, including a family medical history and history of obesity
• All medications, vitamins or other supplements your child takes, including doses
• What your child typically eats in a week, and how active he or she is
• Questions to ask your doctor

Bring a family member or friend along, if possible, to help you remember all the information you're given.

For childhood obesity, some basic questions to ask your doctor include:

• What other health problems is my child likely to develop?
• What are the treatment options?
• Are there medications that might help manage my child's weight and other health conditions?
• How long will treatment take?
• What can I do to help my child lose weight?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your child's doctor or other health care provider is likely to ask you a number of questions about your child's eating and activity, including:

• What does your child eat in a typical day?
• How much activity does your child get in a typical day?
• What factors do you believe affect your child's weight?
• What diets or treatments, if any, have you tried to help your child lose weight?
• Are you ready to make changes in your family's lifestyle to help your child lose weight?
• What might prevent your child from losing weight?
• How often does the family eat together? Does the child help prepare the food?
• Does your child, or family, eat while watching TV, texting or using a computer?

What you can do in the meantime

If you have days or weeks before your child's scheduled appointment, keep a record of what your child eats and how active he or she is.

• Helping your child who is overweight. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/weight-management/helping-your-child-who-is-overweight. Oct. 14, 2020.
• Childhood obesity causes and consequences. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/childhood/causes.html. Accessed Oct. 14, 2020.
• Kliegman RM, et al. Overweight and obesity. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 14, 2020.
• Hay WW, et al., eds. Normal childhood nutrition and its disorders. In: Current Diagnosis & Treatment: Pediatrics. 25th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed Oct. 20, 2020.
• Skelton JA. Management of childhood obesity in the primary care setting. https://www.uptodate.com/contents/search. Accessed Oct. 14, 2020.
• Klish WJ, et al. Definition, epidemiology and etiology of obesity in children and adolescents. https://www.uptodate.com/contents/search. Accessed Oct. 14, 2020.
• Polfuss ML, et al. Childhood obesity: Evidence-based guidelines for clinical practice — Part one. Journal of Pediatric Health Care. 2020; doi:10.1016/j.pedhc.2019.12.003.
• Davis RL, et al. Childhood obesity: Evidence-based guidelines for clinical practice — Part two. Journal of Pediatric Health Care. 2020; doi:10.1016/j.pedhc.2020.07.011.
• Mayo Clinic Minute: Out of shape kids and diabetes

Associated Procedures

• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Your gift holds great power – donate today!

Make your tax-deductible gift and be part of the cutting-edge research and care that's changing medicine.

• Search Menu
• Sign in through your institution
• Advance articles
• Special Issues
• Author Guidelines
• Submission Site
• Open Access
• Self Archiving Policy
• Why publish with this journal?
• About Translational Behavioral Medicine
• About Society of Behavioral Medicine
• Journal Staff
• Advertising and Corporate Services
• Journals Career Network
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Introduction, nih efforts, gaps and opportunities, acknowledgments, compliance with ethical standards.

• < Previous

Childhood obesity research at the NIH: Efforts, gaps, and opportunities

• Article contents
• Figures & tables
• Supplementary Data

S Sonia Arteaga, Layla Esposito, Stavroula K Osganian, Charlotte A Pratt, Jill Reedy, Deborah Young-Hyman, Childhood obesity research at the NIH: Efforts, gaps, and opportunities, Translational Behavioral Medicine , Volume 8, Issue 6, December 2018, Pages 962–967, https://doi.org/10.1093/tbm/iby090

• Permissions Icon Permissions

Childhood obesity is a major public health challenge. This article describes an overview of the National Institutes of Health (NIH) behavioral and social sciences childhood obesity research efforts. The overview will highlight five areas of childhood obesity research supported by the NIH: (a) basic behavioral and social sciences; (b) early childhood; (c) policies, programs, and environmental strategies; (d) health disparities; and (e) transagency and public–private collaboration. The article also describes potential gaps and opportunities in the areas of childhood obesity and severe obesity, measurement, and sleep.

Practice: The National Institutes of Health (NIH) supports a number of funding announcements, workshops, and dietary assessment tools related to childhood obesity.

Policy: Childhood obesity continues to be a major public health challenge, and research related to programs, policies, and/or environmental strategies could be further explored to assess factors related to the promotion of healthy weight among children.

Research: To address the childhood obesity epidemic, the NIH supports a broad spectrum of biomedical and behavioral research that seeks to identify the causes and consequences of childhood obesity to develop new and more effective approaches to its prevention and treatment, and synergize and disseminate evidence within the NIH and with other stakeholder organizations.

Childhood obesity continues to be a major public health challenge with 18.5% of children aged 2–19 years having obesity [ 1 ]. Despite earlier reports that there may be stabilization of obesity among children [ 2 ], recent findings suggest that obesity is not decreasing and severe obesity is increasing among Hispanic children [ 3 , 4 ]. Children who have obesity are more likely to have cardiovascular risk factors [ 5 , 6 ], type 2 diabetes [ 7 ], and are at increased risk for morbidity and mortality as adults [ 8 ] including increased risk of developing several types of cancer [ 9 ].

To address the childhood obesity epidemic, the National Institutes of Health (NIH) supports a broad spectrum of biomedical and behavioral research that seeks to identify the causes and consequences of childhood obesity and to develop new and more effective approaches to its prevention and treatment [ 10 ]. The childhood obesity research that NIH supports includes studies in pregnancy, infancy, childhood, adolescence, and prevention and treatment approaches in families, schools, and other community settings, as well as in health care settings. The NIH also supports basic behavioral and social science research that is providing insights into factors related to the development, prevention, and treatment of childhood obesity, as well as environmental and policy-related research.

In the following section, we provide an overview of the NIH behavioral and social sciences childhood obesity research efforts. This overview is not meant to be a comprehensive summary of NIH’s childhood obesity activities, but instead is based on active and recently completed NIH-funded research activities including workshops and funding announcements as they relate to the behavioral and social sciences. This overview highlights five areas of childhood obesity research supported by the NIH: (a) basic behavioral and social sciences; (b) early childhood; (c) policies, programs, and environmental strategies; (d) health disparities; and (e) transagency and public–private collaboration. Based on research findings and workshop recommendations, discussions on potential gaps and future opportunities in childhood obesity research are provided.

Basic behavioral and social sciences research in childhood obesity

The NIH has long recognized the importance of basic behavioral and social science research related to pediatric obesity and has supported numerous efforts through various Institute and Center initiatives as well as through investigator-initiated research [ 11 ]. In particular, one major initiative, the Obesity-Related Behavioral Intervention Trials (ORBIT) consortium ( www.nihorbit.org ), was a trans-NIH program led by the National Heart, Lung, and Blood Institute (NHLBI) that facilitated the translation of basic behavioral and social science findings into pediatric and adult obesity-related interventions [ 12 ]. The findings from ORBIT and other investigator-initiated research have advanced our understanding of several drivers of food intake and eating behaviors such as taste preferences, self-regulation, impulsivity, sensitization to the relative reinforcing value of food, food reward and inhibition, emotional eating, habituation to food, and ability to delay gratification [ 13 ]. Another important trans-NIH initiative is the Science of Behavior Change (SOBC) that focuses on understanding mechanisms for novel targets of behavior change. Self-regulation, stress resilience and reactivity, and interpersonal and social processes have all been identified by SOBC as promising targets of behavior change and intervention development [ 14 ], and all of these targets can be considered relevant for obesity prevention and control.

Despite significant advances in our understanding of eating behaviors, the individual characteristics and processes that predict and explain physical activity behaviors are not well understood. In response, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) held a Workshop on Behavioral Phenotyping of Physical Activity and Sedentary Behavior in December 2015 to identify gaps and promising research opportunities in behavioral and psychological phenotyping related to variation in physical activity and sedentary behaviors as they relate to obesity [ 15 ]. This workshop resulted in the release of an NIDDK-led, trans-NIH program announcement (PAR-18–105) Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity.

Finally, research has demonstrated that characterizing and influencing individuals’ behaviors in relation to obesity prevention and treatment is increasingly complex and will require more personalized intervention approaches. Individuals’ behaviors do not operate in a vacuum nor are individuals necessarily characterized by one behavioral phenotype[ 16 ]. Future research in this area could work toward deciphering underlying behavioral mechanisms and developing theoretical frameworks that incorporate a more comprehensive and interdisciplinary approach, identifying patterns of behavioral and psychosocial phenotypes in the context of their various environmental influences.

Early childhood

Early childhood is a critical time period in the development of obesity, and the NIH supports several efforts focusing on the prenatal period through age 5. Recognizing the importance of the role of early childhood in the development of obesity, the NIH sponsored a 2013 workshop on the “Prevention of Obesity in Infancy and Early Childhood” [ 17 ], which resulted in a funding announcement, PA-18–032: Understanding Factors in Infancy and Early Childhood (Birth to 24 Months) that Influence Obesity Development (R01 Clinical Trial Optional).

In addition to studying obesity during infancy, the NIH also recognizes the importance of trans-generational impacts and has two large research initiatives that offer opportunities to better explore the trans-generational effects of obesity and its mechanisms: (a) Lifestyle Interventions for Expectant Moms (LIFE-Moms) and (b) Environmental influences on Child Health Outcomes (ECHO) program. Pregnancy is an opportunity to intervene and influence outcomes for the mother and offspring. In 2011, the NIH launched the LIFE-Moms consortium to determine whether behavioral and lifestyle interventions in overweight and obese pregnancy would have an effect on excessive gestational weight gain and impact maternal and child outcomes [ 18 ]. The findings from the LIFE-Moms consortium show that women randomized to the intervention group gained less weight compared with the standard care group [ 19 ]. The de-identified LIFE-Moms data will be available for investigators to access and analyze for future manuscripts. For more information, see https://repository.niddk.nih.gov/home/ .

In 2016, the NIH launched ECHO to fund multiple, synergistic, longitudinal studies using 83 pediatric cohorts to investigate environmental exposures—including physical, chemical, biological, social, behavioral, natural, and built environments—on child health and development [ 20 ]. Obesity is a key pediatric outcome with data to be contributed by all cohorts, enabling investigators to explore how obesity emerges from a complex web of exposures in early childhood. Future research could continue to explore the mechanisms of how early-life exposures contribute to the development of obesity and what factors (e.g., home and pediatric settings) may be leveraged to encourage healthy weight development.

Policies, programs, and environmental strategies

Policies, programs, and environmental strategies have an important influence on childhood obesity, but how and to what extent they affect childhood obesity warrants further study. Many of the factors addressable by policy and environmental change, such as large infrastructure changes or implementation of taxes or subsidies, are not under the control of researchers and may not be studied using traditional randomized study designs, relying instead on a study design referred to as a natural experiment [ 21 ]. A 2010 Institute of Medicine report and 2011 NIH Strategic Plan for Obesity recommended increased emphasis on evaluation of policy and environmental changes to determine their impact on improved diet, physical activity, and weight outcomes [ 22 , 23 ].

The NIH supports the evaluation of natural experiments through funding announcements PAR-17–178: Evaluating Natural Experiments in Healthcare to Improve Diabetes Prevention and Treatment (R18), PA-16–165: Obesity Policy Evaluation Research (R01), and PAR-18-854: Time-Sensitive Obesity Policy and Program Evaluation (R01). The grants funded through the aforementioned funding announcements cover a wide range of policy and environmental strategies including changes to the built environment through light rails, parks, and transportation improvements and the influence on physical activity and health; policies targeting sugar-sweetened beverages and the impact on diet and added sugars; and how later school start times are associated with weight and health outcomes among adolescents.

In addition to investigator-initiated research, the NIH has also launched large initiatives to assess how multi-level environmental factors affect childhood obesity. The NIH Healthy Communities Study was an observational study of 130 diverse communities that sought to determine the associations between characteristics of community programs and policies and body mass index (BMI), diet, and physical activity in children [ 24 ]. Data were collected on children (retrospectively up to 10 years using medical abstraction), their parents, the home environment, school lunch and physical activity environments, and community programs and policies (retrospectively up to 10 years). The results show that over time, more intense programs and policies are related to lower childhood BMI and that there are disparities in this association by sociodemographic family and community characteristics [ 25 ]. A de-identified public use dataset of the Healthy Communities Study is available for researchers to access at https://biolincc.nhlbi.nih.gov/home/ . Future research could investigate how contextual factors within communities (e.g., race/ethnicity of the community, crime, housing) interact with community programs and policies to promote healthy or obesogenic environments.

Health disparities

Obesity prevalence has risen to epidemic levels, particularly among various racial and ethnic minority groups, including Hispanics, African Americans, American Indians/Alaskan Natives, and low-income populations both in urban and rural communities and in all age groups across the lifespan [ 2 ]. To promote the health of future generations of adults, many NIH institutes have funded research addressing health disparities to gain a better understanding of the etiology of obesity as well as interventions that would lower the prevalence of obesity. The Childhood Obesity Prevention and Treatment Research (COPTR) consortium is an example of a large NIH initiative addressing health disparities and childhood obesity. COPTR tested multi-level multicomponent intervention approaches [ 26 ] to prevent excess weight gain in nonoverweight and overweight youth and to reduce weight in obese and severely obese youth [ 27 ]. Research funded under this consortium targeted preschoolers (2–5 years old) and preadolescents and adolescents (7–15 years old) with a total sample size of ~1,750 ( N ~50% females and ~70% minorities) for 3 years of intervention [ 27 ]. Two obesity prevention trials tested approaches that target home, community, and primary care settings for preschool children living in low-income and ethnically diverse neighborhoods. Two obesity treatment trials examined therapies for overweight and obese children, 7–15 years old, in school and home settings in collaboration with local youth organizations. The findings from COPTR could contribute to future understanding of the multiple factors, including social determinants of health indicators, to prevent or treat obesity among a diverse population of low-income children [ 28 , 29 ].

Recently, NIH staff led a systematic review of interventions addressing obesity disparities with the goal of providing guidance for future research, particularly in populations with a high prevalence of obesity and obesity-related cardiometabolic risk. The review noted a dearth of high-quality research that targets minority populations and a limited number of clinical trials in youth [ 30 ]. NIH staff also convened workshops such as the Multi-Level Intervention Research Methods: Recommendations for Targeting Hard-to-Reach, High-Risk or Vulnerable Populations and Communities. Recommendations from the workshop have been published elsewhere [ 31 ] and include recommendations under the following topics: study design and analytical approaches, intervention implementation, cultural adaptation of intervention, use of community health workers, and training of interventionists. Funding opportunity announcements that are relevant to health disparities research include PA-18–412: Addressing Health Disparities in NIDDK Diseases (R01 Clinical Trial Not Allowed); PA-18–152: Reducing Health Disparities Among Minority and Underserved Children (R01 Clinical Trial Optional); and PA-18–169: Reducing Health Disparities Among Minority and Underserved Children (R21 Clinical Trial Optional). Future research needs to better understand the biological and behavioral mechanisms of childhood obesity as well as the contextual and environmental factors that may alleviate or exacerbate obesity disparities [ 32 ].

Transagency and public–private partnership

Launched in 2009, the National Collaborative on Childhood Obesity Research (NCCOR; www.nccor.org ) brings together the nation’s four largest childhood obesity research funders—Centers for Disease Control and Prevention, NIH, United States Department of Agriculture, and Robert Wood Johnson Foundation—in a public–private collaboration to accelerate progress in reducing childhood obesity. Major NCCOR foci are identifying and evaluating practical and sustainable interventions; improving research resources (see Measurement section in this article for examples) to facilitate childhood obesity research and program evaluation; providing national leadership to accelerate implementation of evidence-informed practice and policy; and developing synergistic childhood obesity initiatives across multiple stakeholders [ 33 ].

NCCOR uses this collaborative approach to combine resources and expertise from stakeholder organizations to identify emerging areas of research need, formulate projects within the scope of the NCCOR mission, and identify external collaborators and funding sources by which to implement projects. Examples of NCCOR NIH led or co-led activities include (a) the Healthy Communities Study ( https://www.nhlbi.nih.gov/science/healthy-communities-study-hcs/ ), (b) the Johns Hopkins Global Obesity Center ( www.globalobesity.org ), (c) the Envision Research Network ( https://www.nccor.org/envision/publications.html ), and (d) the Childhood Obesity Declines ( https://www.nccor.org/projects/obesity-declines/ ) among others. Of note is that NCCOR recognizes that many and varied research design and evaluation approaches are needed to better understand the difficulties in reducing rates of childhood obesity, especially in the context of community-based initiatives. Thus, the initiatives cited here span research efforts, targeting individual behavior change to policy implementation, environmental to systemic social determinants of childhood obesity, and recognize the importance of community and academic partnerships. In addition to facilitating research resources and improving intervention and research methods, NCCOR is dedicated to the dissemination of promising evidence regarding intervention strategies and evidence-informed programs to policy makers and program implementers, particularly those embedded in the community and those addressing health inequities and underserved communities. Future research could continue to explore how partnerships with various entities such as housing, transportation, education, and social services can work together to more effectively deliver childhood obesity interventions.

In addition to the abovementioned NIH efforts, severe obesity, measurement issues in childhood obesity research, and the mechanisms associated with sleep and obesity have emerged as gaps and opportunities for further childhood obesity research.

Severe obesity

Severe obesity in youth, defined as BMI ≥ 1.2 times the 95th percentile or an absolute BMI ≥ 35 kg/m 2 , is a prevalent and serious disease with a limited number of effective and safe treatment options [ 34 ]. The prevalence of severe obesity among all children is 5.6% and is highest (7.7%) among adolescents aged 12–19 years [ 3 ]. To address the issue of severe obesity among adolescents, a workshop led by NIDDK, in cooperation with several NIH Institutes and Centers, entitled “Developing Precision Medicine Approaches to the Treatment of Severe Obesity in Adolescents” ( https://www.niddk.nih.gov/news/meetings-workshops/2017/workshop-developing-precision-medicine-approaches-treatment-severe-obesity-adolescents ) was convened in September 2017 to explore the current state of the science and identify (a) what is known regarding the epidemiology and biopsychosocial determinants of severe obesity in adolescents, (b) what is known regarding effectiveness of treatments for severe obesity in adolescents and predictors of response, and (c) gaps and opportunities for future research to develop more effective and targeted treatments for adolescents with severe obesity. Several gaps were identified and recommendations were made for opportunities to accelerate research to advance precision medicine approaches to treat severe obesity in adolescents and to enhance methodological rigor in pediatric obesity research. More research is needed to better understand the underlying etiology and pathophysiology of severe obesity in children and developing effective intervention approaches.

Measurement

Measurement is a fundamental component of all forms of research, including research on childhood obesity. The development and consistent use of high-quality, comparable measures and research methods is a priority. To address this need and encourage innovative research with novel assessment approaches, better statistical methods and modeling, and tools for culturally diverse populations and/or children at various ages, the NIH supports the Diet and Physical Activity Assessment Methodology (PA-16–167). However, the advancement and application of appropriate diet and physical activity measures remains challenging, as highlighted at two workshops at NIH, “Extending Dietary Patterns Research Methods” [ 35 ] and “Research Strategies for Nutritional and Physical Activity Epidemiology and Cancer Prevention” [ 36 ].

NIH resources are available to provide guidance on selecting measures and to provide tools for research. For example, NCI developed the Dietary Assessment Primer ( https://dietassessmentprimer.cancer.gov/ ) to help determine the best way to assess diet, and specific dietary assessment tools, such as the Automated Self-Administered 24-Hour (ASA24; https://epi.grants.cancer.gov/asa24/ ) and Dietary Assessment Tool and the Diet History Questionnaire ( https://epi.grants.cancer.gov/dhq2/ ). In addition, NCCOR’s Measures Registry and User Guides ( https://www.nccor.org/nccor-tools/measures/ ) were developed for four relevant domains, including diet, physical activity, food environment, and physical activity environment, and were designed to provide an overview of measurement, describe general principles of measurement selection, present case studies, and direct researchers to additional resources across the lifespan.

Although these tools are useful, opportunities exist to further develop objective measurements of diet and physical activity through new technologies that integrate and exploit advances in wearable sensors and other novel image-based tools. More sophisticated exposure characterization for childhood obesity researchers could allow for measurement of individual diet and physical activity behaviors as well as a linkage in real time to other details that include geospatial location, time, and context, providing opportunities to examine new research questions and identify potential targets for intervention.

Sleep and obesity

Recent meta-analyses have found an association between shortened sleep duration and increased risk of obesity in children [ 37–39 ]. The relationship between sleep and obesity is stronger in younger children than in adolescents [ 37 ], and more research is needed to better understand why the relationship varies with age. Future research could also investigate the mechanisms of sleep/circadian rhythms and the development of obesity including how in utero factors may affect those mechanisms. Sleep is a modifiable behavior, and research is needed to better understand how improving sleep may affect weight gain, weight loss, and weight maintenance. For instance, a recent study found that it was possible to increase sleep in children, and the increased sleep condition versus decreased sleep condition was associated with lower self-reported caloric intake and weight, but the study was short in duration and had a small sample size [ 40 ]. More research is needed to better understand how intervention approaches including sleep can lead to the prevention and treatment of obesity. Furthermore, future research could address how health disparities may interact with sleep to affect obesity. NIH is currently supporting funding announcement PAR-17–234: Mechanisms and Consequences of Sleep Disparities in the U.S. (R01).

This article highlights NIH childhood obesity research efforts in the behavioral and social sciences. There are several activities that the NIH has undertaken to further the knowledge, prevention, and treatment of childhood obesity. In addition to the aforementioned NIH efforts, there are emerging gaps and opportunities related to severe obesity, measurement issues, and sleep and obesity. The childhood obesity epidemic continues to grow, and the NIH is committed to supporting research that will help alleviate the obesity epidemic. NIH will continue to support behavioral and social science approaches to better understand the drivers of childhood obesity and to develop effective interventions.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Diabetes and Digestive and Kidney Diseases, National Cancer Institute, Office of Behavioral and Social Science Research, the National Institutes of Health, or the U.S. Department of Health and Human Services.

Funding: This commentary was not funded.

Conflicts of Interest: All authors declare they have no conflicts of interest.

Ethical Approval: Human rights, informed consent, and animal welfare ethical statements are not applicable.

Hales CM , Carroll MD , Fryar CD , Ogden CL . Prevalence of obesity among adults and youth: United States, 2015–2016 . NCHS Data Brief . 2017 October;( 288 ): 1 – 8 .

Google Scholar

Ogden CL , Carroll MD , Lawman HG , et al.  Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014 . JAMA . 2016 ; 315 ( 21 ): 2292 – 2299 .

Hales CM , Fryar CD , Carroll MD , Freedman DS , Ogden CL . Trends in obesity and severe obesity prevalence in us youth and adults by sex and age, 2007–2008 to 2015–2016 . JAMA . 2018;319(16):1723–1725 . doi: 10.1001/jama.2018.3060

Skinner AC , Ravanbakht SN , Skelton JA , Perrin EM , Armstrong SC . Prevalence of obesity and severe obesity in US children, 1999–2016 . Pediatrics . 2018;141(3):e20173459 . doi: 10.1542/peds.2017–3459

Freedman DS , Mei Z , Srinivasan SR , Berenson GS , Dietz WH . Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study . J Pediatr . 2007 ; 150 ( 1 ): 12 – 17.e2 .

Koskinen J , Juonala M , Dwyer T , et al.  Impact of lipid measurements in youth in addition to conventional clinic-based risk factors on predicting preclinical atherosclerosis in adulthood: International Childhood Cardiovascular Cohort Consortium . Circulation . 2018 ; 137 ( 12 ): 1246 – 1255 .

Goran MI , Ball GD , Cruz ML . Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents . J Clin Endocrinol Metab . 2003 ; 88 ( 4 ): 1417 – 1427 .

Reilly JJ , Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review . Int J Obes (Lond) . 2011 ; 35 : 891 – 898 .

World Cancer Research Fund/American Institute for Cancer Research . Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective . Washington, DC: American Institute for Cancer Research ; 2007 .

Google Preview

Rodgers GP , Collins FS . The next generation of obesity research: no time to waste . JAMA . 2012 ; 308 ( 11 ): 1095 – 1096 .

Czajkowski SM . National Institutes of Health update: translating basic behavioral science into new pediatric obesity interventions . Pediatr Clin North Am . 2016 ; 63 ( 3 ): 389 – 399 .

Naar S . From bench to bedside: T1 translation of basic behavioral science into novel pediatric obesity interventions . Pediatr Clin North Am . 2016 ; 63 ( 3 ): xv – xvi .

Young-Hyman D . Introduction to special issue: self-regulation of appetite – it’s complicated . Obesity (Silver Spring) . 2017 ; 25 ( suppl 1 ): S5 – S7 .

Nielsen L , Riddle M , King JW , et al.  ; NIH Science of Behavior Change Implementation Team . The NIH science of behavior change program: transforming the science through a focus on mechanisms of change . Behav Res Ther . 2018 ; 101 : 3 – 11 .

Bryan AD , Jakicic JM , Hunter CM , Evans ME , Yanovski SZ , Epstein LH . Behavioral and psychological phenotyping of physical activity and sedentary behavior: implications for weight management . Obesity (Silver Spring) . 2017 ; 25 ( 10 ): 1653 – 1659 .

Kral TVE, Moore RH, Chittams J, Jones E, O’Malley L, Fisher JO. Identifying behavioral phenotypes for childhood obesity. Appetite. 2018;127:87–96. doi:10.1016/j.appet.2018.04.021

Lumeng JC , Taveras EM , Birch L , Yanovski SZ . Prevention of obesity in infancy and early childhood: a National Institutes of Health workshop . JAMA Pediatr . 2015 ; 169 ( 5 ): 484 – 490 .

Clifton RG , Evans M , Cahill AG , et al.  ; LIFE-Moms Research Group . Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity . Obesity . 2016 ; 24 ( 2 ): 305 – 313 .

Peaceman AM, Clifton RG, Phelan S, et al.; LIFE‐Moms Research Group. Lifestyle interventions limit gestational weight gain in women with overweight or obesity: LIFE-Moms prospective meta-analysis. Obesity . 2018;26(9):1396–1404. doi:10.1002/oby.22250

Gillman MW , Blaisdell CJ . Environmental influences on child health outcomes, a research program of the National Institutes of Health . Curr Opin Pediatr . 2018 ; 30 ( 2 ): 260 – 262 .

Hunter CM , McKinnon RA , Esposito L . News from the NIH: research to evaluate “natural experiments” related to obesity and diabetes . Transl Behav Med . 2014 ; 4 ( 2 ): 127 – 129 .

Institute of Medicine . Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making . Washington, DC : The National Academies Press ; 2010 .

The NIH Obesity Research Task Force . Strategic Plan for NIH Obesity Research . NIH Publication No. 11–5493. Bethesda, MD: The National Institutes of Health ; 2011 .

Arteaga SS , Loria CM , Crawford PB , et al.  The Healthy Communities Study: its rationale, aims, and approach . Am J Prev Med . 2015 ; 49 ( 4 ): 615 – 623 .

Strauss WJ , Nagaraja J , Landgraf AJ , et al.  The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study . Pediatr Obes . 2018 . Epub ahead of print. doi: 10.1111/ijpo.12266

Pratt CA , Arteaga S , Loria C . Forging a future of better cardiovascular health: addressing childhood obesity . J Am Coll Cardiol . 2014 ; 63 ( 4 ): 369 – 371 .

Pratt CA , Boyington J , Esposito L , et al.  Childhood Obesity Prevention and Treatment Research (COPTR): interventions addressing multiple influences in childhood and adolescent obesity . Contemp Clin Trials . 2013 ; 36 ( 2 ): 406 – 413 .

Barkin SV , Heerman WJ , Sommer EC , et al.  Effect of a behavioral intervention for underserved preschool-age children on change in body mass index: a randomized clinical trial . JAMA . 2018;320(5):450–460 .

French SA , Sherwood NE , et al.  NET-works randomized clinical trial: Results of a three-year childhood obesity prevention intervention for preschool-aged children . Am J Public Health. 2018 July. in press

Pratt CA , Loria CM , Arteaga SS , et al.  A systematic review of obesity disparities research . Am J Prev Med . 2017 ; 53 ( 1 ): 113 – 122 .

Stevens J , Pratt C , Boyington J , et al.  Multilevel interventions targeting obesity: research recommendations for vulnerable populations . Am J Prev Med . 2017 ; 52 ( 1 ): 115 – 124 .

Krueger PM , Reither EN . Mind the gap: race/ethnic and socioeconomic disparities in obesity . Curr Diab Rep . 2015 ; 15 ( 11 ): 95 .

Writing Group for the National Collaborative on Childhood Obesity Research . A national collaborative for building the field of childhood obesity research . Am J Prev Med . 2018 ; 54 ( 3 ): 453 – 464 .

Kelly AS , Barlow SE , Rao G , et al.  ; American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology . Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association . Circulation . 2013 ; 128 ( 15 ): 1689 – 1712 .

Reedy J , Subar AF , George SM , Krebs-Smith SM . Extending methods in dietary patterns research . Nutrients . 2018 ; 10 ( 5 ) :571.

Mahabir S , Willett WC , Friedenreich CM , et al.  Research strategies for nutritional and physical activity epidemiology and cancer prevention . Cancer Epidemiol Biomarkers Prev . 2018 ; 27 ( 3 ): 233 – 244 .

Fatima Y , Doi SA , Mamun AA . Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis . Obes Rev . 2015 ; 16 ( 2 ): 137 – 149 .

Miller MA , Kruisbrink M , Wallace J , Ji C , Cappuccio FP . Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies . Sleep . 2018 ; 41 ( 4 ). doi:10.1093/sleep/zsy018

Wu Y , Gong Q , Zou Z , Li H , Zhang X . Short sleep duration and obesity among children: a systematic review and meta-analysis of prospective studies . Obes Res Clin Pract . 2017 ; 11 ( 2 ): 140 – 150 .

Hart CN , Hawley NL , Wing RR . Development of a behavioral sleep intervention as a novel approach for pediatric obesity in school-aged children . Sleep Med Clin . 2016 ; 11 ( 4 ): 515 – 523 .

Email alerts

Citing articles via.

• Recommend to Your Librarian
• Advertising & Corporate Services

Affiliations

• Online ISSN 1613-9860
• Print ISSN 1869-6716
• Copyright © 2024 Society of Behavioural Medicine
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Disclaimer » Advertising

• HealthyChildren.org

• Previous Article
• Next Article

Trends in Severe Obesity Among Children Aged 2 to 4 Years in WIC: 2010 to 2020

• Article contents
• Figures & tables
• Supplementary Data
• Peer Review
• Get Permissions
• Cite Icon Cite
• Search Site

Lixia Zhao , David S. Freedman , Heidi M. Blanck , Sohyun Park; Trends in Severe Obesity Among Children Aged 2 to 4 Years in WIC: 2010 to 2020. Pediatrics January 2024; 153 (1): e2023062461. 10.1542/peds.2023-062461

Download citation file:

• Ris (Zotero)
• Reference Manager

To examine the prevalence and trends in severe obesity among 16.6 million children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from 2010 to 2020.

Severe obesity was defined as a sex-specific BMI for age ≥120% of the 95th percentile on the Centers for Disease Control and Prevention growth charts or BMI ≥35 kg/m 2 . Joinpoint regression was used to identify when changes occurred in the overall trend. Logistic regression was used to compute the adjusted prevalence differences between years controlling for sex, age, and race and ethnicity.

The prevalence of severe obesity significantly decreased from 2.1% in 2010 to 1.8% in 2016 and then increased to 2.0% in 2020. From 2010 to 2016, the prevalence decreased significantly among all sociodemographic subgroups except for American Indian/Alaska Native (AI/AN) children. The largest decreases were among 4-year-olds, Asian/Pacific Islander and Hispanic children, and children from higher-income households. However, from 2016 to 2020, the prevalence increased significantly overall and among sociodemographic subgroups, except for AI/AN and non-Hispanic white children. The largest increases occurred in 4-year-olds and Hispanic children. Among 56 WIC agencies, the prevalence significantly declined in 17 agencies, and 1 agency (Mississippi) showed a significant increase from 2010 to 2016. In contrast, 21 agencies had significant increases, and only Alaska had a significant decrease from 2016 to 2020.

Although severe obesity prevalence in toddlers declined from 2010 to 2016, recent trends are upward. Early identification and access to evidence-based family healthy weight programs for at-risk children can support families and child health.

Combating Childhood Obesity

Advertising Disclaimer »

Citing articles via

Email alerts.

Affiliations

• Editorial Board
• Editorial Policies
• Journal Blogs
• Pediatrics On Call
• Online ISSN 1098-4275
• Print ISSN 0031-4005
• Pediatrics Open Science
• Hospital Pediatrics
• Pediatrics in Review
• AAP Grand Rounds
• Latest News
• Pediatric Care Online
• Red Book Online
• Pediatric Patient Education
• AAP Toolkits
• AAP Pediatric Coding Newsletter

First 1,000 Days Knowledge Center

Institutions/librarians, group practices, licensing/permissions, integrations, advertising.

• Privacy Statement | Accessibility Statement | Terms of Use | Support Center | Contact Us
• © Copyright American Academy of Pediatrics

This Feature Is Available To Subscribers Only

Sign In or Create an Account

Loading metrics

Open Access

Peer-reviewed

Research Article

Is the rise in childhood obesity rates leading to an increase in hospitalizations due to dengue?

Contributed equally to this work with: Chandima Jeewandara, Maneshka Vindesh Karunananda, Suranga Fernando

Roles Conceptualization, Data curation, Funding acquisition, Project administration, Resources, Supervision

Affiliation Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka

Roles Data curation, Investigation, Project administration, Writing – review & editing

Roles Data curation, Methodology, Project administration

Affiliation Ministry of Health, Colombo, Sri Lanka

Roles Data curation, Software

Roles Investigation, Project administration

¶ Membership of Seroprevalence study group is provided in the Acknowledgements.

Roles Funding acquisition, Resources, Writing – review & editing

¶ ‡ These authors are joint senior authors on this work.

Affiliation MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom

•  [ ... ],

Roles Conceptualization, Formal analysis, Funding acquisition, Project administration, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka, MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom

• [ view all ]
• [ view less ]
• Chandima Jeewandara, 
• Maneshka Vindesh Karunananda, 
• Suranga Fernando, 
• Saubhagya Danasekara, 
• Gamini Jayakody, 
• Segarajasingam Arulkumaran, 
• Nayana Yasindu Samaraweera, 
• Sarathchandra Kumarawansha, 
• Subramaniyam Sivaganesh, 

• Published: June 27, 2024
• https://doi.org/10.1371/journal.pntd.0012248
• Peer Review
• Reader Comments

Obesity and diabetes are known risk factors for severe dengue. Therefore, we sought to investigate the association of obesity with increased risk of hospitalization, as there is limited information.

Methods and findings

Children aged 10 to 18 years (n = 4782), were recruited from 9 districts in Sri Lanka using a stratified multi-stage cluster sampling method. Details of previous admissions to hospital due to dengue and anthropometric measurements were recorded and seropositivity rates for dengue were assessed. The body mass index (BMI) centile in children aged 10 to 18, was derived by plotting the values on the WHO BMI-for-age growth charts, to acquire the percentile ranking.

Although the dengue seropositivity rates were similar in children of the different BMI centiles, 12/66 (18.2%) seropositive children with a BMI centile >97 th , had been hospitalized for dengue, compared to 103/1086 (9.48%) of children with a BMI centile of <97 th . The logistic regression model suggested that BMI centiles 50 th to 85 th (OR = 1.06, 95% CI, 1.00 to 1.11, p = 0.048) and BMI centile of >97 th (OR 2.33, 95% CI, 1.47 to 3.67, p = 0.0003) was significantly associated with hospitalization when compared to children in other BMI categories.

Conclusions

Obesity appears to be associated with an increased risk of hospitalization in dengue, which should be further investigated in longitudinal prospective studies. With the increase in obesity in many countries, it would be important to create awareness regarding obesity and risk of severe disease and hospitalization in dengue.

Author summary

Although obesity and diabetes are known risk factors for severe dengue, there is limited information on whether they are risk factors for increased hospitalization due to dengue. To investigate this, we studied the association of obesity with hospitalization rates for dengue, in children aged 10 to 18 years (n = 4782), who were recruited from 9 districts in Sri Lanka using a stratified multi-stage cluster sampling method. Details of previous admissions to hospital due to dengue and anthropometric measurements were recorded and seropositivity rates for dengue were assessed. The body mass index centile (BMI) in children aged 10 to 18, was derived by plotting the values on the WHO BMI-for-age growth charts, to acquire the percentile ranking. We found that BMI centiles 50 th to 85 th and BMI centile of >97 th were significantly associated with hospitalization rates when compared to children in other BMI categories, which should be further investigated in longitudinal prospective studies.

Citation: Jeewandara C, Karunananda MV, Fernando S, Danasekara S, Jayakody G, Arulkumaran S, et al. (2024) Is the rise in childhood obesity rates leading to an increase in hospitalizations due to dengue? PLoS Negl Trop Dis 18(6): e0012248. https://doi.org/10.1371/journal.pntd.0012248

Editor: Amy C. Morrison, University of California Davis School of Veterinary Medicine, UNITED STATES

Received: September 21, 2023; Accepted: May 24, 2024; Published: June 27, 2024

Copyright: © 2024 Jeewandara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data is available in the manuscript and the supplementary files.

Funding: This study has been supported by the World Health Organization Unity Studies (GNM and CJ), a global sero-epidemiological standardization initiative, with funding to the World Health Organization and the UK Medical Research Council (GSO). The World Health Organization unity trial protocol was adopted in trial design. The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Dengue is a climate sensitive infection, which was named as 1 of the top 10 threats to global health by the WHO in 2019 [ 1 ]. The incidence of dengue is markedly rising in many endemic countries, due in part to intense circulation of multiple dengue virus (DENV) serotypes, increase in global temperatures and erratic rainfall, rapid urbanization and population expansion [ 2 ]. Three hundred and ninety million individuals are thought to be infected with the DENV annually, resulting in 100 million symptomatic dengue infections [ 3 ]. Although symptomatic dengue is estimated to occur in 1 in 4 of those who are infected with the virus, many studies have reported a wide variability in the ratio of symptomatic: asymptomatic dengue infections. For instance, from 1 in 1.1 to 2.9 in 2004 to 2007 in Thailand [ 4 ], 1 in 6.1 in 1980 to 1981 in Thailand [ 5 ], 1 in 6 to 13 in Nicaragua [ 6 ] and more recently 1 in 1.5 in Indonesia [ 7 ]. These differences could be due to different factors such as differences in the virulence of the virus, intense transmission resulting in an increased number of secondary dengue infections associated with a higher risk of severe disease, the interval between infection with different DENV serotypes and host factors [ 8 ]. However, there is limited information if host factors such as the presence of comorbidities increase the likelihood of symptomatic infection leading to hospitalizations.

Sri Lanka has experienced dengue outbreaks for over 3 decades, with the incidence rising over time as seen in many countries [ 9 ]. The reported cases in Sri Lanka reflects the number of patients who are clinically diagnosed as having dengue and who are hospitalized [ 9 ]. In Sri Lanka, as in many other countries, point-of care diagnostic tests such as the dengue NS1 antigen test, or confirmatory tests such as quantitative real-time PCR is not done in public hospitals, due to the non-availability of such tests [ 10 ]. Therefore, those who present to out-patient departments with symptomatic dengue infections, who do not require hospitalization are not included in the reported number of cases. The prevalence of diabetes has markedly increased in Sri Lanka, especially in the Western province, where the prevalence of diabetes as risen from 5.02% in 1990, 16.4% in 2006, 27.6% by 2015 to 29% in 2019 [ 9 , 11 ]. The prevalence of obesity among children also rose from 6.43% in 2003 to by 9.85% 2013, in Colombo, Sri Lanka [ 9 ]. Approximately 50% of dengue infections in Sri Lanka are reported from the Western province, which has seen a marked rise over time [ 9 ]. Although there could be multiple factors that led to this rise, such as changes in dengue transmission, evolution of the DENV leading to increased virulence, climate change and an increased proportion of those experiencing a secondary dengue infection [ 10 ], many host factors could have played a role. For instance, the presence of comorbidities such as obesity, diabetes and renal disease increases the risk of developing severe dengue [ 8 , 12 ]. As obesity and diabetes are risk factors for occurrence of severe disease, it is possible that they could also lead to an increase in symptomatic/ apparent infection in those infected with the DENV and lead to increase in hospitalizations.

Although obesity is a known risk factor for severe dengue in hospitalized patients [ 13 , 14 ], whether obesity is a risk factor for an increase in hospitalizations has not been studied. Given the marked rise in obesity, in order to adopt suitable control strategies for dengue, it would be important to find out if obesity indeed increases the risk of hospitalization. Therefore, we investigated if obesity is associated with an increased risk of hospitalization in a large cohort of Sri Lankan children, in an island-wide dengue sero-surveillance study.

Ethics statement

Ethics approval was obtained from the Ethics review committee of University of Sri Jayewardenepura and administrative clearance was obtained from the Ministry of Health Sri Lanka. Informed written consent was obtained from the parents or guardians and assent was obtained from all children. Approval number COVID 12/21.

Study participants and sampling technique

We carried out an island-wide dengue serosurvey in 4782 school children between the age of 10 and 18 years, who were attending public or private schools in Sri Lanka, during September 2022 to 31st March 2023 [ 15 ]. Briefly, healthy children without any comorbidities were recruited following informed written consent from the parents/guardians and assent was taken from children ( Table 1 ). The study was carried out in 9 districts in Sri Lanka, representative of each of the 9 provinces ( Fig 1 ). A stratified multi-stage cluster sampling method was used to select the schools in each district, with a cluster size of 40 students from each cluster. A probability proportionate to the size (PPS) sampling technique was used to select the sample size from each district, as the population size and urbanicity grade varied in different districts. The schools were classified as based in urban, rural or estate areas (tea plantation areas in central highlands) based on the classification from the latest census for Sri Lanka [ 16 ].

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

Each yellow circle corresponds to a study site. The basemap was obtained from the following sources at ArcGIS: Esri, TomTom, Garmin, FAO, NOAA, USGS, OpenStreetMap contributors, and the GIS User Community. https://basemaps.arcgis.com/arcgis/rest/services/World_Basemap_v2/VectorTileServer .

https://doi.org/10.1371/journal.pntd.0012248.g001

https://doi.org/10.1371/journal.pntd.0012248.t001

Anthropometric measurements were obtained at the time the data was collected and blood samples obtained at the schools of the children. The height was measured by a stadiometer to within 0.5cm and weight was measured using a digital scale, which was calibrated regularly throughout the study. In calculating the body mass index centile (BMI) in children aged 10 to 18, the BMI was plotted on the WHO BMI for age growth charts for boys or girls to acquire the percentile ranking, as percentile rankings are the most suitable indicator for growth patterns in children [ 17 ].

Determining past dengue disease severity

The parents/guardians of all children who were enrolled in the study were asked to bring all relevant records and diagnosis cards of past hospital admissions, outpatient treatment and clinic attendance. In Sri Lanka, a diagnosis card is issued for each episode of hospitalization, which includes data such as the diagnosis of the illness, relevant clinical, radiological and laboratory findings during hospitalization that supported the clinical diagnosis. Accordingly, details of previous admissions to hospital due to a clinically diagnosed dengue infection were recorded. Those who were found to be seropositive for dengue, but who were not admitted to hospital were considered as not hospitalized due to dengue.

Assessment of dengue seropositivity

Dengue seropositivity was determined as previously described using a commercial assay (PanBio Indirect IgG ELISA), which has been widely used for dengue seroprevalence studies [ 18 – 20 ]. PanBio units were calculated according to the manufacturer instructions and accordingly, PanBio units of > 11 were considered positive, 9–11 was considered equivocal and < 9 was considered negative.

Statistical analysis

GraphPad Prism version 9.5 and Jupyter Notebook (python IDE) was used for statistical analysis and to implement models. As the data were not normally distributed, differences in means were compared using the Mann-Whitney U test (two tailed), and the Kruskal-Walli’s test was used to compare the differences of the antibody levels in the different districts, and in urban, rural and estate sectors. The degree of associations between BMI, urbanicity and the risk of hospitalization with dengue, was expressed as the odds ratio (OR). Chi Square test was used to determine the association of seropositivity and BMI Centiles of children. The associations between BMI, urbanicity socio-demographic factors to hospitalization status for dengue, was analyzed with the Binary Logistic Regression Model ( S1 Data ) and implemented using the Synthetic minority oversampling technique (SMOTE) to recover the imbalanced data. The data was considered to be imbalanced as the number of hospitalized children were far fewer than the children who were not hospitalized. Therefore, in order to develop the best performing model, SMOTE model was implemented. Co-morbidities were not assessed in the model as all children were previously healthy apart from varying BMIs.

BMI centile and risk of hospitalization due to dengue infection

Overall 1152/4782 (24.1%) were found to be seropositive for dengue and age-stratified seroprevalence rates of each of the districts, and seropositivity rates based on urbanicity has been previously described for this cohort [ 15 ]. The number of children enrolled from each district and their demographics are shown in Table 1 .

The number of children who had been hospitalized for dengue out of the total number of children who were seropositive for dengue was 182/1152 (15.8%). The BMI centiles of all children aged 10 to 18 (n = 4782), the dengue seropositivity rates of children of different BMIs and hospitalization rates are shown in Table 2 . A large proportion (22.1%) of children in Sri Lanka were underweight with their BMIs <3 rd centile for age, according to the WHO BMI for age growth charts for boys or girls [ 17 ]. However, 4.5% of children had a BMI of >97 th centile for age, when plotted on the WHO BMI for age charts ( S1 Table ). The dengue seropositivity rates were between 18.9% to 24.6% in children of the BMI groups <97% centile, while the seropositivity rates were 30.7% in those who had a BMI centile of >97 th , which were not significantly different (p = 0.16). Of the seropositive children with BMI centile >97 th , 12/66 (18.2%) were hospitalized, compared to 103/1086 (9.48%), of children with a BMI centile of <97 th ( Fig 2 ). Those with a BMI centile of >97 th , were twice as likely (odds ratio 2.1, 95% CI, 1.1 to 3.9, p = 0.03) to have been hospitalized for dengue compared to children with a lower BMI. The logistic regression model suggested that BMI centiles 50 th to 85 th (OR = 1.06, 95% C.I,1.00 to 1.11, p = 0.048) and BMI centile of >97 th (odds ratio = 2.33, 95% CI, 1.47 to 3.67, p = 0.0003) was significantly associated with hospitalization when compared to children in other BMI categories.

In addition to the BMI centiles, the risk of hospitalization was significantly higher for females when compared to males (odds ratio = 1.03, 95% CI, 1.00 to 1.06, p = 0.001).

https://doi.org/10.1371/journal.pntd.0012248.g002

https://doi.org/10.1371/journal.pntd.0012248.t002

Urbanicity and risk of hospitalization

Dengue is predominantly an urban infection, as Aedes aegypti is the main vector responsible for transmitting dengue along with Aedes albopictus [ 21 ]. Therefore, we assessed the risk of hospitalization based on the grade of urbanicity ( S2 Table ). 32/293 (10.9%) dengue seropositive children living in urban areas and 83/859 (9.66%) living in rural and estate areas had been hospitalized for a dengue infection. The implemented logistic model shows that the significant association for urban areas (OR = 1.05, 95% CI, 1.00–1.09, p = 0.015) with the risk of hospitalization with respect to rural areas, although this risk was low.

In this study we have assessed if obesity was associated with an increased risk of hospitalization during an acute dengue infection by assessing hospitalization rates and the BMIs at the time of recruitment to our island wide sero-surveillance study. We found that obese children (BMI centile >97 th ) were twice as likely to be hospitalized than leaner children. However, although we adopted a novel approach, which uses less resources and time than a prospective, longitudinal observational study, to investigate potential associations between obesity and risk of hospitalization, as this is a retrospective-observational study, there are certain limitations. We only assessed anthropometric measurements at the time of recruitment to this cross-sectional, serosurvey, it would not reflect the BMIs of children at the time of them being infected with the DENV, which is a major limitation of the study. Furthermore, only 12/115 (10.4%) children hospitalized due to dengue had a BMI >97 th centile, which suggests that many other factors play a role in symptomatic dengue leading to hospitalization. Nevertheless, although there are many studies that show obesity and diabetes are risk factors for severe dengue in hospitalized patients, if obesity itself leads to increased hospitalization has not been studied. Therefore, despite the limitations, we believe it would be important to explore the findings of our study, by longitudinal study cohorts, to find out if obesity itself was a risk factor for hospitalization and if so the immune mechanisms that lead to this.

Although many high income countries have had the BMIs of their populations rising, the BMIs have plateaued in these countries and in Latin America, while there is a marked and steady rise in the BMI of the population in South Asia and Southeast Asia [ 22 ]. The relationship between obesity and development severe dengue had been observed for many years and reported in children in studies in the 1990s from Thailand, India and El Salvodor [ 23 – 25 ]. Many subsequent studies showed that obesity was an independent risk factor for developing severe dengue in hospitalized patients [ 13 , 14 ] including a recent metanalysis [ 26 ]. However, this is the first study reporting that obesity may also associate with higher rates of hospitalization, which needs further examination with longitudinal studies. The number of cases of dengue reported from many countries reflect the number of suspected dengue patients admitted to hospitals, due to the limited availability of point-of care diagnostic tests and confirmatory tests [ 10 , 27 ]. Therefore, factors that lead to an increase in hospitalizations would also lead to an increase in the reported number of dengue cases in these countries. As there is a marked rise in obesity in many Asian countries, this could be an additional factor contributing the increase in hospitalization rates, along with intense transmission, co-circulating of multiple DENV serotypes and environmental factors such as climate change, urbanization, and improper waste management.

Obesity is associated with an increase in risk of severe disease due to many other infections such as influenza and COVID-19. While public education programs have focused on the importance of reducing obesity to prevent occurrence of diabetes, cardiovascular diseases and cancer, there has been limited focus on the impact of obesity on many infectious diseases. If the increase in obesity leads to higher hospitalization rates due to dengue, obesity would be an important contributing factor for the current trend in an increase in hospitalizations, experienced in many dengue endemic countries. Therefore, it would be crucial to further investigate the risk of hospitalization due to obesity and to carry out public health campaigns, educating the public on the prevention of obesity. Furthermore, the mechanisms by which obesity and diabetes increase disease severity of dengue, should be further explored to develop biomarkers and therapeutics specially targeting at risk populations.

Supporting information

S1 table. percentages of children in different bmi centile categories for each of the 9 districts sampled and island-wide..

https://doi.org/10.1371/journal.pntd.0012248.s001

S2 Table. Dengue seropositivity rates and hospitalisation rates for dengue in dengue seropositive children in urban, rural and estate areas island-wide.

https://doi.org/10.1371/journal.pntd.0012248.s002

S1 Data. Supplementary data on binary regression model.

https://doi.org/10.1371/journal.pntd.0012248.s003

S2 Data. Dataset used to generate tables and figures in manuscript.

https://doi.org/10.1371/journal.pntd.0012248.s004

Acknowledgments

Seroprevalence study group includes the following members:

Lahiru Perera, Pradeep Pushpakumara, Laksiri Gomes, Jeewantha Jayamali, Inoka Sepali Aberathna, Thashmi Nimasha, Madushika Dissanayake, Shyrar Ramu, Deneshan Peranantharajah, Hashini Colambage, Rivindu Wickramanayake, Harshani Chathurangika, Farha Bary, Sathsara Yatiwelle, Michael Harvie, Maheli Deheragoda, Tibutius Jayadas, Shashini Ishara, Dinuka Ariyaratne, Shashika Dayarathna, Ruwanthi Wijekulasuriya, Chathura Ranathunga.

• 1. Organization WH. Ten threats to global health in 2019: World Health Organization; 2019 [cited 2019]. https://www.who.int/emergencies/ten-threats-to-global-health-in-2019 .
• 2. Geographical expansion of cases of dengue and chikungunya beyond the historical areas of transmission in the Region of the Americas [Internet]. WHO; 2023; 23rd March 2023. https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON448#:~:text=During%20the%20same%20period%2C%20the,100%20000%20population%20(3) .
• View Article
• PubMed/NCBI
• Google Scholar
• 16. Lanka DoCaSS. Sri Lanka Census of Population and Housing, 2011 Concepts and Definitions. 2011.
• 17. Centre for Disease Control and Prevention U. About Child & Teen BMI. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion; 2021.

. The following is not true of childhood obesity: Group of answer choices d. There is a genetic component in obesity. a. It has tripled in the USA since the 1960s. b. 15% OF U.S. children are obese. c. Parents who are controlling and directive regarding their children's diets are less likely to have obese children.

The statement that is not true of childhood obesity is: "Parents who are controlling and directive regarding their children's diets are less likely to have obese children." Here option C is the correct answer.

Research indicates that overly controlling and restrictive feeding practices can actually increase the risk of childhood obesity.

When parents exert excessive control over their children's diets, it can lead to negative psychological effects, such as decreased self-regulation and increased food cravings.

Restrictive feeding practices may also promote an unhealthy relationship with food and result in rebellious eating behaviors. Instead, fostering a supportive and balanced approach to food, emphasizing healthy choices without being overly controlling, is more likely to promote a healthy weight in children. Therefore option C is the correct answer.

To learn more about obesity

https://brainly.com/question/1646944

Related Questions

muneeb a, dhamoon as. inferior vena cava filter. 2022 may 11. in: statpearls [internet]. treasure island (fl): statpearls publishing; 2022 jan–. pmid: 31751090.

The article titled "Inferior Vena Cava Filter" by Muneeb and Dhamoon provides information on the use of inferior vena cava ( IVC ) filters.

This article is part of the StatPearls series, an online medical reference source. The article discusses the purpose and placement of IVC filters, which are medical devices designed to prevent blood clots from traveling to the lungs (pulmonary embolism) in high-risk individuals.

It explains that IVC filters are typically recommended for patients who cannot tolerate or have failed anticoagulant therapy or have a contraindication to it.

The authors discuss the different types of IVC filters, including retrievable and permanent filters, and their placement techniques. They also outline the potential complications associated with IVC filters, such as filter migration, filter fracture, and thrombosis .

The article emphasizes the importance of careful patient selection, proper placement technique, and ongoing monitoring for patients with IVC filters. It also highlights the need for shared decision-making between healthcare providers and patients when considering the use of IVC filters.

Overall, the article provides a concise overview of IVC filters, their indications, placement techniques, and associated considerations. It serves as a valuable resource for healthcare professionals seeking information on this topic.

To learn more about blood clots

brainly.com/question/15885207

whihc of the following oxygen delivery devices should be used for treatment of a concious patient who has inhaled a poisonous gas and is ventilating adequately

In the scenario you described, the appropriate oxygen delivery device for a conscious patient who is ventilating adequately would be a non- rebreather mask . A non-rebreather mask is a face mask that covers both the nose and mouth and has a reservoir bag attached.

It delivers a high concentration of oxygen and allows the patient to inhale oxygen from the reservoir bag while exhaling through vents on the sides of the mask.

The non-rebreather mask is commonly used in cases where a high concentration of oxygen is required, such as in the treatment of poisoning or severe respiratory distress. It ensures that the patient receives a sufficient amount of oxygen and helps to flush out any remaining poisonous gas from their system.

It's important to note that in medical emergencies, it's always best to consult a healthcare professional or follow the specific protocols and guidelines established by your local emergency medical services.

Learn more about oxygen on:

https://brainly.com/question/33311650

a series of cirrhotic patients with refractory variceal bleeding and child-pugh c14 or 15 scores. in-hospital transplant-free mortality was 100%.

Cirrhosis is a progressive and incurable disease that leads to various complications such as ascites, hepatic encephalopathy, spontaneous bacterial peritonitis , and variceal hemorrhage. Variceal bleeding is a life-threatening complication of cirrhosis and is the most common cause of death in cirrhotic patients.

The Child-Pugh score is a clinical score that helps to assess the severity of liver disease. It is based on five clinical parameters such as serum bilirubin, serum albumin, prothrombin time, the presence of ascites, and the presence of encephalopathy .

The Child-Pugh score ranges from A to C, with C indicating the most severe liver disease. Patients with Child-Pugh C cirrhosis have a high risk of mortality due to liver disease. Refractory variceal bleeding is a severe complication of cirrhosis that occurs despite treatment with endoscopic or pharmacologic therapy. In-hospital transplant-free mortality of refractory variceal bleeding in patients with Child-Pugh C cirrhosis is high.

According to research, patients with Child-Pugh C cirrhosis and refractory variceal bleeding have an in-hospital transplant-free mortality rate of 100%. This indicates that there is a need for urgent liver transplantation in these patients to improve their survival. In conclusion, patients with Child-Pugh C cirrhosis and refractory variceal bleeding have a poor prognosis, and liver transplantation should be considered urgently.

To know more about incurable visit :

https://brainly.com/question/29761399

stereotactic radiosurgery for patients with trigeminal enrualgia assocaited with petroclival meningiomas

Trigeminal neuralgia (TN) is a neurological condition that causes severe facial pain. TN is caused by irritation or damage to the trigeminal nerve , which is one of the largest nerves in the head.

TN is commonly associated with petroclival meningiomas, which are tumors that grow in the base of the skull.

Stereotactic radiosurgery is a treatment option for patients with TN associated with petroclival meningiomas.

Stereotactic radiosurgery (SRS) is a non-invasive treatment option that uses focused beams of radiation to treat tumors or other conditions in the brain.

SRS is commonly used to treat petroclival meningiomas, which are located in the base of the skull.

SRS can be used to treat trigeminal neuralgia associated with petroclival meningiomas by targeting the area of the trigeminal nerve that is causing the pain.

SRS is a highly precise treatment option that can be performed on an outpatient basis.

Patients typically receive one or more treatments over a period of several weeks.

SRS is generally well-tolerated, with few side effects.

Some patients may experience mild fatigue or headaches after treatment, but these symptoms typically resolve within a few days.

SRS is a safe and effective treatment option for patients with trigeminal neuralgia associated with petroclival meningiomas.

SRS can provide long-term pain relief and improve quality of life for patients.

If you are experiencing facial pain associated with petroclival meningiomas, talk to your doctor to see if SRS is a treatment option for you.

To know more about trigeminal nerve visit:

https://brainly.com/question/3355841

which treatment woudl the nruse suggest to an adolescent with type 1 diabetes if an insulin reaction occurrs quizlet

When a diabetic person has an insulin reaction, it indicates that the glucose levels in their blood have become too low. This can be caused by the overuse of insulin , not eating enough food, or engaging in too much physical activity.

In response to a low blood glucose level, the nurse would recommend administering a fast-acting carbohydrate. This could be anything that is easily digestible and contains a high amount of carbohydrates .

Orange juice, a sugar-containing soft drink, glucose tablets, or candy can be included in this list. The treatment that a nurse would suggest for an adolescent with type 1 diabetes if an insulin reaction occurred is to administer fast-acting carbohydrates, which should be something that is easily digestible and contains a high amount of carbohydrates . Some of the recommended fast-acting carbohydrates that are most common include orange juice, sugar-containing soft drinks, glucose tablets, and candy.

In case the condition is severe or does not improve after consuming fast-acting carbohydrates, the nurse would recommend injecting glucagon. Glucagon works by raising the glucose levels in the blood by signaling the liver to release glucose stored in it into the bloodstream.

When someone is having an insulin reaction, the injection of glucagon is often used as an emergency treatment to quickly raise their blood glucose level in a situation where they are unconscious or unable to eat or drink.

To know more about glucose visit:

https://brainly.com/question/13555266

Chelsea occasionally takes aspirin to relieve a headache. Chelsea is Group of answer choices using a transdermal drug. engaging in drug abuse. likely to develop cross-tolerance. using an over-the-counter (OTC) drug.

Chelsea is using an over-the-counter (OTC) drug , aspirin, to relieve her occasional headaches. This does not indicate drug abuse or cross-tolerance development. Aspirin, commonly available without a prescription, is classified as an OTC drug.

Based on the given information, Chelsea's use of aspirin to alleviate her headaches is considered an appropriate use of an over-the-counter (OTC) drug. Aspirin is a widely available medication used to relieve pain, including headaches.

It is not classified as a transdermal drug , which refers to medications delivered through the skin, such as patches or creams. Additionally, using aspirin occasionally for headache relief does not imply drug abuse, as long as she follows the recommended dosage and does not exceed the maximum daily limits.

Cross-tolerance typically occurs when an individual develops tolerance to one substance and subsequently experiences reduced effects from other similar substances.

However, this concept does not apply in Chelsea's case since she is using a single medication, aspirin, and not developing tolerance to other drugs.

TO know more about the over-the-counter (OTC) drug

https://brainly.com/question/517690

an rn in a primary care office is caring for a 10-year-old patient experiencing fever, chills, nasal congestion, and a sore throat. the patient’s mother indicates that the child had been ill for the past two days, experiencing a poor appetite and sleepiness. the nurse swabs the patient’s throat for rapid microbial analysis, suspecting the patient’s symptoms are due to a common pathogen.

The RN in the primary care office is providing care for a 10-year-old patient presenting with symptoms such as fever, chills, nasal congestion , and a sore throat.

According to the patient's mother, the child has been unwell for the past two days, displaying reduced appetite and increased sleepiness. Suspecting a common pathogen as the likely cause of the symptoms, the nurse decides to perform a throat swab for rapid microbial analysis.

This diagnostic procedure involves obtaining a sample from the patient's throat to identify the specific pathogen responsible for the illness. By analyzing the swab results, the nurse can gather valuable information to guide appropriate treatment and management, ensuring optimal care and facilitating the child's recovery.

To know more about nasal congestion

https://brainly.com/question/31845254

Which consensus-based standard describes the hazardous materials training competencies for operations level responders?

The consensus-based standard that describes the hazardous materials training competencies for operations-level responders is known as NFPA 472

Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents.

NFPA stands for the National Fire Protection Association, which is a widely recognized organization that develops and publishes standards related to fire safety and hazardous materials response.

NFPA 472 provides guidance and establishes minimum training requirements for responders who may be involved in handling hazardous materials incidents.

The standard covers various aspects of hazardous materials response, including recognizing and identifying hazardous materials , implementing protective measures, conducting risk assessments, and understanding the principles of decontamination and containment.

Know more about NFPA 472:

https://brainly.com/question/30248016

How can the clinical staff of the facility informally band together to negotiate for safer working conditions

Clinical staff can informally band together to negotiate for safer working conditions, ensuring their concerns are heard and addressed by management.

To informally band together and negotiate for safer working conditions, clinical staff in a facility can take the following steps:

1. Identify common concerns: The staff should come together and identify the specific safety issues they are facing in the workplace . This could include anything from inadequate staffing levels to a lack of proper equipment or training.

2. Establish a core group: Form a small group of dedicated staff members who are willing to take the lead in advocating for safer working conditions. This group will act as a representative body for the entire staff.

3. Gather information: Research and gather relevant information about best practices and safety regulations in healthcare settings. This will provide the group with a solid foundation for their negotiations.

4. Develop a proposal : Based on the identified concerns and gathered information, the group should develop a clear and concise proposal outlining the changes they are seeking. This proposal should include specific details and evidence supporting the need for safer working conditions.

5. Present the proposal: Schedule a meeting with the management or administration of the facility to present the proposal. It is important to approach this meeting in a professional and respectful manner, clearly articulating the staff's concerns and the proposed solutions.

6. Build support: Engage with other staff members and gain their support for the proposal. This can be done through meetings, surveys, or petitions. A united front will strengthen the staff's bargaining power.

7. Communicate with stakeholders : Maintain open lines of communication with stakeholders such as management, administration, and relevant regulatory bodies. This will ensure that progress is tracked and that concerns are addressed in a timely manner.

8. Document incidents: Keep a record of any incidents or issues related to unsafe working conditions. This documentation will provide evidence to support the staff's claims and help in negotiations.

To learn more about clinical staff

https://brainly.com/question/28844379

While auscultating a trauma victim's chest for breath sounds you believe you hear muffle heart sounds. You assess that this:

If a trauma victim's chest is auscultated for breath sounds and muffled heart sounds are detected, it could mean that they have a pneumothorax .

A pneumothorax is a collapsed lung resulting in air or gas collecting in the pleural space, causing a complete or partial lung collapse . A pneumothorax can be a medical emergency that needs immediate intervention and treatment . It can be caused by various injuries, such as blunt force trauma to the chest, rib fractures, or penetrating injuries to the chest wall.

A pneumothorax can be diagnosed using a chest X-ray , CT scan, or ultrasound. While auscultating a trauma victim's chest for breath sounds, if the practitioner hears muffled or absent lung sounds on the affected side and increased respiratory distress, it could be a sign of a pneumothorax. A chest X-ray can help diagnose the extent of the pneumothorax and how much of the lung has collapsed.

A pneumothorax has several treatment options, depending on the severity and extent of the lung collapse. Treatment can range from observation for small and mild pneumothorax to more aggressive treatment, including chest tube insertion or surgery for severe or life-threatening pneumothorax.

Learn more about pneumothorax : https://brainly.com/question/26704006

Practice guideline summary: Use of fMRI in the presurgical evaluation of patients with epilepsy: Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology.

The practice guideline summary you mentioned is titled "Use of fMRI in the presurgical evaluation of patients with epilepsy: Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology."

This guideline was developed by experts in the field and provides recommendations on the use of functional magnetic resonance imaging (fMRI) in the preoperative evaluation of epilepsy patients .

It aims to guide healthcare professionals in the appropriate use of fMRI to help localize the epileptogenic zone and improve surgical outcomes for patients with epilepsy.

The guideline emphasizes the importance of fMRI as a valuable tool for identifying brain regions involved in epileptic activity. It discusses the indications, technical considerations, and interpretation of fMRI findings, as well as its integration with other diagnostic modalities.

The recommendations provided aim to enhance the accuracy and effectiveness of presurgical evaluations , leading to better treatment decisions and improved outcomes for epilepsy patients.

To learn more about fMRI

https://brainly.com/question/19340373

There are no contraindications to use of a Swiss ball in therapeutic exercises Question 8 options: True False

False. Swiss ball can be a useful and versatile tool in therapeutic exercise programs, but there are several contraindications and precautions that need to be considered before using it.

A Swiss ball is a large, inflatable ball used in physical therapy, rehabilitation, and exercise to improve posture, balance, and core stability.

It is a versatile piece of equipment that can be used in many ways to improve strength, flexibility, and coordination.

Swiss ball exercises can be very beneficial for many people, but they are not suitable for everyone.

Some people may have conditions or injuries that make Swiss ball exercises unsafe or inappropriate.

For example, Swiss ball exercises can place significant stress on the spine and may not be suitable for people with spinal conditions such as spinal stenosis, herniated discs , or osteoporosis.

In addition, people with certain balance or coordination problems may not be able to perform Swiss ball exercises safely.

There are also certain precautions to consider, such as ensuring that the ball is properly inflated and that exercises are performed in a safe and controlled environment.

In conclusion, there are contraindications and precautions to consider before using a Swiss ball in therapeutic exercises.

Therefore, the statement "There are no contraindications to use of a Swiss ball in therapeutic exercises" is false.

To know more about therapeutic exercise visit:

https://brainly.com/question/3522643

ase D: You are a physician taking care of a 19-year old woman with type II diabetes. A thorough history and physical exam reveal: height

As a physician caring for a 19-year-old woman with type II diabetes, the history and physical exam reveal important information about her condition.

Type II diabetes is a chronic metabolic disorder characterized by insulin resistance and impaired glucose regulation. In the case of this 19-year-old woman, her age and diagnosis of type II diabetes suggest that she is experiencing early-onset diabetes, which is becoming increasingly common due to lifestyle factors such as poor diet and sedentary behavior.

Conducting a thorough history and physical exam is essential for evaluating the patient's overall health and assessing the impact of diabetes on her body. The history may include information about her family history of diabetes, previous medical conditions , and lifestyle factors. The physical exam can help identify potential complications of diabetes, such as obesity, high blood pressure, or signs of diabetic neuropathy.

The combination of history and physical exam findings allows the physician to develop a comprehensive understanding of the patient's condition, determine appropriate treatment strategies , and monitor her progress over time. It is crucial to address both the management of diabetes and the prevention of long-term complications to ensure her overall well-being.

Learn more about physical exam

brainly.com/question/31840413

outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure: post hoc analysis of a randomized clinical trial

The post hoc analysis of a randomized clinical trial has been conducted to determine the outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure.

Intracerebral hemorrhage (ICH) refers to bleeding that occurs inside the brain. This bleeding can quickly kill brain cells as it increases pressure inside the skull. Symptoms can include headaches, nausea, vomiting, and seizures. In some cases, a person with ICH may also experience difficulty speaking, paralysis, or other symptoms, depending on the area of the brain where the bleeding occurs .Outcomes of the analysis:The study showed that intensive reduction of systolic blood pressure did not significantly reduce the chances of poor outcomes, including death or severe disability, in people with intracerebral hemorrhage (ICH) and excessively high initial systolic blood pressure. However, the risk of serious adverse effects, such as kidney injury and electrolyte imbalances , was higher in the intensive treatment group than in the standard treatment group.Specifically, the study showed that the odds of poor outcomes (modified Rankin Scale score of 4-6, indicating severe disability or death) were similar between the intensive treatment group and the standard treatment group (odds ratio, 1.04; 95% CI, 0.85-1.28; P = .69). However, the odds of serious adverse effects (systolic blood pressure <120 mm Hg, serum creatinine level >2.0 mg/dL, or serum potassium level <3.0 mEq/L) were higher in the intensive treatment group than in the standard treatment group (odds ratio, 1.93; 95% CI, 1.33-2.80; P = .001).Thus, the study concluded that the risks of intensive systolic blood pressure reduction may outweigh the benefits in patients with ICH and excessively high initial systolic blood pressure.

To know more about death penalty :

https://brainly.com/question/25182125

The patient is a 20-year-old college student who has type 1 diabetes and normally walks each evening as part of an exercise regimen. The patient plans to enroll in a swimming class. Which adjustment should be made based on this information

Based on the information provided, the following adjustments should be made for the 20-year-old college student with type 1 diabetes who regularly walks and plans to enroll in a swimming class:

1. Testing blood sugar levels before and after swimming: It is crucial for the patient to test their blood sugar levels before and after swimming . This is important because swimming can potentially cause a drop in blood sugar levels (hypoglycemia), which can be dangerous . Monitoring blood sugar levels will help ensure stability and allow the patient to take appropriate actions if necessary.

2. Always keep snacks or carbohydrates nearby: It is advisable for the patient to have quick-acting carbohydrates or snacks readily available during swimming in case of hypoglycemia . These can provide a rapid source of glucose to counteract low blood sugar levels.

3. Consult with a doctor: Since the patient has type 1 diabetes, it is essential to consult with a healthcare professional before making any changes to their exercise routine. Seeking medical advice is important because the doctor can assess the patient's specific needs, monitor their blood sugar levels , and make any necessary adjustments to their insulin dosage or treatment plan.

4. Stay hydrated: Swimming is a great exercise for individuals with diabetes, but it can also lead to dehydration. It is important for the patient to stay properly hydrated during exercise to prevent complications like hypoglycemia . Dehydration can cause blood sugar levels to rise, so regular intake of fluids is essential.

5. Exercise caution: It is important for the patient to take precautions while swimming to avoid any accidental injuries related to hypoglycemia or hyperglycemia . Safety measures such as avoiding deep water and swimming with a partner should be taken. Being cautious and aware of their condition will help prevent potential risks while enjoying swimming as an exercise.

Overall, swimming can be a beneficial form of exercise for individuals with type 1 diabetes, but it requires extra precautions to ensure safety and stability of blood sugar levels. The patient should be well-informed, prepared, and aware of their body's response to swimming , and they should always prioritize their health and well-being during physical activities.

To know more about hypoglycemia visit:

https://brainly.com/question/32508753

The client vomits during the surgical procedure. the best action by the nurse is:_______.

The best action by the nurse is to turn the client to the side (recovery position) to prevent aspiration .

When a client vomits during a surgical procedure, the nurse's immediate priority is to prevent aspiration, which is the inhalation of vomit into the lungs.

Turning the client to the side helps to protect the airway and minimize the risk of aspiration.

By turning the client to the side, gravity can assist in draining the vomit away from the airway and reducing the chances of it being inhaled. This position also allows for easier clearance of vomitus from the mouth and prevents obstruction of the airway.

Additionally, the nurse should provide appropriate support and reassurance to the client, ensuring their safety and monitoring their vital signs.

Depending on the situation and the client's condition, the nurse may also need to inform the surgical team and document the incident for further evaluation.

Overall, turning the client to the side is a crucial and immediate action that helps to protect the client's airway and prevent complications associated with aspiration during the surgical procedure .

To know more about " Aspiration " refer here:

https://brainly.com/question/33591634#

When the pulp displays symptoms of lingering pain and the clinical diagnostic findings show that the pulp is incapable of healing, what treatment is warranted in order to save the tooth?

When the pulp displays symptoms of lingering pain and the clinical diagnostic findings show that the pulp is incapable of healing, the treatment that is warranted in order to save the tooth is root canal therapy.

In this treatment, the infected pulp tissue is removed from the root canals of the tooth, and the canals are disinfected and filled with an inert material called gutta-percha. A crown is then placed over the tooth to protect it from further damage. Root canal therapy is a common and effective treatment for saving teeth that would otherwise need to be extracted. The procedure is usually performed under local anesthesia, and patients can expect to experience some mild discomfort and sensitivity for a few days following the treatment. It is important to note that not all cases of tooth pain and infection require root canal therapy. In some cases, the infection may be treated with antibiotics or other medications . Your dentist will evaluate your individual case and recommend the best course of treatment based on your specific needs. In conclusion, when the pulp displays symptoms of lingering pain and the clinical diagnostic findings show that the pulp is incapable of healing, root canal therapy is the most appropriate treatment for saving the tooth.

To know more about diagnostic visit :

https://brainly.com/question/29494168

Dosing andEfficacyofGlutamine Supplementation in Human Exercise and Sport Training1,2 Michael Gleeson*

Dosing and Efficacy of Glutamine Supplementation in Human Exercise and Sport Training

Authors: Michael Gleeson, Ron Maughan

Published: Nutrition Reviews, 2008

DOI: 10.1111/j.1753-4887.2008.00158.x

The paper reviews the evidence for the efficacy of glutamine supplementation in human exercise and sport training. Glutamine is an amino acid that is essential for many bodily functions, including protein synthesis, immune function, and muscle recovery.

The paper found that there is some evidence that glutamine supplementation can improve exercise performance and reduce the incidence of infections in athletes. However, the evidence is mixed and more research is needed to determine the optimal dosing and efficacy of glutamine supplementation for athletes.

The paper concludes that glutamine supplementation may be beneficial for athletes , but more research is needed to determine the optimal dosing and efficacy.

Here are some of the key findings of the paper:

The paper also discusses the potential risks of glutamine supplementation, which include diarrhea, nausea, and bloating. The authors conclude that the risks of glutamine supplementation are generally low, but more research is needed to determine the long-term safety of glutamine supplementation.

To know more about Glutamine Supplementation refer here :    

https://brainly.com/question/32142697#

#SPJ11                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

a nurse is providing education tot aclient who has a prescription for a blood transfusion which of the followinf

In providing education to a client who has a prescription for a blood transfusion , the nurse should include the statement: "You must immediately report any symptoms like chills, nausea, or itching." This statement emphasizes the importance of the client being vigilant and proactive in monitoring their own well-being during the transfusion process. The correct option is D.

Reporting any symptoms such as chills, nausea, or itching is crucial because these could indicate a potential adverse reaction or transfusion-related complication. Immediate reporting allows the healthcare team to promptly assess and intervene if necessary, ensuring the client's safety and well-being.

The other statements listed have some limitations or may not provide the comprehensive information needed for the client's understanding and active participation in their care. While checking vital signs every 15 minutes is important during a blood transfusion (Statement A), it alone does not encompass all aspects of client monitoring and safety. Depending solely on a nursing assistant to check on the client periodically (Statement B) may not provide the level of expertise and assessment needed to identify early signs of complications.

Statement C is not accurate as adverse effects can occur at any time during the transfusion, not just within the first 15 to 30 minutes. Therefore, the emphasis should be on immediate reporting of any symptoms throughout the entire transfusion process.

Overall, the nurse should prioritize empowering the client to actively participate in their care and promptly report any concerning symptoms, enabling the healthcare team to take appropriate actions and ensure the client's safety during the blood transfusion.

Hence, the correct option is D.

To know more about blood transfusion , refer to the link below:

https://brainly.com/question/29762401#

Complete Question:

A nurse is providing education to a client who has a prescription for a blood transfusion. Which of the following statements should the nurse include in the teaching?

A. "I will check your vital signs every 15 minutes throughout the blood transfusion."

B. "I might have a nursing assistant check on you periodically during the transfusion."

C. "If you have no adverse effects in the first 15 to 30 minutes, you will not have any adverse effects later."

D. "You must immediately report any symptoms like chills, nausea, or itching."

a young parent brings the school-aged child to the office for a sports physical examination. during the appointment, the parent informs the nurse about being worried because the child does not like school and does not seem to be reading, writing, or spelling as well as others in the class. the parent adds that the child struggles to get organized and to manage time. what condition does the nurse suspect?

The nurse suspects that the child may be having Attention Deficit Hyperactivity Disorder (ADHD). ADHD is a developmental and behavioral disorder that affects children's ability to pay attention, control impulsivity , and control motor activity.

Children with ADHD are hyperactive, inattentive, and impulsive. Inattention, hyperactivity, and impulsivity are the three core symptoms of ADHD.

ADHD is a chronic condition that affects more than one's ability to pay attention, hyperactivity, and impulsivity.

It also affects the ability to learn, self-esteem, and social skills .

It is usually diagnosed in childhood, but some people are not diagnosed until adolescence or adulthood.

ADHD is caused by a variety of factors, including genetics, brain development, and environmental factors.

It has been linked to low levels of dopamine, a neurotransmitter that plays a role in attention and reward in the brain.

Treatment for ADHD includes medications, behavioral therapy , and lifestyle changes.

Stimulant medications like Ritalin and Adderall are used to treat ADHD.

These medications work by increasing dopamine levels in the brain, which can help with attention and motivation.

Behavior therapy helps children learn how to manage their symptoms by teaching them coping strategies and social skills.

Lifestyle changes like exercise, a healthy diet, and adequate sleep can also help manage symptoms of ADHD.

To know more about Attention Deficit Hyperactivity Disorder visit:

https://brainly.com/question/7774650

The nurse is teaching a client about newly prescribed cyclosporine. Which client statement indicates a need for further teaching

The nurse should provide the client with additional guidance regarding the proper administration of the medication. It is crucial to ensure that the client understands how to take cyclosporine correctly to optimize its effectiveness in treating their specific condition.

Cyclosporine is a medication commonly prescribed to suppress the immune system in organ transplant recipients and individuals with autoimmune diseases like rheumatoid arthritis, psoriasis, and Crohn's disease. In this scenario, the nurse is educating a patient about their newly prescribed cyclosporine. However, the client's statement of intending to take cyclosporine with their morning coffee indicates a need for further instruction.

It is important to note that grapefruit or grapefruit juice should not be consumed alongside cyclosporine, as they can significantly increase the medication's levels in the bloodstream . Additionally, a high-fat meal should be avoided while taking cyclosporine, as it can also elevate the medication levels in the blood. The ideal approach is to take cyclosporine at the same time every day and with a full glass of water. Taking cyclosporine with coffee can diminish its effectiveness.

Given this information, the nurse should provide the client with additional guidance regarding the proper administration of the medication. It is crucial to ensure that the client understands how to take cyclosporine correctly to optimize its effectiveness in treating their specific condition.

To know more about Cyclosporine visit:

https://brainly.com/question/31603575

use the surface integral in stok'es theorem to calculate the ciruclation of the field f around the curve c in the indicated direction

The result of the surface integral will give you the circulation of F around C.

Stokes' theorem relates the circulation of a vector field around a closed curve C to the flux of the curl of the vector field through a surface S bounded by C.

Mathematically, it is given by:

∮C F · dr = ∬S (curl F) · dS

∮C F · dr represents the circulation of the vector field F around the closed curve C.

∬S (curl F) · dS represents the flux of the curl of the vector field F through the surface S bounded by C.

To calculate the circulation of the vector field F around the curve C in the indicated direction , you need to follow these steps:

Define the vector field F(x, y, z) and its curl.

Choose a surface S bounded by the curve C and calculate the outward unit normal vector dS (it points outward from S).

Compute the curl of F, i.e., curl F.

Evaluate the flux of curl F through S, which is given by the surface integral ∬S (curl F) · dS.

Without specific details about the vector field F and the curve C, it's not possible to provide an exact calculation. If you provide the specific vector field F and the curve C, I'd be happy to help you walk through the steps to calculate the circulation using Stokes' theorem .

To learn more about circulation

https://brainly.com/question/13759634

When assessing a client prior to the administration of digoxin (lanoxin, apo-digoxin), which data is most important for the nurse to consider?

When assessing a client prior to the administration of digoxin, the most important data for the nurse to consider is the client's heart rate and rhythm.

Digoxin is a medication commonly used to treat heart conditions, such as heart failure and certain types of arrhythmias. It works by slowing down the heart rate and increasing the strength of each heartbeat.

However, digoxin can have toxic effects if the dose is not adjusted properly or if the client's heart rate is already too slow.

Therefore, it is crucial for the nurse to assess the client's heart rate and rhythm before administering digoxin to ensure it is within the appropriate range for safe administration.

Learn more about Digoxin

https://brainly.com/question/12978309

A 29-year-old G2P1 woman at 36 weeks gestation is seen for management of her gestational diabetes. Despite diet modification, the patient has required insulin to control her serum glucose levels. She has gained 25 pounds with the pregnancy. Which of the following complications is least likely to occur

A 29-year-old G2P1 woman at 36 weeks gestation is seen for management of her gestational diabetes . Despite diet modification, the patient has required insulin to control her serum glucose levels.

She has gained 25 pounds with the pregnancy. The complications that are likely to occur in a woman with gestational diabetes include pre-eclampsia, fetal macrosomia , preterm labor, and cesarean delivery.

However, the complications that are least likely to occur in a woman with gestational diabetes include the development of a skin condition, such as acne.The insulin resistance and hyperglycemia associated with gestational diabetes can lead to the development of fetal macrosomia, which is the main risk associated with gestational diabetes. Fetal macrosomia refers to the condition in which the fetus is abnormally large, usually weighing more than 4,000 grams (8.8 pounds) at birth.

This can cause complications during delivery, such as shoulder dystocia and birth injuries, and can increase the risk of cesarean delivery. Pre-eclampsia is a complication of pregnancy characterized by high blood pressure and proteinuria. It can lead to serious complications for both the mother and fetus if left untreated. Preterm labor, which is defined as labor that occurs before 37 weeks of pregnancy, is another potential complication of gestational diabetes.

In conclusion, the complications that are least likely to occur in a woman with gestational diabetes include skin conditions like acne.

To know more about gestational diabetes visit:

https://brainly.com/question/10240405

case 1 preoperative diagnosis: malignant neoplasm glottis postoperative diagnosis: malignant neoplasm glottis(diagnosis to report for the procedure.) procedure: an incision is made low in the neck. the trachea is identified in the middle and an opening is created to allow for the new breathing passage. a tracheostomy(this is the performed procedure.) tube is inserted and secured with sutures. the patient tolerated the procedure well and was sent to recovery without complications. what are the cpt® and icd-10-cm codes reported?

Based on the information provided, the CPT® code for the performed procedure is 31600, which is for a tracheostomy tube placement. The ICD-10-CM code for the preoperative and postoperative diagnosis of malignant neoplasm of the glottis is C32.0.

This code specifically represents the insertion of a tube into the trachea to establish an airway. The ICD-10-CM code for the preoperative and postoperative diagnosis of malignant neoplasm of the glottis is C32.0.

This code is used to identify cases of malignant (cancerous) neoplasms or tumors located in the glottis, which is a part of the larynx or voice box.

Proper coding and documentation are crucial for accurate medical billing and reimbursement processes. It is important to consult with a qualified healthcare professional or coding specialist for specific coding requirements and guidelines.

To learn more about tracheostomy tubes

https://brainly.com/question/12906333

intermediate-term outcomes following transcatheter aortic valve implantation in patients with history of liver cirrhosis.

Intermediate-term outcomes following transcatheter aortic valve implantation in patients with a history of liver cirrhosis should be evaluated.

Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat aortic valve disease. However, patients with a history of liver cirrhosis may have unique considerations and potential risks associated with the procedure.

Therefore, it is important to assess the intermediate-term outcomes of TAVI in this specific patient population. This evaluation can provide valuable insights into the safety, effectiveness, and potential complications of TAVI in individuals with liver cirrhosis.

By examining intermediate-term outcomes, healthcare professionals can better understand the benefits and risks of TAVI in these patients and make informed decisions regarding their treatment options.

To know more about transcatheter visit -

brainly.com/question/28450122

a young client is being treated for a femoral fracture suffered in a snowboarding accident. the nurse's most recent assessment reveals that the client

In a young patient who has experienced a femoral fracture and is now displaying uncharacteristic confusion, a diagnostic test that should be performed is an electrolyte assessment (Option A).

Electrolyte imbalances , such as disturbances in sodium, potassium, calcium, or magnesium levels, can affect brain function and lead to neurological symptoms, including confusion. In this case, the patient's confusion may be related to an electrolyte imbalance caused by factors such as trauma, stress, or fluid shifts associated with the fracture and subsequent treatment.

By conducting an electrolyte assessment , healthcare providers can evaluate the patient's electrolyte levels and identify any imbalances that may be contributing to the neurological symptoms. Once identified, appropriate interventions can be implemented to restore electrolyte balance and improve the patient's cognitive function.

While the other options ( electrocardiogram , arterial blood gases, abdominal ultrasound) may be useful in certain clinical scenarios, they are not specifically indicated for evaluating confusion related to a femoral fracture.

To learn more about diagnostic

https://brainly.com/question/30725877

A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nursesmost recent assessment reveals that the patient is uncharacteristically confused. What diagnostic testshould be performed on this patient?

A.Electrolyte assessment

B.Electrocardiogram

C.Arterial blood gases

D.Abdominal ultrasound

n Patients With Functional Movement Disorders, Is Specialized Physical Therapy Effective in Improving Motor Symptoms? A Critically Appraised Topic

Functional Movement Disorders (FMD) is a common neurological disorder characterized by abnormal motor or sensory movements that are not associated with an underlying neurological condition. Specialized physical therapy is a treatment option for individuals with FMD, which aims to improve motor symptoms. The effectiveness of specialized physical therapy in improving motor symptoms in patients with FMD has been a subject of research and discussion. Several studies have evaluated the effectiveness of specialized physical therapy in improving motor symptoms in patients with FMD. One of the studies is a randomized controlled trial conducted by Nielsen and colleagues, which involved 100 patients with FMD. The study found that specialized physical therapy was effective in improving motor symptoms in patients with FMD. The treatment consisted of 12 sessions of individualized physiotherapy, which included a combination of techniques such as education, motor retraining, and psychological interventions . Another study conducted by LaFaver and colleagues evaluated the effectiveness of a multidisciplinary rehabilitation program, which included physical therapy , occupational therapy, and cognitive-behavioral therapy , in improving motor symptoms in patients with FMD. The study involved 12 patients with FMD and found that the multidisciplinary rehabilitation program was effective in improving motor symptoms. In conclusion, specialized physical therapy is effective in improving motor symptoms in patients with FMD. The treatment consists of individualized physiotherapy, which includes a combination of techniques such as education, motor retraining, and psychological interventions. Multidisciplinary rehabilitation programs, which include physical therapy, occupational therapy, and cognitive-behavioral therapy, are also effective in improving motor symptoms in patients with FMD.

To know more about physical therapy visit:

https://brainly.com/question/30641989

I have a good relationship with my provider I feel a strong connection with my provider I am very committed to my provider Overall, I am very satisfied with my provider I would strongly recommend my provider to a friend

The relationship between a patient and their healthcare provider plays a crucial role in the patient's overall experience.

Having a good relationship with your healthcare provider is vital in ensuring a positive healthcare experience.

It provides a level of comfort and trust that enables patients to share their concerns and feel heard.

In this case, it is evident that you have established an excellent rapport with your provider.

Having a strong connection with your healthcare provider is a reflection of mutual respect, honesty, and effective communication.

It allows for better decision-making and shared responsibility in your care.

When patients and providers are committed to one another, they work together to achieve the best possible outcome for the patient's health.

Patient satisfaction is a measure of how well healthcare providers meet patients' expectations, and it is closely tied to the quality of care received.

Being satisfied with your healthcare provider is an essential component of healthcare experience.

If patients are satisfied, they are more likely to continue seeking care and will recommend their provider to others. In conclusion, A patient who is satisfied with their provider is more likely to continue seeking care and recommend their provider to others.

To know more about crucial role visit:

https://brainly.com/question/28214951

What joint spaces are open on an ap oblique foot projection with accurate positioning?

On an AP oblique foot projection with accurate positioning, the joint spaces that are typically open include the tarsometatarsal joints, metatarsophalangeal joints, and interphalangeal joints.

On an AP oblique foot projection with accurate positioning , several joint spaces are typically open. These include the tarsometatarsal joints, which are the joints between the tarsal bones and the metatarsal bones, allowing for flexibility and weight distribution in the foot.

The metatarsophalangeal joints found between the metatarsal bones and the proximal phalanges are also typically open. These joints allow for flexion and extension of the toes.

Finally, the interphalangeal joints , located between the phalanges, are open as well, enabling movement and articulation between the toe bones. Accurate positioning of the foot in the oblique projection helps visualize these joint spaces clearly for diagnostic purposes.

To learn more about foot projection

https://brainly.com/question/33581574

Pennington Biomedical Research Presented at NUTRITION 2024 in Chicago

June 29, 2024 · Baton Rouge, LA

NUTRITION 2024 , the annual flagship meeting of the American Society of Nutrition, is taking place June 29-July 2 in Chicago, and a number of research findings from the Pennington Biomedical Research Center will be presented during the conference.

NUTRITION 2024 is one of the country’s top nutrition meetings featuring scientific symposia and educational sessions, original research studies presented in oral and poster sessions and flash talks. In addition, award lectures delivered by distinguished leaders; professional and career development opportunities; special sessions and events planned by ASN’s vibrant scientific communities known as Groups Engaging Members; Opportunities to network and engage with members of the nutrition community from around the globe; and access to the latest technology, services, and products related to health and nutrition are presented during the event.

“The American Society of Nutrition the pre-eminent professional organization for nutrition researchers and clinicians, and it is fitting that Pennington Biomedical be well represented at the annual meeting,” said Dr. John Kirwan, Pennington Biomedical Executive Director. “More than 1,600 original research studies will be presented at this year’s event with many of those directly involving researchers from Pennington Biomedical or our collaborators around the world.”

Leading researchers, practitioners, global and public health professionals, policymakers, advocacy leaders, industry professionals, or anyone working to advance nutrition science and its practical application will be in attendance. NUTRITION 2024 also is a “must attend” event for rising leaders in the field, such as postdoctoral fellows and undergraduate, graduate, and medical students.

During the meeting, the following researchers from Pennington Biomedical will present:

• Dr. Candice Myers, Assistant Professor, as a presenting author on “Contributions of Food Insecurity in Adulthood to Nutrition and Health Disparities”
• Dr. Stephen Hennigar, Assistant Professor, as session chair for “Micronutrients Supplementation and Human Health”
• Dr. Hanim Diktas, Postdoctoral Researcher in Dr. Corby Martin’s laboratory, as a presenting author on “Innovative Nutrition Education Interventions Across Populations”
• Dr. David Barney, Postdoctoral Researcher in Dr. Hennigar’s laboratory, as session chair “Vitamins and Minerals” poster theater flash session
• Dr. Barney as session chair for “Vitamins and Minerals” GEM forum
• Dr. Barney as a presenting author on “Dietary Manipulation to Support Exercise Performance” poster theater flash session
• Dr. Terrence Riley, Postdoctoral Researcher in Dr. Claire Berryman’s laboratory, as a presenting author on “Dietary Associations with Gut Microbial Community and Metabolic Changes” poster theater flash session

For more information contact:

Joe Coussan, Media Relations Manager, [email protected] , 225-763-3049 or Ernie Ballard, Senior Director of Communications & Marketing, [email protected] , 225-263-2677 .

About the Pennington Biomedical Research Center

The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the triggers of obesity, diabetes, cardiovascular disease, cancer and dementia. The Center conducts basic, clinical, and population research, and is a campus of the LSU System. The research enterprise at Pennington Biomedical includes over 530 employees within a network of 44 clinics and research laboratories, and 13 highly specialized core service facilities. Its scientists and physician/scientists are supported by research trainees, lab technicians, nurses, dietitians, and other support personnel. Pennington Biomedical is a state-of-the-art research facility on a 222-acre campus in Baton Rouge. For more information, see www.pbrc.edu .

Pennington Biomedical Research Center 6400 Perkins Road Baton Rouge, LA 70808

Centers & Institutes

Metabolic Basis of Disease Center 

Institute for Dementia Research & Prevention

Louisiana Clinical & Translational Science Center

Nutrition Obesity Research Center

Metamor Institute

Center for Military Performance & Resilience

Childhood Obesity and Diabetes Research  

Human Research Protections Program

Research Kitchen + Recipes

Business Development

LAUNCHED Program

Pennington Biomedical Research Foundation

Our Partners

Obesity Society

American Diabetes Association

Sign Up For Updates

6400 Perkins Rd. Baton Rouge, LA 70808 ph: (225) 763-2500 fax: (225) 763-3022

©   Copyright Pennington Biomedical Research Center

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Obes Pillars
• v.4; 2022 Dec
• PMC10662005

Review of upstream social factors contributing to childhood obesity

Dominique r. williams.

a The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA

Amy Braddock

b Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA

Marcella Houser

c LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA

Associated Data

1. background.

In the United States, childhood obesity rates have steadily risen for more than three decades. As of 2018, 16.1% of U.S. children and adolescents (2–19 years of age) have a body mass index (BMI) greater than the 85th percentile for age and sex (overweight) and 19.3% have a BMI greater than the 95th percentile (obesity) [ 1 ]. Multiple obesity prevention and treatment efforts, with particular attention directed to the first 1000 days of life, have been implemented with the goal of improving childhood nutrition and health [ 2 ]. Despite countless efforts, the prevalence of obesity in U.S preschool children (2–5 years) currently approaches 13 percent [ 3 , 4 ].

Pediatric obesity does not affect communities equally, with minoritized groups and specific geographic areas experiencing disproportionately higher obesity rates. Among children and adolescents aged 2–19 years, prevalence of obesity affects non-Hispanic Blacks (25.1%), Mexican Americans (24.9%), Hispanics (23.0%), American Indian/Alaska Native (AI/AN) (29.7%), and Native Hawaiian or Other Pacific Islander (NHPI) (23% at 8 years of age) at higher rates compared to non-Hispanic Whites (14.7%) [ 1 , 5 , 6 ].

Many of the racialized differences in obesity rates reflect inequities that are “neither natural nor inevitable” [ 7 ] but rather the result of unfair social structures or institutional practices that confer unearned privilege to one group while subjugating another group [ 8 ]. Additionally, obesity is a complex disease that results from complicated interactions with, and reactions to, social, environmental, and biological variables that can affect mood, energy regulation, and health status.

The complexity of obesity spans a lifetime. Obesity in childhood increases the risk of pediatric cardiovascular disease, diabetes, depression, and anxiety while also increasing the risk of obesity and premature death in adulthood. To develop a comprehensive, inclusive and equitable framework for the treatment and prevention of childhood obesity, clinicians are encouraged to evaluate the root causes of the inequitable access, prevalence, and outcomes observed among minoritized communities. Insight into lived experiences and the context in which the child and family views historical and present-day life are invaluable in this effort. This paper will shed light on upstream contributors to obesity, provide actionable steps for clinicians, identify gaps in obesity-related care, and propose future directions for childhood obesity management and research ( Fig. 1 ).

Factors contributing to obesity.

2. Upstream factors contributing to obesity

2.1. epigenetic modification, toxic stress, and adverse childhood experiences, 2.1.1. case study 1: antonia and daniela.

15-year-old Daniela is accompanied by her mother, Antonia, to establish care and discuss weight gain and a dark rash on her neck. Past medical history is negative; however, Antonia was recently diagnosed with type 2 diabetes (T2D) after suffering from gestational diabetes (GDM) with each of her pregnancies. Daniela's pattern of weight gain and dark rash have worsened in the past year. Two years ago, Daniela and her family immigrated from Honduras after her father was killed during an armed home invasion. She now lives in a multigenerational household that includes her mother, 2 younger siblings, maternal grandmother as well as maternal aunt and her 3 children. She attends the local public high school where she plays on the soccer team – which was unavailable at her former school due to neighborhood violence. The family eats traditional Honduran meals for dinner, otherwise Daniela eats very little during the day; she skips breakfast most days and drinks soda with chips for lunch. On physical exam, the BMI is 38 (>95 th percentile) and acanthosis nigricans is noted on the neck and axillae.

2.1.2. Epigenetic modifications

Daniela's story introduces the concept of epigenetics, or the study of how environment and behavior may lead to changes that affect gene function. Whereas genetic changes are irreversible and alter DNA sequences within genes, epigenetic changes are modifiable, reversible, and exert their influence on the gene expression of DNA sequences [ 9 ]. Epigenetic modifications may affect infants as they develop in-utero, and later in childhood. Maternal factors during pregnancy such as gestational diabetes, excessive weight gain, or tobacco use can manifest as epigenetic modifications that contribute to the development of pediatric obesity [ 10 ]. In the case of Daniela, her mother suffered from gestational diabetes during all 3 of her pregnancies and lived in a neighborhood affected by community violence. Postnatal environmental factors (high carbohydrate diet with few fruits and vegetables, inadequate sleep, and physical inactivity) are associated with epigenetic changes that increase the risk of obesity [ 2 ]. Additional associated threats for epigenetic changes include racial inequities and structural racism, adverse childhood events (ACEs), food insecurity, food deserts, housing instability, and community violence and disruption [ 11 , 12 ].

2.1.3. Toxic stress

Current literature suggests that chronic, toxic stress experienced through poor social determinants of health (SDOH), and life events can lead to obesity in children through two distinct physiological pathways: disruption of the hypothalamic-pituitary-adrenal (HPA) axis from allostatic overload and through epigenetic modifications [ [13] , [14] , [15] , [16] ]. The body normally responds to stress through heightened energy and hormonal responses to meet the perceived threat until the stress is passed. Threats that are severe, constant or ongoing become toxic and may overtax the normal stress response [ 17 ]. Allostatic load is the term for the cumulative effect of life stressors (chronic or episodic) on the body [ 18 ]. Allostatic overload occurs when the body is unable to successfully manage these stressors. Chronic inflammation, diminished immune response, and energy dysregulation are end-results of allostatic overload [ 18 ]. In a comprehensive approach to patients and families similar to Daniela who are affected by obesity, clinicians are encouraged to consider the role of chronic, pervasive, toxic stress in the development and progression of obesity.

2.1.4. Adverse childhood experiences (ACEs)

The landmark study on ACEs identified 3 major categories of adversity experienced in childhood (household dysfunction, abuse, and neglect) which were strongly associated with increased risk of poor health [ 19 ]. As the number of ACEs that an individual experienced increased, so did the risk for adverse health outcomes such as obesity, cardiometabolic diseases, diabetes, substance abuse, depression, and suicide attempts [ 19 , 20 ]. Amongst middle-class, insured individuals, greater than two-thirds experienced at least one ACE and nearly 25% experienced 3 or more ACEs [ 20 ].

ACEs are associated with childhood obesity, albeit signs may be delayed, presenting as many as 5 years after the traumatic event [ 21 ]. The prevalence of ACEs is higher in children and adults from minoritized groups compared to predominantly White communities [ [22] , [23] , [24] , [25] , [26] ]. This association may partially explain the higher burden of poor health and life outcomes experienced by minoritized groups. The original ACEs study measured conventional ACEs (ACE-C) which assessed individuals in middle to upper middle-class communities, focusing on parameters within the home such as abuse, neglect, and household dysfunction [ 19 ]. Cronholm et al. studied a more socioeconomically and racially diverse urban population, expanding the ACE-C to include experiences within the community [ 27 ]. The expanded ACEs (ACE-E) include witnessing or experiencing community violence, placement in foster care, death of family member, and witness to frequent interpersonal or community conflict. Cronholm's results revealed that 72.9% of 1784 respondents experienced at least one ACE-C, 63.4% at least one ACE-E, and 49.3% experienced at least one of both. Most importantly, 13.9% experienced only ACE-E, suggesting that conventional ACE assessment would have missed risk factors more common in communities with more racial, ethnic and socioeconomic diversity [ 27 ].

2.1.5. Upstream contributors for immigrants

Some immigrant children like Daniela, are at high risk for chronic stress or trauma from racism, unsafe neighborhoods in country of origin, and relocation to another community or country [ 28 ]. Other potential stressors include food insecurity, limited (if any) access to health care, and fears of family separation. Poor health literacy, exacerbated by the absence of written materials and instructions in the patient's preferred language, can hinder an immigrant family's ability to manage chronic diseases including obesity and diabetes [ 29 ].

2.1.6. Case 1 actionable steps

Providers can (1) strive to learn more about patient's history and living situation, (2) use Trauma Informed Care (TIC) principles, and (3) address health literacy and cultural barriers. TIC asks clinicians to consider the role that trauma and lingering traumatic stress plays in the lives of their patients. Trauma-informed care considers physical, emotional, social, or historical trauma which can all have harmful effects on mental and physical health [ 30 ]. Clinicians can use a “trauma lens” to provide patients and their families with the tools for building supportive relationships and fostering resilience [ 31 , 32 ]. With over 40% of children and adolescents experiencing four or more different types of traumas and adversity [ 33 ] and because trauma is more common in families experiencing health inequities, all health systems and practices treating child obesity are encouraged to increase awareness and uniformly implement trauma-informed care techniques [ 34 ]. Table 1 describes strategies for the use of trauma informed care principles.

Table 1

Strategies for trauma informed care (TIC).

ACEs = Adverse Childhood Experiences; TIC = Trauma informed care.

Daniela's history indicates a high risk of epigenetic changes from toxic stress related to ACEs, maternal GDM and T2DM, community violence, and witnessing the death of her father. Learning more about Daniela's history and current living situation helps her clinician consider and address sources of trauma. In order to provide care that supports the family and does not retraumatize, the clinician uses TIC principles to recognize the impact of potential, unspoken traumas brought to any clinical encounter. TIC technique are provided in Table 1 [ 32 , 34 , 35 ]. By addressing health literacy, language and cultural barriers, the clinician provides patients like Daniela with culturally relevant counseling and resources. Table 2 illustrates the impact of epigenetics, toxic stress, and ACEs through the case study of Antonia and Daniela.

Table 2

Case study 1: Antonia and Daniela – epigenetics, toxic stress, and ACEs.

2.2. Historical trauma

2.2.1. case study 2: susan and charlie.

Charlie is a 32-week male born vaginally to a 27-year-old Choctaw mother, Susan, after premature rupture of membranes and labor. Charlie was born at the local hospital near the Choctaw reservation but required transfer to a regional neonatal intensive care unit (NICU) 50 miles away. The pregnancy was complicated by late prenatal care, gestational diabetes, and depression. After learning of the gestational diabetes, Susan became distraught and afraid, thinking about her many relatives with diabetes who required daily injections, experienced blindness, or underwent limb amputation. She has watched her relatives attempt to follow both tribal and western medicine. Susan lives on the Choctaw Indian Reservation with her husband and 3 generations of her family, as most of them have been awaiting housing assistance for years. Though she has remained sober for 11 years, multiple family members continue to struggle with alcohol use disorder.

2.2.2. The impact of historical trauma

The story of Susan and Charlie invokes images of historical trauma or the cumulative, multigenerational, collective experience of emotional and psychological injury experienced by specific cultures, races, or ethnic communities [ 36 ]. Intertwined through the interpersonal and collective experience, examples of historical trauma include enslavement, displacement (i.e. internment camps, Indian reservations), exploitation, and cultural disruption, often resulting in unresolved grief [ 36 ]. The combined emotional and psychological stresses of historical trauma impact individuals over the lifespan and across generations, stemming from massive group trauma experiences that result in cumulative and self-perpetuating consequences [ 37 ]. Younger generations of traumatized groups, who did not experience the original traumatic event, may still manifest symptoms of trauma such as low self-esteem, self-destructive behaviors, depression, anxiety and suicidality [ 37 , 38 ]. Susan's multigeneration household struggles with housing instability, substance use disorder and chronic disease, likely related to historical trauma, ACEs, toxic stress and epigenetic modification.

Because of familiarity with Choctaw culture, beliefs, and historical trauma, the NICU clinical team understood the barriers that Susan experienced in seeking care at the Indian Health Service, as well as her fears, mental health, and substance abuse issues. After his premature birth, Charlie's NICU clinical team screened for ACEs, SDOH, and used TIC methodology. This enabled Susan's clinician to provide more informed, empathetic care for Charlie and his family as well as offer appropriate community and cultural resources.

2.2.2. Case study 2 actionable steps

Clinicians can develop an understanding of the histories and cultures of the communities they serve, mindful that not all members of a community will have the same experiences or beliefs. Knowledge of traditional beliefs are helpful in designing integrative approaches to healing and incorporating them into clinical practice to provide culturally appropriate and safe care [ 33 ]. Trauma informed technique are included in Table 1 and resources in Appendix [ 32 , 34 , 35 ]. Table 3 illustrates the impact of historical trauma through the case study of Susan and Charlie.

Table 3

Case study 2: Susan and Charlie - historical trauma.

IHS=Indian Health Service.

2.3. Structural racism and social determinants of health

2.3.1. case study 3: rachel and macy.

Macy is a 9-month-old African American female who presents with her grandmother, Rachel, for an office visit to discuss decreased intake. Macy's weight-for-length is at the 99 th percentile for age. Macy's 20-year-old mother, Renee, died within hours of delivery. The family was told it was from complications of high blood pressure but Rachel seems unsure. She has cared for Macy since birth. Macy's diet currently includes formula, juice and some table foods. Macy lives in a 2-bedroom apartment with her grandmother and boyfriend, and 2 other children ages 14 and 16 years – Macy's maternal aunt and uncle. The family would like to move out but have not been approved for home loans to afford a big enough house in a better neighborhood. They tried to rent a house, but each time the home suddenly becomes “unavailable” when the landlord meets Rachel and her boyfriend in person. The last time they looked at a property, one of the neighbors called the police complaining of “dangerous looking people lurking around.”

2.3.2. Structural racism

Black maternal health inequities. Food deserts. Redlining. Profiling. Structural racism serves as a chronic and insidious accelerator of adverse environments and experiences which contribute to inequities in the prevalence of childhood obesity, infant mortality and low birth weight, and higher maternal morbidity and mortality among Black women [ 39 , 40 ]. A systematic review examining the relationship between racial discrimination and child health in 121 studies found significant results in 76%, and associations between racial discrimination and negative mental health [ 40 ]. The 2021 National Healthcare Quality and Disparities Report found that quality measures tracking person-centered care, patient safety, healthy living, effective treatment, care coordination, and affordable care were worse for Black (43% of quality metrics), Hispanic (36%), AI/AN (40%), Asian (28%), and NHPI (28%) individuals when compared to White counterparts [ 41 ]. The report noted that reduced health care access in minoritized groups was unchanged from annual reports over previous two decades [ 41 ]. The historical and intentional exclusion of certain minoritized groups coupled with disinvestment of specific neighborhoods that include predominantly Black, Indigenous and People of Color have contributed to the modern-day racial segregation of neighborhoods and communities. The inadequate resources of healthcare facilities and fewer primary care and subspecialty clinics result in reduced access to healthcare in these minoritized communities [ 42 ], leading to higher rates of obesity and other chronic diseases [ 15 ]. Chronic stress from racism as experienced through practices exemplified by racialized residential segregation (redlining), police violence and mass incarceration, and healthcare inequities affects individual and community health [ 14 ]. The combined interactions of ACEs, SDOH, racism, epigenetics, and historical trauma and the resultant toxic stress can accelerate and exacerbate the risk of obesity in susceptible children and adults [ 43 ].

2.3.3. Structural racism and immigrants

A literature review by Misra et al. considers how structural racism uniquely impacts the health of racialized immigrants [ 29 ]. The authors propose that structural disadvantages for immigrants are embedded into governmental and institutional policies and impact immigrant health via three pathways: formal racialization via immigration policy and citizenship status; informal racialization via disproportionate immigration enforcement and criminalization including ongoing threats of incarceration and deportation; and economic exploitation and disinvestment [ 29 ]. Racialized policies impact immigrant health through psychosocial experiences (fear, stress, and trauma); inequitable access to essential resources (food, employment, housing, and health care quality); and experiences of discrimination, neglect, violence, and abuse [ [44] , [45] , [46] , [47] , [48] ].

2.3.4. Social determinants of health

The case of Rachel and Macy underscores how social determinants of health can influence a child in utero and after delivery ( Table 4 ). SDOHs are environmental conditions which influence a wide range of health outcomes and quality of life. Poor SDOHs are disproportionately experienced by children from racial and ethnic minoritized groups [ 49 ]. The common theme among the constructs of SDOH and structural racism is that upstream factors have downstream effects that manifest in measurable adverse health outcomes including obesity in children [ 50 ]. SDOHs are influenced by economic, political, and social factors, including racism, and are not the result of individual behavior choices or a genetic predisposition [ 51 ]. The American Academy of Pediatrics states that racism is a core social determinant of health that drives health inequities in children [ 52 ].

Table 4

Case 3: Rachel and Macy - social determinants of health and structural racism.

2.3.5. Case Study 3 Actionable Steps

Approaching the patient and family with respectful curiosity of their story unmasks upstream contributors, directs areas of concern to better focus treatment, and suggests possible interventions. Root causes of chronic stress emerge as clinicians ask “What has happened to you and your family? Tell me your story.” Strictly counseling on diet and physical activity can be ineffective if upstream barriers are not considered. Upstream barriers include, among others, unaddressed food insecurity, lack of transportation, and undiagnosed maternal or caregiver depression which may lead to difficulty maintaining employment for financial stability, adhering to subsequent health maintenance appointments, and contribute to abnormal growth and mental health issues for the child. A more nuanced awareness of intentional exclusion and historical disinvestment of neighborhoods aids treatment plans when considering the family's living environment, housing stability, community safety, and proximity to services including food, school, and healthcare. Table 4 demonstrates, through the story of Macy and Rachel, the intersectionality of structural racism and SDOH with factors described in other cases, i.e., toxic stress, adverse childhood experiences, health inequities. Table 5 offers practice and personal-level opportunities for clinicians to address structural racism.

Table 5

Steps to address racism and develop resiliency.

Adapted from Garner et al., 2021; Goddard, 2021; National Association of Pediatric Nurse Practitioners, 2019.

2.4. Latent adverse childhood experiences

2.4.1. case study 4: elizabeth and gary.

Gary is an 18-month-old White male who presents for a well child visit. His mother, Elizabeth, is concerned because Gary is very clingy and doesn't talk as much as his 16-month-old cousin. Gary's weight-for-length is at the 99 th percentile for age. His birth and medical histories are uncomplicated. Elizabeth received early prenatal care and experienced a “healthy” pregnancy that included adequate exercise, normal weight gain, blood sugar, and blood pressure. Gary was delivered at 39 weeks (birth weight 7 lbs. 14 oz). He was exclusively breastfed until six months of age then transitioned to baby food. Gary continues breastfeeding in addition to eating a variety of table foods, fruits and vegetables. Elizabeth works as elementary school teacher and has employer-sponsored health insurance that covers the cost of the breast pump she uses while at work. Since his parents' divorce, Gary lives with mother.

Despite having adequate financial resources, a safe community, access to health care, healthy affordable foods, and employer-sponsored health insurance, 18-month Gary developed obesity and speech delays possibly due to other risk factors. Using the Safe Environment for Every Kid (SEEK) Questionnaire, Gary screened positive for ACEs including maternal depression, domestic violence, and divorced parents [ 54 ]. Parental stressors, parental divorce and intimate partner violence can increase the risk of obesity as well as mood disorders, speech delay, and other developmental issues [ 55 ]. Unconscious or implicit bias may lead some to believe there are no “ obvious” risk factors for ACEs and obesity in this case. Though the risk factors may be “hidden,” universal ACEs screening and careful history-taking assists in the discovery of such risk factors and guides clinical care. The ultimate goals are to decrease chronic stress and optimize treatment strategies.

2.4.2. Case study 4 actionable steps

ACEs constitute any potentially traumatic events that are perceived stressful to the recipient. While some ACEs may seem obvious, other events such as maternal history of depression, intimate partner violence, weight-based victimization, or peer rejection may be more difficult to detect. Consider ACEs screening for every child, but especially children with obesity, developmental delay, risk for historical trauma, or parental history of mental health disorders.

When medical practices strive to develop medical homes where every parent feels acknowledged and supported, the practice can build supportive relationships that cultivate resilience in children. Vigilance is needed to provide systematic, routine screenings to help with early detection of changes in social or household resources. To potentially mitigate the harmful effects of ACEs, clinicians are encouraged at every encounter to ask about, and listen to the stories of parents, caregivers, and children, regardless of their perceived risk.

While evaluating for past trauma is important, assessment must be balanced with the ability to provide appropriate support of what is discovered at the encounter. Providers can become familiar with supportive community resources, such as social workers, counselors, shelters or support groups, food banks, and cultural centers. Universally employ the four “R” components of trauma informed care as hidden trauma may exist in any patient or family: Realize, Recognize, Respond, and Resist Re-traumatization ( Table 1 ) [ 32 , 34 , 35 ] [ Appendix 1 ]. Finally, the Substance Abuse and Mental Health Services Administration (SAMHSA) publication on trauma informed approach can further inform providers and their practices [ 56 ]. Table 6 illustrates the impact of ACEs through the story of Elizabeth and Gary.

Table 6

Case 4: Elizabeth and Gary - Easy to miss ACES.

EAP = Employee Assistance Program.

3. Discussion

Childhood obesity is a challenging disease to treat. To devise effective strategies for prevention and treatment of childhood obesity, we need to first acknowledge and understand the factors contributing to disparate prevalence and inequitable outcomes found in minoritized and other communities. By acknowledging the role of upstream contributors, pediatric clinicians are able to engage in strategies to optimize the health and well-being of their patients [ 52 ].

In addition to the actionable steps discussed earlier, clinicians can benefit from utilizing tools such as The Implicit Association Test to help explore personal biases [ 57 ]; engage in community activities or educational offerings that augment an understanding of upstream contributing factors to obesity; and continue to be curious to learn their patients’ histories and stories in order to build empathy and reduce frustration in treatment progress [ 58 ]. Providers can also consider universal screening for ACEs and SDOH.

The treatment approach to obesity has historically been overly simplified with a narrow focus of “energy in = energy out”. While diet and exercise are important, they do not tell the whole story or begin to explain the complex interactions of the upstream factors discussed in this paper. Providers are encouraged to look beyond this insufficient model of energy balance, to address historical trauma and other external contributors to health disparities including childhood obesity.

The cases of Daniela, Charlie, Macy, and Gary highlight why the status quo has not been successful in reducing childhood obesity. Providers cannot effectively treat childhood obesity without exploring and addressing the impact of upstream contributors like epigenetics, ACEs, toxic stress, structural and immigrant racism, SDOH, and latent ACEs. By understanding health disparities, we can reframe obesity and its disproportionate prevalence to focus on addressing modifiable risk factors.

4. Conclusion

While this review describes several upstream factors contributing to childhood obesity and offers actionable steps to incorporate into in clinical practice, there are likely many other factors yet to be identified. Furthermore, implementation of actionable steps may come with challenges as clinicians often encounter barriers to optimize obesity management in their practices [ 59 ]. Fig. 2 depicts several barriers to both clinicians and patients, not to mention additional barriers like unmet or unrealistic expectations, inadequate practice space or support services to deliver weight management, and lack of clinical experience. Future research can help to determine best practices in integrating new information into obesity and weight management, clinician education, and the healthcare systems. Continued diligence and curiosity combined with additional investment in clinical research and community resources will assist clinicians in providing targeted care to children and adolescents with obesity.

Barriers to Pediatric Obesity Care∗. ∗Figure used with permission [ 59 ].

Clinicians may also benefit from acknowledging how their approach to childhood obesity may be influenced by their beliefs and lived experiences, and their lack of familiarity with these and other upstream contributors. Clinicians can reimagine clinical care and practice workflow to address obesity by incorporating the practice of trauma-informed care, and implementing the actionable items discussed in this article. Given the increasing rate of obesity among children and adolescents, clinicians and patients alike will benefit from an approach to care that includes a more comprehensive and inclusive framework.

Author contribution (CRediT authorship contribution statement)

All authors were involved in the conception of the article, contributed to the literature searches and identification of pertinent articles, critically reviewed the manuscript, and had final approval of the submitted version.

Ethical review

This submission represents the original work of the authors supported by appropriately cited professional literature. This work did not involve human subjects.

Source of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declarations of competing interest

Acknowledgements.

The authors thank Amy Randall-McSorley, MS, EdD for her critical reading and editing of the manuscript. The authors gratefully acknowledge the graphic art assistance of Amy R. Sharn, MS, RDN, LD in the preparation of Fig. 1 . This manuscript received no funding.

Appendix A Supplementary data related to this article can be found at https://doi.org/10.1016/j.obpill.2022.100040 .

Appendix A. Supplementary data

The following are the supplementary data related to this article: