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Prevention of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews.
Hoelscher, DM, Brann, LS, O'Brien, S, Handu, D, Rozga, M
Journal of the Academy of Nutrition and Dietetics. 2022;(2):410-423.e6
Abstract
This Academy of Nutrition and Dietetics Position Paper reports current evidence on pediatric overweight and obesity prevention interventions and discusses implications for registered dietitian nutritionists (RDNs). An overview of current systematic reviews provided evidence-based results from a range of nutrition interventions according to developmental age group (ages 2 to 5, 6 to 12, and 13 to 17 years). Twenty-one current systematic reviews of nutrition interventions demonstrated a beneficial effect of nutrition and physical activity interventions on body mass index measures and no adverse events were identified. RDNs impart nutrition expertise in a wide range of settings to provide comprehensive care for children and adolescents as their nutrition and developmental needs change over time. This Position Paper outlines the current roles of, and proposed directions for, RDNs engaged in pediatric overweight and obesity prevention. Prevention of pediatric overweight and obesity requires comprehensive strategies ranging from policy-level to individual-level interventions in settings that will have the most beneficial impact for children according to their developmental stage. This Position Paper advocates for increased availability of nutrition and food access programs and interventions to reduce risk of pediatric obesity and associated adverse health outcomes both now and for future generations.
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British Dietetic Association's Obesity Specialist Group dietetic obesity management interventions in children and young people: review & clinical application.
Stewart, L, Easter, S, ,
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2021;(1):224-232
Abstract
BACKGROUND Dietitians play a vital role in the management of childhood obesity. To support that role the Obesity Specialist Group of the British Dietetic Association commissioned a review and clinical application paper. This current paper is a summary of that review document, which is available on the BDA's website. METHODS The initial sources of evidence were guidelines, published reviews and government guidance. Best practice advice was sought from networks including the BDA's Obesity and Paediatric Specialists groups. The original document was reviewed by a review group and members of the Obesity and Paediatric Specialist group's committees. RESULTS The overall aim of dietetic interventions in childhood weight management should be to deliver evidence based dietetic weight management care, which helps maintain positive lifestyle changes. To support this aim the review recommends the UK BMI cut off points in setting service referral and triaging criteria. Ensuring the whole child's world is taken into account when undertaking assessment and throughout the programme process is essential. Dietitians working in this field require behavioural change skills, motivational techniques and the ability to communicate to children of differing ages and their parents. Knowledge of local child safe guarding procedures are necessary for all working in this field. Recommendations on basic and advanced skills required are specified. CONCLUSIONS This paper was written to compliment a full review document. The complexities around case management, child protection issues and competing family motivations require dietitians trained at undergraduate and postgraduate level to deliver high quality weight management and behavioural change.
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3.
Front-Of-Pack Nutrition Labelling: A Position Statement of the European Academy of Paediatrics and the European Childhood Obesity Group.
Dereń, K, Dembiński, Ł, Wyszyńska, J, Mazur, A, Weghuber, D, Łuszczki, E, Hadjipanayis, A, Koletzko, B
Annals of nutrition & metabolism. 2021;(1):23-28
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Abstract
BACKGROUND Due to the growing risk of obesity and related diseases in the population of children, effective preventive measures are of great importance. Front-of-pack (FOP) nutrition labelling may contribute to health promotion by increasing consumer awareness on the nutritional qualities of packaged foods and purchasing decisions, and it may stimulate food providers to improve the composition of products. SUMMARY Appropriate labelling should enable customers to make healthy choices quickly and intuitively. Key Messages: The European Academy of Paediatrics and the European Childhood Obesity Group makes an appeal to European Union legislators to immediately introduce a mandatory, uniform, and interpretative FOP nutrition labelling system.
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Simple Energy Balance or Microbiome for Childhood Obesity Prevention?
Baranowski, T, Motil, KJ
Nutrients. 2021;(8)
Abstract
Obesity prevention interventions generally have either not worked or had effects inadequate to mitigate the problem. They have been predicated on the simple energy balance model, which has been severely questioned by biological scientists. Numerous other etiological mechanisms have been proposed, including the intestinal microbiome, which has been related to childhood obesity in numerous ways. Public health research is needed in regard to diet and the microbiome, which hopefully will lead to effective child obesity prevention.
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The Effects of Non-Nutritive Sweetener Consumption in the Pediatric Populations: What We Know, What We Don't, and What We Need to Learn.
Shum, B, Georgia, S
Frontiers in endocrinology. 2021;:625415
Abstract
Childhood obesity is increasing at an alarming rate in the United States. This trend carries serious risk of children developing obesity-related diseases including Type 2 diabetes and cardiovascular disease. Non-nutritive sweeteners (NNS) are used as substitution for table sugar as a way to prevent weight gain. Their consumption is ubiquitous in adults and children; however the long-term health outcomes of chronic NNS consumption in children are unclear. Conflicting observational studies suggest that children consuming NNS are at risk of obesity and development of type 2 diabetes, while others concluded some benefits in weight reduction. Here, we review the physiological mechanisms that can contribute to the negative metabolic effects of NNS. We will focus on how NNS alters the sweet perception leading to increase caloric consumption, how NNs alters the gut microbiota, and how NNS may disrupt glucose homeostasis and initiate a vicious cycle of pancreatic endocrine dysfunction. Studies focused on the pediatric population are limited but necessary to determine whether the potential weight loss benefits outweigh the potential negative metabolic outcomes during this critical development period.
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Progress towards Achieving the Recommendations of the Commission on Ending Childhood Obesity: A Comprehensive Review and Analysis of Current Policies, Actions and Implementation Gaps in Thailand.
Phulkerd, S, Nakraksa, P, Mo-Suwan, L, Lawrence, M
Nutrients. 2021;(6)
Abstract
Despite a significant commitment to tackling childhood overweight and obesity, questions remain about the progress the Thai Government has made in implementing childhood obesity prevention policies and actions. This study aimed to review and assess the implementation of the government's policies and actions for childhood obesity prevention in Thailand compared with the recommendations of the Commission on Ending Childhood Obesity and to identify the implementation gaps. Policy data were collected from governmental and NGO websites and publications and via direct contact with government officials. Stakeholder meetings were held to seek further information and advice on implementation gaps and to give recommendations. The analysis of each policy was conducted against pre-determined criteria formulated from literature assessments and stakeholder consultations. The policies and actions that were implemented by the Government were consistent with 33 broad policy actions and 55 specific policy actions. Preconception and pregnancy care was the policy area that was most implemented. Six broad policy actions were assessed as 'high' performance, these were: sugar-sweetened beverage taxation, nutrient labeling, nutrition guidance for preconception and pregnancy care, the International Code of Marketing of Breast-milk Substitutes, regulatory measures for supporting maternal breastfeeding, and regulations on the marketing of complementary foods and beverages. Policy coherence and monitoring and evaluation (M&E) were identified as major implementation gaps. Increasing the effectiveness of childhood obesity prevention in Thailand will require national immediate attention towards building infrastructure to enhance coherence among the policies and to put in place M&E mechanisms for each policy.
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[Eating disorders and obesity in adolescents: Another challenge of our times].
Behar, R, Marín, V
Andes pediatrica : revista Chilena de pediatria. 2021;(4):626-630
Abstract
Obesity (OB) and feeding and eating disorders (FED) are complex and prevalent pathologies in ado lescents. OB has been shown to be a risk factor for developing binge eating disorder and bulimia nervosa, and vice versa, these FED also develop OB. However, obese adolescents may present atypical or sub-threshold criteria for FED. The objective of this review is to describe the epidemiological, cli nical, and therapeutic relationship between FED and OB in adolescents, with emphasis on the urgent need for research and collaboration among professionals in the fields of mental health and nutrition.
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Association of maternal caffeine intake during pregnancy with low birth weight, childhood overweight, and obesity: a meta-analysis of cohort studies.
Jin, F, Qiao, C
International journal of obesity (2005). 2021;(2):279-287
Abstract
BACKGROUND Epidemiological studies reported inconsistent results on the associations between maternal caffeine intake during pregnancy and risk of low birth weight (LBW) and childhood overweight and obesity in their offspring. METHODS We conducted a meta-analysis of cohort studies to quantitatively assess these associations. Pertinent studies were identified by searching PubMed and Embase through June 2019. Study-specifics risk estimates were combined using fixed effects models, or random-effects models when significant heterogeneity was detected. Dose-response analysis was modeled by using restricted cubic splines. RESULTS A total of 15 cohort studies, with 102,347 pregnancy women, was included in the meta-analysis. The pooled relative risk (RR) for LBW was 1.33 (95% CI: 1.12, 1.57) for mothers with the highest compared with the lowest level of caffeine intake during pregnancy, with significant heterogeneity across studies (I2 = 49.3%, P = 0.032). The pooled RR was 1.07 (95% CI: 1.02, 1.11) for each 100 mg/day increase of caffeine intake. The pooled RR for childhood overweight and obesity was 1.39 (95% CI: 1.15, 1.69) for mothers with the highest compared with the lowest level of caffeine intake during pregnancy. No significant heterogeneity across studies was detected (I2 = 38.9%, P = 0.179). The pooled RR was 1.31 (95% CI: 1.11, 1.55) for each 100 mg/day increase of caffeine intake. No evidence of publication bias was indicated. CONCLUSIONS Maternal caffeine intake during pregnancy is associated with higher risk of LBW and childhood overweight and obesity. Further studies may focus on investigating the potential mechanisms before the recommendation of complete avoidance of caffeine intake during pregnancy.
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Promoting Fruit and Vegetable Consumption for Childhood Obesity Prevention.
Folkvord, F, Naderer, B, Coates, A, Boyland, E
Nutrients. 2021;(1)
Abstract
Currently, food marketing for unhealthy foods is omnipresent. Foods high in fat, salt, and sugar (HFSS) are advertised intensively on several media platforms, including digital platforms that are increasingly used by children, such as social media, and can be bought almost everywhere. This could contribute to the obesity epidemic that we are facing. As the majority of children and adolescents do not eat the recommended amount of fruits and vegetables (F&V), which leads to chronic diseases, we need to change the obesogenic environment to a healthogenic environment. Reducing the marketing of energy-dense snacks to children and increasing the promotion of healthier foods, such as fruits and vegetables, may be an effective and necessary instrument to improve the dietary intake of children and reduce the risk of their experiencing some chronic diseases later in life. With this focused narrative review, we provide an overview of how children and adolescents react to food promotions and how food promotional efforts might be a useful tool to increase the attractiveness of fruit and vegetables. This review therefore contributes to the question of how changing the advertising and media environment of children and adolescents could help create a world where the healthy choice is the easier choice, which would reduce childhood obesity and improve children's health, as well as to make the food system more sustainable.
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Pediatric Metabolic and Bariatric Surgery.
Steinhart, A, Tsao, D, Pratt, JSA
The Surgical clinics of North America. 2021;(2):199-212
Abstract
Childhood obesity can lead to comorbidities that cause significant decrease in health-related quality of life and early mortality. Recognition of obesity as a disease of polygenic etiology can help deter implicit bias. Current guidelines for treating severe obesity in children recommend referral to a multidisciplinary treatment center that offers metabolic and bariatric surgery at any age when a child develops a body mass index that is greater than 120% of the 95th percentile. Obesity medications and lifestyle counseling about diet and exercise are not adequate treatment for severe childhood obesity. Early referral can significantly improve quality and quantity of life.