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In This Issue of JAMA Pediatrics
March 2018


JAMA Pediatr. 2018;172(3):205. doi:10.1001/jamapediatrics.2017.3333


Obesity is an evolving epidemic in the United States. Pan and colleagues examine the trend in obesity for children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children over a 14-year period. While the benefits of breastfeeding are well known, methods to increase the prevalence of breastfeeding have not been well studied. In a study of more than 22 million children aged 2 to 4 years, the overall adjusted prevalence of severe obesity increased during 2000 to 2004, decreased slightly during 2004 to 2010, and decreased further during 2010 to 2014; all changes were statistically significant. Finally some good news on this topic!

Prior observational studies in adults have indicated a contagion phenomenon for obesity, meaning that having friends who are overweight increases the likelihood that you will be as well. Datar and Nicosia test this hypothesis using data from 38 military posts. Routine “assignment” of military service members to installations created exogenous variations in exposure to communities who are obese. They found small but significant associations between being assigned to a base with higher community obesity rates and subsequent obesity. The Editorial by Epstein and Wen highlights 3 other areas to consider when interpreting these findings: (1) social distances, (2) shared common environments, and (3) the transmission of obesity between first-degree relatives or within families.


Early intervention advocates have argued that the benefits pay out over a lifetime. Reynolds and colleagues present 30-year follow-up data on almost 1400 children who received early services compared with matched controls at age 4 to 6 years. The intervention was associated with a 48% higher rate of degree completion (an associate’s degree or higher) compared with lesser participation. Preschool participation was independently associated with most attainment outcomes, including years of education, with greater benefits for those whose mothers had dropped out of high school.

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We are still working to improve the quality of asthma care. Halterman and colleagues conducted a randomized clinical trial of a telemedicine-enhanced, school-based asthma management system in 400 children. The intervention resulted in increased symptom-free days and fewer emergency department visits or hospitalizations. This represents a potentially promising new approach for asthma management.