Obesity Medications Work Best for Young People When Combined With Lifestyle Support
Key Takeaways:
- Among young people with obesity, pairing medication with structured behavioural and lifestyle support produced the largest short-term reductions in BMI.
- Metformin combined with behaviour and lifestyle treatment lowered BMI by 4.95, whereas metformin used on its own showed no significant change.
- Semaglutide plus counselling was linked to the biggest BMI reduction of any approach, although this estimate rested on a single trial.
Support matters as much as the medicine
Children and adolescents with obesity who received a combination of medication and structured lifestyle treatments achieved the greatest short-term reductions in BMI, according to a new evidence synthesis. The findings point away from prescribing in isolation and towards a model in which medication is layered on top of behavioural and family support rather than used as a stand-alone fix.
How the study was conducted
Researchers carried out a systematic review and network meta-analysis, searching the literature databases through June 2025, to work out which obesity treatments perform best for young people. A network meta-analysis allows multiple interventions to be compared against one another even where they have not all been tested head-to-head in the same trial.
The final analysis brought together 42 randomised clinical trials involving 3835 participants aged 10–19 years with obesity. The median age was 14.5 years, and 59.2% of participants were female individuals. Most of the included studies followed up participants over 6–12 months, placing the emphasis firmly on short-term outcomes.
The interventions assessed fell into several categories: structured behavioural and lifestyle treatments, in both standard and intensive forms; counselling; medications, including GLP-1 receptor agonists, metformin, orlistat, and phentermine–topiramate; and combinations of medication with lifestyle treatment.
The primary outcomes were changes in BMI and BMI z-score, while the secondary outcomes were changes in waist circumference, fat mass, and lean mass. The interventions were then ranked in order of effectiveness.
On study quality, the risk for bias was judged low in 21.4% of trials and high in 26.2%, with the remaining 52.4% raising some concerns. The overall certainty of the evidence ranged from very low to high, so the strength of the findings varies considerably from one comparison to another.
What the analysis found
Across the 35 trials that reported BMI and the 19 that reported BMI z-score, medications produced larger reductions when paired with lifestyle treatments than when used alone. Metformin illustrates the pattern clearly: combined with behaviour and lifestyle treatment it was associated with a reduction of 4.95 in BMI, whereas metformin used on its own showed no significant change in BMI.
Semaglutide plus counselling was associated with the largest reduction in BMI (mean difference [MD], −8.31) and in BMI z-score (MD, −1.80). This estimate, however, came from a single trial, so it should be read with caution.
Behavioural and lifestyle treatment on its own was associated with reductions in BMI (MD, −3.85; five studies) and in BMI z-score (MD, −0.89; one study) – results that matched or exceeded the effect of certain medications used alone. Combination treatments were linked to the largest reductions in fat mass, drawing on 21 studies.
What it means in practice
The authors framed the combined approach as consistently outperforming medication given without support. “[The] finding suggests that even combining medication with basic counselling was still superior to giving medication without any lifestyle support,” the researchers wrote. “Medications should never be prescribed in isolation; a person-centered, family-centered approach matching treatment intensity to medical need is essential,” they added.
Where the research came from
The study was led by Ke-wen Wan, MSc, of Hong Kong Baptist University in Hong Kong SAR, China. It was published online on 22 June in JAMA Pediatrics.
Limitations to consider
Several caveats temper the results. The findings for newer medications were based on only a few small trials, which limits confidence in those specific estimates. The wide age range may have obscured differences by age or stage of puberty, since a 10-year-old and a 19-year-old can respond very differently to the same intervention. Most of the trials also did not report data on race, ethnicity, or income, leaving open questions about how the findings apply across different populations.
Funding and disclosures
The study received funding from grants from Hong Kong Baptist University. One author reported serving on professional boards related to childhood obesity and receiving travel grants or reimbursements, and another author reported receiving consulting fees from pharmaceutical companies. Detailed disclosures are available in the original article.
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Air Pollution May Raise Obesity Risk in Children by Affecting Impulse Control
Key Takeaways:
- New peer reviewed research suggests early exposure to PM2.5 air pollution may contribute to childhood obesity by affecting children’s impulse control.
- Babies exposed to higher PM2.5 levels during their first year of life were more likely to show later difficulties with inhibitory control, which were linked to higher body fat and BMI between ages four and eight.
- Researchers say individual steps such as HEPA filtration may help reduce exposure, but wider policy action is needed to limit PM2.5 pollution.
Study links PM2.5 exposure with later weight gain
Exposure to common air pollution may contribute to childhood obesity by disrupting children’s ability to control impulses, according to new first of its kind peer reviewed research.
The study, led by researchers at Mount Sinai’s Icahn School of Medicine, focused on particulate matter 2.5, known as PM2.5. This pollutant is made up of microscopic solid or liquid particles suspended in the air. Common manmade sources include traffic emissions and the burning of fossil fuels.
PM2.5 is considered a probable carcinogen and has been linked to a range of health problems, including dementia and strokes. Previous research has also shown that PM2.5 has obesogenic properties, meaning it may disrupt metabolism and is associated with weight gain.
Impulse control identified as a possible pathway
Researchers said the new study is the first to identify impulse control as a potential pathway linking early PM2.5 exposure with childhood obesity.
The study found that babies exposed to higher levels of PM2.5 during their first year of life were more likely to develop difficulties with impulse control later in childhood. Those behavioural changes were then associated with higher body fat and higher BMI among children aged between four and eight.
“A lot of the obesity research primarily focuses on – and is being shaped by – diet and physical activity, and a lot may not include environmental exposures, including air pollution,” said Jamil Lane, a co-author with Mt Sinai’s Icahn School of Medicine.
“Our study is novel in that we are showing that high levels of air pollution early in life may cause more difficulty with self-regulation, which contributes to weight gain.”
Why early life exposure matters
The researchers examined data from 434 children born largely between 2007 and 2008 in Mexico City. The children are part of a longitudinal health study.
The authors modelled ambient PM2.5 exposure during pregnancy and during the children’s first year of life. Lane described this early period as a “very sensitive window” for brain development.
The children were later assessed for impulsivity and measures linked to obesity. According to the study, the group with the highest PM2.5 exposure showed a pattern of high impulsivity, reflecting significant deficits in inhibitory control.
How brain development and eating behaviour may be connected
Poor inhibitory control is already well established as being linked to obesity. Bob Wright, a study co-author and environmental epidemiologist at Mount Sinai, said the authors questioned whether PM2.5’s neurotoxic effects and obesity were “part of the same processes”.
“Our study shows that greater early exposure to PM2.5 in the first year of life is associated with alterations in inhibitory control function in childhood,” the study’s authors wrote. “The effect is likely due to altered eating behaviors related to inhibitory control that are programmed early in life.”
The findings suggest that air pollution exposure early in life may affect brain pathways involved in self-regulation, which could then influence eating behaviours and weight gain later in childhood.
Study limitations and wider context
The study acknowledges several limitations, including its small population size and limited covariates.
However, Cecilia Moura, a clean transportation scientist with the Union of Concerned Scientists, who was not involved in the research, said the study was sound and that the novel findings “indicate there is sufficient evidence supporting the correlation to motivate policies and regulations that mitigate exposure to PM2.5”.
The research comes against the backdrop of high levels of obesity in the United States. In 2018, about 42% of American adults were estimated to have obesity.
Steps families can take to reduce exposure
The researchers said people can take some steps to help protect themselves and their children from PM2.5 exposure.
Home HEPA air filtration systems are effective at removing PM2.5. Furnace filters rated MERV 13 or higher can also capture much of the pollutant. DIY filtration systems made with a box fan, cardboard, tape, and pleated air filters have also been shown to reduce particulate matter.
The authors advised parents to avoid high congestion areas as much as possible and to stay indoors when wildfire smoke is heavy.
Researchers call for policy action
Despite these individual measures, researchers stressed that people cannot fully protect themselves from air pollution exposure on their own. They said the findings underline the need for wider policy solutions and greater public awareness.
“There is not going to be change if people are not aware and lobbying for it, but policy change takes a long time and there are things we can do to protect ourselves,” Wright said.
CCH insights:
This study provides more evidence of the complex array of factors that can contribute to obesity, and may be one reason (of many) that people from lower socioeconomic backgrounds have a higher risk of developing obesity. When we use the term ‘obesogenic environment’ most of us think of the plethora of fast-food outlets, the abundance of UPFs in food shops and our reliance on motorised transport – but we need to think even more widely than that, to include the quality of air we are breathing.
Building that wider, evidence-based picture of what actually drives obesity – across the biological, behavioural, social and environmental – is the foundation of good obesity care, and it’s what our CPD short course Obesity Essentials is designed to give any healthcare professional. Those wanting to go further can explore our PGCert in Obesity Care, which examines the full range of contributing factors in depth.
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Maternal Obesity Before Pregnancy Tied to 64% Higher Childhood Obesity Risk
Key Takeaways:
- Children whose mothers had obesity before pregnancy were 64% more likely to be affected by overweight or obesity by age 3.
- Gaining excess weight during pregnancy – common among about 41% of mothers studied – was linked to a 39% higher risk.
- Maternal weight factors mattered at different stages, and the links varied between Hispanic and non-Hispanic families.
The roots of childhood obesity may begin in the womb
New research led by the George Mason University College of Public Health has found that children whose mothers began pregnancy with obesity were 64% more likely to be affected by overweight or obesity by age 3. Excessive weight gain during pregnancy was associated with a 39% increase in that risk.
“Our findings suggest that childhood obesity risk may not develop in a single, uniform way, but maternal health before and during pregnancy may play a larger role than many people realize,” said study lead author Hua Min, associate professor in the Department of Health Administration and Policy.
Timing appears to matter
Different pregnancy-related weight factors appeared to matter at different stages. Excess weight gain during pregnancy was more closely linked to infant weight, while maternal obesity was more strongly associated with weight later in toddlerhood. Researchers also found that excess weight gain during pregnancy was common, affecting about four in 10 mothers in the study.
A large, ethnically diverse US study
Published in the International Journal of Obesity, the research is among the largest and most ethnically diverse longitudinal studies in the United States to examine how maternal weight may influence obesity risk in early childhood. Researchers tracked nearly 3,000 mother-child pairs, drawing on data from a Northern Virginia birth cohort taking part in the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.
The George Mason research team included Michael S. Bloom of the Department of Global and Community Health, along with Grace Lawrence, Alma Fuller and Kathi C. Huddleston of the School of Nursing.
Why this matters
Childhood obesity remains one of the most pressing health challenges in the United States. The study notes that nearly 90% of children with obesity at age 3 will continue to be affected by overweight or obesity into early adulthood. Those early patterns can carry long-term consequences, increasing the risk of diabetes, cardiovascular disease and other chronic health problems.
Researchers say the findings reinforce the importance of maternal health before and during pregnancy – not just for pregnancy outcomes, but also for a child’s long-term health trajectory. The findings also suggest that obesity risk may develop differently across populations, with patterns varying among demographic groups.
Study details
The findings were based on the First Thousand Days of Life Study, a Northern Virginia birth cohort taking part in the ECHO Program, which examines how early-life experiences affect child health. George Mason was selected as an ECHO research site in 2019.
Researchers enrolled 2,899 mother-child pairs in Northern Virginia between 2012 and 2019, following families from pregnancy through to age 3.
Key findings
The strongest signal came from maternal weight before conception. Children whose mothers had obesity before pregnancy were 64% more likely to be affected by overweight or obesity by age 3, and the risk rose incrementally with weight: for every one-point increase in maternal pre-pregnancy body mass index (BMI), the likelihood of childhood overweight or obesity climbed by about 4%.
Weight gain during pregnancy carried its own, separate risk. Children whose mothers gained excessive weight while pregnant were about 39% more likely to be affected by overweight or obesity by age 3, and roughly 41% of mothers in the study gained more than national guidelines recommend. Notably, the two factors seemed to act at different points in early life: excess weight gain during pregnancy showed stronger links to higher weight in infancy, whereas maternal weight before pregnancy became more strongly associated with higher child weight later in early childhood. The associations also differed between Hispanic and non-Hispanic families, suggesting that obesity risk may develop differently across populations.
Looking ahead
Taken together, the findings point to the period before and during pregnancy as a meaningful window for a child’s long-term health, rather than a single moment or cause. Because the maternal weight factors appeared to matter at different stages, and because the associations varied between demographic groups, the researchers suggest that efforts to understand and address childhood obesity may need to account for how risk builds over time and how it differs across populations.
Source: George Mason University
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Childhood Obesity Risk May Begin With Fathers, Long Before Birth
Key Takeaways:
- A review in Current Obesity Reports argues that fathers influence their children’s obesity risk through several interacting biological, behavioural, and environmental pathways that begin before conception – not only through the mother.
- Paternal obesity is linked to poorer sperm quality and to epigenetic changes in sperm that can alter gene expression in the developing embryo, although some of these changes appear reversible through lifestyle modification before conception.
- The authors call for obesity prevention to include fathers explicitly – through preconceptional counselling, perinatal education for both parents, supportive workplace policies, and more research into the paternal role.
A wider lens on obesity research
A recent review published in the journal Current Obesity Reports suggests that fathers shape their children’s risk of obesity through multiple interacting pathways that begin before conception. The authors argue that efforts to prevent and study childhood obesity should focus on fathers as well as mothers.
Childhood obesity continues to rise in the United States, alongside increasing rates of overweight and obesity among adults. Current projections suggest that more than 250 million Americans could be living with overweight or obesity by 2050.
Research shows that children are more likely to develop obesity when one or both parents are affected, and the risk is highest when both parents have obesity. This pattern reflects the complex interplay of genetic, biological, behavioural, and environmental factors that influence obesity risk across generations.
The Developmental Origins of Health and Disease (DOHaD) framework holds that the periconceptional period is critical in setting the foundation for long-term outcomes, including cardiometabolic disease, through exposure to environmental factors. Maternal nutrition, obesity, and metabolism have been studied in detail because they shape the fetal environment.
More recently, the Paternal Origins of Health and Disease (POHaD) framework has been brought under the DOHaD umbrella. The current review examined the biological, psychological, and behavioural pathways through which paternal factors affect children’s health – though not in isolation from family dynamics and other environmental and social factors. The authors stress that paternal influences operate alongside maternal and broader family influences rather than separately from them.
How obesity alters sperm and offspring metabolism
Around 40% to 70% of obesity is heritable, mediated by hundreds of obesity-linked genetic variants. Obesity in fathers can affect the metabolic health of their offspring through several routes.
Paternal obesity influences sperm quality, reducing sperm concentration and motility and increasing the rate of sperm DNA fragmentation. These changes are linked to the adverse effects of obesity on paternal metabolism. The same sperm abnormalities are reflected in a 30% to 66% increase in the risk of infertility among men with obesity, and they raise the risk of pregnancy loss independently of maternal factors.
Obesity is associated with metabolic dysregulation through disrupted endocrine regulation of sperm production, testicular and systemic inflammation, and epigenetic alterations in sperm. Because sperm cells are produced continuously and mature over several months before conception, there is a wide window during which environmental exposures can leave their mark.
These epigenetic changes are heritable and can affect gene expression in the developing embryo, across pathways tied to appetite regulation, insulin signalling, and fat metabolism. In animal studies, a high-fat diet in the father is associated with obesity-related changes in the offspring. Even so, while animal research provides strong evidence for these mechanisms, the equivalent biological pathways in humans remain incompletely understood.
Notably, some obesity-associated epigenetic changes in sperm appear to be reversible through lifestyle modification before conception.
How a father’s habits shape his child’s behaviours
Becoming a father tends to be associated with weight gain and with changes across multiple health behaviours, for better or worse. A healthy preconceptional paternal diet is associated with improved sperm quality and concentration, regardless of age and body mass index (BMI), while a poor-quality diet has the opposite effect.
The quality of a father’s diet, his physical activity habits, his feeding practices, and his parenting style all influence a child’s eating and activity levels – both directly and indirectly through role modelling. The same applies to a father’s physical activity and sedentary habits.
How neighbourhood and food access shape outcomes
A father’s risk of obesity is influenced by many other factors, including income, education, and neighbourhood type.
The residential neighbourhood affects a child’s diet directly, through food access, and indirectly, through its association with food security, socioeconomic status, and the father’s mental health. Food insecurity is linked to higher consumption of high-calorie foods and an increased risk of obesity. Likewise, limited access to safe recreational spaces restricts physical activity and raises obesity risk.
These factors operate at the family level, touching everything from the father’s physiology and parenting style to the child’s developmental environment. Together they interact to compound the increase in obesity risk across generations.
Mental health is particularly important. A father living with depression is less likely to have an engaged or positive parenting style, or to value preventive healthcare for himself or his family. This can worsen a child’s eating and sleep behaviours and increase obesity risk. Children living with a parent experiencing depression are also at greater risk of adverse childhood experiences (ACEs), which may affect their long-term obesity risk.
Why fathers may shape obesity risk from the start
The authors conclude that fathers play an important role in how obesity risk is transmitted across generations – a process that begins preconceptionally and continues through childhood. They note, however, that much of the current evidence is observational, and that further human research is needed to better understand the biological mechanisms linking paternal health and offspring obesity risk.
They suggest that obesity prevention strategies should include preconceptional counselling that addresses fathers as well as mothers; perinatal education aimed at both parents; the inclusion of fathers in obesity prevention methods; workplace policies that support paternal involvement in childcare; and greater priority for research examining the father’s role in transmitting obesity risk across generations.
CCH insights:
At CCH we have been interested in the mounting evidence around the paternal origins of health and disease (POHaD) for some time, particularly in relation to obesity. This review provides a comprehensive summary of the evidence so far for the important role of fathers, not just in terms of their biological intergenerational impact, but also through health-related behaviours and their influence on the child’s environment.
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Whole Milk and Childhood Obesity – New Study Challenges Long-Standing Dietary Advice
Key Takeaways:
- Children who consumed whole-fat milk in early childhood showed lower odds of living with obesity in later childhood compared with those consuming reduced-fat options
- The study found no evidence that whole milk increases adiposity, challenging decades of low-fat dietary guidance
- Researchers suggest milk fat may influence satiety and overall dietary patterns, although mechanisms remain unclear
Rethinking milk fat and childhood health
New research from the University of Toronto suggests that children who consume whole-fat milk during early childhood may have a lower likelihood of living with obesity in middle childhood than those who drink reduced-fat milk.
These findings contribute to a growing body of evidence indicating that lower-fat milk may not provide the protective effect against childhood obesity that has long been assumed. For several decades, dietary guidelines in many countries have promoted low-fat dairy products. For example, Canada’s Dietary Guidelines in 2019 continued to recommend reduced-fat options, reflecting a broader historical focus on reducing dietary fat intake.
Study overview and design
The study, published in the American Journal of Clinical Nutrition, is described as one of the most comprehensive analyses to date examining the relationship between milk consumption and childhood obesity over time.
Researchers, including former postdoctoral fellow Tara Zeitoun and doctoral student Zheng Hao Chen, analysed data from the CHILD Cohort Study. This large, prospective study tracks health data from thousands of children from before birth through to adolescence.
Caregivers reported the type of milk consumed by children, including skim, one per cent, two per cent, and whole-fat milk. Researchers then assessed a range of outcomes at ages five and eight, including:
- Body mass index (BMI)
- Waist-to-height ratio
- Fat mass
- Preclinical and clinical obesity status
Key findings
Milk consumption was common among participants, with over 90 per cent of children consuming milk before the age of five. Among these:
- 24 per cent consumed whole-fat milk
- Approximately half consumed less than one cup per day
Despite relatively modest intake, notable differences emerged. Children who consumed whole milk at age five had significantly lower BMI at age eight. They also had 69 per cent lower odds of living with obesity compared with children who consumed skim milk.
In addition, researchers identified a broader pattern in which higher milk fat content was associated with more favourable adiposity profiles.
Expert insight
Kozeta Miliku, a professor of nutritional sciences at the University of Toronto’s Temerty Faculty of Medicine and a researcher at the Joannah and Brian Lawson Centre for Child Nutrition, emphasised the implications of these findings:
“The most important learning from this study is that whole milk was not associated with higher adiposity or obesity risks risk in children, and may even be linked to healthier growth patterns,”
She also highlighted the limitations of focusing narrowly on fat reduction:
“Switching to lower-fat milk has been about cutting fat in the diet, but that may miss the bigger picture,” says Miliku. “When we think about healthy growth, it’s important to consider the overall nutritional context. Removing fat does not automatically make skim milk a healthier choice for children.”
Implications for public health guidance
The findings raise important questions about long-standing public health recommendations. Prior to 2019, Health Canada advised that children transition from whole milk to reduced-fat milk from the age of two. Similarly, the Dietary Guidelines for Americans 2020–2025 supported reduced-fat dairy intake.
However, recent policy developments suggest a shift in thinking. In the United States, the Whole Milk for Healthy Kids Act has allowed full-fat milk to be reintroduced into school lunches, aligning with updated national guidance that is more permissive of full-fat dairy.
Possible biological mechanisms
While the study did not directly investigate underlying mechanisms, the researchers proposed several hypotheses:
- Milk fat may enhance satiety, potentially reducing the consumption of energy-dense, nutrient-poor foods
- It may influence overall energy balance
- It could play a role in metabolic pathways linked to growth and nutritional status
These potential explanations highlight the complexity of dietary patterns and suggest that focusing on single nutrients may overlook broader physiological effects.
The need for further research
Miliku noted that additional research is needed to better understand how milk fat may influence obesity risk and whether any protective effects persist into adolescence and adulthood.
With Canada’s 2019 dietary recommendations offering limited specific guidance on milk consumption for children, the study’s findings may help inform future discussions among parents, clinicians, and policymakers.
A broader view of healthy diets
Miliku concluded by reinforcing the importance of overall dietary quality:
“Whole fat milk can be part of a healthy diet and does not on its own increase obesity risk,” she adds. “And it’s important to think about the overall quality of the diet – the fruits and vegetables, whole grains and protein-rich foods they consume.”
Funding and support
The research was funded by the Canadian Institutes of Health Research and the Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto, supported through a donation by President’s Choice Children’s Charity.
CCH insights:
This interesting new research will hopefully be the trigger for governments and public health bodies to review and amend their outdated advice to choose low-fat dairy options instead of full-fat. The reductionist approach to nutrition, which considers food just in terms of calories and individual nutrients, is an oversimplification which does not help our understanding of the relationship between food and health. If the best food for children early in life is whole milk, why would it be beneficial for them to suddenly switch to low-fat milk at the age of 2?
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Children with Obesity Face Elevated Long-Term Health Risks Even with Normal Test Results, Study Finds
Key Takeaways:
- Children living with obesity can face significantly higher risks of future disease even when current clinical tests appear normal
- By early adulthood, rates of type 2 diabetes, hypertension and abnormal lipids are markedly higher compared with the general population
- Effective obesity treatment in childhood is associated with meaningful reductions in long-term health risks
Rethinking “metabolically healthy” obesity in childhood
Children living with obesity who show no immediate signs of metabolic complications may still be at substantial risk of developing serious health conditions later in life. New research from the Karolinska Institutet, published in JAMA Pediatrics, challenges the long-standing notion that some children with obesity can be considered “metabolically healthy” and therefore may not require intervention.
The findings contribute to an ongoing clinical debate about whether normal blood markers, liver function and blood pressure in childhood are sufficient indicators of long-term health.
“There has been a debate about whether children with normal blood and liver values and normal blood pressure might not need treatment for their obesity. Our study shows that this assumption is incorrect,” says Claude Marcus, professor at the Department of Clinical Science, Intervention and Technology at Karolinska Institutet.
Study design and population
The study followed just over 7,200 children aged 7–17 in Sweden who had initiated obesity treatment. Participants were tracked longitudinally up to the age of 30, allowing researchers to assess long-term health outcomes.
Children were grouped into three categories:
- Those with metabolically healthy obesity (MHO)
- Those with obesity and impaired cardiometabolic risk markers (MUO)
- A control group drawn from the general population
This design enabled a direct comparison of long-term disease risk across different metabolic profiles in childhood.
A clearly increased risk of future disease
Despite appearing clinically healthy in childhood, individuals with MHO demonstrated a substantially elevated risk of developing cardiometabolic diseases by early adulthood.
By the age of 30:
- 9 percent of individuals with MHO had developed type 2 diabetes, compared with 17 percent in the MUO group and 0.5 percent in the control group
- High blood pressure was observed in 11 percent of the MHO group, 18 percent of the MUO group and 4 percent of the general population
- Abnormal blood lipid levels were present in 5 percent of those with MHO and 13 percent of those with MUO, compared with just 1 percent among controls
These findings indicate that even in the absence of early warning signs, children living with obesity carry a significantly increased burden of future disease risk.
“Even children with obesity who show no signs of cardiometabolic impact have a clearly increased risk of future diseases. This means that normal blood pressure and the absence of abnormal blood test results are not sufficient protection against future morbidity,” says Emilia Hagman, associate professor at the same department and the study’s corresponding author.
The role of early treatment
All children included in the study received structured support aimed at improving lifestyle habits. Researchers examined whether treatment response during childhood influenced long-term outcomes.
A strong response to treatment was associated with a reduced risk of developing all studied conditions – including type 2 diabetes, hypertension and dyslipidaemia. Notably, this protective effect was observed in both MHO and MUO groups.
This suggests that early intervention has meaningful and lasting clinical benefits, regardless of a child’s initial metabolic profile.
“Our results suggest that all children with obesity need treatment, even if they appear completely healthy upon examination,” says Claude Marcus.
Data sources and funding
The study drew on data from Sweden’s national quality registry BORIS, alongside several national health data registries.
Funding was provided by multiple organisations, including the Center for Innovative Medicine, the Ollie and Elof Ericsson Foundation and the Freemason Foundation for Children’s Welfare.
Several researchers reported receiving compensation from companies unrelated to this work. A full list of potential conflicts of interest is available in the original scientific publication.
Implications for clinical practice
The findings underscore the limitations of relying solely on current metabolic markers when assessing risk in children living with obesity. Even in the absence of immediate clinical abnormalities, long-term risks remain significant.
For clinicians, this supports a more proactive and inclusive approach to obesity management in paediatric populations – one that does not defer intervention based on apparently normal test results, but instead recognises obesity itself as a key driver of future health risk.
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AI Diet Recommendations for Adolescents Show Significant Nutritional Gaps, Study Finds
Key Takeaways:
- AI-generated diet plans consistently underestimated energy and key macronutrients required by adolescents
- Macronutrient balance was frequently misaligned with clinical guidelines, with lower carbohydrates and higher fat and protein levels
- Researchers caution that AI tools should not replace dietitians for adolescent nutrition without professional oversight
Growing demand for accessible nutrition support
Artificial intelligence is increasingly being used to support dietary planning, particularly in areas where access to qualified professionals is limited. However, a new study published in Frontiers in Nutrition raises important concerns about the reliability of these tools when applied to adolescents living with overweight or obesity.
Globally, adolescent overweight and obesity are rising at pace, affecting an estimated 390 million young people in 2022. In many regions, this now represents the most common form of malnutrition. Excess body weight in adolescence is associated with a range of adverse health outcomes, including type 2 diabetes, dyslipidaemia, hypertension, and sleep apnoea. It also increases the likelihood of obesity in adulthood and is linked to reduced quality of life.
Alongside physical health risks, adolescents may experience body image concerns and engage in harmful weight control behaviours such as self-induced vomiting or misuse of laxatives.
Dietary modification remains central to improving outcomes. Dietitians play a key role in delivering tailored, evidence-based nutrition plans aligned with established guidelines. However, limited access and workforce pressures can restrict the availability of personalised support.
AI tools, including chatbots and large language models, are increasingly being explored as a way to bridge this gap. While they can provide general dietary guidance, concerns remain about their accuracy, safety, and ability to replicate the individualised care provided by trained professionals.
Study design – comparing AI models with dietitian plans
To better understand the role of AI in adolescent nutrition, researchers conducted a direct comparison between AI-generated diet plans and those created by a dietitian.
Five AI systems were evaluated: ChatGPT-4o, Gemini 2.5 Pro, Claude 4.1, Bing Chat-5GPT, and Perplexity. Across two sessions, these models generated a total of 60 diet plans. Each plan covered three days and was based on four standardised adolescent profiles, including boys and girls living with overweight or obesity.
These AI-generated plans were compared with dietitian-designed one-day plans developed in line with established nutritional recommendations. The reference plans followed a macronutrient distribution of:
- 45–50 % carbohydrates
- 30–35 % fat
- 15–20 % protein
The researchers then analysed energy intake, macronutrient composition, micronutrient content, safety, and feasibility.
Consistent underestimation of energy and macronutrients
The findings revealed a clear and consistent pattern across all AI models. Diet plans generated by AI underestimated both total energy intake and key macronutrients when compared with dietitian-designed plans.
On average:
- Energy intake was lower by 695 kcal
- Protein intake was reduced by 20 g
- Fat intake was reduced by 16 g
- Carbohydrate intake was reduced by 115 g
Given the high energy demands of adolescence, such deficits could have meaningful clinical implications, particularly for growth, development, and overall health.
Macronutrient imbalance – a shift away from guidelines
Beyond total intake, the balance of macronutrients was also significantly altered in AI-generated plans.
Some AI models recommended:
- Protein intake up to 23.7 %
- Fat intake up to 44.5 %
Both values exceeded recommended levels. In contrast, carbohydrate intake accounted for no more than 36.3 %, falling below guideline recommendations.
Dietitian-designed plans, by comparison, remained closely aligned with clinical standards:
- Carbohydrates: 44 %–46 %
- Protein: 18 %–20 %
- Fat: 36 %–37 %
The authors noted:
“This pattern illustrates a systematic shift across all AI models to lower CHO, higher protein, and higher lipid meal structures, indicating that the macronutrient balance, not just the amount of gram-based nutrients, is significantly disrupted in AI-generated plans.”
Researchers suggest that AI models may be influenced by popular dietary trends, such as low-carbohydrate or ketogenic approaches, rather than evidence-based adolescent nutrition guidelines. This shift may pose risks during a critical period of physical and cognitive development.
Micronutrient variability raises additional concerns
In addition to macronutrient discrepancies, the study identified significant variability in micronutrient composition across AI-generated plans.
No model consistently matched the dietitian-designed reference diet across all nutrients. This inconsistency raises concerns about potential micronutrient deficiencies, which could further compromise adolescent health.
The findings suggest that AI tools currently lack the technical precision required to accurately estimate both macro- and micronutrient needs in personalised dietary plans for adolescents.
Strengths and limitations of the study
The study offers several notable strengths. It evaluated multiple AI models, allowing for robust comparison across systems. The use of three-day diet plans enabled identification of consistent patterns rather than isolated outputs. Dietitian-designed plans provided a credible clinical benchmark, and the inclusion of both macro- and micronutrient analysis allowed for a comprehensive assessment of dietary quality.
However, there are limitations to consider. The findings are specific to the models tested, which are rapidly evolving. Standardised adolescent profiles may not fully capture real-world complexity, limiting personalisation. The use of simulated scenarios rather than real-life behaviours may reduce ecological validity. Additionally, prompts were standardised and delivered in a single language, which may limit generalisability across populations.
Implications for clinical practice and AI use
The study highlights important risks associated with the unsupervised use of AI for adolescent dietary planning.
As the authors conclude:
“AI models have exhibited clinically significant deviations in diet plans for adolescents at both macro and micro levels.”
These deviations include consistently lower energy and carbohydrate recommendations compared with dietitian-designed plans.
Until these limitations are addressed, AI-generated diet plans should be used with caution. They may serve as a supplementary tool under professional supervision, but they are not currently a safe or reliable substitute for qualified dietary guidance in adolescents.
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Reducing Parental Stress May Help Lower Childhood Obesity Risk, Yale Study Suggests
Key Takeaways:
- A Yale study suggests that reducing parental stress may play an important role in lowering obesity risk in young children.
- Parents who took part in a mindfulness-based stress management programme showed improvements in parenting behaviours and children’s eating habits.
- Children whose parents received the stress-focused intervention were less likely to gain excess weight during follow-up compared with those receiving standard nutrition advice alone.
Childhood obesity continues to rise
Childhood obesity has been increasing in recent years and remains a major public health concern. According to the U.S. Centers for Disease Control and Prevention, approximately one in five children and adolescents in the United States met the clinical definition of obesity in 2024.
Efforts to prevent obesity in children have traditionally focused on encouraging healthier diets and increasing levels of physical activity. However, new research from Yale University suggests that another factor may also be important in shaping children’s health outcomes – parental stress.
A research team led by psychologist Rajita Sinha has found evidence that helping parents manage stress more effectively may reduce obesity risk among young children. The findings were published in the journal Pediatrics.
“It’s the third leg of the stool,” said Sinha. “We already knew that stress can be a big contributor in the development of childhood obesity. The surprise was that when parents handled stress better, their parenting improved, and their young child’s obesity risk went down.”
How parent stress may influence children’s health
Previous research has shown that children are more likely to develop obesity if their parents are living with obesity. However, scientists have increasingly suspected that psychological and environmental factors within families may also influence early childhood weight gain.
Parental stress has emerged as one such potential contributor.
Studies suggest that parents experiencing high levels of stress may be more likely to rely on convenient or fast-food options and less nutritious dietary patterns. These habits can influence the types of foods available in the home and shape children’s developing eating behaviours.
Stress can also affect broader family routines. When parents feel overwhelmed, regular meal patterns may become disrupted, healthier foods may be replaced with more convenient alternatives, and positive parenting behaviours may decline. Reduced patience, decreased emotional responsiveness, and less consistent family structure may all affect children’s wellbeing.
Despite these insights, most childhood obesity prevention programmes continue to focus primarily on nutrition education and physical activity promotion.
According to Sinha, these approaches alone often fail to produce long-lasting behavioural change.
Sinha is the Foundations Fund Professor in Psychiatry and a professor in neuroscience and child study at Yale School of Medicine.
A randomised trial examining stress reduction
To better understand the potential role of parental stress, the research team conducted a 12-week randomised prevention trial involving 114 parents.
Participants represented diverse ethnic and socioeconomic backgrounds and all had children aged between two and five years old who were living with overweight or obesity.
Parents were randomly assigned to one of two groups:
- Parenting Mindfully for Health (PMH) – a stress-focused intervention programme
- Standard counselling focusing on nutrition and physical activity
The Parenting Mindfully for Health programme combined several elements. Parents were taught mindfulness techniques and behavioural self-regulation strategies designed to help them manage stress more effectively. The programme also included guidance on healthy eating and physical activity for families.
Both groups attended weekly sessions lasting up to two hours over the 12-week study period.
During the programme, researchers measured parental stress levels, parenting behaviours, and children’s weight. Parenting behaviours assessed included warmth, listening, patience, and positive emotional interactions with children.
Researchers also evaluated children’s dietary patterns, including both healthy and unhealthy food consumption.
Children’s weight was measured again three months after the programme ended in order to assess whether any benefits were sustained.
Stress reduction linked to improvements in parenting and eating habits
The results showed clear differences between the two groups.
Parents who participated in the Parenting Mindfully for Health programme experienced significant reductions in stress levels, alongside improvements in parenting behaviours.
Children in these families also showed reductions in unhealthy food intake.
Importantly, during the three-month follow-up period, children in the PMH group did not experience significant weight gain.
In contrast, the comparison group receiving only nutrition and physical activity counselling showed no meaningful improvements in parental stress or parenting behaviours.
Children in this group experienced greater weight gain during the follow-up period and were six times more likely to move into the overweight or obesity risk category.
Researchers also observed differences in the relationships between stress, parenting, and children’s diet.
Among families in the control group, higher parental stress remained associated with weaker parenting behaviours and lower intake of healthy foods among children.
However, this relationship was no longer statistically significant in families who had participated in the stress management intervention.
“The combination of mindfulness with behavioral self-regulation to manage stress, integrated with healthy nutrition and physical activity, seemed to protect the young children from some of the negative effects of stress on weight gain,” Sinha said.
Building on research into stress and chronic disease
The study builds on broader research conducted at the Yale Stress Center, an interdisciplinary consortium established through a 2007 National Institutes of Health Common Fund initiative.
The centre investigates the biological and behavioural effects of stress, including how stress influences health behaviours and contributes to chronic mental and physical illnesses.
Researchers involved in the current study emphasised that childhood obesity remains a pressing health concern.
“Childhood obesity is such a major issue right now, and the results of this study are highly relevant to the current administration’s priority of reducing childhood chronic diseases,” said Sinha. “When people start moving up the weight scale, their risk of obesity-related illnesses, even in children, is increased.”
The findings suggest that addressing parental stress may represent an additional strategy for preventing early childhood obesity.
Longer-term studies are now underway to better understand the sustained effects of the Parenting Mindfully for Health programme. According to Sinha, results from a larger group of families followed for two years are expected in future research.
Research team and funding
The study was co-led by Wendy Silverman, the Alfred A. Professor in the Child Study Center and professor of psychology, and Ania Jastreboff, the Harvey and Kate Cushing Professor of Medicine and professor of pediatrics.
Additional contributors came from several departments at Yale School of Medicine, including pediatrics, neuroscience, and the Yale Child Study Center.
Researchers from the Bethesda Group, the Chicago School of Professional Psychology, the University of New Mexico, and George Mason University also participated in the study.
The research was supported by funding from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
CCH insight:
Childhood obesity is rising and is a major public health concern, so research like this, which improves our understanding of the determinants of childhood obesity, are very valuable. We know that stress causes overeating in many adults, and it is not surprising that it can impact their children too. People experiencing high levels of stress are usually time-poor and will find it very challenging to provide a healthy diet and lifestyle for their young children. The intervention described in the study appears to be effective, but the difficulty will be in scaling it up, at an affordable cost, so it can reach tens or hundreds of thousands of families. Developing an online version would be one way to approach this.
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Almost a Quarter of UK GPs Report Obesity in Children Aged Four and Under
Key Takeaways:
- Nearly one in four UK GPs report seeing children aged four and under where obesity is a clinical concern, with cases identified even in infancy.
- Most GPs find conversations about weight with children and parents difficult, citing fear of distress, stigma and complaints.
- The survey also raises concerns about inappropriate private access to GLP-1 weight loss medicines among adults who do not meet eligibility criteria.
Growing concern among family doctors
Almost a quarter of UK general practitioners report seeing children aged four or under who are living with obesity, according to a new survey of family doctors. The findings point to what respondents described as an “alarming” escalation of childhood obesity presenting at ever younger ages.
The research found that almost half of GPs, 49 per cent, have seen boys and girls up to the age of seven with obesity, including a small number of children younger than one year old. These early presentations raise concerns about long-term health consequences and the pressures faced by primary care clinicians in addressing weight sensitively and effectively.
Survey scope and headline findings
The survey, conducted by MDDUS, asked 540 family doctors about their experiences of managing obesity, the rapid growth in the use of weight loss medications, and the implications of widespread overweight and obesity for the NHS.
Almost one in four respondents, 23 per cent, said they had seen children aged zero to four where obesity was a clinical concern. Across childhood more broadly, 81 per cent of doctors reported seeing obesity in children between the age of 12 months and 11 years.
Dr John Holden, chief medical officer at MDDUS, said:
“These findings are an alarming confirmation of the growing crisis of childhood obesity across the country and the very real difficulties this creates in everyday GP consultations.”
Challenges of discussing weight with families
Despite the scale of the issue, most GPs reported significant difficulty in raising concerns about weight with children and their families. Four in five doctors, 80 per cent, said they find it somewhat or very challenging to talk to the parents of a child under 16 living with obesity about their weight and health. Only 10 per cent said they found such conversations easy.
Nearly two thirds of respondents, 65 per cent, also reported difficulty speaking directly with young people themselves about weight, with just 20 per cent describing those discussions as easy.
Doctors cited multiple reasons for this hesitation. Conversations with parents are often constrained by concerns that parents may become upset, reported by 72 per cent, angry, reported by 47 per cent, or may make a complaint, reported by 24 per cent. A further 74 per cent worried that such discussions could cause shame or stigma. Similar concerns were reported when speaking with children, including fears that conversations about weight could contribute to disordered eating behaviours.
The wider determinants of childhood obesity
Respondents highlighted that obesity is shaped by complex and interrelated factors, including poverty, limited access to nutritious food, and fewer safe or affordable opportunities for children to be physically active. These realities, the survey suggests, shape how GPs approach discussions about weight.
Dr Holden said GPs therefore approach these conversations “with care and empathy for families under pressure”. He added:
“When parents feel judged or blamed, conversations can quickly become emotionally charged and, as our members tell us, can lead to complaints from distressed or angry parents.”
Calls for stronger prevention measures
Katharine Jenner, executive director of the Obesity Health Alliance, said the findings underline a failure to protect children early in life.
She said that the high numbers of GPs seeing infants and very young children with obesity “is another sign we’re letting children down before they even start school. If we’re serious about prevention, it has to begin in the earliest years, otherwise the damage follow them through life.”
Jenner called for a stronger focus on prevention, including reformulation of food and drink products to improve their nutritional quality, tighter restrictions on the marketing of products high in fat, salt and sugar, and better support for families facing structural and financial barriers to healthy eating.
Concerns over private access to weight loss drugs
Alongside childhood obesity, the survey also explored GP experiences of adult patients using weight loss medications inappropriately. Doctors reported that some adults who should not be using GLP-1 weight loss drugs are obtaining them through deception from private pharmacies.
These include people with eating disorders, such as anorexia or bulimia, and people already taking other medications that could interact adversely with so-called “fat jabs” and pose risks to their health.
It is estimated that around 1.5 million people in Britain are using GLP-1 medicines for weight loss, the majority having obtained them privately rather than through the NHS, where eligibility criteria are strict.
One GP told the survey that GLP-1s are being “accessed privately pretty indiscriminately by many people whose body mass index is not in the obese category”. Another described a patient with a history of anorexia nervosa who had also obtained the drugs privately. Overall, 67 per cent of family doctors said they had seen patients using GLP-1s despite not meeting eligibility rules.
These findings raise questions about how rigorously private pharmacies are carrying out appropriate checks, including assessments of medical history and potential drug interactions, before supplying weight loss medications.
Implications for the NHS and future care
The vast majority of GPs surveyed said obesity is likely to be a defining public health challenge during their careers, with 92 per cent agreeing with that statement. An even higher proportion, 95 per cent, believe obesity will significantly affect the NHS’s ability to deliver care.
However, views on weight loss injections were more mixed. While 59 per cent of respondents believe such medications will ultimately save the NHS money, 22 per cent disagreed.
Government response
The Department of Health and Social Care did not comment directly on the survey findings. A spokesperson said:
“Every child deserves the best possible start in life, which is why this government is taking decisive action to tackle childhood obesity.
“We are restricting junk food advertising on television before 9pm and online, a move expected to remove up to 7.2bn calories per year from children’s diets; while giving local authorities new powers to stop fast food shops opening outside schools.
“Through our ten-year health plan, we’re shifting the focus from sickness to prevention to create a healthier nation.”
CCH insight:
This study highlights the considerable challenges that primary care practitioners face in addressing obesity in young children. It is a very sensitive issue, and there may also be cultural attitudes that see overweight children as beautiful or healthy. Unfortunately, healthcare professionals in the UK are not trained to deal with obesity and the unique challenges it presents. It requires a very sensitive approach, communicating with parents in a non-judgemental way, highlighting the role of the obesogenic environment and finding ways to support behaviour change at a family level. On the positive side, if this can be achieved, an entire family can benefit from these interventions, not just the child with excess weight.
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Digital Health Tools Offer Scalable Solutions for Early Childhood Sleep Challenges
Key Takeaways:
- Digital sleep interventions demonstrate meaningful improvements in sleep outcomes for young children, with high levels of parental engagement across diverse formats.
- Parents also benefit, with several studies reporting reduced stress and improved sleep quality alongside improvements in their children’s sleep.
- While early results are promising, gaps remain in long-term evidence, objective sleep measurement and inclusion of families from minority and low-resource communities.
Digital health and early childhood sleep
A new scoping review led by researchers at the University of Miami Miller School of Medicine highlights the growing role of digital tools in helping parents support healthier sleep in early childhood. The review was spearheaded by Azizi Seixas, PhD, and Girardin Jean-Louis, PhD, and describes strong parental engagement, meaningful improvements in sleep outcomes and emerging best practices for future innovation in paediatric sleep health.
Sleep problems in young children, ranging from bedtime resistance and frequent night wakings to obstructive sleep apnoea, are closely linked to multiple aspects of development. Persistent sleep disturbances beyond infancy have been associated with challenges in school readiness, mood regulation and long-term health outcomes. Against this backdrop, the rapid expansion of mobile apps, telehealth services and online learning platforms has positioned digital health as a potentially powerful avenue for supporting families navigating sleep difficulties.
“This study fills an important gap in the pediatric sleep literature by showing how digital tools can capture real-world sleep behaviors at scale,” said Dr Seixas. “From a public health standpoint, these technologies help us identify population-level patterns earlier, especially in communities where sleep problems often go unrecognized. Clinically, they give providers objective, continuous data that can guide more personalized and timely interventions, ultimately improving outcomes for children who need support the most.”
A global review of digital sleep interventions
Dr Seixas, an associate professor of psychiatry and behavioural sciences, director of The Media and Innovation Lab, associate director of the Center for Translational Sleep and Circadian Sciences and interim chair of the Department of Informatics and Health Data Science at the Miller School, and Dr Jean-Louis, professor of psychiatry and behavioural sciences and neurology and director of the Center for Translational Sleep and Circadian Sciences, led an extensive scoping review of the scientific literature.
The research team screened more than 2,100 articles published from database inception through April 2025 across multiple academic sources. Following rigorous screening, 21 studies met the final inclusion criteria.
Collectively, these studies involved thousands of parents, dozens of healthcare professionals and nearly 500 parent-child dyads who participated in digital sleep intervention trials. The breadth of study designs and populations provided a wide-ranging view of how digital approaches are being applied in early childhood sleep support.
Types of digital tools evaluated
The review encompassed a diverse range of digital sleep interventions, including:
- Mobile applications designed to guide bedtime routines and monitor sleep behaviours
- Web-based educational modules for parents
- Telehealth programmes offering remote coaching and behavioural guidance
- Social media-enhanced parent support groups
- Wearable devices and data dashboards used for sleep tracking
- Robotic or kiosk-based sleep education tools
Across all formats, parental engagement emerged as a consistent strength. Most interventions focused on equipping parents with practical strategies to implement at home, often grounded in cognitive-behavioural therapy for insomnia or other evidence-based behavioural approaches.
Improvements in sleep outcomes for children and parents
A majority of the digital interventions reviewed were associated with improvements in at least one clinical sleep outcome for children. In many cases, benefits extended beyond the child to parents and caregivers.
Reported improvements for children included:
- Longer total sleep duration, documented in six studies
- Fewer night wakings
- Shorter sleep onset latency, defined as the time taken to fall asleep
- Improved sleep efficiency
- Reduced early-morning awakenings
- Improved breathing-related symptoms, including snoring detection through mobile tools
Several studies also reported positive effects on parental wellbeing, including reduced stress levels and improvements in parental sleep quality. One mobile application, Dr Lullaby, was associated with a significant reduction in the need for parents to remain in the room while their child fell asleep, suggesting improved sleep independence.
Telehealth and neurodevelopmental conditions
Telehealth interventions were particularly valuable for families of children with autism spectrum disorder. In randomised controlled trials, parents who received remote coaching on behavioural sleep strategies reported significant improvements in their children’s sleep by weeks five and ten of the intervention. These benefits were sustained at 16-week follow-up, indicating potential durability of effect.
Web-based educational programmes also demonstrated value. Online modules such as Mini-KiSS and the SKIP asthma-sleep intervention supported parents in establishing healthier bedtime routines and reducing night-time disruptions. These programmes consistently received high ratings for usability and acceptability among participating families.
The role of social support
The review highlighted the added value of social connection within digital interventions. In one study, an online healthy-lifestyle programme for young children showed no measurable sleep improvements until researchers introduced a closed Facebook group for parents. The addition of peer support facilitated shared problem-solving and encouragement, leading to significant gains in children’s sleep duration.
Gaps and priorities for future research
Despite the encouraging findings, the review identified several important limitations in the current evidence base:
- Approximately half of the studies involved predominantly white families, despite evidence that sleep problems disproportionately affect children from minority backgrounds.
- Most studies focused on short-term outcomes, with limited data on long-term effectiveness.
- Wearable devices were underused as objective measures of sleep.
- Children with chronic health conditions were underrepresented, even though early evidence suggests tailored digital interventions may be particularly effective for these groups.
Implications for clinical care and global paediatric health
Digital sleep health tools are becoming increasingly accessible, engaging and aligned with how families use technology in everyday life. This review suggests that when these tools are thoughtfully designed and grounded in behavioural science, they can meaningfully improve sleep outcomes for young children while also supporting parental wellbeing.
For clinicians, digital interventions may function as scalable extensions of care, offering education, behaviour tracking and reinforcement of healthy nightly routines. For researchers and developers, the next challenge lies in ensuring these tools are inclusive and reach families who may benefit most, particularly those in minority or low-resource communities.
The authors conclude that digital paediatric sleep interventions “show promise to educate parents and improve sleep outcomes in their child, extending benefits to the whole family.” With targeted innovation and equitable implementation, digital sleep solutions could become an integral component of paediatric care worldwide.
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Bottle Feeding Toddlers to Sleep Linked to Tooth Decay and Excess Weight in Early Childhood
Key Takeaways:
- More than three in ten toddlers were still being bottle fed to sleep at two years of age
- Bottle feeding to sleep at age two was linked to almost double the risk of overweight in early childhood
- Continuing the practice at age three was associated with nearly twice as many teeth affected by decay
Parents and carers are being urged to avoid using bottles to help toddlers fall asleep, after new research found clear links between the practice, early childhood tooth decay, and excess weight gain.
The study, published in the Australian and New Zealand Journal of Public Health, was led by researchers at the University of Sydney and drew on data from more than 700 toddlers participating in Western Sydney University’s Healthy Smiles Healthy Kids (HSHK) cohort study. The long running study follows children from birth to examine factors influencing oral health and broader health outcomes.
Study design and data sources
Researchers analysed information collected through surveys completed by mothers, alongside clinical dental examinations and measurements of children’s height and weight. Importantly, the analysis also accounted for a range of other factors known to influence dental health and body weight, allowing the researchers to better isolate the impact of bottle feeding to sleep.
What the researchers found
The findings showed that bottle feeding to sleep remains common well beyond infancy and is associated with measurable health risks:
- More than 30 percent of children were still bottle fed to sleep at two years of age
- Children who were bottle fed to sleep at age two were almost twice as likely to have overweight in early childhood
- Children who were bottle fed to sleep at age three had nearly double the number of teeth affected by dental decay
Why bottle feeding to sleep matters
Lead author Heilok Cheng, a PhD candidate in the Susan Wakil School of Nursing and Midwifery at the University of Sydney, emphasised that most parents and carers are acting with good intentions but may not be fully aware of the longer term risks.
“Australian recommendations advise parents to start introducing cups at 6 months of age and stop using baby bottles at 12 months. Bottle feeding in bed is not recommended at any age. Our research now provides a much more robust evidence base for that advice.”
She explained that many commonly used drinks for toddlers can increase the risk of dental decay.
“Common toddler drinks, including cow’s milk and formula, often contain either natural or added sugars, increasing the risk of tooth decay. When a bottle is offered at bedtime it’s often being used by carers to calm an unsettled child or encourage the child to drift off to sleep. Because the bottle isn’t being offered in response to hunger, it can lead to overfeeding, putting children at risk of unhealthy weight gain.”
Cheng also highlighted the need for better support for families navigating infant and toddler feeding practices.
“We need to do more to support families and help them avoid getting into the habit of putting a child or baby to bed with a bottle, so that our future generations are set up with a healthy future from the start.”
Wider implications for policy and prevention
The authors note that the findings reinforce the importance of coordinated public health action to reduce childhood obesity and improve oral health. They also point to the potential value of universal dental care as part of a broader strategy to prevent avoidable dental disease in early life.
About the Healthy Smiles Healthy Kids study
The Healthy Smiles Healthy Kids (HSHK) cohort study is led by Associate Professor Amit Arora from Western Sydney University, in collaboration with Sydney Local Health District, South Western Sydney Local Health District, the University of Sydney, the University of Queensland, the University of Technology Sydney, and Curtin University.
The study is funded by the Australian National Health and Medical Research Council, NSW Health, the Australian Dental Research Foundation, and the Oral Health Foundation. The full paper, “Bottle feeding to sleep beyond 12 months is associated with higher risk of tooth decay and overweight in Australian children: Findings from the Healthy Smiles Healthy Kids cohort study”, was published in the Australian and New Zealand Journal of Public Health.
CCH insight:
This is an interesting study, which provides very strong evidence for avoiding bedtime bottle-feeding to help infants get to sleep. It would be interesting to know if the excess weight gain resulting from bedtime bottle-feeding is due simply to the extra calories provided by the bedtime milk, or if it also encourages increased emotional eating – it is believed that emotional eating, which is a common cause of overeating in adults, has its behavioural origin in the soothing effect we experience when suckling as a baby, so we come to associate fatty sugary food (like breast or formula milk) with bringing relief from anxiety and stress.
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Maternal Obesity Linked to Early Changes in Infant Gut Microbiome, Study Suggests
Key Takeaways:
- Infants born to mothers with obesity show distinct differences in gut bacteria during the first six months of life, including reduced microbial diversity.
- These early microbial changes are associated with pathways linked to fat metabolism, particularly in the first three months after birth.
- Researchers suggest that early-life interventions targeting the gut microbiome may help reduce longer-term metabolic risks for children.
Maternal obesity and the infant gut microbiome
Babies born to mothers with obesity may begin life with a markedly different gut microbiome, a factor that could influence their metabolism and long-term health, according to new research from Nazarbayev University (NU).
The study, led by researchers Almagul Kushugulova and Samat Kozhakhmetov, explored how maternal obesity may shape the early development of the gut microbiome in infants. The research team followed 24 mothers and their babies from birth to six months of age, analysing stool samples using advanced DNA sequencing techniques.
By comparing infants born to mothers with obesity with those born to mothers without obesity, the researchers identified clear differences in the composition and diversity of gut bacteria during early life.
Reduced microbial diversity and altered metabolic pathways
The analysis showed that infants of mothers with obesity had significantly lower gut microbial diversity. In addition, these infants had a higher abundance of bacterial species associated with fat metabolism.
These differences were most pronounced during the first three months of life, a period widely recognised as critical for the establishment of the gut microbiome and for metabolic programming.
“During the first three months of life, we observed what appears to be a shift in how gut bacteria process nutrients – with a tendency toward fat storage pathways rather than breaking down carbohydrates for energy,” Kozhakhmetov explained.
He noted that this early metabolic pattern may have implications for how energy balance is regulated later in life.
Opportunities for early intervention
The researchers suggest that their findings open the door to preventive strategies during infancy. Kozhakhmetov highlighted that understanding these early microbial shifts could inform interventions aimed at promoting healthier metabolic outcomes.
This discovery, he said, “opens up possibilities for early intervention”, including approaches such as targeted probiotics or tailored dietary guidance designed to support a more balanced gut microbiome and potentially reduce future metabolic risk.
Beyond metabolism – immune and appetite regulation
The implications of the findings may extend beyond metabolism alone. The researchers propose that maternal obesity could also influence immune system development and appetite regulation in children through microbial transmission.
“We tend to think that we only pass on our genes to our children. But our research suggests that we may also pass on our bacteria – and the type of bacteria a child inherits could have important effects on their long-term health, potentially influencing their health trajectory as they grow,” Kushugulova said.
This perspective reinforces the idea that early-life exposures play a significant role in shaping health across the life course.
Placing the findings in context
The study, published in the journal Biomedicines, adds to a growing body of research highlighting the importance of the early-life microbiome. Previous studies have linked maternal weight status and gut dysbiosis to disrupted nutrient metabolism, inflammation, and changes in immune, metabolic, or neurodevelopmental outcomes in children.
As obesity during pregnancy becomes increasingly common worldwide, the authors argue that maternal health should be viewed as a key determinant not only of pregnancy outcomes, but also of a child’s longer-term metabolic health.
Implications for future research and practice
The researchers conclude that interventions targeting the gut microbiota during early infancy may represent a promising avenue for reducing health risks associated with maternal obesity. Further research will be needed to determine which strategies are most effective, when they should be implemented, and how they can be integrated into routine maternal and child healthcare.
Taken together, the findings underline the importance of addressing obesity before and during pregnancy, while also highlighting the potential of microbiome-focused approaches to support healthier outcomes for future generations.
CCH insight:
Evidence for the role of the gut microbiome in obesity and metabolic health continues to grow. This study is ground-breaking in demonstrating that maternal obesity influences the new-born child’s microbiome, potentially priming the child for health challenges later in life right from their first few weeks of life. On the positive side, this offers the potential to identify babies at risk of metabolic diseases from a very early stage of life, and also the opportunity for early interventions though diet, pre- and probiotics.
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