IMPORTANCE Previous analyses of obesity trends among children and adolescents showed an increase between 1988–1994 and 1999–2000, but no change between 2003–2004 and 2011–2012, except for a significant decline among children aged 2 to 5 years. OBJECTIVES To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011–2014 and investigate trends by age between 1988–1994 and 2013–2014. DESIGN, SETTING, AND PARTICIPANTS Children and adolescents aged 2 to 19 years with measured weight and height in the 1988–1994 through 2013–2014 National Health and Nutrition Examination Surveys. EXPOSURES Survey period. MAIN OUTCOMES AND MEASURES Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011–2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005–2006 and 2013–2014 also were conducted. RESULTS Measurements from 40 780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988–1994 and 2013–2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011–2014 was 17.0% (95% CI, 15.5%−18.6%) and extreme obesity was 5.8% (95% CI, 4.9%−6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%−8.8%) in 1988–1994 to 13.9% (95% CI,10.7%−17.7%) (P < .001) in 2003–2004 and then decreased to 9.4% (95% CI, 6.8%−12.6%)(P = .03) in 2013–2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%−13.4%) in 1988–1994 to 19.6% (95% CI, 17.1%−22.4%) (P < .001) in 2007–2008, and then did not change (2013–2014: 17.4% [95% CI, 13.8%−21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988–1994 (10.5% [95% CI, 8.8%−12.5%]) and 2013–2014 (20.6% [95% CI, 16.2%−25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%−5.0%] in 1988–1994 to 4.3% [95% CI,3.0%−6.1%] in 2013–2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI,1.7%−3.9%] in 1988–1994 to 9.1% [95% CI, 7.0%−11.5%] in 2013–2014; P < .001). No significant trends were observed between 2005–2006 and 2013–2014 (P value range, .09-.87). CONCLUSIONS AND RELEVANCE In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011–2014 was 17.0% and extreme obesity was 5.8%. Between 1988–1994 and 2013–2014, the prevalence of obesity increased until 2003–2004 and then decreased in children aged 2 to 5 years, increased until 2007–2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.

IMPORTANCE Policy makers have implemented beverage taxes to generate revenue and reduce consumption of sweetened drinks. In January 2017, Philadelphia, Pennsylvania, became the second US city to implement a beverage excise tax (1.5 cents per ounce). OBJECTIVES To compare changes in beverage prices and sales following the implementation of the tax in Philadelphia compared with Baltimore, Maryland (a control city without a tax) and to assess potential cross-border shopping to avoid the tax in neighboring zip codes. DESIGN, SETTING, AND PARTICIPANTS This study used a difference-indifferences approach and analyzed sales data to compare changes between January 1, 2016, before the tax, and December 31, 2017, after the tax. Differences by store type, beverage sweetener status, and beverage size were examined. The commercial retailer sales data included large chain store sales in Philadelphia, Baltimore, and the Pennsylvania zip codes bordering Philadelphia. These data reflect approximately 25% of the ounces of taxed beverages sold in Philadelphia. EXPOSURES Philadelphia's tax on sugar-sweetened and artificially sweetened beverages. MAIN OUTCOMES AND MEASURES Change in taxed beverage prices and volume sales.

Results suggest that increased relative handgrip strength may be associated with a better profile of cardiovascular health biomarkers among U.S. adults. Relative grip strength, which both adjusts for the confounding of mass and assesses concomitant health risks of increased body size and low muscle strength, may be a useful public health measure of muscle strength.

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.