Association of sugar-sweetened beverage intake with maternal postpartum weight retention.

OBJECTIVE: During the perinatal period, modifiable behaviours contributing to excess weight gain, including sugar-sweetened beverage (SSB) intake, are understudied. We examined the extent to which perinatal SSB intake affects postpartum weight retention (PPWR). DESIGN: We measured SSB intake frequency in the third trimester and 1-month postpartum using the NHANES Dietary Screener Questionnaire. We assessed the association between SSB intake and PPWR (difference between 6-month postpartum and pregravid weight) using multivariable regression adjusted for socio-demographic and anthropometric variables. SETTING: Greater Boston area. PARTICIPANTS: Three hundred forty-eight mother-infant pairs in the Rise and SHINE prospective birth cohort. RESULTS: Mean age was 32·7 (sd 5·0) years; the sample was 47 % white, 32 % Hispanic, 14 % Asian and 7 % Black. Women reported mean daily SSB intake frequencies of 0·9 (sd 1·2) and 0·7 (sd 1·0) times/d in the third trimester and 1-month postpartum, respectively. At 6-month postpartum, average weight retention was 3·4 (sd 5·7) kg; 108 (sd 31 %) women had substantial PPWR, defined as a ≥ 5 kg increase between pregravid and 6-month postpartum weight. Each 1-time/d increment in SSB intake frequency during the third trimester (ß = 0·46 kg (95 % CI, 0·07, 0·86)) and 1-month postpartum (ß = 0·52 kg (95 % CI 0·03, 1·00)) was associated with higher weight retention at 6 months. Increased SSB intake frequency in the third trimester (OR: 1·37; 95 % CI 1·10, 1·75) and 1-month postpartum (OR: 1·17; 95 % CI 0·92, 1·52) resulted in higher odds of substantial PPWR. CONCLUSIONS: SSB consumption during the perinatal period is associated with higher weight retention at 6-month postpartum. Avoiding SSB may reduce the risk of excess weight retention.

Use of Telehealth to Enhance Care in a Family-Centered Childhood Obesity Intervention.

Family-centered childhood obesity interventions have been found to be effective. We describe the use of telehealth for tailored behavior change support in a family-centered randomized trial. Children of 2 to 12 years with body mass index ≥85th percentile were randomized to Enhanced Primary Care (EPC) or Enhanced Primary Care + Coaching (EPC + C). EPC + C received 6 health coach visits (in-person or by video or phone call) over 1 year. Telehealth modalities included interactive text messaging, video calls, and an online community resource map. There were 360 children randomized to the EPC + C arm; 87% of parents completed ≥1 health coaching contacts. Overall, 93% parents were sent text messages of which 99% responded at least once. About 72% parents were very satisfied with the message content and 97% were satisfied with information provided about community health resources. The high level of participant engagement and satisfaction suggests that telehealth is feasible and acceptable in family-centered childhood obesity programs.

Parent-Perceived Stress and Its Association With Children's Weight and Obesity-Related Behaviors.

INTRODUCTION: Psychosocial stress is associated with obesity in adult and pediatric populations, but few studies have examined the relationship between parent-perceived stress and risk of child obesity and related behaviors. METHODS: We studied 689 pairs of parents and children aged 2 to 12 in Massachusetts with a body mass index (BMI) at or above the 85th percentile. Recruitment occurred from June 2014 to March 2015, and data collection ended in March 2016. We asked parents about their perceived stress and categorized responses as low, moderate, or high. We examined associations of parents' stress with children's BMI, expressed as a percentage of the 95th percentile (%BMIp95), and obesity-related behaviors by using multivariable regression models adjusted for child and parent characteristics. We stratified results by race/ethnicity, annual household income, and the child's age. RESULTS: In fully adjusted models, the association between high versus low parent-reported stress and children's %BMIp95 remained significant only for children in low-income households (ß = 5.12; 95% confidence interval [CI], 0.94-9.30) and for non-Hispanic black children (ß = 7.76; 95% CI, 1.85-13.66). Parents with high or moderate stress versus low stress were less likely to report that their children met recommendations for fast-food consumption (high stress, prevalence ratio [PR] = 0.79; 95% CI, 0.65-0.96; moderate stress, PR = 0.70; 95% CI, 0.59-0.82), but parents with high versus low stress were more likely to report meeting daily physical activity recommendations (PR = 1.21; 95% CI, 1.01-1.45). CONCLUSION: Among children with overweight or obesity, parent-perceived stress was associated with fast-food consumption and physical activity. Parent-perceived stress was associated with child %BMIp95 among children in low-income households and non-Hispanic black children. Obesity interventions should consider parent-perceived stress and potential differences in the nature of stress experienced by parents of different racial/ethnic and socioeconomic backgrounds.

Determinants of Binge Eating Symptoms in Children with Overweight/Obesity.

BACKGROUND: Examining binge eating symptoms before the diagnosis of binge eating disorder in children with obesity could provide important information on prevention of future eating disorders. METHODS: We examined the prevalence and multilevel determinants of three binge eating symptoms: (1) sneaking, hiding, or hoarding food; (2) eating in the absence of hunger, and (3) inhibition or embarrassment when eating in front of others among 817 children aged 5-12 years old with overweight/obesity receiving primary care in eastern Massachusetts. We examined the associations of child and parent/household characteristics with the prevalence ratios (PRs) of these three binge eating symptoms. RESULTS: Approximately one-third of parents reported that their children would sneak, hide, or hoard food; 40% ate large amounts in the absence of hunger; and 8% were inhibited/embarrassed when eating in front of others. In multivariate analyses, greater screen time was associated with a higher prevalence of sneaking, hiding, or hoarding (PR 1.06, 95% CI: 1.01-1.11). We found that children with severe obesity (PR 1.50, 95% CI: 1.24-1.81 vs. nonsevere obesity) had higher prevalence of eating in the absence of hunger. Increased hours of screen time were associated with higher prevalence of eating in the absence of hunger, (PR: 1.07, 95% CI: 1.03-1.11), whereas longer sleep duration (PR: 0.90, 95% CI: 0.82-0.99) was associated with lower prevalence of eating in the absence of hunger. CONCLUSIONS: Eating in the absence of hunger was the most common symptom in our sample and was associated with screen time and sleep. ClinicalTrials.gov NCT01537510.

Three-Year Improvements in Weight Status and Weight-Related Behaviors in Middle School Students: The Healthy Choices Study.

INTRODUCTION: Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting. OBJECTIVE: Evaluate Healthy Choices (HC), a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity. METHODS: We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components. SETTING/PARTICIPANTS: Consecutive sample of 45 of 51 middle schools participating in the HC program with complete baseline and follow-up survey data including a subsample of 35 schools with measured anthropomentry for 5,665 7th grade students. INTERVENTION: Schools developed a multi-disciplinary team and implemented an obesity prevention curriculum, before and after school activities, environmental and policy changes and health promotions targeting a 5-2-1 theme: eat ≥ 5 servings/day of fruits and vegetables (FV), watch ≤ 2 hours of television (TV) and participate in ≥ 1 hours/day of physical activity (PA) on most days. MAIN OUTCOME MEASURES: 1) School-level percent of students achieving targeted behaviors and percent overweight/obese; and 2) individual odds of overweight/obesity. RESULTS: The percent achieving behavioral goals over three years increased significantly for FV: 16.4 to 19.4 (p = 0.001), TV: 53.4 to 58.2 (p = 0.003) and PA: 37.1 to 39.9 (p = 0.02), adjusting for school size, baseline mean age and percent female, non-Hispanic White, and eligible for free and reduced price lunch. In 35 schools with anthropometry, the percent of overweight/obese 7th grade students decreased from 42.1 to 38.4 (p = 0.016). Having a team that met the HC definition was associated with lower odds of overweight/obesity (OR = 0.83, CI: 0.71-0.98). CONCLUSIONS AND RELEVANCE: The HC multi-component intervention demonstrated three-year improvements in weight-related behaviors and weight status across diverse middle schools. Team building appears important to the program's effectiveness.

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City.

BACKGROUND: Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. METHODS: We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children's height and weight and parents reported children's diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. RESULTS: 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. CONCLUSIONS: Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. TRIAL REGISTRATION: ClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.