Objective
Provide the most recent data on the prevalence of obesity and severe obesity among United States children and adolescents aged 2 to 19 years.

Methods
The National Health and Nutrition Examination Survey, 1999–2014, was used. Weight status was defined using measured height and weight and standard definitions as follows: overweight as ≥85th percentile for age- and sex-specific BMI; class I obesity as ≥95th percentile; class II obesity as ≥120 of the 95th percentile, or BMI ≥35; and class III obesity as ≥140% of the 95th percentile, or BMI ≥40. This study reports the prevalence of obesity by 2-year National Health and Nutrition Examination Survey cycle and Wald tests comparing the 2011–2012 cycle with the 2013–2014 cycle, as well as the linear trend from 1999 to 2014. Multivariable logistic regression models estimated odds ratios for differences by each 2-year cycle.

Results
In 2013–2014, 17.4% of children met criteria for class I obesity, including 6.3% for class II and 2.4% for class III, none statistically different than 2011–2012. A clear, statistically significant increase in all classes of obesity continued from 1999 through 2014.

Conclusions
There is no evidence of a decline in obesity prevalence in any age group, despite substantial clinical and policy efforts targeting the issue.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/oby.21497

Prevalence of obesity and severe obesity in US children, 1999-2014.

With the prevalence of obesity on the rise, keeping young children physically active is an important strategy to promote their health and well-being. But survey instruments to measure physical activity in preschool-aged children are lacking. Furthermore, direct measures of their physical activity are often not feasible in large studies. Time spent playing outdoors is a potential surrogate measure of physical activity for this group, but parental-report measures of outdoor playtime have not been evaluated. This study compared a direct measure of children's physical activity with two parental-report measures of it, finding that they are significantly correlated and suggesting that parental reports are worth future evaluation as a survey measure.

Parental Report of Outdoor Playtime as a Measure of Physical Activity in PreschoolAged Children

Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review.

Sugar-sweetened beverages (SSBs) have little nutritional value and a robust body of evidence has linked the intake of SSBs to weight gain and risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and some cancers. Metabolic Syndrome (MetSyn) is a clustering of risk factors that precedes the development of T2D and CVD; however, evidence linking SSBs to MetSyn is not clear. To make informed recommendations about SSBs, new evidence needs to be considered against existing literature. This review provides an update on the evidence linking SSBs and cardiometabolic outcomes including MetSyn. Findings from prospective cohort studies support a strong positive association between SSBs and weight gain and risk of T2D and coronary heart disease (CHD), independent of adiposity. Associations with MetSyn are less consistent, and there appears to be a sex difference with stroke with greater risk in women. Findings from short-term trials on metabolic risk factors provide mechanistic support for associations with T2D and CHD. Conclusive evidence from cohort studies and trials on risk factors support an etiologic role of SSB in relation to weight gain and risk of T2D and CHD. Continued efforts to reduce intake of SSB should be encouraged to improve the cardiometabolic health of individuals and populations.

Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence.

Although all types of diabetes result in hyperglycemia, the pathophysiology of each type of diabetes is different. These guidelines summarize available data specific to the comprehensive care of youth with type 2 diabetes. The objective is to enrich the recognition of type 2 diabetes in youth, its risk factors, its pathophysiology, its management, and the prevention of associated complications.

Glucose homeostasis is maintained by a balance between insulin secretion from the pancreatic β-cells and sensitivity to insulin in skeletal muscle, adipose tissue, and liver (1). When insulin sensitivity declines, insulin secretion must increase to maintain glucose tolerance, and, in most youth, decreased insulin sensitivity due to puberty and/or obesity is compensated by increased insulin secretion. However, when β-cells cannot secrete sufficient insulin to compensate for insulin resistance, abnormalities in glucose homeostasis ensue, potentially progressing to prediabetes and type 2 diabetes as β-cell function deteriorates further (2–9). The relationship between β-cell function and insulin sensitivity in adults and youth has been demonstrated to be a hyperbolic function and can be described mathematically as the product of insulin sensitivity and β-cell function, called the disposition index (DI) (1). The DI essentially expresses the amount of insulin being secreted relative to the degree of insulin resistance and is a constant for a given degree of glucose tolerance in any one individual.

Overweight and obesity are major acquired contributors to the development of insulin resistance, particularly in the face of the physiologic insulin resistance characteristic of puberty. Robust pancreatic β-cell compensatory insulin secretion maintains normal glucose homeostasis. However, in adolescents with obesity who develop type 2 diabetes, there is severe peripheral and hepatic insulin resistance, with ∼50% lower peripheral insulin sensitivity than peers with obesity without diabetes, along with increased fasting hepatic glucose production and inadequate first- and second-phase insulin secretion, resulting …

/pdf/evaluation-and-management-of-youth-onset-type-2-diabetes-a-3c02you14v.pdf

Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association

Improved patient experience, population health, and reduced cost of care for patients with obesity and other chronic diseases will not be achieved by clinical interventions alone. We offer here a new iteration of the Chronic Care Model that integrates clinical and community systems to address chronic diseases. Obesity contributes substantially to cardiovascular disease, type 2 diabetes mellitus, and cancer. Dietary and physical activity interventions will prevent, mitigate, and treat obesity and its related diseases. Challenges with the implementation of this model include provider training, the need to provide incentives for health systems to move beyond clinical care to link with community systems, and addressing the multiple elements necessary for integration within clinical care and with social systems. The Affordable Care Act, with its emphasis on prevention and new systems for care delivery, provides support for innovative strategies such as those proposed here.

An Integrated Framework For The Prevention And Treatment Of Obesity And Its Related Chronic Diseases

Excess consumption of added sugars, especially from sugary drinks, poses a grave health threat to children and adolescents, disproportionately affecting children of minority and low-income communities. Public policies, such as those detailed in this statement, are needed to decrease child and adolescent consumption of added sugars and improve health.

Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents

Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.

/pdf/physical-activity-assessment-and-counseling-in-pediatric-3cjk4n4h9b.pdf

Physical Activity Assessment and Counseling in Pediatric Clinical Settings.

Community and Clinical Systems for the Prevention and Management of Obesity and Other Chronic Diseases William H. Dietz, MD, PhD, Sumner M. Redstone Global Center for Prevention and Wellness; Brook Belay, MD, MPH, Centers for Disease Control and Prevention; Don Bradley, MD, MHS-CL, Duke University; Scott Kahan, MD, MPH, Johns Hopkins Bloomberg School of Public Health; Natalie D. Muth, MD, MPH, RDN, FAAP, American Council on Exercise; Eduardo Sanchez, MD, MPH, FAAFP, American Heart Association; Loel Solomon, PhD, MPP, Kaiser Permanente (1)

/pdf/a-model-framework-that-integrates-community-and-clinical-2k8s3smbha.pdf

A Model Framework That Integrates Community and Clinical Systems for the Prevention and Management of Obesity and Other Chronic Diseases

From Food to Fuel: Carbohydrate, Protein, Fat, Vitamins, Minerals, Electrolytes, and Water, Dietary Guidelines, General Nutrition Recommendations, and Federal Nutrition Policy Optimizing Sports Performance: Fundamentals of Exercise Physiology and Nutrition, Nutrition Strategies for Optimal Athletic Performance, Exercise, Thermoregulation, and Fluid Balance, Nutritional Strategies for Competitive Endurance, Strength, and Power Athletes Nutritional Supplements and Ergogenic Aids Evaluation of Nutritional Status: Nutrition and Boby Composition Coaching and Assessment, Sports Nutrition for Special Populations 12. Weight Management and Energy Balance Nutrition across the Life Cycle, Nutrition for Athletes with Illness or Injury, Eating and Exercise Disorders, Nutrition for Athletes with Special Dietary Needs Glossary.

Natalie D. Muth

Papers

An Integrated Framework For The Prevention And Treatment Of Obesity And Its Related Chronic Diseases

Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents

Physical Activity Assessment and Counseling in Pediatric Clinical Settings.

A Model Framework That Integrates Community and Clinical Systems for the Prevention and Management of Obesity and Other Chronic Diseases

Sports Nutrition for Health Professionals