OBJECTIVES: To provide updated prevalence data on obesity trends among US children and adolescents aged 2 to 19 years from a nationally representative sample. METHODS: We used the NHANES for years 1999 to 2016. Weight status was determined by using measured height and weight from the physical examination component of the NHANES to calculate age- and sex-specific BMI. We report the prevalence estimates of overweight and obesity (class I, class II, and class III) by 2-year NHANES cycles and compared cycles by using adjusted Wald tests and linear trends by using ordinary least squares regression. RESULTS: White and Asian American children have significantly lower rates of obesity than African American children, Hispanic children, or children of other races. We report a positive linear trend for all definitions of overweight and obesity among children 2–19 years old, most prominently among adolescents. Children aged 2 to 5 years showed a sharp increase in obesity prevalence from 2015 to 2016 compared with the previous cycle. CONCLUSIONS: Despite previous reports that obesity in children and adolescents has remained stable or decreased in recent years, we found no evidence of a decline in obesity prevalence at any age. In contrast, we report a significant increase in severe obesity among children aged 2 to 5 years since the 2013–2014 cycle, a trend that continued upward for many subgroups.

Background Media exposure affects health, including obesity risk. Children’s movies often contain food placements—frequently unhealthy foods. However, it is not known if these cues influence children’s food choices or consumption after viewing. We explored whether children’s snack choices or consumption differs based on: 1) recent exposure to movies with high versus low product placement of unhealthy foods; and 2) children’s weight status. Methods Children ages 9–11 were assigned to watch a high (“Alvin and the Chipmunks,” n=54) or low (“Stuart Little,” n=60) product-placement movie. After viewing, participants selected a snack choice from each of five categories, several of which were specifically featured in “Alvin.” Uneaten snacks from each participant were weighed upon completion. Snack choice and amount consumed by movie were compared by t-tests, and differences in snack choices by movie were tested with logistic regression. Results Participants consumed an average of 800.8 kcal; mean kcal eaten did not vary by movie watched. Participants who watched the high product-placement movie had 3.1 times the odds (95% CI 1.3–7.2) of choosing cheese balls (most featured snack) compared to participants who watched the low product-placement movie. Children who were overweight or obese consumed a mean of 857 kcal (95% CI: 789–925) compared to 783 kcal (95% CI: 742–823, p=0.09) for children who were underweight or healthy weight. Children’s weight status did not significantly affect their choice of snack. Conclusions Branding and obesogenic messaging in children’s movies influenced some choices that children made about snack foods immediately following viewing, especially food with greatest exposure time in the film, but did not affect total calories consumed. Future studies should examine how the accumulation of these messages affects children’s long-term food choices.

Objective: Food insecurity is associated with childhood obesity possibly mediated through caregiver feeding practices and beliefs. We examined if caregiver feeding practices differed by household food security status in a diverse sample of infants. We hypothesize feeding practices differ based on food security status. Patients and Methods: Baseline cross-sectional analysis of data from a randomized controlled trial to prevent obesity. Included in the analysis was 842 caregivers of 2-month-old infants presenting for well-child care at 4 academic institutions. Food insecurity exposure was based on an affirmative answer to one of two items in a 2-item validated questionnaire. Chi-square tests examined the association between parent feeding practices and food security status. Logistic regression adjusted for covariates. Differences in caregiver feeding practices by food security status and race/ethnicity were explored with an interaction term (food security status x race/ethnicity). Results: 43% of families screened as food insecure. In adjusted logistic regression, parents from food-insecure households were more likely to endorse that “the best way to make an infant stop crying is to feed him/her” (aOR: 1.72, 95% CI: 1.28-2.29); and “When my baby cries, I immediately feed him/her” (aOR: 1.40, 95%CI: 1.06-1.83). Food insecure caregivers less frequently endorsed paying attention to their baby when s/he is full or hungry (OR 0.57 95%CI: 0.34-0.96). Racial/ethnic differences in beliefs and behaviors were observed by food security status. Conclusions: During early infancy, feeding practices differed among caregivers by household food security status. Further research is needed to examine whether these practices are associated with increased risk of obesity and obesity-related morbidity.

Objective:Little is known about the concordance of parent and child reports of children's media consumption, even though parents are often asked to report for their children in clinical care settings. We aimed to understand how parent and child reports of children's media consumption differ in an era of changing screen media consumption via personal devices. Methods:As part of a larger study about the reception of health-related cues from children's media, children ages 9 to 11 (N=114) and their parents independently completed identical questionnaires about specific media use and health behaviors. To examine concordance between child and parent reports of children's screen media use, we calculated mean number of minutes per day and proportions reported by the child and parent, and assessed concordance with t-tests and chi-square tests.Results: On a typical day, children reported nearly an hour each of video and app game use, computer use, and television exposure. Overall, child and parent reports were similar, usually

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Objective To determine range of bottle sizes used and examine the relationship between bottle size and total daily consumption of formula. Methods Cross-sectional analysis of baseline data collected as part of Greenlight, a cluster randomized trial to prevent childhood obesity at 4 pediatric resident clinics. The Greenlight study included healthy, term infants. For our analysis, parents of exclusively formula-fed infants reported volume per feed, number of feeds per day, and bottle size, which was dichotomized into “small” (< 6 ounces) or “large” (≥ 6 ounces). We identified determinants of bottle size, and then examined relationships between bottle size and volume fed with log-transformed OLS regression, adjusting for infant age, sex, birth weight, current weight, race/ethnicity, and enrollment in WIC. Results Of 865 participants in the Greenlight study, forty-four percent (n=378; 21.8% white, 40.6% black, 35.3% Hispanic, 2.4% other) of infants were exclusively formula-fed at 2 months. Median volume per day was 30 ounces (IQR 12) and 46.0% of infants used large bottles. Adjusted for covariates, parents using larger bottles reported feeding 4 ounces more formula per day (34.2 ounces, 95% CI: 33.5-34.9 vs. 29.7 ounces, 95% CI: 29.2-30.3, p=0.03). Conclusions Among exclusively formula-fed infants, use of a larger bottle is associated with parental report of more formula intake when compared with infants fed with smaller bottles. If infants fed with larger bottles receive more formula, these infants may be overfed, and, consequently, at risk for obesity.

Children's movies include much obesogenic and weight-stigmatizing content. These messages are not shown in isolated incidences; rather, they often appear on-screen multiple times throughout the entire movie. Future research should explore these trends over time, and their effects.

Background More than half of parents underestimate their overweight child’s weight; however, prior research focuses on children greater than 2 years of age. The objective of this study was to assess whether parents of 2–12month-old infants are able to accurately perceive their children’s weight status. Methods We performed a cross-sectional analysis of data collected from the Greenlight study, a cluster randomized obesity prevention trial, at 4 pediatric clinics serving diverse and low-income populations. Infants’ length and weight were measured at well-child checks, and parents completed questionnaires including demographics and perception of their children’s weight. Weight-for-length (WFL) percentile 5th–≤95th was considered healthy weight and WFL percentile >95th was considered overweight. We used chi-squared tests to compare accuracy by weight category and performed logistic regression to assess accuracy at each time point. Results Approximately 85–90% of infants (N=853 at 2 months, N=563 at 12 months) were at a healthy WFL at all measurement times, and parents of these infants were more likely to have an accurate perception of their child’s weight (accuracy 89–95%) than overweight children (accuracy 7–26%, p<0.001 across time points). Approximately 10% of healthy weight infants were perceived as underweight by their parents at all time points. At 12 months, mothers who were overweight were significantly more likely to underestimate their child’s weight status (p=0.008). Conclusions In our diverse and low-income sample, parents of overweight infants infrequently know that their infants are overweight. Future studies should examine how perception is related to feeding habits and weight status over time. Clinical Trial Registration Addressing Health Literacy and Numeracy to Prevent Childhood Obesity (GreenLight), NCT01040897