Purpose: The purpose of this study was to compare baseline differences in demographics and health behaviours of participants from a randomized controlled trial (Aim2Be) that included recruitment through either pediatric obesity management clinics (clinical) or social media (Facebook) using a targeted advertisement.

Methods: A two-arm waitlist control study design was used. Participants were parent-child dyads with a child aged 10-17 years living with overweight or obesity. Demographic differences between participants recruited from Facebook and  from clinical settings were evaluated using Student’s t-tests and chi-square tests for continuous and categorical outcomes, respectively, using a p<0.01 to account for the possibility of a Type I error. Linear regression models assessed group differences in children's and parents' health behaviours, motivation, self-efficacy, parenting practices, and quality of life after adjusting for covariates (sex, age, income, ethnicity, parental education, household income, parents' marital status, and previous family participation in a weight management program).

Results: Compared to families recruited through weight management clinics (n=95), participants in the Facebook group  (n=123) were younger (M=42 vs M=46 years, p<0.001), had younger children (M=12 vs M=14 years, p<0.001), were more likely to have a male child (57% vs 37%, p=0.003), and identify as white (70% vs 52%). Participants recruited through clinical sites were more likely to have participated in a weight management program (p=0.000) and have higher intentions to participate in such a program in the future (p=0.000) than Facebook participants. Baseline characteristics of participants did not differ; however a few variables were borderline significant (p<0.05). With respect to lifestyle behaviours, Facebook participants reported a higher mean daily caloric intake (M=2236 SD=727 vs. M=1875 SD=705; p=0.014) and lower min/week of physical activity (M=299 SD=47 vs. M=319 SD=165; p=0.022) than clinical site participants. Children's and parents' health behaviours, motivation, self-efficacy, parenting practices, and quality of life did not significantly differ.

Conclusions: Demographic and behavioural characteristics differed depending on the source of recruitment for this trial. While participants recruited through social media are prime participants for lifestyle behaviour interventions, these participants may differ from a clinically recruited population at baseline, which may influence results.

Purpose: Explore the dynamics of mother/daughter dyads on social networking sites (SNSs) and the influence of mothers’ SNS use on various psychosocial health variables in their daughters.

 Methods: 40 mother/daughter dyads completed individual, online surveys which utilized parallel questions. Predictor variables included overall SNS use, photo activities, and interaction activities. Outcome variables included Rosenberg Self-Esteem Scale (RSES), Body Shape Satisfaction Scale (BSSS), Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), Children’s Eating Attitude Test (ChEAT)/ The Eating Attitudes Test (EAT-26), and questions to determine physical activity behaviours. Data were analyzed using a pooled regression actor-partner interdependence model.

 Results/findings: Actor effects were significant for both mothers and daughters. For the daughter partner effects, eight relationships were significant: 1) Overall SNS use and RSES (t = -2.28, p<.05), 2) Overall SNS use and BSSS (t = -2.50, p<.05), 3) Overall SNS use and SATAQ-4 (t = 4.47, p<.05), 4) Overall SNS use and EAT-26/ChEAT (t = 4.59, p<.05), 5) SNS photo activities and SATAQ-4 (t = 4.03, p<.05), 6) SNS photo activities and EAT-26/ChEAT (t = 3.92, p<.05), 7) SNS interaction activities and RSES (t = 2.46, p<.05), and 8) SNS interaction activities and RSES (t = -3.83, p<.05). None of the mother partner effect were statistically significant.

 Conclusions: The present study delivers a better understanding towards the dyadic relationships between SNS behaviours and self-esteem, body satisfaction, societal and interpersonal aspects of appearance ideals, eating disorder symptoms/concerns, and physical activity behaviours among mothers and their early adolescent daughters. Findings suggest that mothers need to foster positive SNS behaviour, and that greater emphasis should be placed on discouraging negative modelling behaviours online.

Purpose: In efforts to combat pediatric obesity and identify children at high-risk, physicians and health professionals widely practice screening and classifying weight status using age- and sex-specific body mass index (BMI) percentiles [Herman et al., 2009]. However, maturation-related misclassification may result in overestimations of overweight prevalence rates among early maturing adolescents, and underestimations among later maturing adolescents [Pietrobelli, 1998 & USPSTF, 2017]. The purpose of this investigation is to determine the rate of occurrence of misclassification of weight status among young girls due to standard chronological age-and-sex matched reference data at age 12.

Methods: Females (n=221) in grades K-8 participated in school health screenings of body mass and stature annually from 2006-2020. Age-and-sex-specific BMI percentiles were calculated at age 12, and weight status was determined based on CDC growth charts. Height velocities were graphed based on longitudinal data from age 8-14 years to determine somatic maturity (biological age) based on age at peak height velocity. The number of participants whose weight status was misclassified at age 12 when adjusted for biological age was determined.

Results/Findings: Twenty-seven percent of participants were classified as overweight (13%) and obese (14%) at age 12 based on chronological age (11.9 ± 0.2 years). The distribution of early, average, and late maturers was 38%, 34%, and 28%, respectively. When adjusting for biological age (12.1 ± 0.9 years), 6% (14/221) of participants were reclassified, with 1.4% obese participants reclassified as overweight, and 2.3% overweight participants reclassified as normal weight. Underestimations were also seen with 2.3% normal weight participants reclassified as overweight and 0.5% overweight participants reclassified as obese.

Conclusion: Our study found only 4% of girls were reclassified into a lower weight category; thus maturation does not appear to influence or misclassify in young girls. These results are in conflict with a previous study (Gillison et al., 2017) which found 22% of overweight or obese girls were reclassified into a lower weight category when adjusting for maturity.

Purpose: Appetitive traits in children, measured by the Child Eating Behavior Questionnaire (CEBQ) and Baby Eating Behavior Questionnaire (BEBQ), predict body weight and are heritable. However, much is still to be learnt about how appetitive traits evolve through development. Here we investigate tracking (i.e. persistence of rank order over time) and age-related differences in eating behaviors as assessed in childhood and infancy.

Methods: We used data from our ongoing cohort study, Resonance, on CEBQ (8 sub-scales: food responsiveness, enjoyment of food, emotional overeating, desire to drink, satiety responsiveness, slowness in eating, food fussiness, emotional undereating) assessed in children 2-15 years, and BEBQ (4 sub-scales: food responsiveness, enjoyment of food, satiety responsiveness, slowness in eating) assessed in children 1-17 months. Cross-sectional Pearson correlations of appetitive traits and age were tested for all participants with at least one observation (CEBQ: n=294, BEBQ: n= 153). In addition, we sourced children’s first and second observations of the CEBQ (n=118) and BEBQ (n=36) to test tracking within individuals (paired correlations) and age-related differences within individuals (paired t-tests).

Results/findings: CEBQ correlations with age suggested that satiety responsiveness, slowness in eating, and desire to drink decreased with age (r=-.172, p=.003; r=-.296, p<.001; r=-.234, p<.001), while emotional overeating increased with age (r=.228, p<.001). Paired t-tests also supported an increase in emotional overeating with age within individuals (M: 1.55 vs. 1.71, p=.002). All CEBQ sub-scales demonstrated high tracking (r=.503 to .751, p<.001). BEBQ correlations with age suggested that slowness in eating decreased with age (r=-.212, p=.008). Paired t-tests did not reveal any age-related differences. Satiety responsiveness, but not the other BEBQ sub-scales, showed high tracking (r=.436, p=.008). 

Conclusion: Initial findings from the Resonance cohort suggest that food avoidant traits are negatively related with age, and that emotional overeating increases with age. All appetitive traits showed tracking within individuals through childhood, and satiety responsiveness tracked through infancy. Further research into how these traits evolve through development could help parents know what to expect, facilitate intervention development, and stimulate research into environmental and biological contributions to appetite development.

 

Purpose: The coronavirus disease-2019 (COVID-19) pandemic led to the closure of schools around the world. The structured days hypothesis posits that the school day regulates children’s engagement in obesogenic behaviors and, in turn, weight status. This study evaluated the impact of COVID-19 related school closures on children’s body mass index z-score (zBMI).

Methods: This interrupted time-series study included two elementary/primary schools in the United States. Schools closed on March 16^th, 2020, and did not reopen until the following school year (i.e., September 9^th, 2020). Height and weight were collected from children (N=1804, mean age=8.8 years SD=2.1, 51.3% male, 64.6% Black) each August/September from 2017-2020. BMI was calculated and transformed into zBMI. Mixed-effects linear regression estimated yearly zBMI change prior to (i.e., 2017-2019) and in the year of pandemic school closures (i.e. 2019-2020). Subgroup analyses by sex, race (i.e., Black, White, other race), weight status (World Health Organization defined overweight or obese [OWOB] and normal weight), and grade (i.e., lower=kindergarten-2^nd grade, and upper=3^rd-6^th grade) were conducted.

Results/findings: Prior to pandemic school closures children’s yearly zBMI change was +0.03 (95CI=-0.10, 0.15). Change in the year of the pandemic school closures was +0.34 (95CI=0.21, 0.47), representing an acceleration in zBMI change of +0.31 (95CI=0.19, 0.44). For girls, zBMI change accelerated by +0.26 (95CI=0.12, 0.40) during the pandemic year, while boys experienced an acceleration of +0.35 (95CI=0.20, 0.50). Acceleration in zBMI change was observed for Black (+0.39, 95CI=-0.22, 0.55), White (+0.20, 95CI=0.06, 0.35), and those identified as another race (+0.34, 95CI=0.06, 0.61) during the pandemic year. For children classified as normal weight prior to the pandemic zBMI change accelerated by +0.52 (95CI=-0.38, 0.67) while it did not accelerate for children classified as OWOB prior to pandemic (-0.03 (95CI=-0.14, 0.08). Yearly zBMI change accelerated for lower elementary/primary (+0.25, 95CI=0.12, 0.38) and upper elementary/primary children (+0.37, 95CI=0.19, 0.54).

Conclusions: In this sample zBMI accelerated for all children, except for children classified as OWOB prior to the pandemic. If similar zBMI accelerations occurred for children across the world, public health interventions to address this rapid unhealthy BMI gain will be urgently needed. 

Methods:  Parents of 231 elementary schoolers (ages 7-12) from a larger cohort completed the Beverage and Snack Questionnaire on 2-3 random days each week for 6 weeks in Spring (April/May) and Summer (June/July). Foods were classified as healthy (i.e., fruit, vegetables, unsweetened dairy) or unhealthy (i.e., convenience foods, sweets/desserts, salty snacks, sugar-sweetened beverages) based on the Healthy Eating Index. Mixed models were used to compare differences in means and changes in slope between years, accounting for age, sex, and race.

Results: Before the pandemic (2018 to 2019), there were no significant changes in springtime consumption of either healthy (B = 0.10 95CI 0.00 to 0.10) or unhealthy (B=0.06, 95CI -0.12 to 0.24) foods. In spring 2020, both healthy and unhealthy food consumption increased significantly; children consumed an extra 0.3 (95CI 0.16 to 0.45) healthy and 1.2 (95CI 0.96 to 1.50) unhealthy foods/day. Summertime consumption of healthy and unhealthy foods was already increasing prior to the pandemic (B=0.12, [95CI 0.03 to 0.12] and B=0.46 [95CI 0.28 to 0.63], respectively). Healthy food consumption accelerated by an extra 0.2 (95CI 0.06 to 0.34) foods/day during the pandemic. While there was a significant increase in unhealthy foods consumed during the pandemic compared to previous years, the relative increase was not greater than expected given previous trends in summer eating habits (B=0.23, 95CI -.04 to .50).

Implications: Increased unhealthy food consumption during the pandemic is concerning given the risk for weight gain. Increases in summertime unhealthy food consumption, even prior to the pandemic, highlight the risk of unhealthy weight gain during summer vacation. The pandemic school closures may have altered children’s health behaviors by mimicking an ‘extended summer vacation,’ devoid of external structure. This may contribute to a population-wide increase in childhood obesity, warranting public health intervention.