OBJECTIVE: To explore the association between rs2587552 polymorphism (has a strong lin-kage disequilibrium with rs1800497 which had been found in many studies to be related to obesity, r²=0.85) of DRD2 gene and the effect of a childhood obesity intervention in Chinese population, and provide a scientific basis for future personalized childhood obesity intervention based on genetic background. METHODS: From a multi-center cluster randomized controlled trial studying the effect of a childhood obesity intervention, we enrolled 382 children from 8 primary schools (192 and 190 children from intervention and control groups, respectively) in Beijing as study subjects. Saliva was collected and DNA was extracted to detect the rs2587552 polymorphism of DRD2 gene, and the interactions between the gene and study arms on childhood obesity indicators [including body weight, body mass index (BMI), BMI Z-score, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio, and body fat percentage] were analyzed. RESULTS: No association was found between rs2587552 polymorphism and the changes in hip circumference or body fat percentage in the intervention group (P>0.05). However, in the control group, children carrying the A allele at DRD2 rs2587552 locus showed a greater increase in hip circumference and body fat percentage compared with those not carrying A allele (P < 0.001). There were interactions between rs2587552 polymorphism of DRD2 gene and study arms on the changes in hip circumference and body fat percentage (P=0.007 and 0.015, respectively). Compared with the control group, children in the intervention group carrying the A allele at DRD2 rs2587552 locus showed decrease in hip circumference by (-1.30 cm, 95%CI: -2.25 to -0.35, P=0.007) and decrease in body fat percentage by (-1.34%, 95%CI: -2.42 to -0.27, P=0.015) compared with those not carrying A allele. The results were consistent between the dominant model and the additive model (hip circumfe-rence: -0.66 cm, 95%CI: -1.28 to -0.03, P=0.041; body fat percentage: -0.69%, 95%CI: -1.40 to 0.02, P=0.056). No interaction was found between rs2587552 polymorphism and study arms on the changes in other childhood obesity-related indicators (P>0.05). CONCLUSION Children carrying the A allele at rs2587552 polymorphism of DRD2 gene are more sensitive to intervention and showed more improvement in hip circumference and body fat percentage after the intervention, suggesting that future personalized childhood obesity lifestyle intervention can be carried out based on the rs2587552 polymorphism of DRD2 gene.
Humans ; Child ; Pediatric Obesity/therapy* ; Prospective Studies ; Polymorphism, Genetic ; Body Mass Index ; Waist Circumference ; Receptors, Dopamine D2/genetics*

pediatric obesity has increased worldwide in the last 20 years. Obese children suffer not only physical complications but also mental health problems such as depression, attention deficit hyperactivity disorder (ADHD), and eating disorders, as well as psychosocial impairments, such as school adjustment problems, bullying, and low self-esteem. Recently, there have been some studies on the association of mental health problems and pediatric obesity. In the treatment of pediatric obesity, many previous studies suggest multidisciplinary treatment. However, cognitive behavioral therapy (CBT) has attracted attention because obese children are accompanied by body image distortion, emotion dysregulation, and difficulties in stimulus control. This review is a narrative summary of the recent studies on mental health problems and CBT in pediatric obesity. The relationship between depression/anxiety and pediatric obesity is still inconsistent but recent studies have revealed a bidirectional relation between depression and obesity. Additionally, some studies suggest that obese children may have eating disorder symptoms, like loss of control eating, and require therapeutic intervention for pediatric obesity treatment. Furthermore, impulsivity and inattention of ADHD symptom is thought to increase the risk of obesity. It has also been suggested that CBT can be very effective for mental health problems such as depression, impulsivity, and body image distortion, that may coexist with pediatric obesity, and use of multimedia and application can be useful in CBT.]]>
Attention Deficit Disorder with Hyperactivity ; Body Image ; Bullying ; Child ; Cognitive Therapy ; Depression ; Eating ; Humans ; Impulsive Behavior ; Mental Health ; Multimedia ; Obesity ; Pediatric Obesity ; Prevalence

Diet-related behavioral modification for healthy eating and lifestyle is required to improve childhood obesity. The present study aimed to develop customized nutritional intervention protocol and education program to find barriers to adhere healthy diet and lifestyle for moderate to severe obese children and adolescents and their families. Theoretical framework approaches can be used to change behavior and achieve goals. Previous studies that described the relationship between behavioral modification and nutrition education theory were reviewed. The social cognitive theory and transtheoretical model were employed with behavioral changes to target a healthful diet and lifestyle. The nutrition care process (NCP) model was adopted to customize nutrition care for the participants. Customized nutritional intervention protocol was developed following as the four steps of the NCP. Firstly, nutrition status of the participants was assessed by the nutrition expert. Nutrition problems were described as “inadequate energy intake,” “overweight/obesity,” or “food and nutrition-related knowledge deficit.” All nutrition sessions were designed for nutrition intervention to give nutritional knowledge and a practical mission in real life for individual goal setting and self-control. Meal planning, portion control, healthy snack selection and cooking with fruits and vegetables were consisted of five components of the nutrition education session. During each session, the participants and their families were interviewed by a nutrition expert for monitoring and evaluating diet-related goal setting and achievement. A theoretical and evidence-based nutritional intervention was developed for the secondary to tertiary prevention of childhood obesity. This nutrition intervention protocol and program might be helpful for the further research on childhood obesity. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0002111
Adolescent ; Behavior Therapy ; Child ; Cooking ; Diet ; Eating ; Education ; Fruit ; Humans ; Information Services ; Life Style ; Meals ; Nutrition Assessment ; Nutritional Status ; Pediatric Obesity ; Self-Control ; Snacks ; Tertiary Prevention ; Vegetables

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: (1) definition and diagnosis of overweight and obesity in children and adolescents; (2) principles of treatment of pediatric obesity; (3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; (4) pharmacotherapy; and (5) bariatric surgery.
Adolescent ; Bariatric Surgery ; Child ; Diagnosis* ; Diet ; Drug Therapy ; Gastroenterology* ; Humans ; Korea ; Life Style ; Mental Health ; Obesity ; Overweight ; Pediatric Obesity*

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: 1) definition and diagnosis of overweight and obesity in children and adolescents; 2) principles of treatment of pediatric obesity; 3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; 4) pharmacotherapy; and 5) bariatric surgery.
Adolescent ; Bariatric Surgery ; Child ; Diagnosis* ; Diet ; Drug Therapy ; Gastroenterology* ; Humans ; Korea ; Life Style ; Mental Health ; Obesity ; Overweight ; Pediatric Obesity*

INTRODUCTION: We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolescents. METHODS: This cross-sectional study included adolescents aged 15-17 years from five randomly selected secondary schools in the Hulu Langat district of Selangor state, Malaysia. Waist circumference (WC) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Information on sociodemographic data, dietary habits, physical activity levels and duration of sleep was obtained via interviewer-administered questionnaires. Participants' habitual food intake was determined using a 73-item Food Frequency Questionnaire. RESULTS: Among 832 participants, 56.0% were girls; 48.4% were Malay, 40.5% Chinese, 10.2% Indian and 0.8% of other ethnic groups. Median age and WC were 16 (interquartile range [IQR] 15-16) years and 67.9 (IQR 63.0-74.6) cm, respectively. Overall prevalence of AO (> 90th percentile on the WC chart) was 11.3%. A higher proportion (22.4%) of Indian adolescents were found to have AO compared with Malay and Chinese adolescents. Logistic regression analysis showed that female gender (adjusted odds ratio [OR] 7.064, 95% confidence interval [CI] 2.087-23.913; p = 0.002), Indian ethnicity (adjusted OR 10.164, 95% CI 2.182-47.346; p = 0.003), irregular meals (adjusted OR 3.193, 95% CI 1.043-9.774; p = 0.042) and increasing body mass index (BMI) (adjusted OR 2.867, 95% CI 2.216-3.710; p < 0.001) were significantly associated with AO. CONCLUSION AO was common among Malaysian adolescents. Female gender, Indian ethnicity, irregular meals and increasing BMI were significant risk factors.
Adolescent ; Body Mass Index ; Cross-Sectional Studies ; Feeding Behavior ; Female ; Humans ; Malaysia ; epidemiology ; Male ; Obesity, Abdominal ; epidemiology ; therapy ; Odds Ratio ; Pediatric Obesity ; epidemiology ; therapy ; Prevalence ; Risk Factors ; Suburban Population ; Surveys and Questionnaires ; Waist Circumference

OBJECTIVE: To investigate the effects of 4-week moderate aerobic exercise plus diet control on serum levels of total insulin-like growth factor 1(IGF-1) and IGF-1 binding protein-3 (IGFBP-3) as well as IGF-1 activity (reflected by molar ratio of IGF-1/IGFBP-3) in female obese adolescents and youths, and their possible role on fat loss, and improvement of glucose and lipid metabolism. METHODS: Nine female obese youths (age:18~19 y) and 30 female obese adolescents (age:14~16 y) were recruited and undertook 4-week aerobic exercise such as swimming and jogging (6 days/week, twice a day, 2 h/time with 5 min rest per 30 min exercise) with gradual increase of intensity from low (heart rate immediately post-exercise of 1st week:100~120 beats/min) to moderate (heart rate immediately post-exercise of 2-4 weeks:120~140 beats/min) level, combined with a diet intervention (total daily energy intake of 1 400 or 1 600 kcal according to basal metabolism rate) in Shanghai Dianfeng weight loss enclosed camp. Nine normal weight young women and 9 female children matched at age and nationality were recruited as the normal control. Before and after the experimental period, anthropometric index (body weight, body mass index(BMI) and waist circumference), glucose and lipid metabolism parameters including fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride (TG); total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL), and serum levels of total IGF-1 and IGFBP-3 were measured, and IGF-1 activity was calculated in the obese and normal control female adolescents. RESULTS: ①Compared with normal control, the serum levels of total IGF-1 and IGFBP-3 were decreased in the female obese youths and adolescents, and IGF-1 activity was reduced only in the obese female adolescents. ②The serum level of IGFBP-3 was down-regulated and IGF-1 activity was up-regulated while no change of serum total IGF-1 was induced by 4-week moderate aerobic exercise plus diet control, accompanied with significant decreases of body weight, BMI and waist circumference as well as improvement of glucose and lipid metabolism in the female obese youths and adolescents. Except for a positive association between the increased IGF-1 activity and the decreased waist circumference was found in the female obese youths by Pearson's correlation analysis, there was no relation of the decreased IGFBP-3, the increased IGF-1 activity with the improvements of anthropometric index and glucose and lipid metabolism in female obese youths and adolescents. CONCLUSIONS The serum level of IGFBP-3 was down-regulated and the IGF-1 activity was up-regulated by 4-week moderate aerobic exercise plus diet control in female obese youths and adolescents. The increase of IGF-1 activity might be associated with the exercise-plus-diet-induced decrease of waist circumstance in female obese youths.
Adolescent ; Blood Glucose ; China ; Diet, Reducing ; Exercise ; Female ; Humans ; Insulin ; blood ; Insulin-Like Growth Factor Binding Protein 3 ; metabolism ; Insulin-Like Growth Factor I ; metabolism ; Pediatric Obesity ; therapy ; Young Adult

The prevalence of obesity among children and adolescents (aged 2-18 years) has increased rapidly, with more than 100 million affected in 2015. Moreover, the epidemic of obesity in this population has been an important public health problem in developed and developing countries for the following reasons. Childhood and adolescent obesity tracks adulthood obesity and has been implicated in many chronic diseases, including type 2 diabetes, hypertension, and cardiovascular disease. Furthermore, childhood and adolescent obesity is linked to adulthood mortality and premature death. Although an imbalance between caloric intake and physical activity is a principal cause of childhood and adolescent obesity, environmental factors are exclusively important for development of obesity among children and adolescents. In addition to genetic and biological factors, socioenvironmental factors, including family, school, community, and national policies, can play a crucial role. The complexity of risk factors for developing obesity among children and adolescents leads to difficulty in treatment for this population. Many interventional trials for childhood and adolescent obesity have been proven ineffective. Therefore, early identification and prevention is the key to control the global epidemic of obesity. Given that the proportion of overweight children and adolescents is far greater than that of obesity, an effective prevention strategy is to focus on overweight youth, who are at high risk for developing obesity. Multifaceted, comprehensive strategies involving behavioral, psychological, and environmental risk factors must also be developed to prevent obesity among children and adolescents.
Adolescent ; Child ; Child, Preschool ; Global Health ; Humans ; Pediatric Obesity ; epidemiology ; etiology ; prevention & control ; therapy ; Risk Assessment ; Risk Factors

PURPOSE: The purpose of this study was to identify trends in intervention studies on childhood obesity in Korea. METHODS: From 1996, when the first research paper on childhood obesity intervention was published, to 2015, 192 published papers were analyzed using descriptive statistics. RESULTS: The number of studies increased sharply between 1996 and 2007, but declined slightly from then. The majority of studies involved only children as intervention participants. Most were elementary students, and overweight and obese children. Exercise therapy was the most common type of intervention. Parental participation was found in 35 studies, while teacher's participation was found in only one study. In many studies physiological indicators were used as measurement variables, but follow-up was done in only 10 studies. Finally, only a few studies applied a conceptual framework, while a quasi-experimental research design was used for most studies. CONCLUSION: Examination of trends in intervention studies on childhood obesity in Korea, shows there has been a quantitative increase but not enough improvement in terms of the quality of interventions. Findings in the present study suggest that it is necessary to seek diversity in terms of study participants, interventions and evaluation method along with quality improvement in research methodology.
Child ; Exercise Therapy ; Follow-Up Studies ; Humans ; Korea* ; Methods ; Only Child ; Overweight ; Parents ; Pediatric Obesity* ; Quality Improvement ; Research Design

PURPOSE: The purpose of the study was to evaluate a parent involvement intervention for childhood obesity intended to increase parents' skills in managing children's weight-related behavior and to improve child-parent relationships. Many studies reported on parental influence on childhood obesity, emphasizing parent involvement in prevention and management of childhood obesity. METHODS: A randomized controlled trial was conducted. Forty-two parents of overweight/obese children were recruited from four cities and randomized to the experimental group or control group. The parental intervention was provided only to parents in the experimental group and consisted of weekly news-letters and text messages for a period of 5 weeks. Exercise classes and nutrition education were provided to all children. Lifestyle Behaviour Checklist and the Child-Parent Relationship Scale (CPRS) were used for measurement of parent outcome. For the child outcome, dietary self-efficacy, exercise frequency, and body mass index were measured. A mixed-design analysis of variance was performed with city location entered as a random effect. RESULTS: After the intervention, CPRS of parents and dietary self-efficacy of children showed an increase in the experimental group (p < .05). Intervention effects differed significantly according to the city location regarding the control efficacy of parents and dietary self-efficacy of children (p < .05). CONCLUSIONS: The results support the effectiveness of the parent involvement intervention in promoting child-parent relationship and dietary self-efficacy of children. However, a 5-week parent involvement intervention was not sufficient to produce significant changes in children's body mass index. Further research is needed to investigate effects of parent involvement intervention with long-term evaluation.
Adult ; Attitude to Health ; *Body Weight Maintenance ; Child ; Diet Therapy/*psychology ; Feeding Behavior/*psychology ; Female ; Health Promotion/*methods ; Humans ; Male ; Middle Aged ; Parent-Child Relations ; Parenting/psychology ; Parents/*psychology ; Pediatric Obesity/*prevention & control ; Republic of Korea