Complexity around childhood obesity
January 6, 2020
Science Daily/University of Notre Dame
In a new study, researchers examined how various psychological characteristics of children struggling with their weight, such as loneliness, anxiety and shyness, combined with similar characteristics of their parents or guardians and family dynamics affect outcomes of nutritional intervention.
The World Health Organization has estimated more than 340 million children and adolescents ages 5-19 are overweight or obese, and the epidemic has been linked to more deaths worldwide than those caused by being underweight.
The Centers for Disease Control recently reported an estimated 1 in 5 children in the United States, ages 12-18, are living with prediabetes -- increasing their risk of developing type 2 diabetes as well as chronic kidney disease, heart disease and stroke.
Efforts to stem the crisis have led clinicians and health professionals to examine both the nutritional and psychological factors of childhood obesity. In a new study led by the University of Notre Dame, researchers examined how various psychological characteristics of children struggling with their weight, such as loneliness, anxiety and shyness, combined with similar characteristics of their parents or guardians and family dynamics affect outcomes of nutritional intervention.
What they found was a "network effect," suggesting a personalized, comprehensive approach to treatment could improve results of nutritional interventions.
"Psychological characteristics clearly have interactional effects," said Nitesh Chawla, the Frank M. Freimann Professor of Computer Science and Engineering at Notre Dame, director of the Center for Network and Data Science and a lead author of the study. "We can no longer simply view them as individualized risk factors to be assessed. We need to account for the specific characteristics for each child, viewing them as a holistic set for which to plan treatment."
The Notre Dame team collaborated with the Centre for Nutritional Recovery and Education (CREN), a not-for-profit, nongovernmental nutritional clinic in São Paulo, Brazil, where patients participate in a two-year interdisciplinary treatment program including family counseling, nutritional workshops and various physical activities. Researchers analyzed the medical records and psychological assessments of 1,541 children who participated in the program.
The study's key takeaway points to the significant impact parents and guardians have on their child's health when it comes to nutrition. Strong family dynamics, such as concern for behavior and treatment and a sense of protectiveness for the child, led to improved outcomes of nutritional interventions. A lack of authority, however, led to minimal changes in results.
"This is quantitative evidence of the success and failure of interactions as they relate to the characteristics and interactions between the child and the parent or guardian," Chawla said.
The study also highlights the need for clinics to expand their views on patient populations. For example, while treatment programs that incorporate development of interpersonal relationship -- familial and otherwise -- may improve outcomes of nutritional interventions, the same treatment plan may not have the same result for children experiencing loneliness coupled with anxiety.
"For the group without anxiety, this makes sense when you consider a treatment plan focused on strengthening a child's social circle and address issues stemming from loneliness, such as poor social network, bullying or self-imposed isolation," said Gisela M.B. Solymos, co-author of the study, former general manager of CREN and former guest scholar at the Kellogg Institute for International Studies at Notre Dame and at the Center for Network and Data Science. "But patients feeling loneliness and anxiety actually showed minimal changes to nutritional interventions, and may be more likely to benefit from additional services at clinics like CREN."
https://www.sciencedaily.com/releases/2020/01/200106161935.htm
Factors that predict obesity by adolescence revealed
October 16, 2019
Science Daily/Murdoch Childrens Research Institute
Three simple factors that predict whether a healthy weight child will be overweight or obese by adolescence have been revealed in a new study led by the Murdoch Children's Research Institute (MCRI).
The research shows three factors -- a child's and mother's Body Mass Index (BMI) and the mother's education level -- predict the onset or resolution of weight problems by adolescence, especially from age 6-7 years onwards.
Each one-unit higher BMI when the child is aged 6-7 years increased the odds at 14-15 years of developing weight problems by three-fold and halved the odds of resolution.
Similarly, every one-unit increase in the mother's BMI when the child is aged 6-7 years increased the odds at 14-15 years of developing weight problems by 5 per cent and decreased the odds of resolution by about 10 per cent.
Mothers having a university degree was associated with lower odds of a child being overweight and obese at ages 2-5 years and higher odds of resolving obesity issues by adolescence.
Study author MCRI's Dr Kate Lycett said the prevalence of being overweight/obese at the age of 14-15 years was 13 per cent among children with none of these three risk factors at age 6-7 years, compared with 71 per cent among those with all risk factors.
Dr Lycett said identifying these three factors may help clinicians predict which children will develop and resolve excess weight with about 70 per cent accuracy.
"In the case of BMI, it is an objective measure that is easily measured and reflects diet and exercise choices, but is free from the challenges of assessing physical activity and diet in a standard clinical appointment such as recall bias," she said.
The findings, published in the latest edition of the International Journal of Obesity, also found children who are overweight or obese at 2-5 years have a low chance of resolving their weight problems by adolescence when these three risk factors are present.
Data was sourced from 3469 participants at birth and 3276 participants at kinder from the Longitudinal Study of Australian Children. The child's height and weight were measured every two years.
Dr Lycett said until now most studies have overlooked the important questions around which children are likely to become overweight/obese and how it be resolved.
"Because clinicians haven't been able to tell which children will grow up to become teens with excess weight, it's been hard to target interventions for those most at risk," she said.
"The consequences of this are dire, with childhood obesity predicting premature death and being implicated in cardiovascular disease, diabetes and cancer."
The study examined how combinations of 25 potential short clinical markers such as time breastfeeding and amount of outdoor activity at various ages predict weight issues, as well as resolution, by ages 10-11 and 14-15 years.
Intriguingly, short questions about poor diet, low physical activity and other common lifestyle factors were not predictive of weight outcomes.
Lead author Professor Markus Juonala, from the University of Turku in Finland, said a simple risk score, which would be easily available to child health clinicians, could help target treatment or prevention.
"Combining data on these three easily obtainable risk factors may help clinicians make appropriate decisions targeting care to those most at risk of adolescent obesity," he said.
"The benefits of removing a focus on those unlikely to need clinical interventions for obesity has largely been ignored, despite an increasing policy emphasis on avoiding wasteful or unnecessary health care."
https://www.sciencedaily.com/releases/2019/10/191016094911.htm
Despite common obesity gene variants obese children lose weight after lifestyle changes
November 28, 2018
Science Daily/University of Copenhagen The Faculty of Health and Medical Sciences
Children who are genetically predisposed to overweight, due to common gene variants, can still lose weight by changing their diet and exercise habits, according to a new study.
Overweight and obesity constitute an increasing global problem that may lead to serious sequelae such as heart attacks, diabetes and cancer. In 2016, 124 million children and adolescents worldwide suffered from obesity. Now researchers from the University of Copenhagen and the Children's Obesity Clinic, the Department of Paediatrics at Holbæk Hospital have examined how genetics affect children and young people's ability to lose excess weight.
'We are trying to understand the genetic driving force behind overweight and whether this force also makes it impossible for some to lose weight. We show that a high genetic predisposition to overweight during childhood in fact had no influence on whether the children reacted to lifestyle intervention compared to children with low genetic predisposition to overweight. The 15 genetic variants we have studied are common in the population and are the ones that in general increase a child's risk of becoming overweight,' says Postdoc at the Novo Nordisk Foundation Center for Basic Metabolic Research at UCPH Theresia Maria Schnurr, who is one of the authors of the study.
The new research results have just been published in the scientific journal Obesity. The researchers' aim was to determine the influence of specific gene variants on children and adolescents' ability to lose weight. Therefore, they studied the 15 specific gene variants implicated in childhood obesity and which are common in the population. In the study, the researchers demonstrate that these genetic variants did not predict whether children and adolescents' were able to lose weight when they changed their lifestyle. So far only children with a rare genetic mutation in the MC4R gene do not seem to lose weight when undergoing lifestyle intervention.
Lifestyle Intervention Led to Weight Loss
The researchers examined 754 children and adolescents with overweight and obesity. The median age was 11.6 years. The genetic profile of all participants was mapped, and the researchers then calculated a genetic risk score for childhood overweight for each participant based on the 15 genetic variants. They all carried one or more of the 15 genetic variants associated with increased risk for obesity and overweight during childhood. To determine whether a genetic predisposition for overweight affected the children and adolescents' ability to lose weight the children had to implement a series of lifestyle changes.
They followed a treatment protocol developed at Holbæk Hospital. The protocol centres around the family with behavioural lifestyle changes. For example, the children and adolescents had to change their diet, means of transportation, physical activity, sedentary activity, amount of sleep, consumption of snacks and sweet things and social activities. The intervention lasted six to 24 months. Subsequently, the researchers followed up on the treatment and found that the lifestyle changes had affected the weight of the participants, despite their genetic disposition for overweight and obesity.
'Large parts of the population believes that when you have problematic genes it is game over. That is why it is very important we send a clear message that even though you have a genetic sensitivity this treatment can help people. We have discovered that it does not matter whether the children and adolescents have an increased genetic risk score or not. They can respond to treatment just as well. This means our treatment is efficient despite carrying common obesity risk genes. It gives hope to people with obesity and obesity related complications such as high blood pressure, cholesterol and fatty liver that we can in fact help them,' says one of the study's authors Jens-Christian Holm, doctor and head of the Children's Obesity Clinic, Holbæk Hospital.
Genetic Markers
The genetic variants the researchers have examined are common in the population and turned out not to have an effect on the ability to lose weight during the intervention. So far, the researchers did not find any biological markers for a poor response on lifestyle intervention except for the rare gene MC4R associated with poor response in terms of weight loss following a lifestyle intervention.
'MC4R is a rare genetic mutation and thus the question remains why around 75 percent of children in a group of children receiving the exact same treatment react more positively to the treatment compared to the remaining 25 percent of children not responding to lifestyle treatment. Identifying additional common genetic markers would help us understand the biological pathways that affect obesity and a person's reaction to lifestyle changes -- and thus in the long term help us provide even better treatments,' says Professor at the Novo Nordisk Foundation Center for Basic Metabolic Research Torben Hansen, last author of the study.
https://www.sciencedaily.com/releases/2018/11/181128115006.htm