We evaluated the efficacy of a 6-month clinic and home-based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health; LAUNCH) to reduce obesity in preschool children ≥95th BMI percentile compared to enhanced standard of care (Pediatrician Counseling; PC). LAUNCH was a family-based behavioral intervention that taught parents to use child behavior management strategies to increase healthy eating and activity for their children and themselves. PC presented the same diet and activity recommendations, but was delivered in a one-time PC session. Eighteen children aged 2–5 years (mean 4.71 ± 1.01) with an average BMI percentile of 98 (±1.60) and an overweight parent were randomized to LAUNCH or PC. Assessments were conducted at baseline, 6 months (end of LAUNCH treatment) and 12 months (6 months following LAUNCH treatment). LAUNCH showed a significantly greater decrease on the primary outcomes of child at month 6 (post-treatment) BMI z (−0.59 ± 0.17), BMI percentile (−2.4 ± 1.0), and weight gain (−2.7 kg ± 1.2) than PC and this difference was maintained at follow-up (month 12). LAUNCH parents also had a significantly greater weight loss (−5.5 kg ± 0.9) at month 6 and 12 (−8.0 kg ± 3.5) than PC parents. Based on the data from this small sample, an intensive intervention that includes child behavior management strategies to improve healthy eating and activity appears more promising in reducing preschool obesity than a low intensity intervention that is typical of treatment that could be delivered in primary care.

Background Comprehensive studies of adolescent bariatric surgery outcomes are in their infancy and are critically needed. The present study examined the rate of change in the body mass index (BMI), health-related quality of life (HRQOL), depressive symptoms, and self-concept in adolescents undergoing Roux-en-Y gastric bypass (RYGB) during the first 24 postoperative months using a prospective longitudinal design at a pediatric medical center. Methods A total of 16 adolescents (mean age 16.2 yr; 62.5% female, mean BMI 59.9 kg/m2; 97% of eligible, consecutive patients) completed the Impact of Weight on Quality of Life-Kids, Pediatric Quality of Life Inventory, Beck Depression Inventory, Self-Perception Profile for Adolescents, and height and weight measurements at baseline and 6, 12, 18, and 24 months after RYGB. A total of 75% participated at all follow-up points. Results Before RYGB, global psychosocial impairments were documented. Hierarchical linear modeling was used to examine the growth trajectories. Several quadratic (nonlinear) trends were revealed. A substantial reduction in weight and depressive symptoms, as well as improved HRQOL and self-concept were identified across the first postoperative year, followed by decelerations in year 2, including weight regain (P < .0001) and slight increases in depressive symptoms (P = .004) and decreases in HRQOL (Social, P = .002; Body Esteem, P = .0007; Physical Comfort, P < .0001; and Total, P < .0001), and self-concept (Social, P = .02; Appearance, P = .002; and Close Friendship, P = .008). Conclusion During the first 24 months after RYGB, preliminary evidence suggests adolescents experience significant weight loss as well as psychosocial and HRQOL improvements. A deceleration in these gains occurred in the second postoperative year. Longer term follow-up with larger samples is critical to determine the weight and psychosocial trajectories, and what role psychosocial status plays in adolescents’ weight change and maintenance.

Background Children from low-SES and ethnic minority backgrounds are at heightened risk for overweight, yet are underrepresented in the pediatric obesity literature. Methods The current paper describes strategies employed to minimize barriers to recruitment and retention of African-American families receiving WIC services in a longitudinal study examining caregiver feeding and child weight. Results Seventy-six families enrolled in the study over 3.5 years, and 50% of the families completed the study. Implications for Practice Despite effortful planning, unanticipated barriers likely contributed to lengthy recruitment and a modest retention rate. Future research should incorporate lessons learned to modify and develop effective strategies for increasing engagement of low-SES and ethnic minority families in research.

OBJECTIVE: Present first published data detailing high-risk behaviors of adolescent high school students (HSS) with extreme obesity (BMI ≥ 99th percentile for age and gender) compared with healthy weight peers (5th–84th percentile). METHODS: The 2007 Youth Risk Behavior Survey was used to compare HSS with extreme obesity (N = 410) and healthy weight peers (N = 8669) in their engagement in (1) tobacco use, (2) alcohol/other drug use, (3) high-risk sexual behaviors, and (4) suicidal behaviors. Logistic regression was used to calculate gender-stratified odds ratios (OR) and 95% confidence intervals (CI), controlling for age and race. RESULTS: HSS with extreme obesity were similar to healthy weight peers in the prevalence of most behaviors related to alcohol/drug use, high-risk sexual activities, and suicide, with the following exceptions: relative to healthy weight HSS, both male and female students with extreme obesity more frequently reported ever trying cigarettes (female students, adjusted OR: 2.0 [95% CI: 1.3–3.2]; male students, OR: 1.5 [CI: 1.2–2.0]). Compared with healthy weight female students, female students with extreme obesity had lower odds of ever having sex (OR: 0.5 [CI: 0.3–0.9]), but greater odds of drinking alcohol/using drugs before their last sexual encounter (OR: 4.6 [CI: 1.2–17.6]), currently smoking (OR: 2.3 [CI: 1.2–4.4]), and using smokeless tobacco (OR: 4.6 [CI: 1.2–17.2]). Compared with healthy weight male students, male students with extreme obesity had greater odds of smoking before age 13 (OR: 1.4 [CI: 1.0–2.0]). CONCLUSIONS: With few exceptions, HSS with extreme obesity engage in high-risk behaviors at rates comparable with healthy weight peers, sometimes in even more dangerous ways. Health care providers should assess risk-taking behaviors in this cohort.

Background/Objectives Bariatric surgery produces robust weight-loss, however, factors associated with long-term weight-loss maintenance among adolescents undergoing Roux-en-Y gastric bypass surgery (RYGB) are unknown. Subjects/Methods Fifty adolescents (mean±SD age and BMI = 17.1±1.7yrs and 59±11kg/m2) underwent RYGB, had follow-up visits at 1-yr and at a visit between 5–12yrs following surgery (FABS-5+ visit; mean±SD 8.1±1.6yrs). A non-surgical comparison group (n=30; mean±SD age and BMI = 15.3±1.7yrs and BMI=52±8kg/m2) was recruited to compare weight trajectories over-time. Questionnaires (health-related and eating behaviors, health responsibility, impact of weight on quality of life, international physical activity questionnaire (IPAQ), and dietary habits via surgery guidelines) were administered at the FABS-5+ visit. Post-hoc, participants were split into 2 groups: long-term weight loss maintainers (n=23; baseline BMI=58.2kg/m2; 1-yr BMI=35.8kg/m2; FABS-5+ BMI=34.9kg/m2) and re-gainers (n=27; baseline BMI=59.8kg/m2; 1-yr BMI=36.8 kg/m2; FABS-5+ BMI=48.0kg/m2) to compare factors which might contribute to differences. Data were analyzed using generalized estimating equations adjusted for age, sex, baseline BMI, baseline diabetes status, and length of follow-up. Results The BMI of the surgical group declined from baseline to 1-yr (−38.5±6.9%), which, despite some regain, was largely maintained until FABS-5+ (−29.6±13.9 % change). The BMI of the comparison group increased from baseline to the FABS-5+ visit (+10.3±20.6%). When the surgical group was split into maintainers and re-gainers, no differences in weight-related and eating behaviors, health responsibility, physical activity/inactivity, or dietary habits were observed between groups. However, at FABS-5+, maintainers had greater overall QOL scores than re-gainers (87.5±10.5 vs. 65.4±20.2, p<0.001) and in each QOL sub-domain (p<0.01 all). Conclusions Long-term weight outcomes for those who underwent weight loss surgery were superior to those who did not undergo surgical treatment. While no behavioral factors were identified as predictors of success in long-term weight-loss maintenance, greater QOL was strongly associated with maintenance of weight loss among adolescents who underwent RYGB surgery.