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Alshihri, A. A., Rogers, H. J., Alqahtani, M. A., & Aldossary, M. S. (2019). Association between Dental Caries and Obesity in Children and Young People: A Narrative Review. International Journal of Dentistry, vol. 2019, Article ID 9105759, 8 pages.

American Academy of Child & Adolescent Psychiatry. (2020). Facts for Families: Screen Time and Children.

American Academy of Pediatrics. (2021). Media and Children.

American Academy of Pediatrics. (2019). Policy Statement: Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents. Pediatrics, 143(4): e20190282.

American Academy of Pediatrics. (2018). Childhood Obesity in Primary Care. Module 1: Childhood Obesity Epidemic and the Role of the Primary Care Provider.

American Academy of Pediatrics. (2017). Policy Statement: Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics, 139(6): e20170967.

American Academy of Pediatrics. (2017). Policy Statement. Stigma Experienced by Children and Adolescents With Obesity. Pediatrics, 140(6): e20173034.

American Academy of Pediatrics. (2016). Policy Statement: Media-and-Young-Minds. Pediatrics, 138(5): e20162591.

American Academy of Pediatrics. (n.d.). Bright Futures: Promoting Oral Health.

American Academy of Pediatrics, Institute for Healthy Childhood Weight. (n.d.). Policy Opportunities Tool.

Baran, J., Weres, A., Wyszyńska, J., Pitucha, G., Czenczek-Lewandowska, E., Rusek, W., Leszczak, J., & Mazur, A. (2020). 60 Minutes Per Day in Moderate to Vigorous Physical Activity as a Natural Health Protector in Young Population. International Journal of Environmental Research and Public Health, 17(23), 8918.

Bouchard, C. (2021). Genetics. Genetics of Obesity: What We Have Learned Over Decades of Research. Obesity, 29(5): 802-820.

Center on Budget and Policy Priorities. (2022). Tracking the COVID-19 Economy’s Effects on Food, Housing, and Employment Hardships.

Centers for Disease Control and Prevention. (2022). Consequences of Obesity.

Centers for Disease Control and Prevention. (2022). Overweight and Obesity.

Centers for Disease Control and Prevention. (2022). Teen Birth Rate by State.

Centers for Disease Control and Prevention. (2022). Births: Final Data for 2020. National Vital Statistics Reports, 70(17): 1-50.

Centers for Disease Control and Prevention. (2021). About Teen Pregnancy.

Centers for Disease Control and Prevention. (2021). Defining Childhood Weight Status.

Centers for Disease Control and Prevention. (2021). Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020. Morbidity and Mortality Weekly Report (MMWR), 70(37);1278–1283.

Centers for Disease Control and Prevention, National Center for Health Statistics. (2021). Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2017–2018.

Centers for Disease Control and Prevention. (2021). National Health and Nutrition Examination Survey (NHANES). (Text of webinar about health and nutritional data collection).

Centers for Disease Control and Prevention. (2021). Rates of Any and Exclusive Breastfeeding by State among Children Born in 2018.

Centers for Disease Control and Prevention. (2021). Births: Provisional Data for 2020. Vital Statistics Rapid Release, Report No. 012.

Centers for Disease Control and Prevention. (2020). National Health and Nutrition Examination Survey (NHANES). Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2017–2018.

Centers for Disease Control and Prevention. (2019). Disability and Obesity.

Centers for Disease Control and Prevention. (2010). Use of World Health Organization and CDC Growth Charts for Children Aged 0—59 Months in the United States. Morbidity and Mortality Weekly Report (MMWR), 59(RR09);1-15.

Child Mind Institute. (2021). The Impact of the COVID-19 Pandemic on Children’s Mental Health What We Know So Far.

Chung, S. (2017). Growth and Puberty in Obese Children and Implications of Body Composition. Journal of Obesity and Metabolic Syndrome, 26(4): 243–250.

Devaux, M., & Vuik, S. (2019). The relationship between childhood obesity and educational outcomes. Book chapter from The Heavy Burden of Obesity: The Economics of Prevention.

Frayer, N. C. & Kim, Y. (2020). Caffeine Intake During Pregnancy and Risk of Childhood Obesity: A Systematic Review. International Journal of Child and Maternal Health and AIDS, 9(3): 364–380.

Harvard T.H. Chan School of Public Health. (n.d.). Obesity Prevention Source.

Imperial College London & World Health Organization. (2017). Worldwide trends in body-mass index, underweight, overweight and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128-9 million children, adolescents, and adults. The Lancet, 390(10113), 2627–2642.

Ingol, T. T., Li, R., Ronau, R., & Klebanoff, M. A. (2021). Underdiagnosis of obesity in pediatric clinical care settings among children born preterm: a retrospective cohort study. International Journal of Obesity, 45: 1717–1727.

Kang, M. J. (2018). The adiposity rebound in the 21^st century children: meaning for what? Clinical and Experimental Pediatrics, 61(12): 375-380.

Kaufman, T. K., Lynch, B. A., & Wilkinson, J. M. (2020). Childhood Obesity: An Evidence-Based Approach to Family-Centered Advice and Support. Journal of Primary Care & Community Health, 11, 2150132720926279.

Kaufman, T. K., Lynch, B. A., & Wilkinson, J. M. (2020). Primary care provider’s role in addressing obesity. Journal of Primary Care & Community Health, 11: 1–6.

Lee, J. S., Jin, M. H., & Lee, H. J. (2022). Clinical and Experimental Pediatrics. Global relationship between parent and child obesity: a systematic review and meta-analysis. Clinical and Experimental Pediatrics, 65(1): 35-46.

Li, Y., Xia, X., Meng, F., & Zhang, C. (2020). Association Between Physical Fitness and Anxiety in Children: A Moderated Mediation Model of Agility and Resilience. Frontiers in Public Health.

Li, Y. F., Lin, S. J, & Chiang T. (2020). BMC Pediatrics. Timing of rapid weight gain and its effect on subsequent overweight or obesity in childhood: findings from a longitudinal birth cohort study. BMC Pediatrics, 20, 293.

Liao, X. P., Yu, Y., Marc, I., Dubois, L., Abdelouahab, N., Bouchard, L., . . . Fraser, W. D. (2019). Prenatal Determinants of Childhood Obesity: A Review of Risk Factors. NYU Langone Medical Center School of Medicine.

Mayo Clinic Health System. (2021). Healthy weight in children starts with healthy habits.

McCrory, M. A., Harbaugh, A. G., Appeadu, S., & Roberts, S. B. (2019). Fast-Food Offerings in the United States in 1986, 1991, and 2016 Show Large Increases in Food Variety, Portion Size, Dietary Energy, and Selected Micronutrients. Journal of the Academy of Nutrition and Dietetics, 119(6): 923-933.

Michael and Susan Dell Center for Healthy Living. (2019). Childhood Obesity Crisis in Texas.

Miller, A. L., Gearhardt, A. N., Retzloff, L., Sturza, J., Kaciroti, N., & Lumeng, J. C. (2018). Early Childhood Stress and Child Age Predict Longitudinal Increases in Obesogenic Eating Among Low-Income Children. Academic Pediatrics, 18(6): 685–691.

Physical Activity Alliance. (n.d.). National Physical Activity Plan.

Nordman H., Jääskeläinen J., Voutilainen, R. (2020). Birth Size as a Determinant of Cardiometabolic Risk Factors in Children. Hormone Research in Paediatrics, 93: 144–153.

Palad, C. J., Yarlagadda, Y., & Stanford, F. C. (2019). Weight stigma and its impact on paediatric care. Current Opinion in Endocrinology, Diabetes and Obesity, 26(1): 19–24.

Paruthi, S., Brooks, L. J., D'Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., . . . Wise, M.S. (2016). Consensus statement of the American Academy of Sleep Medicine on recommended sleep hours for children and adolescents. Journal of Clinical Sleep Medicine, 12(06) :785–786.

Patel, A. I., Madsen, K. A., Maselli, J. H., Cabana, M. D., Stafford, R. S., & Hersh, A. L. (2010). Under-diagnosis of Pediatric Obesity during Outpatient Preventive Care Visits. Academic Pediatrics, 10(6), 405–409.

Pew Research Center. (2020). Parenting Children in the Age of Screens.

Qiao, J., Dai, L. J., Zhang, Q., & Ouyang, Y. Q. (2020). A Meta-Analysis of the Association Between Breastfeeding and Early Childhood Obesity. Journal of Pediatric Health Care, 53: 57-66.

Rao, W-W.,  Zong, Q-Q., Zhang, J-W., An, F-R., Jackson, T., Ungvari, G. S., . . . Xiang, Y-T. (2020). Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis. Journal of Pediatric Health Care, 267: 78-85.

Rito, A. I., Buoncristiano, M., Spinelli, A., Salanave, B., Kunešová, M., Hejgaard, T., . . . Breda, J. (2019). Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017. Obesity Facts, 12: 226–243

Robert Wood Johnson Foundation. (2021). State of Childhood Obesity Annual Report. From Crisis to Opportunity: Reforming Our Nation’s Policies to Help All Children Grow Up Healthy.

Robert Wood Johnson Foundation. (2021). State of Childhood Obesity: Helping All Children Grow Up Healthy. Texas-specific obesity data.

Rodrigues, D., Machado-Rodrigues, A. M., & Padez, C. (2020). Parental misperception of their child's weight status and how weight underestimation is associated with childhood obesity. American Journal of Human Biology, 32(5): e23393.

SanGiovanni , C., McElligott, J., Morella, K., & Basco, W. Jr. (2017). Underdiagnosis and Lower Rates of Office Visits for Overweight/Obese Pediatric Patients in Rural Compared with Urban Areas. Southern Medical Journal, 110(7), 480–485.

Sutaria, S., Devakumar, D., Yasuda, S. S., Das, S., & Saxena, S. (2018). Is obesity associated with depression in children? Systematic review and meta-analysis. Archives of Disease in Childhood, 104: 64–74.

Texas School Physical Activity and Nutrition (SPAN) Survey 2019-2020, funded by DSHS Title V Maternal and Child Health Block Grant. (2021).

Tech Advisor. (2022). How much screen time is healthy for children?

Thomas, K. & Urrego, F. (2017). Are Pediatricians Diagnosing Obese Children? The Ochsner Journal, 17(1), 80–82.

Trust for America’s Health. (2021). The State of Obesity: Better Policies for a Healthier America.

University of Connecticut, Rudd Center for Food Policy and Obesity. (2021). Fast Food f.a.c.t.s. Fast food advertising: Billions in spending, continued high exposure by youth.

U. S. Department of Agriculture. (2021). Economic Research Service. Food Security in the U. S.

U. S. Department of Agriculture. (2020). Dietary Guidelines for Americans 2020 – 2025. Ninth Edition.

U.S. Department of Agriculture. (2018) U. S. Department of Agriculture. America’s Eating Habits: Food Away From Home. Economic Information Bulletin, Number 196.

U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition.

Uy, M. J., Pereira, M. A., Berge, J. M., & Loth, J. A. (2018). How Should We Approach and Discuss Children’s Weight With Parents? A Qualitative Analysis of Recommendations From Parents of Preschool-Aged Children to Physicians. Clinical Pediatrics, 58(2): 226–237.

Ward, Z. J., Bleich, S. N., Long, M. W., & Gortmaker, S. L. PLOS ONE. (2021). Association of body mass index with health care expenditures in the United States by age and sex.

(2018). Socioeconomic Status and Other Factors Associated with Childhood Obesity. Journal of the American Board of Family Medicine, 31(4), 514–521.

World Health Organization. (2021). Infant and young child feeding.

World Health Organization. (2021). Obesity and overweight.

World Health Organization. (2020). Noncommunicable diseases: Childhood overweight and obesity. Q&A.

World Health Organization. (2019). Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children Under 5 Years of Age.

Resources to Share with Patients and Families

American Academy of Pediatrics. (n.d.). Family Media Plan. This website guides families in creating a Personalized Family Media Use Plan.

American Academy of Family Physicians, familydoctor.org. (2020). Emotional eating. This article helps families identify emotional eating behaviors.

Centers for Disease Control and Prevention. (2021). Do Your Children Get Enough Sleep?

Centers for Disease Control and Prevention. (2017). How Much Sleep Do I Need? Chart of recommended sleep hours for ages birth through adulthood.

Harvard T.H. Chan School of Public Health. (2022). Obesity Prevention Recommendations for Families: Complete List.

Mayo Clinic. (2021). Chart of high-fiber foods.

Mayo Clinic. (2020). Childhood Obesity.

U.S. Department of Agriculture. (2020). MyPlate, based on the Dietary Guidelines for Americans, 2020-2025.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.

Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hours of Nursing Continuing Professional Development.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
   • Create a Texas Health Steps account.
   • Complete on-line registration process.
   • Thoroughly read the content of the module.
   • Complete the on-line examination.
   • Complete the evaluation.
2. Commercial Support.
   The THSTEPS Web-based Continuing Education Series has received no commercial support.
3. Disclosure of Relevant Financial Relationships.
   The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
4. Non-Endorsement Statement.
   Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
5. Off-Label Use.
   Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

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