Perhaps 4% of adolescents and nearly 30% of overweight adolescents in the United States meet these criteria for a metabolic syndrome, a constellation of metabolic derangements associated with obesity. These findings may have significant implications for both public health and clinical interventions directed at this high-risk group of mostly overweight young people.

The stigmatization of people with obesity is widespread and causes harm. Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth. Health care professionals continue to seek effective strategies and resources to address the obesity epidemic; however, they also frequently exhibit weight bias and stigmatizing behaviors. This policy statement seeks to raise awareness regarding the prevalence and negative effects of weight stigma on pediatric patients and their families and provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. In summary, these recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting.

Background-The association between concentrations of uric acid and the metabolic syndrome in children and adolescents remains incompletely understood. The objective of this study was to examine how these 2 were associated in a nationally representative sample of US children and adolescents. Methods and Results-We performed a cross-sectional analysis of 1370 males and females aged 12 to 17 years using data from the National Health and Nutrition Examination Survey 1999 -2002. The prevalence of the metabolic syndrome was Ͻ1% among participants in the lowest quartile of serum concentration of uric acid, 3.7% in the second quartile, 10.3% in the third quartile, and 21.1% in the highest quartile. Compared with the lowest 2 quartiles of uric acid together (Յ291.5 mol/L), the odds ratios were 5.80 (95% confidence interval, 3.22 to 10.46) for those in the third quartile (Ͼ291.5 to Յ339 mol/L or Ͼ4.9 to Յ5.7 mg/dL) and 14.79 (95% confidence interval, 7.78 to 28.11) for those in the top quartile (Ͼ339 mol/L) after adjustment for age, sex, race or ethnicity, and concentrations of C-reactive protein.Starting with the lowest quartile of concentration of uric acid, mean concentrations of serum insulin were 66.2, 66.7, 79.9, and 90.9 pmol/L for ascending quartiles, respectively (P for trend Ͻ0.001). Conclusions-Among US children and adolescents, serum concentrations of uric acid are strongly associated with the prevalence of the metabolic syndrome and several of its components.

BackgroundPhthalates impair rodent testicular function and have been associated with anti-androgenic effects in humans, including decreased testosterone levels. Low testosterone in adult human males has been associated with increased prevalence of obesity, insulin resistance, and diabetes.ObjectivesOur objective in this study was to investigate phthalate exposure and its associations with abdominal obesity and insulin resistance.MethodsSubjects were adult U.S. male participants in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. We modeled six phthalate metabolites with prevalent exposure and known or suspected antiandrogenic activity as predictors of waist circumference and log-transformed homeostatic model assessment (HOMA; a measure of insulin resistance) using multiple linear regression, adjusted for age, race/ethnicity, fat and total calorie consumption, physical activity level, serum cotinine, and urine creatinine (model 1); and adjusted for model 1 covariates plus measures of renal and hepatic function (model 2). Metabolites were mono-butyl phthalates (MBP), mono-ethyl phthalate (MEP), mono-(2-ethyl)-hexyl phthalate (MEHP), mono-benzyl phthalate (MBzP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP).ResultsIn model 1, four metabolites were associated with increased waist circumference (MBzP, MEHHP, MEOHP, and MEP; p-values ≤ 0.013) and three with increased HOMA (MBP, MBzP, and MEP; p-values ≤ 0.011). When we also adjusted for renal and hepatic function, parameter estimates declined but all significant results remained so except HOMA-MBP.ConclusionsIn this national cross-section of U.S. men, concentrations of several prevalent phthalate metabolites showed statistically significant correlations with abdominal obesity and insulin resistance. If confirmed by longitudinal studies, our findings would suggest that exposure to these phthalates may contribute to the population burden of obesity, insulin resistance, and related clinical disorders.

Mean waist circumference and waist-height ratio and the prevalence of abdominal obesity among US children and adolescents greatly increased between 1988-1994 and 1999-2004.

Background-Nonalcoholic fatty liver disease (NAFLD), the most common cause of liver disease in children, is associated with obesity and insulin resistance. However, the relationship between NAFLD and cardiovascular risk factors in children is not fully understood. The objective of this study was to determine the association between NAFLD and the presence of metabolic syndrome in overweight and obese children. Methods and Results-This case-control study of 150 overweight children with biopsy-proven NAFLD and 150 overweight children without NAFLD compared rates of metabolic syndrome using Adult Treatment Panel III criteria. Cases and controls were well matched in age, sex, and severity of obesity. Children with NAFLD had significantly higher fasting glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and diastolic blood pressure than overweight and obese children without NAFLD. Subjects with NAFLD also had significantly lower high-density lipoprotein cholesterol than controls. After adjustment for age, sex, race, ethnicity, body mass index, and hyperinsulinemia, children with metabolic syndrome had 5.0 (95% confidence interval, 2.6 to 9.7) times the odds of having NAFLD as overweight and obese children without metabolic syndrome. Conclusions-NAFLD in overweight and obese children is strongly associated with multiple cardiovascular risk factors.The identification of NAFLD in a child should prompt global counseling to address nutrition, physical activity, and avoidance of smoking to prevent the development of cardiovascular disease and type 2 diabetes. (Circulation. 2008; 118:277-283.)

Objective To determine the extent to which the 2007 definitions for severe (body mass index ≥99th percentile for age and gender) and morbid (BMI ≥ 40 kg/m2) obesity affects different groups of American children and adolescents and has increased over time. Methods Analysis of nationally representative data from the National Health and Nutrition Examination Surveys (NHANES) II, III, and 1999–2004;12,384 US children and adolescents ages 2–19 years were included in the analysis. Outcome measures were the proportion of subjects with severe (BMI ≥99th percentile) and morbid (BMI ≥40 kg/m2) obesity, with age, gender, race, and poverty-income ratio (PIR) as key variables. Results In 1999–2004, 3.8% of children 2–19 yr had a BMI ≥99th percentile, with higher prevalence among boys than girls (4.6% vs. 2.9%; p<0.001). Prevalence was highest among Blacks, 5.7% and Mexican Americans, 5.2%, compared with Whites 3.1% (p< 0.001). The prevalence differed by PIR category as well (4.3% for those with PIR ≤3 vs. 2.5% for those with PIR > 3; p = 0.002). A BMI ≥40 was found in 1.3% of adolescents 12–19 yr, with similar associations with race and poverty. The overall prevalence of BMI ≥99th percentile has increased by more than 300% since NHANES II (1976), and over 70% since NHANES III (1994) in children 2–19 years of age. Conclusion Rates of severe childhood obesity have tripled in the last 25 years, with significant differences by race, gender and poverty. This places demands on healthcare and community services, especially because the highest rates are among children who are frequently underserved by the health care system.

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