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Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis.
Jebeile, H, Gow, ML, Baur, LA, Garnett, SP, Paxton, SJ, Lister, NB
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(9):1287-1298
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Abstract
This review aimed to investigate the impact of obesity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in children and adolescents with overweight or obesity. Four databases were searched to identify pediatric obesity treatment interventions, with a dietary component, and validated pre-post intervention assessment of related outcomes. Of 3078 articles screened, 36 met inclusion criteria, with a combined sample of 2589 participants aged 7.8 to 16.9 years. Intervention duration ranged from 1 week to 13 months, with follow-up of 6 months to 6 years from baseline. Prevalence of ED was reported in five studies and was reduced post-intervention. Meta-analyses showed a reduction in bulimic symptoms (eight studies, standardized mean difference [SE], -0.326 [0.09], P < 0.001), emotional eating (six studies, -0.149 [0.06], P = 0.008), binge eating (three studies, -0.588 [0.10], P < 0.001), and drive for thinness (three studies, -0.167 [0.06], P = 0.005) post-intervention. At follow-up, a reduction in ED risk (six studies, -0.313 [0.13], P = 0.012), emotional eating (five studies, -0.259 [0.05], P < 0.001), eating concern (three studies, -0.501 [0.06], P < 0.001), and drive for thinness (two studies, -0.375 [0.07], P < 0.001) was found. Structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms.
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Maternal nicotine dependence is associated with longitudinal increases in child obesogenic eating behaviors.
Cummings, JR, Gearhardt, AN, Miller, AL, Hyde, LW, Lumeng, JC
Pediatric obesity. 2019;(11):e12541
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Abstract
BACKGROUND Meta-analysis shows that parental cigarette smoking is associated with child obesity. OBJECTIVES This study tested for associations between severity of maternal nicotine dependence and longitudinal changes in child eating behavior in archival data analysis. METHODS Maternal nicotine dependence was assessed with the Fagerstrom Test for Nicotine Dependence. Child eating behavior was assessed with the Child Eating Behavior Questionnaire when children were ages 4, 6, 8, and 10. RESULTS Over and above the influence of child age, child biological sex, and family income-to-needs ratio, more severe maternal nicotine dependence was associated with greater increases in child Food Responsiveness (γ = 0.07, SEγ = 0.03, P = .014, 95% CI [0.01, 0.13]) and Emotional Overeating (γ = 0.06, SEγ = 0.03, P = .024, 95% CI [0.01, 0.11]) across 6 years. CONCLUSIONS Maternal nicotine dependence may be a transdiagnostic risk factor that identifies children at risk for reward-driven, obesogenic eating behavior.
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Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis.
Micha, R, Karageorgou, D, Bakogianni, I, Trichia, E, Whitsel, LP, Story, M, Peñalvo, JL, Mozaffarian, D
PloS one. 2018;(3):e0194555
Abstract
BACKGROUND School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. OBJECTIVE To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. METHODS We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children's dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg's and Egger's test evaluated potential publication bias. RESULTS From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. CONCLUSIONS Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.