Emotional Health Predicts Changes in Body Mass Index (BMI-z) Among Black and Latino Youth Direct and indirect effects of a family-based intervention in early adolescence on parent-youth relationship quality, late adolescent health, and early adult obesity. Evaluating Parents and Adult Caregivers as ‘Agents of Change’ for Treating Obese Children – Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement from the American Heart Association Obesity in children. Part 2: Prevention and management The association of physical activity and physical fitness with pre-adolescent obesity: an observational study in Metromanila, Philippines. Childhood obesity: impact on cardiac geometry and function. Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials Obesity and Type 2 Diabetes Risk in Midadult Life: The Role of Childhood Adversity Effects of the Dietary Approaches to Stop Hypertension Diet, Exercise, and Caloric Restriction on Neurocognition in Overweight Adults With High Blood Pressure Depressive symptoms in adolescence: the association with multiple health risk behaviors. Motivational Interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: Methodology and design A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults Innovative interventions in pediatric obesity: commentary and future directions. Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children Perceived weight in youths and risk of overweight or obesity six years later. Childhood Cumulative Risk and Obesity: The Mediating Role of Self-Regulatory Ability Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Weight Management Interventions in Adult and Pediatric Asthma Populations: A Systematic Review. Gut Microbiota in the First 2 Years of Life and the Association with Body Mass Index at Age 12 in a Norwegian Birth Cohort The Relationship between Obesity and Cognitive Performance in Children: A Longitudinal Study. Relationship between weight status and delay discounting in a sample of adolescent cigarette smokers A Transtheoretical, Case Management Approach to the Treatment of Pediatric Obesity Effects of 3 hours a week of physical activity on body fat and cardio-respiratory parameters in obese boys.
Childhood obesity is a complex and multifaceted health problem linked to elevated risk for chronic diseases , such as diabetes , cancer , hypertension , and cardiovascular disease.1,2 Although research has increased dramatically in the past 2 decades , questions regarding factors driving overweight and obesity remain , particularly among youth of color who experience disproportionate rates of obesity and comorbid health conditions.3 Adolescence is a critical period in the developmental trajectory,4 in part because overweight and obese adolescents are more likely to remain overweight and /or obese in adulthood.3 Overweight and obesity have been associated with adverse symptoms and intra- and interpersonal psychological , social , and emotional issues that continue into adulthood , including depression and anxiety , social withdrawal , feeling worthless , lower self-esteem , and behavioral problems.5–7 Poor mental health may lead to increases in weight due to fluctuations in appetite , obesogenic behaviors ( eg , overeating ) to cope with negative mood , sedentary behavior , and increased isolation.8 Chronic stress or experiences of discrimination may also influence physiology and behaviors that affect weight gain.9 On the other h and , increased body mass index ( BMI ) could result in adverse emotional outcomes over time due to weight-based stigma , bullying , or poor self-esteem.5,6 The few longitudinal studies that have examined the association between emotional health and physical health outcomes have primarily taken a narrow focus of mental health symptoms ( e.g. , only examining depression)10 or behavioral concerns ( e.g. , conduct).11 Physical outcomes , including BMI , were often collected by self-report12 and /or retrospectively.13 Furthermore , they have been limited to predominantly White sample s of older adolescents or adults.12,13 Persistent racial and ethnic disparities in overweight and obesity further complicate research as well as clinical prevention and intervention efforts . Black and Latino youth experience disproportionate levels of overweight and obesity beginning as early as preschool and are more likely to remain obese as adults compared with Whites.14 Blacks and Latinos also are at disproportionate risk for multiple negative health conditions associated with overweight and obesity , such as diabetes.14,15 Reasons for such disparities remain poorly understood and understudied . Although emotional health has been associated with weight in both adults and youth,16 prior research has been limited to cross-sectional studies .17 Longitudinal , prospect i ve design s are critical to explicate the association between emotional health and BMI among Black and Latino youth . The primary objective of this study is to examine whether negative emotional symptoms prospect ively predict increases in BMI z-scores ( BMI -z ) across 2 years among a sample of predominantly Black and Latino , urban youth . We hypothesize that more negative emotional symptoms measured at baseline ( grade s 5 and 6 ) would predict increases in BMI -z scores 2 years later . Results can inform programs and interventions aim ed at reducing obesity in youth of color We explored family processes in adolescence that may influence the likelihood of  obesity  in early adulthood using a r and omized trial of a family-based intervention ( the Family Check-Up , or FCU ) . The FCU has been shown to reduce escalations in antisocial behavior and depression in adolescence by supporting positive family management practice s , but no research has examined the mechanisms by which the FCU could influence health-related attitudes and behaviors linked to obesity . Participants were 998 adolescents ( n = 526 male ; n = 423 European American ; M age 12.21 years ) and their families , recruited in 6th grade from 3 middle schools in the Pacific Northwest . We used structural equation modeling ( SEM ) and an Intent-To-Treat ( ITT ) design to evaluate the direct and indirect effects of the FCU on parent-youth relationship quality ( ages 12 - 15 ) , healthy lifestyle behaviors , eating attitudes , depressive symptoms ( all measured at age 17 ) , and obesity ( age 22 ) . We found that the FCU led to greater parent-youth relationship quality , which predicted enhanced health-related behaviors , reduced maladaptive eating attitudes , and reduced depression . In turn , reduced maladaptive eating attitudes predicted reduced odds of obesity . The indirect effect of the  FCU on obesity by way of parent-youth relationship quality and eating attitudes was significant . Our findings illustrate how family processes may influence adolescent health and suggest that family functioning may be an additional factor to consider when developing intervention programs for obesity This Scientific Statement addresses  Parents and Adult Caregivers ( PACs )  as ‘ agents of change ’ for obese children . Evidence is review ed to support the notion that PACs can leverage behavior change and reduce positive energy balance in obese youth , and research opportunities for the field are discussed . The Statement has three specific aims : First , the core behavior change strategies for PACs as used in family-based treatment programs are review ed . These strategies reduce childhood overweight compared to no treatment or nutrition education alone , although their limited potency is recognized . Second , the strength of evidence is evaluated for the hypothesis that greater parental ‘ involvement ’ in treatment is associated with greater reductions in child overweight . Drawing upon r and omized clinical trials that varied the degree/nature of parental involvement , and observational analyses that assessed parental adherence to behavioral strategies , we report limited and inconsistent support . For example , only 17 % of the intervention studies reported differential improvements in child overweight as function of parental involvement after treatment . On the other h and , greater parental adherence predicted better child weight outcomes after 2 and 5 years in certain studies . Third , research gaps identified throughout this review process are delineated and new opportunities for the field are proposed . For example , the assessment of refined parenting phenotypes , cultural tailoring of interventions , examination of family relationships , and incorporating new technologies in treatment represent topics needing further study . A conceptual model is proposed to guide research on underst and ing the determinants of parental feeding and physical-activity parenting practice s. The Statement strives to innovate the scope and potency of PAC treatments for childhood obesity # # # # Summary points In the first part of this article we described how obesity in children is measured , its prevalence , whether children should be screened , and the risk factors for and consequences of obesity.1 In this part we review the current evidence on the prevention and management of childhood obesity . # # # # Sources and selection criteria This review draws on the Foresight report , guidance from the National Institute for Health and Clinical Excellence and the Australian National Health Medical Research Council , and Cochrane review . In April 2008 we search ed the Cochrane Library data base of review s and the Centre for Review s and Dissemination data bases using the search term “ obesity ” . We also conducted a Medline search ( ( Child$ or paediatric or pediatric or adolescent ) and ( Obes$ or overweight ) ) limited to 1 January 2005 to 6 May 2008 and “ review articles ” ; this identified 1105 articles . We read the abstract s of these articles and retrieved relevant papers . We also used articles from our own bibliographies collected over the past 10 years . The evidence to support the measurement , prevention , and management of obesity in children is still relatively weak , with few r and omised controlled trials or systematic review s. The strength of evidence is developing and the up date d Cochrane review that will be published in 2009 BACKGROUND Childhood obesity has been inconsistently associated with decreased levels of physical activity and fitness . Moreover , little is known about this relationship among Filipino preteens . METHODS This cross sectional study reports the association between childhood obesity , measures of physical activity , and fitness .  Children aged 11 to 12 from r and omly selected schools from San Juan , Metromanila were included . Outcome measures were body mass index , Filipino modified Physical Activity Question naire for Older children ( F_PAQ-C ) ,  st and ing broad jump , 50 m sprint  and  20 m multistage shuttle run .  RESULTS 380 children participated in the study . Obese children had significantly lower median scores in the F_PAQ-C compared with overweight children . Overweight children had lower scores in the st and ing broad jump , 50 m sprints and predicted VO2max as compared with children with normal BMI . There were modest associations between the 50 m sprint , predicted VO2max , and F_PAQ-C. CONCLUSION Our study has showed that physical activity and fitness scores were strongly correlated with childhood obesity . If childhood physical fitness is a predictor of physical fitness in adulthood which is a risk factor in cardiovascular diseases , there is a strong possibility that the prevalence of cardiovascular disease in the Philippines will increase dramatically in the future OBJECTIVES The aim of our study was to assess geometric and functional changes of the heart in obese compared with nonobese children and adolescents . BACKGROUND Obesity in children and adolescents has increased over the past decades and is considered a strong risk factor for future cardiovascular morbidity and mortality . Obesity has been associated with myocardial structural alterations that may influence cardiac mechanics . METHODS We prospect ively recruited 61 obese ( 13.5 ± 2.7 years of age , 46 % male sex , SD score body mass index , 2.52 ± 0.60 ) and 40 nonobese ( 14.1 ± 2.8 years of age , 50 % male sex , SD score body mass index , -0.33 ± 0.83 ) consecutive , nonselected Caucasian children and adolescents . A st and ardized 2-dimensional ( 2D ) echocardiography and 2D speckle-tracking analysis was performed in all children .  Furthermore , blood chemistry including lipid and glucose metabolism was assessed in all children . RESULTS Compared with nonobese children , blood pressure , low-density lipoprotein cholesterol , and parameters of glucose metabolism were significantly increased in obese children , whereas high-density lipoprotein cholesterol was significantly lower . Compared with nonobese children , obese children were characterized by enlarged left- and right-sided cardiac chambers , thicker left ventricular walls , and , consequently , increased left ventricular mass . Despite a comparable left ventricular ejection fraction , decreased tissue Doppler-derived peak systolic velocity and regional basoseptal strain were found in obese children compared with nonobese children . Beyond that , 2D speckle tracking-derived longitudinal ( -18.2 ± 2.0 vs. -20.5 ± 2.3 , p < 0.001 ) and circumferential ( -17.0 ± 2.7 vs. -19.5 ± 2.9 , p < 0.001 ) strain of the left ventricle was reduced in obese children compared with nonobese children . Diastolic function was also impaired in obese compared with nonobese children . Both longitudinal strain and circumferential strain were independently associated with obesity . CONCLUSIONS The results of this study demonstrate that childhood obesity is associated with significant changes in myocardial geometry and function , indicating an early onset of potentially unfavorable alterations in the myocardium Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting OBJECTIVE . Child abuse has been associated with poorer physical health in adulthood , but less is known about childhood adversity more broadly , including neglect and family problems , or the pathways from adversity to adult disease . We have examined how different stressful emotional or neglectful childhood adversities are related to adiposity and glucose control in midadulthood , taking into account childhood factors , and whether the relationships are mediated by adult health behaviors and socioeconomic position . METHODS . This was a prospect i ve longitudinal study of 9310 members of the 1958 British birth cohort who participated in a biomedical interview at 45 years of age . Primary outcomes consisted of continuous measures of BMI , waist circumference , and glycosylated hemoglobin at 45 years and categorical indicators : total obesity ( BMI ≥ 30 ) , central obesity ( waist circumference : ≥102 cm for men and ≥88 cm for women ) , and glycosylated hemoglobin level of ≥6 . RESULTS . The risk of obesity increased by 20 % to 50 % for several adversities ( physical abuse , verbal abuse , witnessed abuse , humiliation , neglect , strict upbringing , physical punishment , conflict or tension , low parental aspirations or interest in education , hardly takes outings with parents , and father hardly reads to child ) . Adversities with the strongest associations with adiposity ( eg , physical abuse ) tended to be associated with glycosylated hemoglobin levels of ≥6 , but in most cases associations were explained by adjustment for adulthood mediators such as adiposity . Effects of other adversities reflecting less severe emotional neglect and family environment were largely explained by childhood socioeconomic factors . CONCLUSIONS . Some childhood adversities increase the risk of obesity in adulthood and thereby increase the risk for type 2 diabetes  . Research is needed to underst and the interrelatedness of adversities , the social context of their occurrence , and trajectories from adversity to adult disease High blood pressure increases the risks of stroke , dementia , and neurocognitive dysfunction . Although aerobic exercise and dietary modifications have been shown to reduce blood pressure , no r and omized trials have examined the effects of aerobic exercise combined with dietary modification on neurocognitive functioning in individuals with high blood pressure ( ie , prehypertension and stage 1 hypertension ) . As part of a larger investigation , 124 participants with elevated blood pressure ( systolic blood pressure 130 to 159 mm Hg or diastolic blood pressure 85 to 99 mm Hg ) who were sedentary and overweight or obese ( body mass index : 25 to 40 kg/m2 ) were r and omized to the Dietary Approaches to Stop Hypertension ( DASH ) diet alone , DASH combined with a behavioral weight management program including exercise and caloric restriction , or a usual diet control group . Participants completed a battery of neurocognitive tests of executive function-memory-learning and psychomotor speed at baseline and again after the 4-month intervention . Participants on the DASH diet combined with a behavioral weight management program exhibited greater improvements in executive function-memory-learning ( Cohen 's D=0.562 ; P=0.008 ) and psychomotor speed ( Cohen 's D=0.480 ; P=0.023 ) , and DASH diet alone participants exhibited better psychomotor speed ( Cohen 's D=0.440 ; P=0.036 ) compared with the usual diet control . Neurocognitive improvements appeared to be mediated by increased aerobic fitness and weight loss . Also , participants with greater intima-medial thickness and higher systolic blood pressure showed greater improvements in executive function-memory-learning in the group on the DASH diet combined with a behavioral weight management program . In conclusion , combining aerobic exercise with the DASH diet and caloric restriction improves neurocognitive function among sedentary and overweight/obese individuals with prehypertension and hypertension OBJECTIVE Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking , this is one of the few studies that examined the association between depression and multiple risk behaviors . METHODS A brief mail question naire , which screened for age , gender , weight , height , sedentary behaviors , physical activity , perception of general health , functional impairment and depressive symptoms , was completed by a sample of 2291 youth ( 60.7 % response rate ) aged 13 - 17 enrolled in a health care plan . A subset of youth who screened positive on the two-item depression screen and a r and om sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use . RESULTS Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity , had a poorer perception of health , spent more time on the computer , got along less well with parents and friends , had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use . CONCLUSIONS Because many adverse health behaviors that develop in adolescence continue into adulthood , the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual , school , community and primary care level Background Childhood obesity is associated with serious physiological and psychological consequences including type 2 diabetes , higher rates of depression and low self-esteem . With the population of overweight and obese youth increasing , appropriate interventions are needed that speak to the issue of readiness to change and motivation to maintain adherence to healthy behavior changes . Motivational Interviewing ( MI ) is a method of therapy found to resolve ambivalence , enhance intrinsic motivation and promote confidence in a person 's ability to make behavior changes . While MI has shown promise in the adult obesity literature as effecting positive lifestyle change , little is known about the effectiveness of MI with overweight and obese youth . This study aims to : 1 ) demonstrate that MI is an effective intervention for increasing a person 's self-efficacy ; 2 ) demonstrate that exposure to MI will facilitate healthy behavior changes ; 3 ) explore psychological changes related to participation in MI and 4 ) compare physiological and anthropometric outcomes before and after intervention . Methods / Design The current investigation is a prospect i ve study conducted with ongoing participants who regularly attend an outpatient pediatric care center for weight-loss . Overweight youth ( BMI > 85th % ile ) between the ages of 10 and 18 who meet eligibility criteria will be recruited . Participants will be r and omly assigned to a control group ( social skills training ) or a treatment group ( MI ) . Participants will meet with the therapist for approximately 30 minutes prior to seeing the dietician , over the course of 6 months . Participants will also undergo a full day assessment at the beginning and end of psychology intervention to evaluate body fat , and metabolic risk ( screening for diabetes , high cholesterol , high blood pressure and fitness level ) . The paper and pencil portions of the assessment s as well as the clinical testing will occur at baseline and at the conclusion of the intervention ( 6 months ) with a repeat assessment 6 months following the completion of the intervention . Discussion Results from this study are expected to enhance our underst and ing of the efficacy of  MI with children and adolescents who are overweight or obese . Trial registration Current Controlled Trials # NCT00326404 Loneliness is a prevalent and global problem for adult population s and has been linked to multiple chronic conditions in quantitative studies . This paper presents a systematic review of quantitative studies that examined the links between  loneliness  and common chronic conditions including : heart disease , hypertension , stroke , lung disease , and metabolic disorders . A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness population s.  Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease , hypertension , stroke , and lung disease . The relationships among loneliness , obesity , and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons . Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions . Future longitudinal r and omized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care As described in the manuscripts in this special issue , pediatric obesity is an epidemic that challenges the health of children in the United States and globally , and places considerable burden on all levels of our health care system . During the past decade , pediatric psychologists have actively pursued an underst and ing of the psychosocial correlates of pediatric obesity and developed effective interventions based on this knowledge . This special issue is a reflection of the considerable progress that has been made in this arena , while simultaneously paving the way for the work that remains to be done . Treatment Models Several of the manuscripts in this special issue outline novel approaches for intervening with obese children and adolescents . Overweight/obese adolescents present a particular challenge for intervention stemming from developmentally normative striving for autonomy , the ambiguous role of parents in initiating and supporting weight control , and decreased body satisfaction ( Jelalian et al. , 2010 ) . Walpole , Dettmer , Morrongiello , McCrindle , and Hamilton ( 2013 ) r and omized youth with a mean age of 13.9 years to six sessions of motivational interviewing ( MI ) or social skills training combined with st and ard care . There was no advantage to MI over social skills training with regard to change in body mass index z-score ( z BMI ) or self-efficacy . When groups were combined , adolescents demonstrated significant increases in self-efficacy related to weight-control behaviors and a trend toward decrease in weight status . Of interest , attendance at MI sessions was superior to that for social skills sessions , suggesting that MI may be an effective strategy for engaging adolescents . MI may serve as an initial engagement strategy or an adjunctive treatment to support weight control in adolescents . In a study with adults ( West , DiLillo , Bursac , Gore , & Greene , 2007 ) , participants r and omized to st and ard group-based behavioral obesity treatment combined with adjunctive motivational sessions demonstrated superior weight loss compared with those r and omized to behavioral weight loss treatment and attention control sessions . In the area of weight control for adolescents , we may need to combine MI with more intensive lifestyle interventions to see incremental benefits in body mass index ( BMI ) decrease . A second strategy for enhancing motivation to facilitate weight change is seen in the study by Saelens , Lozano , and Scholz ( 2013 ) . This study , which was conducted with school-age children rather than adolescents , presents another model for incorporating motivational factors into intervention development . These investigators r and omized children between the ages of 7 and 11 years to a 20-week behavioral weight-control intervention with a st and ard untailored prescription of weekly goals by the interventionist or a ‘ ‘ self-directed ’ ’ approach in which parent – child dyads were encouraged to increase autonomy in selection of weekly goals based on their own motivation . Interestingly , children and parents in both treatment conditions showed significant reductions in z BMI and BMI , respectively , with no added benefit associated with the enhanced motivational approach . As noted by the authors , there may be alternative models for more explicitly enhancing motivation that would result in stronger outcomes Background There is growing evidence of the impact of overweight and obesity on short- and long-term functioning , health and well-being . Internationally , childhood obesity rates continue to rise in some countries ( for example , Mexico , India , China and Canada ) , although there is emerging evidence of a slowing of this increase or a plateauing in some age groups . In most European countries , the United States and Australia , however , socioeconomic inequalities in relation to obesity and risk factors for obesity are widening . Addressing inequalities in obesity , therefore , has a very high profile on the public health and health services agendas . However , there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity . Methods and design This article describes the protocol for a National Health Service Trust ( NHS ) National Institute for Health Research -funded systematic review of public health interventions at the individual , community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years . The studies will be selected only if ( 1 ) they included a primary outcome that is a proxy for body fatness and ( 2 ) examined differential effects with regard to socioeconomic status ( education , income , occupation , social class , deprivation and poverty ) or the intervention was targeted specifically at disadvantaged groups ( for example , children of the unemployed , lone parents , low income and so on ) or at people who live in deprived areas . A rigorous and inclusive international literature search will be conducted for r and omised and nonr and omised controlled trials , prospect i ve and retrospective cohort studies ( with and /or without control groups ) and prospect i ve repeat cross-sectional studies ( with and /or without control groups ) . The following electronic data bases will be search ed : MEDLINE , Embase , CINAHL , PsycINFO , Social Science Citation Index , ASSIA , IBSS , Sociological Abstract s and the NHS Economic Evaluation Data base . Data base search es will be supplemented with website and grey literature search es . No studies will be excluded on the basis of language , country of origin or publication date . Study inclusion , data extraction and quality appraisal will be conducted by two review ers . Meta- analysis and narrative synthesis will be conducted . The main analysis will examine the effects of ( 1 ) individual , ( 2 ) community and ( 3 ) societal level public health interventions on socioeconomic inequalities in childhood obesity . Interventions will be characterised by their level of action and their approach to tackling inequalities . Context ual information on how such public health interventions are organised , implemented and delivered will also be examined . Discussion In this review , we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity , highlight any gaps in the evidence base and seek to establish how such public health interventions are organised , implemented and delivered . PROSPERO registration number : OBJECTIVE To examine the association between perceived overweight in adolescents and the development of overweight or obesity later in life . METHODS This paper uses data from a prospect i ve , two-wave cohort study . Participants are 2445 adolescents 11 - 17years of age who reported perceived weight at baseline and also had height and weight measured at baseline and at follow-up six years later sample d from managed care groups in a large metropolitan area . RESULTS Youths who perceived themselves as overweight at baseline were approximately 2.5 times as likely to be overweight or obese six years later compared to youths who perceived themselves as average weight ( OR=2.45 , 95 % CI=1.77 - 3.39 ) , after adjusting for weight status at baseline , demographic characteristics , major depression , physical activity and dieting behaviors . Those who perceived themselves as skinny were less likely to be overweight or obese later ( OR=0.36 , 95 % CI=0.27 - 0.49 ) . CONCLUSIONS Perceived overweight was associated with overweight or obesity later in life . This relationship was not fully explained by extreme weight control behaviors or major depression . Further research is needed to explore the mechanism involved Objectives : We tested whether early childhood risk exposures are related to weight gain in adolescence and evaluate an underlying mechanism , self-regulatory behavior , for the risk-obesity link . Methods : Cumulative risk exposure to 9 sociodemographic ( eg , poverty ) , physical ( eg , subst and ard housing ) , and psychosocial ( eg , family turmoil ) stressors was assessed in 244 nine-year-old children .  BMI was calculated at age 9 and then 4 years later . At age 9 , children ’s ability to delay gratification as an index of self-regulatory behavior was assessed . Path analyses were then estimated to evaluate our mediational model ( Cumulative risk → Self-regulation → BMI ) over a 4-year period in a prospect i ve , longitudinal design . Results : Nine-year-old children exposed to a greater accumulation of multiple risk factors show larger gains in adiposity over the next four year period , net of their initial BMI . These gains in BMI during early adolescence are largely accounted for by deteriorated self-regulatory abilities among children facing more cumulative risks . Conclusions : Early childhood risk exposure leads to larger gains in BMI in adolescence . Given the importance of childhood adiposity to the development of obesity later in life , underst and ing the underlying mechanisms that link early experience to weight gain is an essential task . Deficiencies in self-regulation in response to chronic stress appears to be an important agent in the obesity epidemic Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : BACKGROUND Ample evidence suggests a dose-response relationship between increasing weight and level of asthma risk or reduced asthma control . To establish reversibility , several r and omized controlled trials ( RCTs ) have recently been published to investigate the impact of weight management on asthma . This systematic review synthesizes evidence from these RCTs on the effects of weight management ( weight loss , weight maintenance , maintenance of lost weight , or weight gain prevention ) interventions on  asthma outcomes in both adult and pediatric population s. METHODS We search ed Medline , CINAHL , PsychInfo , and Cochrane for studies published between 1950 and November 2014 . Two research ers independently rated the included studies using the quality assessment tool for RCTs as outlined in the 2013 Obesity Treatment Guideline . Discrepancies were resolved by consensus after discussion between the raters and , if needed , with the senior author . RESULTS Four RCTs in adults and 3 in children and adolescents were included . The adult studies seem to consistently support the benefit of substantial weight loss , but a threshold effect may exist such that only weight loss beyond a minimal amount will likely lead to clinical ly important improvement in asthma outcomes . Three of them suggest that the threshold may lie between 5 - 10 % of weight loss . RCTs in youth suggest that modest calorie reductions alone or combined with increased physical activity , or even a healthy normocaloric diet , may lead to improved asthma outcomes . However , most RCTs review ed were limited by small sample size , short intervention duration s , and short follow-up periods . CONCLUSION Trial evidence shows the promise of weight loss interventions for asthma control in adults and youth . More adequately-powered , long-term RCTs are needed to eluci date the role of weight loss and other weight management interventions in asthma control and prevention . Definitive data are needed to guide clinical and public health practice to effectively address the dual epidemic of obesity and asthma Underst and ing the role of the early-life gut microbiota in obesity is important because there may be opportunities for preventive strategies . We examined the relationships between  infant gut microbiota at six times during the first two years of life and BMI at age 12 in a birth cohort of 165 children and their mothers . We found that the gut microbiota from early life to two years shows an increasingly strong association with childhood BMI . This study provides preliminary evidence that the gut microbiome at 2 years of age may offer useful information to help to identify youth who are at risk for obesity , which could facilitate more-targeted early prevention efforts . ABSTRACT Childhood obesity is a growing problem worldwide . Recent research suggests that the gut microbiota may play an important and potentially causal role in the development of obesity and may be one mechanism that explains the transgenerational transmission of obesity risk . Here we examine the early-life gut microbiota at days 4 , 10 , 30 , 120 , 365 , and 730 and the association with body mass index ( BMI ) z-scores at age 12 in a Norwegian prospect i ve cohort ( n = 165 ) , and evaluate how these BMI -associated taxa relate to maternal overweight/obesity ( Ow/Ob ) and excessive gestational weight gain ( GWG ) . We performed 16S rRNA gene sequencing on the gut microbiota sample s. Taxonomic phylogeny at days 10 and 730 was significantly associated with childhood BMI , and the gut microbiota taxa at two years of age explained over 50 % of the variation in childhood BMI in this cohort . The subset of the early-life taxa within the gut microbiota that best predicted later childhood BMI showed substantial overlap with the maternal taxa most strongly associated with maternal Ow/Ob and excessive GWG . Our results show an association between the infant gut microbiota and later BMI , and they offer preliminary evidence that the infant gut microbiota , particularly at 2 years of age , may have potential to help identify children at risk for obesity . IMPORTANCE Underst and ing the role of the early-life gut microbiota in obesity is important because there may be opportunities for preventive strategies . We examined the relationships between  infant gut microbiota at six times during the first two years of life and BMI at age 12 in a birth cohort of 165 children and their mothers . We found that the gut microbiota from early life to two years shows an increasingly strong association with childhood BMI . This study provides preliminary evidence that the gut microbiome at 2 years of age may offer useful information to help to identify youth who are at risk for obesity , which could facilitate more-targeted early prevention efforts BACKGROUND The relationship between obesity and academic outcomes remains unclear . We evaluated the association between obesity and cognitive performance in US children . METHODS We analyzed two nationally representative prospect i ve cohorts of children in the 1979 National Longitudinal Survey of Youth , ages 2 through 8 at baseline and followed for 6 years , from 1988 to 1994 ( cohort 1 , n=2672 ) and 1994 to 2000 ( cohort 2 , n=1991 ) . The main exposure variable was obesity ( defined as never obese , became obese , always obese , and became nonobese ) . The main outcomes were st and ardized scores on four cognitive assessment s. Univariate regression analyses of test scores on obesity were performed . Fixed-effects regression models , controlling for measured and unmeasured time-invariant confounders , were additionally adjusted for time-variant confounders to analyze the impact of change in obesity status on change in test scores . RESULTS Unadjusted analyses revealed a significant association between obesity and Peabody Individual Achievement Test ( PIAT ) scores . In cohort 1 , always obese children had lower PIAT math scores than never obese children ( β=-7.48 ; p<0.05 ) . Always obese boys had lower PIAT math scores than those who were never obese ( β=-16.45 ; p<0.01 ) . In cohort 2 , PIAT math scores were lower in the became obese category than the never obese category ( β=-4.10 ; p<0.05 ) . Always obese girls had lower PIAT reading scores than those who were never obese ( β=-11.28 ; p<0.01 ) . Fixed-effects models additionally adjusted for Home Observation Measurement of the Environment , Short Form score and height percentile showed no significant relationship between obesity and test scores in either cohort . CONCLUSION Childhood obesity is unlikely to be causally related to cognitive performance Obesity and cigarette smoking are often cited separately as the top two preventable causes of death in the United States ; however , little research has explored the factors associated with being both obese and a smoker . Delay discounting is a behavioral characteristic that may underlie both of these conditions/behaviors . Delay discounting describes the extent to which an individual discounts the value of an outcome because of a delay in its occurrence . Higher rates of discounting are often considered as an index of impulsivity and have been linked with obesity and cigarette smoking . No research to date has explored  delay discounting  in a sample of obese smokers . For this study , adolescent smokers classified as obese ( body mass index > 95th percentile ) and healthy weight ( body mass index between the 5th and 85th percentiles ) were compared on a laboratory assessment of delay discounting .  Obese smokers  discounted significantly more by delay than healthy weight smokers . This difference remained statistically significant even after controlling for demographic variables that differed across groups . These findings suggest that the relationships between  delay discounting and obesity and cigarette smoking may be additive , such that extreme discounting might proportionally increase the risk of becoming an obese smoker . However , future prospect i ve study is needed to fully determine the veracity of this hypothesis Objective : The percentage of obese children in the United States has increased dramatically over the past three decades , particularly among ethnic/ racial minorities . This study sought to examine the impact of a clinical case-management intervention based upon the Transtheoretical Model ( TTM ) to reduce obesity and increase physical activity in children . Methods : Nineteen obese African-American children ages 8 - 12 were recruited from two pediatric clinics and were r and omized to either a 12-week intervention group or a control group . Dependent variables included body mass index ( BMI ) percentile , physical activity , and stage of change for the child and parent . Results : In comparison to the control group , the intervention group demonstrated significant decreases in BMI and improvements in daily vigorous physical activity . The children in the intervention group demonstrated movement toward action/maintenance stages of change . Conclusions : A 12-week TTM-based case management intervention can have a favorable impact on obesity and physical activity in African-American child The prevalence of overweight or fat children and adolescents has markedly increased in Hungary during the past three decades . Among the possible factors insufficient physical activity and a relative or absolute excess of calorie intake associated to it can be regarded as the most important ones . The aim of the study was to analyse the effects of a 20-week aerobic exercise on body composition and on the exercise tested cardio-respiratory functions in 10-year-old obese boys . Obesity was defined by a BMI greater than the cut-off value reported by Cole and co-workers ( 5 ) and a relative body fat content above 30 % ( 13 ) . Of the study group 21 volunteer children completed the program ; the contrast group contained 28 obese boys . Mean calendar age was 10.03 + /- 0.26 in the study group ( S ) and 9.88 + /- 0.29 in the control group ( C ) . The members of group S had two curricular physical education ( PE ) classes a week and three extracurricular aerobic physical activity sessions of 60 min net time in the afternoon , on Mondays ( swimming and water games ) , Wednesdays ( folk dance ) and Fridays ( soccer ) . Group C had only 2 PE classes a week . Anthropometric and spiroergometric data were collected in the middle of January and June of 2004 . Relative body fat content and BMI did not increase during the observation period in contrast to the significant increase of both in the control group . Peak minute ventilation , aerobic power , oxygen pulse , and running distance ( performed on a treadmill ) increased in group S , and did not change in group C. The program was considered successful despite that the changes in the observed physiological and physical indicators appeared to be slight . However , the 5-month elevated level of physical activity brought about such development in the physical status of the obese subjects that might be an appropriate basis for regular training . Fortunately , the cardio-respiratory functions of the investigated boys were not affected yet by obesity , consequently the really dramatic change in their further lifestyle exclusively depends on their decision
Overall , we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning , such as executive functioning , attention , visuo-spatial performance , and motor skill .
The existing literature is mixed on the effects among obesity , general cognitive functioning , language , learning , memory , and academic achievement .
Executive dysfunction is associated with obesity-related behaviors , such as increased intake , disinhibited eating , and less physical activity .
Physical activity is positively linked with motor skill .
Childhood obesity rates have risen dramatically over the past few decades .
Although obesity has been linked to poorer neurocognitive functioning in adults , much less is known about this relationship in children and adolescents .
Therefore , we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth .