Childhood Obesity

Neighborhood food access is considered a structural determinant of childhood obesity, yet prior studies report inconsistent findings, and longitudinal weight trajectories are understudied. This study sought to examine the association between neighborhood food access and obesity risk across the COVID-19 pandemic, which exacerbated pediatric obesity disparities.

We conducted a retrospective longitudinal cohort study of 13,832 children aged 2–11 years receiving primary care in eastern Massachusetts between 2019 and 2024. Baseline residential addresses were geocoded to classify a child’s residence in low-income, low-food access neighborhoods with low vehicle availability (LILV). Mixed-effects models examined associations between LILV residence and repeated BMI z-scores and obesity risk over follow-up, adjusting for insurance type. Secondary analyses among publicly insured children (n = 3548) explored the association between LILV residence and obesity risk, adjusting for household food insecurity.

At baseline, 26.1% of children resided in LILV neighborhoods. No significant differences in BMI z-scores or obesity risk were observed at age 5 years. By age 10, LILV residence was associated with higher BMI z-scores [β = 0.08; 95% confidence interval (CI): 0.01–0.16] and increased obesity risk [risk ratio (RR) = 1.55; 95% CI: 1.01–2.39]. By age 15, associations strengthened [BMI z-score β = 0.14; 95% CI: 0.05–0.22; obesity RR = 1.94; 95% CI: 1.17–3.23]. Among the subset of children with public insurance, these associations were not observed.

Residence in low-income, low-food access neighborhoods is associated with higher BMI and obesity risk across childhood and adolescence, independent of insurance type. These findings highlight neighborhood food access as a potentially modifiable structural determinant of pediatric obesity disparities.

Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for adolescents with severe obesity; however, some health care providers are hesitant to refer adolescents due to concerns regarding decisional capacity. Structured educational materials provided prior to MBS have the potential to improve informed decision-making. The objective of this study was to characterize topics that may not be adequately addressed in existing structured educational materials for adolescents seeking MBS.

Semi-structured, qualitative interviews were conducted with adolescents who had undergone MBS and with parents or guardians of postoperative adolescents. Thematic saturation was assessed by considering properties from a base number of interviews (n = 7) and a run length (n = 2). Interrater reliability was established at the theme level. An adolescent citizen scientist was approached to provide feedback on the codebook.

In total, six adolescents and six parents or guardians diverse in race and ethnicity were interviewed. For adolescents, the average age at the time of the procedure was 16 years (standard deviation = 2.37). Most participants (n = 5) underwent vertical sleeve gastrectomy. Five key themes were identified that provide additional information on the preferred format of delivery (interactive materials, teen-specific materials) and topics that may not be adequately addressed (physical aspects of surgery, psychosocial well-being, and specific resources for parents or guardians).

This current study identified gaps in the format of delivery and topics covered in structured preoperative educational materials. Future work should determine if these gaps are widespread across accredited MBS centers. Furthermore, the development of additional materials should be considered.

The Starting Early Program (StEP) promotes healthy nutrition during early life and leads to healthier child weight, but whether dietary patterns contribute to weight or mediate StEP weight outcomes has not been studied.

This secondary analysis identified infant dietary patterns in StEP, determined associations between dietary patterns and child weight outcomes, and examined whether dietary patterns mediated the relationship between StEP and child weight.

Data were from 377 mother-infant dyads in a randomized trial testing the efficacy of StEP. Dietary patterns at 10 months were identified using latent class analysis. Child weights were abstracted from medical records at 12, 24, and 36 months. Associations between infant dietary patterns and weight-for-age z-score (WFAz) and likelihood of being classified as overweight (WFA ≥85th percentile) were assessed using linear and logistic multivariable regression models. Mediation was used to assess intervention effects on WFAz via impacts on infant dietary patterns.

Four classes of infant dietary patterns were identified: Breastfed-High variety, Formula fed-High variety, Formula fed-Low variety, and Mixed fed-Low variety. Compared to the Breastfed-High variety class, infants in the Formula fed-Low variety class had higher WFAz and were more likely to be classified as overweight at 24 and 36 months. Participation in StEP increased membership in Breastfed-High variety, which mediated the association between StEP and lower WFAz at 24 months.

Infant dietary patterns were identified, and some were associated with child overweight. StEP was associated with a dietary pattern most consistent with guidelines, which mediated intervention effects on child weight.

Participants from the CANadian Pediatric Weight management Registry were stratified by age (6–11-year-olds; 12–17-year-olds) and sex to determine MHO/MUO status at baseline and 1-year follow-up.

In this sample (n = 387), the baseline and 1-year follow-up prevalence of MHO were 35% and 34%, respectively. Obesity status remained stable in 72% of participants. Of the 387 participants, n = 55 transitioned from MHO to MUO, while n = 53 transitioned from MUO to MHO by 1 year. Patterns of change in MHO were generally similar across sexes and age groups.

In this study, MHO was present in approximately one-third of children and adolescents, with one-quarter changing MHO to MUO or MUO to MHO status from baseline to 1-year follow-up.

Children spend 33–35 hours per week in family child-care homes and may consume up to five meals and snacks there, making these settings important for understanding how food especially fruits and vegetables are prepared and served. The purpose was to examine frequency and variety, preparation styles by meal, and identify predictors of fresh and frozen fruit and vegetable service in Oklahoma family child care homes (FCCH).

Ninety-six FCCHs participated in two cohorts (n = 51 in-person; n = 45 virtual). Frequency, variety, and preparation styles of fruits/vegetables were recorded for both in-person and virtual cohorts. The average frequency and variety of fruits and vegetables, and the frequency of their preparation styles were calculated. The association of FCCH characteristics with fresh/frozen fruits and vegetables service score was examined.

All FCCH providers identified as female (mean age 43.9 ± 15.1 years). At breakfast, whole fruits and juice were served by 88.6% and 6.8% of providers, respectively. At lunch, whole fruits and juice were served by 86.6%–94.1% and 2.0%–4.4%, and vegetables by 94.1%–97.8%. At snack, fruits, fruit juice, and vegetables were served by 60%, 13.3%, and 11.1%, respectively. Bananas and apples/applesauce were the most common fruits, and carrots and green beans were the most common vegetables served. Fresh fruit was most common at breakfast (77.3%), lunch (53%–61%), and snack (63%). Fresh and frozen vegetables were equally prevalent (50%) at breakfast, canned vegetables (44–57%) at lunch, and fresh vegetables (100%) at snack. No provider/program characteristics were associated with fresh/frozen service scores.

Opportunities exist to improve fruits/vegetables service in Oklahoma FCCHs by serving vegetables at breakfast and snacks and reducing juice and canned options.

Inadequate care access may exacerbate the childhood obesity epidemic. Obesity treatments are recommended for adolescents, but the health-economic impacts of unequal treatment access are unclear. This study aims to evaluate the cost-effectiveness of improving access levels to adolescent obesity care and treatment.

In this economic evaluation, we used a decision-analytic model to simulate a synthetic cohort of 1000 US adolescents from ages 12 to 26 on an annual basis. Modeled treatment strategies included phentermine-topiramate, semaglutide, bariatric surgery, and lifestyle modification (usual care). Primary analysis modeled perfect care access for reproducibility with prior studies. Secondary analyses modeled imperfect access to primary care visits, specialty visits, and treatment initiation among distinct groups by insurance coverage or race and ethnicity. Uncertainty analyses tested model parameter estimates. Outcomes were costs, health effects [averted obesity cases, quality-adjusted life years (QALYs)], and incremental cost-effectiveness ratios (ICERs) from health care sector and limited societal perspectives, including caregiver time.

Phentermine-topiramate (vs. lifestyle) yielded an ICER of 2025 US$112,141/QALY, and semaglutide (vs. phentermine-topiramate) yielded $166,513/QALY under perfect access. Under imperfect access, cost-effectiveness and health gains were reduced. Cost-effectiveness was reduced by 11%, and averted obesity cases decreased from 57% to 3% for semaglutide. Health gains were lowest in Medicaid-insured, Black, or Hispanic youth. ICERs were sensitive to medication characteristics (costs, efficacy, discontinuation) and health utilities.

In this economic evaluation, phentermine-topiramate and semaglutide were cost-effective under $200,000/QALY, using 2025 pricing. Care access disparities limit health-economic gains for adolescents. Improving care access is critical to addressing the childhood obesity epidemic.

This clinical trial evaluated hepatic fat content and weight loss in adolescents with severe obesity and metabolic dysfunction–associated steatotic liver disease (MASLD) following short-term meal replacement therapy (MRT).

Adolescents aged 12–17 years with severe obesity (BMI ≥1.2 × 95th percentile or ≥35 kg/m²) and magnetic resonance imaging–confirmed MASLD (hepatic fat fraction [HFF] ≥5%) completed a 4- to 8-week MRT program (∼500 kcal/day deficit) targeting ≥5% BMI reduction. Participants underwent ¹H-magnetic resonance spectroscopy at baseline and at follow-up, along with 2-hour mixed-meal tolerance testing.

Seventeen adolescents [baseline mean (standard deviation or SD) BMI = 39.9 (4.1) kg/m²; age = 16.0 (1.6) years; 65% male; HFF = 15.6 (5.1)%] demonstrated a mean absolute decrease in BMI of 5.6% [−2.23 kg/m²; 95% confidence interval (CI): −2.45, −2.02; p < 0.001] and a 37.3% relative reduction (95% CI: 26.4%, 48.1%; p < 0.001) in HFF. Despite HFF reduction, 13 out of 17 had MASLD at study conclusion. Decrease in HFF corresponded to significant reductions in triglycerides [difference (95% CI): −5.8 mg/dL (−9.4, −2.1); p = 0.012], glucose area under the curve (AUC) [−2.2 mg/dL (−3.2, −1.3); p = 0.021], and leptin AUC [−40.5 pg/mL (−57.1, −23.9); p = 0.009]. No significant difference in alanine aminotransferase was observed.

Short-term MRT was associated with reductions in liver fat and improvements in metabolic biomarkers among adolescents with MASLD. Large-scale trials are needed to evaluate the implementation of MRT as part of a multimodal treatment strategy in this population. [Clinical Trial Registration: Enhancing Weight Loss Maintenance with GLP-1 RA (BYDUREON™) in Adolescents With Severe Obesity, NCT02496611, https://clinicaltrials.gov/study/NCT02496611].

To examine changes in weight status after initiating zonisamide in children with epilepsy and elevated body mass index (BMI).

Retrospective chart review of children aged 2 to ≤18 years with epilepsy treated with zonisamide, assessing BMI changes over 2 years.

A total of 140 children were included; mean age (SD) at initiation was 9.60 years (3.93). BMI categories included 28 children with severe obesity, 28 with mild–moderate obesity, 28 with overweight, and 56 with healthy weight. Participants were 56.6% female, 91.4% non-Hispanic/Latino, and 88.6% White. At 2 years, BMI z score decreased significantly across all BMI groups: severe obesity −0.38 (N = 13, 95% CI −0.64 to −0.13; p = 0.003), mild-moderate obesity −0.39 (N = 15, 95% CI −0.62 to −0.16; p = 0.001), overweight −0.60 (N = 14, 95% CI −0.84 to −0.36; p < 0.001), and healthy weight −0.46 (N = 21, 95% CI −0.63 to −0.28; p < 0.001). Significant BMI z score reductions were also observed across age groups: 2–10 years −0.48 (N = 40, 95% CI −0.62 to −0.34), >10–13 years −0.27 (N = 15, 95% CI −0.50 to −0.04), and ≥13 years −0.63 (N = 12, 95% CI 0.89 to −0.36).

BMI reduction persisted up to 2 years following zonisamide initiation in children with epilepsy. Further prospective studies are needed to evaluate the weight loss effect and safety of zonisamide in children with epilepsy and elevated BMI.