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Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.

Aims

To evaluate relationships between diet quality and cardiovascular outcomes.

Methods

Six databases were searched for studies published between January 2007 and October 2021. Eligible studies included cohort studies that assessed the relationship between a priori diet quality and cardiovascular disease mortality and morbidity in adults. The Academy of Nutrition and Dietetics Checklist was used to assess the risk of bias. Study characteristics and outcomes were extracted from eligible studies using standardised processes. Data were summarised using risk ratios for cardiovascular disease incidence and mortality with difference compared for highest versus lowest diet quality synthesised in meta-analyses using a random effects model.

Results

Of the 4780 studies identified, 159 studies (n = 6 272 676 adults) were included. Meta-analyses identified a significantly lower cardiovascular disease incidence (n = 42 studies, relative risk 0.83, 95% CI 0.82–0.84, p < 0.001) and mortality risk (n = 49 studies, relative risk 0.83, 95% CI 0.82–0.84, p < 0.001) among those with highest versus lowest diet quality. In sensitivity analyses of a high number of pooled studies (≥13 studies) the Mediterranean style diet patterns and adherence to the heart healthy diet guidelines were significantly associated with a risk reduction of 15% and 14% for cardiovascular disease incidence and 17% and 20% for cardiovascular disease mortality respectively (p < 0.05).

Conclusions

Higher diet quality is associated with lower incidence and risk of mortality for cardiovascular disease however, significant study heterogeneity was identified for these relationships.

In this multi-professional review, we will provide the in-depth knowledge required to work in the expanding field of obesity treatment. The prevalence of obesity has doubled in adults and quadrupled in children over the last three decades. The most common treatment offered has been lifestyle treatment, which has a modest or little long-term effect. Recently, several new treatment options-leading to improved weight loss-have become available. However, long-term care is not only about weight loss but also aims to improve health and wellbeing overall. In the era of personalized medicine, we have an obligation to tailor the treatment in close dialogue with our patients. The main focus of this review is new pharmacological treatments and modern metabolic surgery, with practical guidance on what to consider when selecting and guiding the patients and what to include in the follow-up care. Furthermore, we discuss common clinical challenges, such as patients with concurrent eating disorder or mental health problems, and treatment in the older adults. We also provide recommendations on how to deal with obesity in a non-stigmatizing way to diminish weight stigma during treatment. Finally, we present six microcases-obesity treatment for persons with neuropsychiatric disorders and/or intellectual disability; obesity treatment in the nonresponsive patient who has "tried everything"; and hypoglycemia, abdominal pain, and weight regain after metabolic surgery-to highlight common problems in weight-loss treatment and provide personalized treatment suggestions.

INTRODUCTION: With the rapid development of treatment modalities for obesity management, there is a growing need for guidelines. This was acknowledged by the Swedish National Board of Health and Welfare and in 2020 the process of producing the first national guidelines for obesity care, including both children and adults, was initiated. The main aim was to ensure equal high standard care throughout Sweden by supporting decision makers to allocate resources to the best knowledge-based care.

METHODS: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation.

RESULTS: In total, 20 recommendations were issued encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers.

CONCLUSIONS: National guidelines for improved standard care and evidence based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.

AIM: To assess the prevalence of overweight among Swedish 4 year olds in 2018, 2020 and 2022, taking socioeconomic variables into account.

METHODS: Aggregated regional data on children's body mass index were collected. The socioeconomic Care Need Index (CNI), foreign background, low education, being a single parent, low income and childhood poverty, were assessed. The differences in overweight, including obesity, were tested for Sweden and for regions.

RESULTS: Data were available for 303 843 children, representing 87% of children born in 2014, 2016 and 2018. Overweight or obesity were found in 11 177 (11.4%) of children in 2022, decreasing from 2020 (13.3%, p < 0.001) but at the same level as in 2018. Regional low CNI, low level of foreign background, education and income as well as being a single parent were associated with a higher prevalence of overweight or obesity in all cohorts (p < 0.001). In regions with high levels of childhood poverty, overweight or obesity were more prevalent during (p = 0.009) and after the pandemic (p < 0.001).

CONCLUSION: Three national cohorts demonstrate that the increase in overweight during the COVID-19 pandemic has returned to pre-pandemic levels, but the inequalities in health associated with socioeconomic vulnerability of the regions remained.

BACKGROUND: Early childhood obesity interventions supporting parents have the largest effects on child weight status. However, long-term follow-ups are lacking.

OBJECTIVE: To examine weight status 48 months after obesity treatment initiation for 4- to 6-year-olds.

METHODS: 177 families were recruited to the More and Less study, a 12-month randomized controlled trial (RCT) conducted in Sweden (2012-2017); 6 children were excluded due to medical diagnoses. Thus, 171 families (non-Swedish origin 59%, university degree 40%) were eligible for this 48-month follow-up with modified intention-to-treat (n = 114 had 48-month data, n = 34 dropped out, n = 23 lost to follow-up). The RCT compared 3 treatment approaches: a 10-week parent support program (1.5 h/w) with follow-up booster sessions (PGB) or without (PGNB), and standard outpatient treatment (ST). Treatment effects on primary outcome (BMI-SDS) and secondary outcomes (BMI, %IOTF25 i.e., the distance, in percent, above the cut-off for overweight) were assessed. Clinically significant reduction of BMI-SDS (≥0.5) was assessed with risk ratio. Sociodemographic factors and attendance were examined by three-way interactions.

RESULTS: After 48 months (mean 50 months, range 38-67 months) mean (95% CI) BMI-SDS was reduced in all groups: PGB -0.45 (-0.18 to -0.73, p < 0.001), PGNB -0.34 (-0.13 to -0.55, p < 0.001), ST -0.25 (-0.10 to -0.40, p < 0.001), no significant difference between groups. A clinically significant reduction of BMI-SDS ≥ 0.5 was obtained in 53.7% of PGB which was twice as likely compared to ST, 33.0%, RR 2.03 (1.27 to 3.27, p = 0.003), with no difference to PGNB, 46.6% (p = 0.113). %IOTF25 was unchanged from baseline for PGB 4.50 (-1.64 to 10.63), and significantly lower compared to ST 11.92 (8.40 to 15.44) (p = 0.043). Sociodemographics or attendance had no effect.

CONCLUSION: The intensive parent-support early childhood obesity intervention led to better weight status outcomes over time, though BMI-SDS alone did not reflect this. Further research should investigate how to assess weight changes in growing children.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT01792531 .

Objective: To estimate the cost and cost-effectiveness of Bright Bodies, a high-intensity, family-based intervention demonstrated to improve BMI among children with obesity in a randomized controlled trial.

Methods: We developed a microsimulation model to project 10-year BMI trajectories of 8-16 year-old children with obesity using data from National Longitudinal Surveys and Centers for Disease Control and Prevention growth charts and validated the model using data from the Bright Bodies trial and a follow-up study. We used the trial data to estimate the average reduction in BMI per person-year over 10 years and the incremental costs of Bright Bodies, compared with traditional clinical weight management (control), from a health system perspective in 2020 US dollars. Using results from studies of Medical Expenditure Panel Survey data, we projected long-term obesity-related medical expenditure.

Results: In the primary analysis, assuming depreciating effects post-intervention, Bright Bodies is expected to achieve an average reduction in BMI of 1.67 kg/m² (95% Uncertainty Interval: 1.43-1.94) per person-year over 10 years compared with control. The incremental intervention cost of Bright Bodies was $360 ($292-$421) per person compared with the clinical control. However, savings in obesity-related health care expenditure offset these costs and the expected cost-savings of Bright Bodies is $1,126 ($689-$1,693) per person over 10-years. The projected time to achieving cost savings compared with clinical control was 3.58 (2.63-5.17) years.

Conclusions: While resource-intensive, our findings suggest Bright Bodies is cost-saving compared with clinical control by averting future obesity-related health care costs among children with obesity.

AIM: This paper summarised national data on the prevalence of overweight and obesity among 4-year-old children in Sweden in 2020, the first year of the COVID-19 pandemic. It compares this with data from 2018. Differences between regions and sex were identified.

METHODS: Comparative data from Swedish Child Health Services were available for 18/21 regions. Chi-square tests were used to compare data from 2018 and 2020 and to examine differences between the sexes. Sex and year were examined through interaction tests.

RESULTS: In 2020, 13.3% of the 100 001 children had overweight or obesity: 15.1% of the girls and 11.6% of the boys (p < 0.001). In 2018, 11.4% of the 105 445 children had overweight or obesity: 13.2% of the girls and 9.4% of the boys. This was an overall increase of 16.6% (p = 0.000) in the national Swedish data from 2018 to 2020. The increase between the years was greater for obesity (31.8%, p = 0.000) than for overweight (13.3%, p = 0.000).

CONCLUSION: The prevalence of overweight and obesity among 4-year-olds in Sweden increased during the COVID-19 pandemic and needs to be addressed. The prevalence needs to be followed as part of prevention programmes and to evaluate health interventions.