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We sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). We also sought to illustrate how clinical data can be used to identify children most at-risk for SGAP-induced weight gain, which cannot be done using process-focused measures.Electronic health record (EHR) data and Medicaid claims were linked from 2013 to 2019. We quantified sociodemographic differences between children with and without pre- and post-BMI values. We developed a linear regression model of post-BMI to examine pre-post changes in BMI among 4 groups: 1) BH/SGAP+ children had behavioral health conditions and were taking SGAP; 2) BH/SGAP- children had behavioral health conditions without taking SGAP; 3) children with asthma; and 4) healthy children.Of 363,360 EHR-Medicaid linked children, 18,726 were BH/SGAP+. Roughly 4% of linked children and 8% of BH/SGAP+ children had both pre and post values of BMI required to assess quality of SGAP monitoring. The percentage varied with gender and race-ethnicity. The RMeeting the 2030 Centers for Medicare and Medicaid Services goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked EHR and claims data allows identifying children at higher risk for SGAP-induced weight gain.

Obesity is a multifactorial disease that disproportionally affects diverse racial and ethnic groups. Structural racism influences racial inequities in obesity prevalence through environmental factors, such as racism and discrimination, socioeconomic status, increased levels of stress, and bias in the health care delivery system. Researchers, clinicians, and policy makers must work to address the environmental and systematic barriers that contribute to health inequities in the United States. Specifically, clinicians should quantitatively and qualitatively assess environmental and social factors and proactively engage in patient-centered care to tailor available treatments based on identified needs and experiences.

To examine how the teach-back, interactive communication loop between patient and provider, is utilized and its role in diabetes care delivery.This was a cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) 2011-2016. The study sample included US adults aged 18 or older with diabetes. Survey-design adjusted analyses were used to examine patterns of teach-back utilization across patient socioeconomic/clinical characteristics, patient-provider interactions, and diabetes care education.Analysis of 2901 US adults with diabetes showed that 25.0 % reported patient teach-back experience during their visit to care. Compared with patients without teach-back, those with teach-back experience had higher scores on interaction quality with their providers (composite score: 90.8 vs. 55.8, P .001). Those with teach-back were also more to receive additional advice on diet and exercise from providers (67.0 % vs. 60.9 %, P = 0.03) and to report that they were confident in diabetes self-care management (75.7 % vs. 70.3 %, P =0.03).Teach-back communication appears to be effective in patient-provider interaction and diabetes care education, leading to higher confidence in self-care management.Despite its potential, the utilization of teach-back communication is suboptimal. More effort is needed to promote effective use of teach-back communication in routine diabetes care.

Background Obesity is a significant risk factor of several cancers that imposes a substantial economic burden on US healthcare that remains to be quantified. We estimated the excess costs and economic burden of obesity-related cancers in the United States. Methods From the Medical Expenditure Panel Survey (2008-2015) data, we identified 19 405 cancer survivors and 175 498 non-cancer individuals. We estimated annual health expenditures using generalized linear regression with log link and gamma distribution by cancer types (stratified by 11 obesity-related cancers and other cancer types), controlling for sociodemographic and clinical characteristics. All cost estimates were adjusted to 2015 USD value. Results The average annual total health expenditures were $21 503 (95% CI, $20 946-$22 061) for those with obesity-related cancer and $13 120 (95% CI, $12 920-$13 319) for those with other cancer types. There was a positive association between body mass index and health expenditures among cancer survivors: for each additional 5-unit increase in body mass index, the average predicted expenditures increase by $1503 among those with obesity-related cancer and by $722 among those with other cancers. With adjustments for sociodemographic and clinical characteristics, the mean incremental expenditures of treating obesity-related cancer were 2.1 times higher than those of other cancers ($4492 vs $2139) and more considerable among the non-elderly cancer population. Obesity-related cancers accounted for nearly 43.5% of total direct cancer care expenditures, estimated at $35.9 billion in 2015. Conclusion The economic burden of obesity-related cancer in the United States is substantial. Our findings suggest a need for the inclusion of comprehensive obesity prevention and treatment in cancer care.

We characterized the prevalence of obesity among Florida children 2–19 years old using electronic health records (EHRs). The obesity prevalence for 331,641 children was 16.9%. Obesity prevalence at 6–11 years (19.5%) and 12–19 years (18.9%) were approximately double the prevalence of obesity among children 2–5 years (9.9%). The highest prevalence of severe obesity occurred in rural Florida (21.7%) and non-Hispanic children with multiple races had the highest obesity prevalence (21.1%) across all racial/ethnic groups. Our results highlight EHR as a low-cost alternative to estimate the prevalence of obesity and severe obesity in Florida children, both overall and within subpopulations.

We investigated the relationship between adverse childhood experiences (ACEs) and children’s internalising symptoms and externalising problems in the Wales Adoption Cohort Study, a prospective longitudinal study that used case file records (n = 374) for a sample of British children adopted from care (M = 2 years, 55% male). Parents (n = 96) completed questionnaires at 3–5 months, 15–17 months, and 31–33 months post-placement. We hypothesised that: (1) children adopted from care would have experienced more ACEs than children in the general population; (2) the number of ACEs would be associated with higher internalising symptom and externalising problem scores; and (3) adoptive parental warmth would moderate the relationship between ACEs and post-placement internalising symptoms and externalising problems. Nearly half (42%) of the children experienced four or more ACEs. Internalising symptoms and externalising problems were significantly higher than the UK general population. The number of ACEs was associated with internalising symptoms 3 years post-adoptive placement but this relationship was moderated by adoptive parental warmth. This study profiles the experiences and characteristics of a national sample of adopted children and highlights the potential importance of parent warmth as a factor that ameliorates the impact of ACEs on poor child outcomes.

OBJECTIVES: This study assessed the feasibility and acceptability of an ABT healthy lifestyle intervention among diverse adolescent cisgender girls with overweight/obesity (OW/OB). METHODS: Adolescent cisgender girls ages 14 to 19 with a BMI ≥ 85(th) percentile-for-sex-and-age were recruited for participation in a single-arm feasibility study. The primary outcomes were recruitment and retention while the secondary outcome was change in BMI Z-score over the 6-month intervention. Exploratory outcomes included obesity-related factors, health-related behaviors, and psychological factors. RESULTS: Recruitment goals were achieved; thirteen adolescents (>60% racial/ethnic minorities) participated in the intervention, and eleven completed the intervention (85% retention). In completers (n = 11), a mean decrease in BMI Z-score of −0.15 (SD = 0.34, Cohen's d = −0.44) was observed. Improvements were also noted for change in percentage of 95(th) percentile (d = −0.35), % body fat (d = −0.35), quality of life (d = 0.71), psychological flexibility (d = −0.86), and depression (d = −0.86). CONCLUSIONS: These preliminary findings suggest an ABT healthy lifestyle intervention tailored for adolescent cisgender girls with OW/OB may be an acceptable treatment that could lead to improvements in BMI Z-score, obesity-related measures, and psychological outcomes. FUNDING SOURCES: This work is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH; UL1TR001427) and WellCare Health Plans, Inc. Dr. Cardel is also supported by the National Institutes of Health National Heart, Lung, and Blood Institute (K01HL141535 and R25HL126146).

Pediatric obesity, a significant public health concern, has been associated with adult premature mortality and the development of type 2 diabetes and cardiovascular disease. Evidence has suggested that the gut microbiota is associated with pediatric obesity. Establishment of the infant gut microbiome is dependent on a dynamic maternal-infant microbiota exchange during early life. The objective of this review is to describe maternal factors such as feeding practices and antibiotic use that may influence the infant gut microbiome and risk for obesity. The complex components in human milk have many nutritional benefits to the infant; however, the microbiome in human milk may be an important factor to help regulate the infant's weight. We discuss maternal antibiotics and the effects on breast milk as critical exposures that alter the infant's gut microbiome and influence the risk of pediatric obesity.

OBJECTIVES: Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least four-fold over the last 35 years. Provision of evidence-based treatment options that are tailored and relevant to the needs of adolescents is paramount, yet difficult to tailor because little is known regarding barriers and facilitators to adolescent weight loss. Thus, identification of barriers and facilitators to weight loss among adolescents with overweight/obesity (OW/OB) is needed. The objective of this qualitative study was to assess perceived barriers and facilitators to a healthy lifestyle and weight loss among adolescents with OW/OB. METHODS: Using 2018–2019 data from eleven focus groups among adolescents aged 14–19 with OW/OB (n = 41; n = 11 boys and n = 30 girls), a moderated, semi-structured focus group guide was used to identify perceived barriers and facilitators to a healthy lifestyle and weight loss. RESULTS: Adolescents reported time, access to healthful foods, food cravings, stress, and weight stigma/shaming as barriers to weight loss. Themes around internal and external psychosocial states (support, motivation) and behaviors including modeling, sports, and other physical activities were identified as both barriers and facilitators. Parents were recognized by teens as both helping and hindering weight loss, but overall teens felt their parents were more so facilitators than barriers, particularly as it related to modeling behaviors. Differences were noted by sex, among which girls reported experiencing weight struggles, whereas boys generally stated they did not struggle with weight, despite all participants meeting criterion for OW/OB. CONCLUSIONS: Adolescent boys and girls with OW/OB perceive their weight status differently and identify a variety of barriers and facilitators to a healthy lifestyle and weight loss. Tailoring adolescent weight management interventions to address these perceived barriers and facilitators, along with noted sex differences, has the potential to improve the quality and effectiveness of adolescent obesity interventions. FUNDING SOURCES: National Heart, Lung, and Blood Institute, National Institute of Health, WellCare Health Plans.

Background: Polyunsaturated fatty acids (PUFAs) are associated with protection from obesity-related phenotypes in adults; however, the relation between reported intake of PUFAs with body-composition outcomes in children remains unknown. Objective: Our objective was to examine how self-reported intakes of PUFAs, including total, n–6 (ω-6), and n–3 (ω-3) PUFAs and ratios of n–6 to n–3 PUFAs and PUFAs to saturated fatty acids (SFAs), are associated with measures of adiposity and lean mass (LM) in children. We hypothesized that higher self-reported intakes of PUFAs and the ratio of PUFAs to SFAs would be positively associated with LM and negatively associated with total adiposity. Methods: Body composition and dietary intake were measured in a racially diverse sample of 311 children (39% European American, 34% African American, and 27% Hispanic American) aged 7–12 y. Body composition and abdominal fat distribution were measured by dual-energy X-ray absorptiometry and computed tomography scans, respectively. Self-reported dietary intakes (including total PUFAs, n–3 PUFAs, n–6 PUFAs, and SFAs) were assessed by using two 24-h recalls. Independent-sample t tests and multiple linear regression analyses were conducted. Results: Total PUFA intake was positively associated with LM (P = 0.049) and negatively associated with percentage of body fat (%BF; P = 0.033) and intra-abdominal adipose tissue (IAAT; P = 0.022). A higher ratio of PUFAs to SFAs was associated with higher LM (P = 0.030) and lower %BF (P = 0.028) and IAAT (P = 0.048). Intakes of n–3 and n–6 PUFAs were positively associated with LM (P = 0.017 and P = 0.021, respectively), and the ratio of n–6 to n–3 PUFAs was negatively associated with IAAT (P = 0.014). All results were independent of biological, environmental, and genetic covariates. Conclusions: Our results show that a higher self-reported intake of PUFAs and a higher ratio of PUFAs to SFAs are positively associated with LM and negatively associated with visceral adiposity and %BF in a healthy cohort of racially diverse children aged 7–12 y. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00726778","term_id":"NCT00726778"}}NCT00726778.

Background: Breakfast is associated with lower body weight in observational studies. Public health authorities commonly recommend breakfast consumption to reduce obesity, but the effectiveness of adopting these recommendations for reducing body weight is unknown. Objective: We tested the relative effectiveness of a recommendation to eat or skip breakfast on weight loss in adults trying to lose weight in a free-living setting. Design: We conducted a multisite, 16-wk, 3-parallel-arm randomized controlled trial in otherwise healthy overweight and obese adults [body mass index (in kg/m2) between 25 and 40] aged 20–65 y. Our primary outcome was weight change. We compared weight change in a control group with weight loss in experimental groups told to eat breakfast or to skip breakfast [no breakfast (NB)]. Randomization was stratified by prerandomization breakfast eating habits. A total of 309 participants were randomly assigned. Results: A total of 283 of the 309 participants who were randomly assigned completed the intervention. Treatment assignment did not have a significant effect on weight loss, and there was no interaction between initial breakfast eating status and treatment. Among skippers, mean (±SD) baseline weight-, age-, sex-, site-, and race-adjusted weight changes were −0.71 ± 1.16, −0.76 ± 1.26, and −0.61 ± 1.18 kg for the control, breakfast, and NB groups, respectively. Among breakfast consumers, mean (±SD) baseline weight-, age-, sex-, site-, and race-adjusted weight changes were −0.53 ± 1.16, −0.59 ± 1.06, and −0.71 ± 1.17 kg for the control, breakfast, and NB groups, respectively. Self-reported compliance with the recommendation was 93.6% for the breakfast group and 92.4% for the NB group. Conclusions: A recommendation to eat or skip breakfast for weight loss was effective at changing self-reported breakfast eating habits, but contrary to widely espoused views this had no discernable effect on weight loss in free-living adults who were attempting to lose weight. This trial was registered at clinicaltrails.gov as {"type":"clinical-trial","attrs":{"text":"NCT01781780","term_id":"NCT01781780"}}NCT01781780.

Background: Hypertension and dyslipidemia have traditionally been associated with dietary sodium and fat intakes, respectively; however, they have recently been associated with the consumption of added sugars in adults and older adolescents, but there is no clear indication of how early in the life span this association manifests. Objective: This study explored the cross-sectional association between added sugar (sugars not naturally occurring in foods) consumption in children, blood pressure (BP), and fasting blood lipids [triglycerides and total, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol]. Design: BP, blood lipids, and dietary intakes were obtained in a multiethnic pediatric sample aged 7–12 y of 122 European American (EA), 106 African American (AA), 84 Hispanic American (HA), and 8 mixed-race children participating in the Admixture Mapping of Ethnic and Racial Insulin Complex Outcomes (AMERICO) study—a cross-sectional study conducted in the Birmingham, AL, metro area investigating the effects of racial-ethnic differences on metabolic and health outcomes. Multiple regression analyses were performed to evaluate the relations of added sugars and sodium intakes with BP and of added sugars and dietary fat intakes with blood lipids. Models were controlled for sex, race-ethnicity, socioeconomic status, Tanner pubertal status, percentage body fat, physical activity, and total energy intake. Results: Added sugars were positively associated with diastolic BP (P = 0.0462, β = 0.0206) and serum triglycerides (P = 0.0206, β = 0.1090). Sodium was not significantly associated with either measure of BP nor was dietary fat with blood lipids. HA children had higher triglycerides but lower added sugar consumption than did either the AA or EA children. The AA participants had higher BP and HDL but lower triglycerides than did either the EA or HA children. Conclusions: These data suggest that increased consumption of added sugars may be associated with adverse cardiovascular health factors in children, specifically elevated diastolic BP and triglycerides. Identification of dietary factors influencing cardiovascular health during childhood could serve as a tool to reduce cardiovascular disease risk. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00726778","term_id":"NCT00726778"}}NCT00726778.

OBJECTIVES: In this study, data from the Jackson Heart Study (JHS) were used to assess the independent associations between objective socioeconomic status (OSS) and subjective social status (SSS) with metabolic syndrome (MetS) severity and MetS indicators in African American (AA) adults at baseline and eight years later. METHODS: Participants included 3870 AA participants (63.1% women; mean age 53.8 ± 13.0, age range 35–84 years). OSS was assessed using annual household income and years of school completed. SSS was measured with the MacArthur Scale, using two 10-rung “ladders” with U.S. society and the individual's community as referent groups for their perceived social rank. Associations of OSS and SSS with a sex- and race/ethnic-specific MetS severity Z-score were examined after adjustment for demographics and MetS risk factors (i.e., nutrition, physical activity, smoking status, and alcohol consumption) at baseline and 8-year follow-up. RESULTS: Independent of OSS, demographic, and lifestyle factors, individuals who placed themselves on lower rungs of a visual ladder depicting relative social standing in society had more severe metabolic syndrome at baseline but not 8-years later (P = 0.0123 and P = 0.3248, respectively). The components of MetS driving the relationship between US-level SSS and MetS severity at baseline were waist circumference and triglyceride levels, as waist circumference and triglycerides at baseline were inversely associated with US-level SSS (P = 0.0124 and P = 0.0074, respectively). OSS components, including measures of income and education, were both independently associated with MetS severity at baseline (P

Background Accumulating evidence implicates diet quality in childhood as playing a significant role in adult cardiometabolic health. Polyunsaturated fatty acids (PUFAs) of the n–6 (ω-6) and n–3 (ω-3) series contribute unique protective effects against cardiometabolic disease. As such, the ratio between n–6 and n–3 PUFAs is a dietary metric of interest in the early life span, although an optimum intake ratio has yet to be determined. Objective This cross-sectional study assesses relations between the ratio of total n–6:n–3 PUFA intake and cardiometabolic risk factors in a racially diverse sample of children (n = 191) from the Admixture Mapping of Ethnic and Racial Insulin Complex Outcomes (AMERICO) study. Methods Outcome measures included waist circumference, lipid concentrations, fasting glucose, and two 24-h dietary recalls from boys and girls aged 7–12 y who self-reported as European American (n = 81), African American (n = 55), or Hispanic American (n = 55). Linear regression analyses were used to assess associations between predictors of interest and outcomes after adjusting for covariates. Results PUFA intake reflected in the n–6:n–3 ratio was inversely associated with concentrations of total and LDL cholesterol [β ± SE: −0.359 ± 0.107 (P = 0.001) and −0.189 ± 0.069 (P = 0.007), respectively]. Exploratory analyses showed that the intake of total n–6 PUFAs was not significantly predictive of any cardiometabolic risk factor assessed, whereas total n–3 PUFA intake was positively associated with concentrations of HDL cholesterol (β ± SE: 0.114 ± 0.042; P = 0.007). Conclusions Results suggest that the effect of n–6 and n–3 PUFA intake reflected in the ratio may be largely driven by n–3 PUFAs in reducing 2 lipid cardiometabolic risk factors among this multiethnic cohort of children. Until an ideal intake ratio is determined, nutritional counseling should focus on meeting recommended levels of both n–3 and n–6 PUFAs in order to establish beneficial childhood dietary patterns that may positively influence adult cardiometabolic health.