Childhood obesity: The state of evidence on solutions

[00:00:14]

ELENA RENKEN: Hello, everyone and welcome to SciLine media briefing on childhood obesity and the state of evidence on solutions. In this briefing we’ll discuss childhood obesity trends which were noted in the Make our Children Healthy Again Report. We’ll learn from the results of past prevention initiatives and from research on ultra processed foods, physical activity, and GLP-1s to help you report on these issues with fuller context. My name is Elena Renken and I’m SciLine’s manager of journalism projects and multimedia. SciLine is an editorially independent nonprofit based at the American Association for the Advancement of Science and funded by philanthropies. So all our services for journalists are free.

Our mission is to make scientific evidence and expertise easy for journalists to use, as they cover all kinds of topics from immigration to business. So that might be environmental stories that are explicitly related to science, or it might be reporting on your local state house where the science angles are less obvious but still valuable. More of our resources are available on sciline.org, including interview opportunities, trainings, and our weekly newsletter. You can also click the blue, I Need An Expert, button on our site. Anytime you need to speak with a scientific expert for your story, we’ll look for a source with the right background to answer your questions before your deadline.

Now, a couple of notes before we get to it. I’m joined here by three experts who have studied different childhood obesity topics. I’ll let each of them introduce themselves and their areas of research. Dr. Fiechtner, would you go ahead?

[00:01:51]

DR. LAUREN FIECHTNER: Sure. Hi, I’m Lauren Fiechtner. I’m the director of nutrition at MassGeneral Brigham for Children. I’m a pediatric gastroenterologist, and my research focuses on childhood obesity and food insecurity. Thanks so much for having me.

[00:02:04]

ELENA RENKEN: Thank you. And Dr. Sacheck, would you introduce yourself next?

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DR. JENNIFER SACHECK: Hello, I’m Jen Sacheck and I’m professor and chair of behavioral and social sciences at the Brown University School of Public Health. My research focuses largely on physical activity and dietary interventions for the promotion of health behaviors and health outcomes in children. And the majority of my research has really spanned working in schools and communities for the past two decades.

[00:02:31]

ELENA RENKEN: Thank you. And Dr. Singhal?

[00:02:34]

DR. VIBHA SINGHAL: I am Vibha Singhal. I am an associate professor of pediatrics at University of California in Los Angeles, and I’m the director of obesity medicine in our children’s hospital. My research focuses on optimizing the treatment outcomes of children, adolescents and young adults with obesity and particularly focused on fertility, bone health, and next generation effects of the newer treatments.

[00:03:07]

ELENA RENKEN: Thank you all. Now, before we begin taking audience questions, I’m going to ask each of our panelists a few questions myself. Journalists on the line, you can submit your own questions at any time during the briefing. Just click the Q&A icon at the bottom of your Zoom screen, and please let us know if you’d like your question directed to any specific panelist. We’ll be posting a recording of this briefing on our website today or tomorrow, and a transcript will be added in the next few days. With that, let’s start. Dr. Fiechtner, first. Childhood obesity rates are higher today than they were a decade ago. So what factors are driving that trend?

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DR. LAUREN FIECHTNER: Yeah, there has been a rise in screen time. We’re all on our iPhones way too much, which, of course, leads to sedentary behavior. There’s also larger portion sizes, and then bigger income gaps and inequities that we know drive obesity levels, particularly we know lower socioeconomic and diverse populations experience overweight and obesity at a higher prevalence than their higher income and white counterparts.

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ELENA RENKEN: Thank you. There’s been a lot of attention on ultra-processed foods as a contributor to obesity. So how do researchers define ultra-processed And what makes these foods a concern?

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DR. LAUREN FIECHTNER: Yeah, the definition is interesting because there’s been multiple definitions, and so it’s very hard to define that. And there’s been various iterations each, you know, few years. So how I’ve been explaining it to my friends who’ve been asking me about their children is if you’re looking at a package and you can read what’s in it and you understand what’s in it, and it would be in a recipe you’re making in your kitchen, that is not an ultra-processed food. If you read it and you don’t understand what’s in there, there’s, like, you know, hydrolyzed protein, modified starches, all these other pieces that are more chemical- like in nature, those are ultra-processed foods. I did you ask me the second part of why we think this is a concern is that ultra-processed foods have been linked to health conditions largely because they make up a big part of our diet and actually other countries’ diets, too. And so that displaces what foods we know really help the body, like whole foods like fruits and vegetables and lean proteins and whole grains.

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ELENA RENKEN: Thank you. Some states, including Massachusetts now provide free school lunches for all students. But there’s been criticism that a lot of those school meals rely heavily on ultra processed foods, potentially worsening obesity rates. What’s your viewpoint on that?

[00:05:56]

DR. LAUREN FIECHTNER: So there have been a lot of studies to show that after the [Healthy, Hunger-Free Kids Act] with the change in school meal nutritional policies, that actually body mass index in the country went down. We know that actually kids during the school year do better in terms of BMI decreases compared to the summer months. And we also know it’s a really powerful tool against food insecurity. So in my research with the Greater Boston Food Bank, we’ve shown, actually, that while household-level food insecurity is rising in this state the last three years, child-level food insecurity is going down, and the dietary quality among our food insecure and food secure households among the children are exactly the same, which really speaks to the power of this universal policy in both addressing chronic disease prevention, obesity, and food insecurity.

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ELENA RENKEN: It’s a good note to break those trends down by age group to get more accurate. And what guidance would you offer to parents and to schools who are seeking to improve children’s nutrition and prevent obesity?

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DR. LAUREN FIECHTNER: Yeah, so I would strongly encourage people to avoid diets and looking on the Internet. A lot of my patients are looking, and before they see me, they’re doing a lot of things that are not evidenced-based, and that can actually lead to eating disorder behavior, and it can make things harder to change in the long run. I also really feel that no food is bad food, and often we label certain foods as bad food, and that can be really triggering to children. All foods give us energy, and some foods are okay in moderation, and other foods are healthier than others. One good easy advice is just to make half the plates fruits or vegetables. And then I get a lot of parents who say, my child will only eat fruits and no vegetables. And I know that vegetables are hard, but fruits are equally as healthy as vegetables. And then, avoid sugary beverages, including juice and soda and focus on whole grains.

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ELENA RENKEN: Great. Thank you. Are there particular nutrition programs or interventions that research shows are especially effective in reducing childhood obesity?

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DR. LAUREN FIECHTNER: Yeah, so I’ve been really lucky for the last 12 years to work with the Centers for Disease Control in developing our Family Healthy Weight Program called the Healthy Weight Clinic. The Centers for Disease Control recognize six Family Healthy Weight Programs that are across the country. And we, in particular, my lab and clinical partners developed one with the American Academy of Pediatrics. We deliver individualized care and care in group settings for families to learn from each other. The clinical team consists of a pediatrician, dietitian, and community health worker, and we train the local pediatricians across the country to implement the program through the AAP. It’s been demonstrated to improve BMI, fruit and vegetable intake, binge eating symptoms, parental stress, and improve kids’ quality of life. We are in nine states and hoping for more. And then, the other five family healthy weight programs are on the CDC’s website and they are also reaching multiple states and actually there are 60 departments of public health that the CDC has funded to take some of these programs up. So there’s real opportunities to feature whatever is in your local community as well.

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ELENA RENKEN: Excellent. Thank you so much. And let’s move on to you, Dr. Sacheck. To start off here, regardless of causes, the consequences of childhood obesity are real and long lasting. So what are some of the key physical, emotional, or social impacts seen in kids with obesity?

[00:09:48]

DR. JENNIFER SACHECK: Yeah, thanks for the question. This is where I started my interest in studying childhood obesity and prevention a long time ago now. But really, it was sort of the health outcomes that we’re seeing and the links that we see now, really, in early childhood that, you know, we didn’t initially know about. So let’s face it, one in three kids right now are with pre-diabetes, so that’s pretty staggering, often associated with obesity risk. But cardiovascular disease risk, we’re seeing elevated blood lipids, triglycerides, HDL, in sub-optimal ranges. And then, muscle, bone and joint health, that can be compromised just functional movements in kids and immune function and asthma, all at elevated risk. But there’s other things like anxiety, sleep disturbances, depending on the amount of excess weight that’s carried and other physiological changes that come with that. But I think, importantly, we have to think about the psychosocial aspects, you know, self-confidence and self-worth and just some of the stigma that, you know, still lies with a child living with excess, you know, body weight and sort of how we socially accept that or not. It’s really unfortunate that in this day and age, it’s still looked at as, you know, something that is not socially acceptable and not considered a disease.

[00:11:04]

ELENA RENKEN: Absolutely. Are there particular outcomes you’re seeing there on the emotional or social side of things?

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DR. JENNIFER SACHECK: Yeah, a lot of time it’s social-emotional well- being. I think it’s social self-worth and competence, athletic competence. We’re talking about physical activity in my section and feeling, like, comfortable in one’s own body to engage in physical activities, to be socially engaged and attend things. It manifests itself in different ways at different ages. But regardless of, you know, cultural background, sex, et cetera, it’s been really emotionally tolling in a lot of children and youth.

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ELENA RENKEN: Yeah. There’s a common perception that today’s kids lead more sedentary lives than previous generations. How accurate is that perception and what do the data show about levels of decline in physical activity among kids, as well as the factors that are driving it and the demographic groups?

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DR. JENNIFER SACHECK: Yeah, it’s a big question. But really, there’s two things to consider in sort of sedentary time on one hand and then physical activity engagement on the other. And I’ll start with, like, physical activity recommendations, which are 60 minutes a day for our children and our youth, and the percent of kids that are not meeting that recommendation is quite staggering. There’s a 2024 U.S. report card on physical activity and children and youth put out by the Physical Activity Alliance, and that’s self-report, and it shows about 20 to 28% of kids are not meeting the recommendation. Those meeting the recommendation are even lower when you objectively measure it with a little gadget. So we see maybe less than 50% of 6 to 11 year olds and maybe like, you know, closer to 10 to 15% of adolescents when you measure it with a gadget.

And then, you see stark disparities in those levels of engagement. Really, we see differences between females and males, boys and girls, starting as early as, you know, early childhood education settings, elementary school. And that persists through adolescence and young adulthood, disparities by different demographics such as between Blacks, Hispanics, and Asian children typically achieve less physical activity than non-Hispanic white children. Also, those living with obesity engage in less physical activity.

And those levels in physical activity engagement have decreased since 2016 when we first had this report. But this data, again, is sort of hard to gather. On the other side, we have sedentary time, and those data, again, are also hard to get at. The best measure that we have that was already mentioned was screen time. So we can capture that pretty well now in our children and youth. And that recommendation is that kids really are on their devices, less than two hours a day, and that includes computer time, which, you know, if you’re in school, that’s an enormous challenge. But again, only about 20% of kids are meeting that recommendation of less than two hours per day. Again, that’s shocking, and that’s a great measure for sedentary time. And again, just like physical activity declining over these past ten years, we’re seeing an increase in the sedentary time. And I think it’s just important to note that they have independent effects on health and synergistic. So we have to sort of decrease the sedentary and increase the physical activity time.

And then, the factors that are really driving it, I mean, we mentioned the iPhones and the gadgets, and I don’t think everyone has an iPhone, but maybe it’s almost ubiquitous now, but I really like to think about the built environment. Really, physical activity has been engineered out of our days and our environment. So we actually have to seek being active versus it just being the natural default. Things like active transportation with kids, walking, biking, that sort of free play that we used to, I think, ideally remember as a child, now it’s much more structured and organized so much so that, you know, parents are finding themselves having to schedule activities after school. And again, that pay to play model, I’d say, is limiting to many kids, and access to being able to be active and sports has gone down.

And then, really, the policies that we have in our schools have also dramatically changed. We’re really worried about teaching to the test and getting kids, you know, the academic achievement. And PE has been crunched, especially in under-resourced and unresourced communities and schools. And recess time, we might see two recesses in a really, you know, great elementary school setting, and then that goes down to one and then maybe one in middle school and none in high school. So it’s a real challenge to really incorporate more physical activity into our days.

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ELENA RENKEN: That’s good for local reporters to see, too, that in all that reporting on school policies and the built environment, physical health is a big angle there.

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DR. JENNIFER SACHECK: Yes, for sure.

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ELENA RENKEN: And what recommendations do you have for parents, for educators, for schools to help children be more physically active? Are there programs or interventions that have been shown to reduce obesity effectively?

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DR. JENNIFER SACHECK: Great. Yes. So first, I think kids need to be comfortable with their bodies and moving, and we’re doing a lot of work now on physical literacy in schools and curricula that sort of gets kids to be competent, confident, motivated to move. You know, if you know how to throw a ball, you’ll want to throw a ball. And if you don’t, you don’t want to. And that’s just an example of trying to get at kids young so they can be active throughout their lives. Really, thinking about whole school approaches, schools, educators, administrators have to think about getting more activity into the day. 30 minutes of physical activity is recommended during the school day to help get to that daily 60 minutes. So finding creative ways in the classroom, not just at PE and recess, families should be connected to understanding what’s going on in schools as well. Work that we’re doing sort of extending the curricula from like PE, so the families can then engage with their kids with what they’re doing in schools.

This is an NIH funded trial that we’re doing through New York Road Runners in New York City, that we’re trying to get out to the families, and again, mostly in low-income communities, urban communities on the East Coast. So that’s great. And then, you know, really, programs that have been effective in getting at obesity, it’s really challenging because, you know, we talk about diet and physical activity for obesity prevention. Physical activity is key for preventing weight gain throughout childhood and adolescence. But getting to 60 minutes, we’re so far from getting kids to that 60 minutes to actually see a dent and sort of reversing the tide.

If we could get there, that first, that’d be the first thing to do. And then, there’s really the studies that have been most effective in combating childhood obesity have been those that have been multi-pronged. You can’t just put one program into schools and, you know, sort of randomize them to a program and see if they change, you know, their weight status. It’s really on multiple levels that we need to get kids more active and also eating healthy and, you know, being sort of healthy on all fronts. But those multi-level, multi-pronged approaches have been shown to be highly effective, and there’s several in our communities that have been shown to be successful in the literature.

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ELENA RENKEN: Thank you. Now, it’s been more than a decade since Michelle Obama’s Let’s Move! campaign launched. So what do we know now about how successful it was in meeting its goal to reduce childhood obesity? And what lessons can policymakers take from it?

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DR. JENNIFER SACHECK: Yep. No, that’s a great question as well. So we did see a decrease in our youngest children during the time of Michelle Obama, the 2008 to 2012, for our youngest kids between ages two and five. We didn’t see an increase in obesity rates during those four years. So I’d like to think we prevented the increase. We did see an increase in obesity rates, you know, since that time. So you could say that it was successful in that regard. Preventing the increase in obesity, I think, is still a huge win for us, and now we need to sort of change the tides in the other direction. But I think what that whole campaign did is really raised awareness. And that’s what we’re seeing right now again. I mean, it’s been, you know, 10, 15 years, and it’s coming back around again.

And I think she really promoted in her Let’s Move! campaign, a multi-level, multi-pronged approach. And we mentioned the Healthy, Hunger-Free Kids Act earlier, which changed school food, which made huge inroads there. And there was a lot of political pushback at that time, but now it’s coming back around, you know, in this day and age. And we also had Let’s Move! Active Schools that really made moving for kids cool and fun and had really innovative programs that were smart, scalable, sustainable. We ran a trial, actually, that benefited from her work in Let’s Move! and randomized schools to these programs and show really effective interventions that could improve physical activity for these kids. Then, also, she just increased the resources. And that awareness for funding for research really propagated a whole host of activities. And I think a lot of these researchers, probably on the screen, benefited from some of the funded proposals that came out of that work.

So I think really successful in that regard. But our current policymakers really need to understand that we don’t have to reinvent the wheel, that some of this has already been put into place, and we want to make sure that we’re not pointing our finger at one root cause. It’s really again, multi-level. We need to think about poverty, access, school-day demands, and resources, and how we sort of tackle that. And I think that we need to put more information out there, not just about food, but also about physical activity.

If you look at the MAHA report for children’s health, physical activity is barely mentioned. There’s also an executive order on physical fitness testing being sort of reinstated. You know, I would heavily advocate if that’s the case, that those measures are actually those linked with health outcomes in kids. There was a 2012 report by the IOM I was part of that actually linked fitness measures in schools that were clearly linked with outcomes. And I’d say, those are probably measures that we should be put into place if we do that again. And then, obviously, we should collect that data. Surveillance and understanding, physical activity of kids, and the fitness level of our kids are critical for understanding the health of our nation. So that’s what I would put out there for our policymakers at this time.

[00:21:14]

ELENA RENKEN: Thank you so much. And let’s turn to you, Dr. Singhal. First off, what medical interventions are currently available for treating childhood obesity and what age groups are they approved for?

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DR. VIBHA SINGHAL: Yeah, thank you so much for that question. So in the last few years, we have seen the FDA approved a couple medications in children 12 and above. First one that we commonly know of as Wegovy, which is a GLP-1, glucagon-like peptide 1 analog. It’s our own endogenous internal hormone that we make and release in response to food. That was approved by the FDA after the age of 12 to be used in the setting of obesity. And the other one is a combination medication commonly available as Qsymia. It is a combination of phentermine which is a stimulant, and topiramate, which commonly my neurology colleagues would use for headaches and seizures. They all affect the appetite pathways in the brain and some other mechanisms. Caloric deficit is how the weight loss is achieved.

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ELENA RENKEN: Thank you. And can you talk a little bit more about the benefits and drawbacks of these GLP-1 medications, both for individuals and on a societal level?

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DR. VIBHA SINGHAL: Sure. So let’s start at the individual level. So we have heard about the increasing rates of obesity. There is also not just the rates of obesity but also the severity of obesity that is increasing. And we have realizing the medical, mental, psychosocial, the enormous effects that obesity has. So these medications in clinical trials which were not very long, you know, one year and some follow-up time, have shown that they lead to medical benefits in terms of weight loss, improvements in blood sugars, the cardiovascular outcomes, blood pressure, lipid levels, cholesterol levels are better. We do need other benefits to be evaluated, which are not yet done as in, you know, do they actually change our dietary intake? Do they actually change our physical activity, incentives, and motivation? So all those need to be done. But medically, in the short trials that we can assess, they’ve been shown to be beneficial.

In terms of drawbacks, there are some acute side effects, if I may, like nausea, vomiting, headache, which, if done well can be managed. But in my practice, I do see some adolescents who will have severe side effects that we have to manage. And in terms of the societal level benefits, I think we do know that severe obesity in childhood tracks into adulthood. There is almost, like, say, a 15-year-old has severe obesity. There is pretty much 80 to 90% chance that they’re going to have obesity as an adult until an intervention is made. They change their lifestyle, they change their behaviors. But also to remember that obesity is a disease. There is an internal change in our biology that leads to that. So these medications are helpful, I think, on a societal scale to prevent diabetes. I’m also an endocrinologist, so the predicted rates of Type II diabetes, by 2050, if we continue, is enormous.

And if you can imagine the impact of having so many people with type 2 diabetes, it’s going to be killing. But we also don’t know some of the other effects like muscle loss is seen with some of these medications, bone loss is seen with some of these medications. We don’t know the effect on the next generation. Some of these cannot be taken during pregnancy. Actually, most of these cannot be taken during pregnancy. Do we see a rebound, weight gain, and how does that affect the baby? Many, many unanswered questions. So I think we need data. We need research, we need large studies which evaluate these outcomes .

[00:26:02]

ELENA RENKEN: Thank you. Medicaid covers screening and diagnosis and treatment services for childhood obesity. So how has this coverage shaped who is receiving care? And when should parents involve their child’s doctor or health insurance provider in seeking treatment?

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DR. VIBHA SINGHAL: Sure. so I have practiced in two states, Massachusetts, and now California in the last three years, and we have already seen changes in the three years. And as we know, obesity affects our lower socioeconomic status families more who are receiving more Medicaid and Medicare support. So this coverage is important, is vital for these families to take care. More recently, we encountered that the nutrition support, the dietitian support, which is so vital in our clinics, they will only cover three visits in a span of one year. Clearly goes against the policy guidelines, the data that we need so many contact hours, and how do we support that? So changes like that are a big detriment to the care we provide and to the families because they are making some changes and it sets them back. So similarly for medications, you know, there were shortages at the company, at the manufacturing level, but we are seeing every January, there are new rules. Insurance companies are deciding what to cover, what not to cover. Again, not totally in following with the FDA approval. FDA approval is for all levels of obesity, but they came up with a cutoff of, We want to cover the most severe cases.

Not wrong, but then what about the people who were already on medications? They are seeing that ping pong effect, which is very detrimental, more detrimental than having a certain level of obesity. So I can’t tell you how many hours I spent fighting with somebody to get the medications approved and not getting that done. So I think we need data. We need the economic analysis as to value added to life, value added to these children, medically, socially, emotionally. So many of your kids drop out from school because of bullying, teasing, and how is it affecting us long-term as a country, as a society. We just need more information.

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ELENA RENKEN: Definitely. Thank you. Last question for you here is about body mass index, or BMI, which continues to be widely used to estimate body fat percentage and assess weight status. Can you talk about the advantages and limitations of relying on BMI for kids, specifically?

[00:29:01]

DR. VIBHA SINGHAL: Absolutely. Very important. So body mass index is a calculation of weight divided by height squared. This comes from taller people should weigh more, shorter people should weigh differently, right? So we have to take height into context, particularly in a growing child, somebody who is gaining height. Absolute numbers don’t mean much at that time. But if you can imagine, it’s a whole body’s weight, right? It has muscle. It has fat. It is measuring everything. Muscle is heavier than fat.

And obesity as a disease is excess of unhealthy fat. We do need a certain amount of fat, but it’s when it gets too much and it’s not functioning properly is when it is a problem, right? So BMI is just a very mathematical calculation. It does not take that into account. It does not tell us if our fat is sick fat. There are people who could have healthy fat, right? My athletes that I see, some of my football players, they’re very muscular. They have more lean mass, which is good, but the BMI will just put them at a higher BMI. So it comes with its problems, but at the same time, it’s a very convenient measure. All we need is a weighing scale and a stadiometer, which is a machine put on the wall where we check the height.

Many other more optimal measures like DEXA measurements and other things are very involved and only available in more research settings. So it’s convenience, it’s good in terms of trends at the extremes of obesity. It’s very well correlated with the amount of fat tissue we have. So I think, clinically, it is an easy, convenient measure as long as the providers recognize, families recognize that it comes with its fallacies.

[00:31:06]

ELENA RENKEN: Great. Thanks to all three of you. We’ll now open things up to asking questions from the audience, and I want to remind reporters on the line to please submit your questions using the Q&A box at the bottom of your Zoom screen. First question for all three of you is what public narratives or media messages about childhood obesity are most harmful or misleading? Doctor Fiechtner, would you want to start?

[00:31:32]

DR. LAUREN FIECHTNER: I think that it’s an individual’s fault. I think this is so multi-layered and there is so much stigma as Jen pointed out, that I think if we can realize that it is no one’s fault, that would be really beneficial to children and that this is so multi level that it’s at the policy level, it’s at the community level, and then at individual genetic level.

[00:32:01]

ELENA RENKEN: And Dr. Sacheck?

[00:32:03]

DR. JENNIFER SACHECK: She stole my thunder. No, I think we need to hammer home, you know, that it is really not a personal problem. I mean, you know, it’s multi-level, multi-factorial, and, you know, the last person is the person with it, right? Like, it’s all the levels that their genetics are trying to manage. And it’s really, really overwhelming for the genetics that many of us are born with. So to keep that in mind always as we try to pave a way forward out of this crisis.

[00:32:34]

ELENA RENKEN: And Dr. Singhal.

[00:32:37]

DR. VIBHA SINGHAL: Absolutely echo with both Lauren and Jennifer that it’s multi-level and the stigma associated with obesity is concerning, and we should not blame the person. As they say, nobody wants to have obesity, right? It’s everything compounded. I would also like to add, I think there are camps in terms of obesity management. It’s not a camp. Everything works. It has to be individualized. We have to keep an open mind. It sometimes comes across that only this should be done or only this should be done. No. I think we need to approach the family from a very systemic level to the individual level and then offer our best possible solution.

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ELENA RENKEN: Thank you. And our first question here is from a freelancer in Baltimore and focused on the sleep angle here. So many sleep scientists link the recent rise in obesity and adolescence to the nationwide trend to start middle and high schools before 8:00 a.m. That began in the 70s and 80s. Today, about four out of five U.S. high school students fail to get at least 8 hours of sleep per night, and younger children also sleep less than in the past. So could any of you comment on insufficient sleep and its relationship to obesity?

[00:34:07]

DR. LAUREN FIECHTNER: I’m not sure any of us are sleep experts, but I can channel. I was at a talk, actually, with another screen-time expert, and he was saying, and I know this from my practice that teenagers are sleeping with their iPhones underneath their pillows. And so the amount of REM sleep that we’re seeing because they’re interrupted constantly by these devices is lower. So I’m channeling someone else, for sure. And then I would say, when a child isn’t doing well in weight management treatment, often, obstructive sleep apnea is something I want to screen out because that tends to be something if we can improve, that can help the BMI decrease, too. I don’t know if either of the other two have things to add.

[00:35:00]

DR. JENNIFER SACHECK: Yeah, I will second that we’re not a sleep expert. I always wish I would do more measures of sleep in my studies. But I would say it’s, like, the less that you’re sleeping, it’s more time that you’re maybe trying to stay awake to do homework or trying to wake yourself up, and where unhealthy behaviors sort of kind of go hand in hand with, you know, maybe poor dietary choices, you’re up later so what do you gravitate to? Probably, if you’re up at 11, you’re not snacking on a salad. And also, that impacts, you know, the engagement in physical activity or sports next day if you’re exhausted. So there’s other things that are sort of layered on top of that that could be negatively impacted.

[00:35:43]

DR. VIBHA SINGHAL: Absolutely agree and it also affects metabolism. So both quantitative and qualitative assessments of sleep, like we try our best to do in the clinics, but both can affect how the same amount of calories in somebody who’s sleep deprived would be processed very differently in somebody who is not sleep deprived. So it’s very crucial to address sleep optimal to the best of the high- schoolers workload.

[00:36:18]

ELENA RENKEN: And I’ve got a question here from a reporter at the Orange County Register. Are there up and coming GLP-1 or other weight management medications that experts are interested in or excited about?

[00:36:33]

DR. VIBHA SINGHAL: I can take that. So there are a lot of medications on the horizon. In the childhood’s age group, the trials are usually lacking and we follow adults. There are oral formulations, so the current GLP-1s are injectables. We have a weekly injectable, but there are oral compounds that are coming. Right now we are just doing one hormone. There are two hormones or three hormone combination drugs that are coming so are in the pipeline. Yes.

[00:37:11]

ELENA RENKEN: Thank you. And I know we touched on school lunches, but I have another related question. Can any of you comment on the role of food assistant programs like WIC and SNAP and the National School Lunch Program in either contributing to or helping mitigate childhood obesity?

[00:37:28]

DR. LAUREN FIECHTNER: Happy to take that one. So we know WIC has decreased childhood obesity over time. SNAP data is a bit more mixed, but it does show a decrease in BMI in the adult side. And then, I think we know that SNAP and WIC improves food insecurity and food insecurity leads to stress, and at least in my trials, those children with food insecurity have always had a worse BMI decrease. So I think those are all good solutions to improving food insecurity, which also would improve obesity.

[00:38:08]

ELENA RENKEN: And a seasonal question here. Is there any evidence based advice for parents on how to manage candy oriented occasions like Halloween this week?

[00:38:18]

DR. LAUREN FIECHTNER: I guess, this is another nutrition question. So I would say that let them have it for Halloween. Like, again, no food is bad food I think is really important. It’s a special time, so let them go for it on Friday. And then, you know, it’s good to think about how you’re limiting that moving forward. Like, in my family, my kids get two pieces, and over time, then they forget about it, usually, and we throw it out, because then it’s Easter. So that’s usually my approach. I don’t know if the other two mothers would like to comment on their candy.

[00:38:58]

DR. JENNIFER SACHECK: Yeah, I also have the nutrition background, but I’ll just go from more of the kids side as well. Like, yeah, the same thing, like, go nuts that first day, and then the mitigation over that following week, and then they’re kind of sick of it themselves. But then it’s also, their candy is up high on a shelf, and they absolutely forget about it, and we do find it. I think we have some left from last year that’s in there, for sure.

[00:39:22]

DR. VIBHA SINGHAL: Exactly the same, you know, just enjoy that day which they’re eating while they are trick or treating and, you know, they start early and then just budget it, and we give ours to the Salvation Army. So yeah.

[00:39:41]

ELENA RENKEN: And we’ve got a question here from Colorado Public Radio. How does food insecurity impact obesity?

[00:39:50]

DR. LAUREN FIECHTNER: Yeah, so we certainly know that children with obesity have worse outcomes when they have food insecurity. I would say, in general, it’s varying data on how food insecurity plays a role in BMI because actually what we’ve shown in our studies, at least on adult level, the dietary quality of food insecure households in Massachusetts versus food secure households, both are eating the same amount of unhealthy food, but food secure households are eating more healthy foods. So some of my research actually focuses on food as medicine in a food pantry setting, and we’ve shown substantial BMI decreases for both the adult and the child when we do give weekly food packages to food insecure families that are healthy and, yeah, overall, good impact.

[00:40:46]

DR. JENNIFER SACHECK: I’ll just add that we did, you know, a review a couple years ago now trying to look at the link between childhood obesity and food insecurity. And it was, you couldn’t discern the cause and effect, but there are those associations there. So further work is needed, obviously, on, like, the cause and effect nature, but there’s tight associations, especially I think it was stronger amongst girls than it was boys in food insecure households.

[00:41:14]

DR. VIBHA SINGHAL: I think, just to add another aspect to it is eating behaviors. Again, it’s not just BMI, but we do see with food insecurity, there could be more binges, disordered eating, just the stress. Again, there may not be one numerical, statistically significant result, but I think it affects so many other parameters of health that can feed in to obesity, stress being one of them. So does play a role.

[00:41:46]

DR. LAUREN FIECHTNER: This point goes back to the SNAP question. So there’s been multiple studies that show when SNAP benefits ran out, people restrict because they have to. And then, once they get their SNAP benefits and they see food, they’re starving and will eat more. So we’ve seen that in our data, and there’s other folks who’ve published on that as well.

[00:42:10]

ELENA RENKEN: Important to note this week. Thank you. And relatedly, I know a couple of you touched on socioeconomic status and income and its relationship to obesity. Are there any other pathways through which those things affect obesity that you could discuss?

[00:42:28]

LAUREN FIECHTNER: I think Vibha and your cortisol, if you want to talk about that. I think the stress piece is really interesting and certainly Dr. Singhal knows a lot about those paths.

[00:42:39]

VIBHA SINGHAL: Yes, so I think the stress. I mean, we talk about ACEs, adverse childhood experiences early in life, and there is so much data to suggest that those experiences can be small or big, and I see this clinically all the time. Just two days ago, I look at, you know, I don’t share the BMI chart, but when I look before and I go, I’m like, What happened here? It just changed trajectory, and you go and find out that there was parental separation. The family, you know, we are in a fire zone, so the family was displaced. So those triggers, those stresses, internalize and externalized stigma that the family is facing food insecurity, not living in a safe household. Having seen, you know, a sibling death or other things, those impact our key, I think, our core. I’m being spiritual and not a scientist here, but they just change your metabolism. And from an endocrinological perspective, it causes the stress response, the stress hormone cortisol, which is our normal, very important hormone. We know in the obesity setting, there are higher levels of those hormones, and that changes how our metabolism, just changes the trajectory of the person, like, moving forward in life.

So it takes a lot to change after that. So I think how we protect our children from those experiences, life happens as is, but how can we, you know, ensure as a society that there are those safety parameters around there? I think it’s so crucial. And just to add the bright side is the protective mechanisms, the family being together, the family participating being outdoors together, they are preventive. They are protective from all those experiences. So I think I don’t know if I twisted and answered your question, but the stress, the socioeconomic status, stress at multiple levels clearly plays a role.

[00:45:07]

ELENA RENKEN: Very good to know. Thank you. I know we’ve also talked a bit about ultra processed foods. Health and Human Services Secretary Kennedy has also raised concerns about food dyes. What does research show about any link between food dyes and childhood obesity? Anyone able to take that?

[00:45:33]

DR. JENNIFER SACHECK: I don’t believe that there’s currently scientifically based conclusive evidence on that linked to obesity.

[00:45:40]

DR. VIBHA SINGHAL: Yeah. I agree. I’m not aware of any scientific evidence either.

[00:45:52]

ELENA RENKEN: Thank you. And a question for Dr. Singhal about the California Health Interview Study conducted at UCLA. If you’re familiar with it?

[00:46:00]

DR. VIBHA SINGHAL: Sorry, I’m not.

[00:46:02]

ELENA RENKEN: More than reasonable. Well, maybe we can speak a little bit more generally, but it sounds like it showed wide fluctuations in teen obesity data from year to year, swinging as much as ten percentage points. Is that something that’s common or can you help people interpret why that might be?

[00:46:20]

DR. VIBHA SINGHAL: So again, not knowing the details, the methodology of the study, hard to interpret. I would first and foremost focus on how the study is done, how the obesity is assessed, what is the sample size each year? What is the demographic each year? I can tell you from my experience, different parts of L.A. would have different rates of obesity. So you have to have the correct sampling methods to assess obesity in a state. I think that would be important. But again, my knowledge is I can only give so much educated answer since I’ve not read the study myself.

[00:47:02]

ELENA RENKEN: More than fair. Thank you. Another question for anyone here. What’s known about environmental exposure to pollutants, especially endocrine disruptors like PCBs and how they impact childhood obesity?

[00:47:20]

DR. VIBHA SINGHAL: I can try a dabble at that one. So we all I mean, this data is coming that Americans in general, have 200 to 300 chemicals that don’t belong in their body at any given time. I think that research, that scientific exploration is very challenging because you cannot, especially in a whole human body, in a working, functional human body. People have taken each chemical that they think is bad and taken them to the laboratory and tweaked it and found a change. But how our system handles it, if I may, like, do we have safety mechanisms built in our biology or not? We don’t know. That being said, we do see an epidemiological trend with increases in these chemicals and things like I encounter, again, as an endocrinologist, early puberty. Post-COVID pandemic, we saw a certain increase in presentation, especially in females with puberty. So was it the psychological stress? Was it the lack of activity? Was it the increases in BMI? I don’t know. I think, again, it comes down to multi- factorial changes. I have a colleague here who does endocrine disruptive chemicals and its impact on placenta and how it transmits to the next generation. So they are not trivial, um I think we will see some more information surface. There are some endocrinologic studies in the setting of hypospadias where the urethra opens under the penis. So there are disease settings where it can be, but I think more needs to come. There is no there is more data on the cancer side of things than truly linking it with obesity that I’m aware of.

[00:49:33]

ELENA RENKEN: Thank you. And another question here. What does research tell us about the best ways to encourage physical activity in kids who aren’t particularly interested in active hobbies?

[00:49:44]

DR. JENNIFER SACHECK: No, it’s a great question probably suitable for everyone. So I think, again, like, the early years really the role modeling, parents, siblings, peers at school and making them comfortable with movement, and then finding those things that they love and trying to incorporate it in ways that’s natural and not forced, so that’s something that they choose to engage in, and it’s not because so and so told them to do that and making them feel good about their bodies in doing those movements. And again, this can be, you know, really, you know, anything, you know, from dancing to, you know, dance, ballet, you know, it’s a walk with a dog or an elderly person down the street. I mean, there’s a lot of different ways to sort of get kids to move without them thinking that they’re exercising. And I think that’s what they need to sort of hold onto and find those things as they evolve through life, too. And I know with every segment of our lives, we kind of gravitate usually typically to different things that fit our lifestyles.

[00:50:59]

DR. ELENA RENKEN: And a further question. To what extent are issues around screen time and inactivity an issue of habits formed during the COVID pandemic? Are there examples of strategies to reverse those habits that have been successful?

[00:51:12]

DR. JENNIFER SACHECK: Yeah, that’s another great question. Clearly, during COVID, we saw a huge, you know, increase in sedentary time and a decrease in physical activity level. I think that the ubiquitous nature of the phones and the sedentary time and screens has creeped into the younger years, unfortunately, much more so than it was. I’m thinking about my own children, and the youngest to the oldest is a ten years difference, and, you know, when she was able to get a phone versus when maybe my youngest might be able to get a phone, I probably have a different mindset now. But yeah, I think it’s really, the sedentary peace and understanding maybe the rules around household use, you know, during meals, no screens, when you can use it close to bedtime, those parameters to sort of instill those at early ages. And even if you have kids of varying ages in the house to sort of keep those sort of consistent across ages, if possible, so that, you know, younger child is not trying to do maybe what the adolescent is getting away with on the flip side, I think the activity patterns, the same thing is that, you know, if we can at least do better on one, we’re making a huge improvement. So getting a little less screen time, you win that battle a little bit, and then maybe working on increasing the physical activity of vice versa. And there are different programs that have worked, but I really think it is also the role models of the families and the caretakers that are setting the stage for their kids, and sometimes we’re not the best role models. So starting there is probably what I would recommend first.

[00:52:46]

DR. LAUREN FIECHTNER: The American Academy of Pediatrics also has a family media contract program that you can go through that is different for different age groups. So I think it’s a really nice resource to tailor the different media use among different age groups, too, and a good conversation starter with your kids and how we do this because it’s not easy.

[00:53:14]

ELENA RENKEN: Well, now we have one more question, which will give our experts here a chance to offer some brief takeaway messages. But first, I want to flag for reporters on the line that you’ll receive a quick email survey when you sign off from this briefing. If you have even 30 seconds to give us any feedback, it really helps us plan our services to give you what you need for your reporting. Now, our final question to each of you, what is one key take home message for reporters who are covering childhood obesity? Dr. Fiechtner, do you want to start off?

[00:53:45]

LAUREN FIECHTNER: Sure. When I started my career, there was a lot of pushback that there was no solutions to treat obesity, and there are quite a few programs that have been tested for over 30 years. You can all find them on the Centers for Disease Control, for the family healthy weight programs. And I think they’re largely effective and they’re in many communities. And so I just hope families know there is treatment. It’s individualized. It’s non- stigmatizing and completely family centered. And as everyone pointed out, multi-factorial. And often those can be added in conjunction with the medications we talked about today, as well.

[00:54:28]

ELENA RENKEN: Thank you. And Dr. Sacheck?

[00:54:31]

DR. JENNIFER SACHECK: Yeah, great. I think that, you know, physical activity might be underappreciated. I started in my career at both, trained in nutrition and physical activity. It’s often like a decade behind nutrition in terms of recommendations and guidance. But really, I think we talked a lot about sedentary time and also meeting physical activity recommendations, but let’s not forget about just light activities, how important that is for health. And maybe for those kids who don’t want to be really active, just moving around more is the key. That, you know, physical activity really does have independent and synergistic effects with changes in diet that can promote, you know, health and prevent, you know, obesity in the long run. So I think that’s the take home message I like to drive home.

[00:55:17]

ELENA RENKEN: Thank you. And Dr. Singhal?

[00:55:20]

DR. VIBHA SINGHAL: Yeah, thank you. So I would just like to say that beware of weight stigma, and that is at multiple levels from internalized stigma in somebody who is bigger bodied to stigma with your medical providers. We have our own checks and assessments to stigma at the society level in the school level with your coaches, athletic coaches. I see so not uncommonly, unfortunately, where a young person is told to sit down because they’re not fast enough. So I think just believing that it is not your fault, empowering our families that it’s not their fault. It is a system-wide thing, multi- layered, multi-factorial. Just keep doing the good fight.

[00:56:16]

ELENA RENKEN: Thank you all so much for these useful insights into the research side of this topic, especially as it’s coming up so often in policy reporting these days. And from all of us at SciLine, thanks to all the journalists who logged on to gather context and ideas for your coverage. I hope we’ll see you at our next briefing. Thanks.