Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group.

There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.

Our health, our research. Identifying public health research priorities among children and youth in a multiethnic population: protocol for a community-based participatory health research priority survey.

INTRODUCTION: Emphasis on public involvement (PI) in health research has increased in the last 20 years. However, there is limited literature on PI in planning and conducting population-based health research. This study aims to identify child and adolescent health research priorities among children and stakeholder groups in Northern Norway by inviting PI groups to collaborate with researchers to develop and conduct a research priority survey. METHODS AND ANALYSIS: This is a community-based participatory research project. The methods for research prioritisation are informed by those developed by the James Lind Alliance. In addition, the survey design and engagement plans are developed in extensive collaboration with child and youth stakeholder groups. Nine PI groups have met three times to develop an anonymous child and youth health research priority survey, as well as strategies for recruitment and dissemination of results. All 5th-10th grade pupils in the Finnmark region will be invited to participate in the survey, as well as caretakers and adults working for and with children and youth. The survey results will be analysed in collaboration with the PI groups, and research priorities checked with existing research literature. ETHICS AND DISSEMINATION: The study is registered and approved by the Data Protection Authorities at the Finnmark Hospital Trust and the Expert Committee for Sami Health Research. Descriptions of methods applied and the survey results will be published in popular and scientific publications.

Supplementary drug treatment to reduce weight in adolescents with severe obesity. / Medikamentell tilleggsbehandling for vektreduksjon hos ungdom med alvorlig fedme.

In 2021, the Norwegian Medicines Agency approved the use of daily injection of liraglutide 3.0 mg (Saxenda) as a supplement to lifestyle treatment for weight control in children ≥ 12 years of age with obesity (isoBMI ≥ 30). We share the treatment experiences of six multidisciplinary obesity clinics in the specialist health service.

Age, income and sleep duration were associated with outcomes in children participating in weight management.

AIM: To explore associations between baseline factors and weight-related outcomes among participants enrolled in a paediatric obesity trial. METHODS: We included children aged 6-12 years participating in a 2-year multidisciplinary family programme who attended a postintervention follow-up 36 months from baseline (n = 62). Outcome measures were change in body mass index standard deviation score (BMI SDS), reduction in BMI SDS ≥0.25 and change in waist circumference (WC). Independent variables included in linear and logistic regression models were age, sex, household income, parents' education, sleep duration, screen time and physical activity. RESULTS: Altogether, 26 children (42%) attained a reduction of BMI SDS ≥0.25. Higher family income and longer sleep duration were associated with greater change in BMI SDS (-0.05 per 100.000 NOK, p = 0.02, and -0.24 per hour, p = 0.02, respectively). Higher age was associated with greater change in WC (-2.1 cm per year, p = 0.01) but lower odds of attaining a reduction in BMI SDS ≥0.25 (OR per year 0.70, p = 0.04). There was a borderline statistically significant trend towards greater increase in WC with longer daily screen time (p = 0.05). CONCLUSION: Age, family income and sleep duration at baseline were associated with weight-related outcomes 1-year postintervention.

Re-referring Children for Multidisciplinary Obesity Management.

OBJECTIVES: To examine characteristics of children referred for obesity management based on referral frequency, child- and referrer-related variables associated with re-referral, and determine whether re-referral increased treatment initiation. STUDY DESIGN: This population-level, retrospective analysis included all 2- to 17-year-olds referred for obesity management to 1 of 3 multidisciplinary clinics in Alberta, Canada between April 2013 and December 2017. Children were dichotomized based on referral frequency, specifically once only or more than once (re-referred). Data were retrieved from standardized referral forms and patient registries. Analyses included logistic regression and generalized estimating equations models. RESULT: We analyzed data from 2745 children (47.2% female; mean age: 11.4 years; mean body mass index z score: 3.03) and 2705 physicians (60.2% female; 65.6% pediatricians). Overall, 300 (10.2%) children were re-referred with most (n = 276; 92.0%) being referred twice. Children were less likely to be re-referred if they were referred by a family physician (vs pediatrician) (aOR 0.62; 95% CI 0.46-0.84; P = .0018) or scheduled a clinic appointment following their index referral (aOR: 0.29; 95% CI 0.21-0.4; P < .001). Treatment initiation was higher in children who were referred once only (42.1%) vs their re-referred peers (18.0%; P < .0001); however, for children who were re-referred, they were more likely to initiate treatment following their second referral (aOR 2.3; 95% CI 1.22-4.31; P = .01). This improvement was not sustained on subsequent referrals (aOR 0.44; 95% CI 0.17-1.12; P = .08). CONCLUSIONS: Few children were re-referred for pediatric obesity management; however, for those children who were re-referred, being re-referred once only increased the likelihood of treatment initiation.

No additional long-term effect of group vs individual family intervention in the treatment of childhood obesity-A randomised trial.

AIM: Long-term evaluations of childhood obesity treatments are needed. We examined changes in weight and cardiometabolic risk 1 year after children completed individual family or group-based weight management interventions. METHODS: In 2009-2010, 6- to 12-year-old children with overweight or obesity from Finnmark and Troms (Norway) were recruited after media coverage and randomised to 24 months of individual family (n = 49) or group intervention (n = 48). Individual family intervention included counselling by a paediatric hospital team and a public health nurse in the local community. Group intervention included meetings with other families and a multidisciplinary hospital team, weekly physical activity sessions and a family camp. The primary outcome body mass index (BMI) and cardiometabolic risk factors were analysed 12 months after intervention. RESULTS: From baseline to 36 months, children's BMI increased 3.0 kg/m2 in individual family and 2.1 kg/m2 in group intervention (between-group -0.9kg/m2 , P = 0.096). Data were available from 62 children (64%). Between-group differences in C peptide (P = 0.01) were detected in favour of group intervention. Pooled data from both treatment groups showed continued decrease in BMI standard deviation score (P < 0.001). CONCLUSION: No between-group difference in BMI was observed 12 months after intervention. Both groups combined showed sustained decrease in BMI standard deviation score.

Adolescent body composition and associations with body size and growth from birth to late adolescence. The Tromsø study: Fit Futures-A Norwegian longitudinal cohort study.

BACKGROUND: Fat and fat-free masses and fat distribution are related to cardiometabolic risk. OBJECTIVES: to explore how birth weight, childhood body mass index (BMI) and BMI gain were related to adolescent body composition and central obesity. METHODS: In a population-based longitudinal study, body composition was measured by dual-energy X-ray absorptiometry in 907 Norwegian adolescents (48% girls). Associations between birth weight, BMI categories, and BMI gain were evaluated by fitting linear mixed models and conditional growth models with fat mass index (FMI, kg/m2 ), fat-free mass index (FFMI, kg/m2 ) standard deviation scores (SDS), and central obesity at 15 to 20 years, as well as change in FMI SDS and FFMI SDS between ages 15 to 17 and 18 to 20 as outcomes. RESULTS: Birth weight was associated with FFMI in adolescence. Greater BMI gain in childhood, conditioned on prior body size, was associated with higher FMI, FFMI, and central overweight/obesity with the strongest associations seen at age 6 to 16.5 years: FMI SDS: ß = 0.67, 95% CI (0.63-0.71), FFMI SDS: 0.46 (0.39, 0.52), in girls, FMI SDS: 0.80 (0.75, 0.86), FFMI SDS: 0.49 (0.43, 0.55), in boys. CONCLUSIONS: Compared with birth and early childhood, high BMI and greater BMI gain at later ages are strong predictors of higher fat mass and central overweight/obesity at 15 to 20 years of age.

The relation between birthweight, childhood body mass index, and overweight and obesity in late adolescence: a longitudinal cohort study from Norway, The Tromsø Study, Fit Futures.

OBJECTIVES: Childhood overweight/obesity is associated with later overweight/obesity. However, the association between birth weight and later overweight/obesity has not been established. The aim of this study was to investigate the relation between both birth weight and childhood body mass index (BMI), and adolescent overweight/obesity in a Norwegian population. METHODS: The Tromsø Study - Fit Futures is a population-based cohort study conducted in 2010-2011 and 2012-2013 in Tromsø, Norway. A representative sample of 961 adolescents participated. Longitudinal anthropometric data were obtained from the Medical Birth Registry of Norway, childhood health records at 2-4 and 5-7 years of age, and repeated measurements at 15-18 and 18-20 years of age. Outcome was defined as normal weight (adult BMI <25 kg/m2) or overweight/obese (adult BMI ≥2 5 kg/m2) at 15-20 years of age according to international age- and sex-specific cut-off values for children. Associations were investigated using generalised estimating equations. RESULTS: In adjusted analyses, a 1-SD (586 g) higher birth weight was associated with a higher OR for overweight/obesity at 15-20 years of age (OR 1.25, 95% CI 1.06 to 1.48). Childhood BMI was also associated with overweight/obesity at 15-20 years of age: a 1-SD (1.35 kg/m2) increase in BMI at age 2-4 years rendered an OR of 1.66 (95% CI 1.40 to 1.96); a 1-SD (1.83 kg/m2) increase in BMI at age 5-7 years rendered an OR of 3.23 (95% CI 2.56 to 4.07). When compared with normal-weight children, those with severe overweight/obesity in childhood (adult BMI ≥27 kg/m2) showed stronger associations with overweight/obesity at 15-20 years of age: OR 3.01 (95% CI 1.47 to 6.18) and OR 11.51 (95% CI 6.63 to 19.99) at ages 2-4 and 5-7, respectively. CONCLUSION: Associations between birth weight and overweight/obesity at 15-20 years of age were modest, whereas the influence of BMI at 2-4 and 5-7 years on overweight/obesity at 15-20 years was moderate to strong.

Health in overweight children: 2-year follow-up of Finnmark Activity School--a randomised trial.

OBJECTIVE: To compare a comprehensive lifestyle intervention for overweight children performed in groups of families with a conventional single-family treatment. Two-year follow-up data on anthropometric and psychological outcome are presented. DESIGN: Overweight and obese children aged 6-12 years with body mass index (BMI) corresponding to ≥27.5 kg/m(2) in adults were randomised to multiple-family (n=48) or single-family intervention (n=49) in a parallel design. Multiple-family intervention comprised an inpatient programme with other families and a multidisciplinary team, follow-up visits in their hometown, weekly physical activity and a family camp. Single-family intervention included counselling by paediatric nurse, paediatric consultant and nutritionist at the hospital and follow-up by a community public health nurse. Primary outcome measures were change in BMI kg/m(2) and BMI SD score after 2 years. RESULTS: BMI increased by 1.29 kg/m(2) in the multiple-family intervention compared with 2.02 kg/m(2) in the single-family intervention (p=0.075). BMI SD score decreased by 0.20 units in the multiple-family group and 0.08 units in the single-family intervention group (p=0.046). A between-group difference of 2.4 cm in waist circumference (p=0.038) was detected. Pooled data from both treatment groups showed a significant decrease in BMI SD score of 0.14 units and a significant decrease in parent-reported and self-reported Strength and Difficulty Questionnaire total score of 1.9 units. CONCLUSIONS: Two-year outcome showed no between-group difference in BMI. A small between-group effect in BMI SD score and waist circumference favouring multiple-family intervention was detected. Pooled data showed an overall improvement in psychological outcome measures and BMI SD score. TRIAL REGISTRATION NUMBER: NCT00872807, http://www.clinicaltrials.gov.

Single versus multiple-family intervention in childhood overweight--Finnmark Activity School: a randomised trial.

OBJECTIVE: To compare a new comprehensive lifestyle programme performed in groups of families with overweight (included obese) children with a more conventional single-family programme. The study design and interim anthropometrical results after 12 months are presented. DESIGN: Altogether 97 overweight and obese children aged 6-12 years with body mass index (BMI) corresponding to cut-off point ≥ 27.5 in adults were included. Study participants were randomised to multiple-family intervention (MUFI) or single-family intervention (SIFI) in a parallel design. MUFI comprised a 3-day inpatient programme at the hospital with other families and a multidisciplinary team, follow-up visits in their hometown individually and in groups, organised physical activity twice weekly and a 4-day family camp after 6 months. SIFI comprised individual counselling by paediatric nurse, paediatric consultant and nutritionist at the hospital and follow-up by public health nurse in the community. Solution focused approach was applied in both interventions. Primary outcome measures were change in BMI kg/m(2) and BMI SD score (BMI SDS). RESULTS: BMI increased by 0.37 units in the MUFI compared to 0.77 units in the SIFI (p=0.18). BMI SDS decreased by 0.16 units in the MUFI group compared to 0.07 units in the SIFI group (p=0.07). Secondary endpoint waist circumference decreased 0.94 cm in the multiple-family group and increased 0.95 cm in the single-family group, p=0.04. CONCLUSIONS: Interim analysis after 12 months showed no between-group difference in terms of BMI or BMI SDS. The MUFI group had a significant decrease in waist circumference compared to the SIFI group. THE TRIAL IS REGISTERED: at http://www.clinicaltrials.gov (NCT00872807).

High prevalence of overweight and obesity among 6-year-old children in Finnmark County, North Norway.

AIM: The aim was to determine the prevalence of overweight and obesity among 6-year-old children in Finnmark, the northernmost county of Norway. METHODS: This is a survey of 1774 children born during 1999 and 2000 from 18 of 19 child healthcare centres in Finnmark. Body mass index data extracted retrospectively in 2007 from health records at the age of 6 years were compared with international definitions of over- and underweight. The prevalence figures were further compared with socio-demographic figures on municipality level. RESULTS: Overall, 19% of the children were classified as overweight or obese; 5% were classified as obese. The prevalence of overweight and obesity was higher among girls (22%) than among boys (16%) (p < 0.01). The prevalence of underweight was 8% among both girls and boys. Despite large variations in the prevalence of overweight and obesity between municipalities (9-35%), no association was found with municipality figures on socio-demographic factors. CONCLUSION: In the northernmost county Finnmark, the prevalence of overweight including obesity among 6-year-old children was somewhat higher than in previous surveys from Norway, especially among girls.