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The Lancet. Diabetes & Endocrinology May 2022This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches.... (Review)
Review
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.
Topics: Adolescent; Adult; COVID-19; Child; Diet; Exercise; Humans; Pandemics; Pediatric Obesity
PubMed: 35248172
DOI: 10.1016/S2213-8587(22)00047-X -
Annual Review of Clinical Psychology May 2020Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature... (Review)
Review
Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.
Topics: Adolescent; Child; Comorbidity; Depression; Humans; Hypertension; Non-alcoholic Fatty Liver Disease; Pediatric Obesity
PubMed: 32097572
DOI: 10.1146/annurev-clinpsy-100219-060201 -
The Journal of Clinical Endocrinology... Mar 2017The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society.
COSPONSORING ASSOCIATIONS
The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society.
OBJECTIVE
To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity.
PARTICIPANTS
The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer.
EVIDENCE
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
CONSENSUS PROCESS
One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline.
CONCLUSION
Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.
Topics: Adolescent; Anti-Obesity Agents; Bariatric Surgery; Child; Comorbidity; Diet Therapy; Diet, Healthy; Endocrinology; Evidence-Based Medicine; Exercise; Exercise Therapy; Humans; Pediatric Obesity; Societies, Medical
PubMed: 28359099
DOI: 10.1210/jc.2016-2573 -
Nature Reviews. Disease Primers May 2023The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income... (Review)
Review
The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.
Topics: Child; Adolescent; Humans; Pediatric Obesity; Quality of Life; Diabetes Mellitus, Type 2; Diet; Comorbidity
PubMed: 37202378
DOI: 10.1038/s41572-023-00435-4 -
Nutrients Nov 2021Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on... (Review)
Review
Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on physical and psychosocial health. We present the evidence that eating disorders and obesity can be managed or prevented using the same interventions in the pediatric age. In the presence of obesity in the pediatric age, disordered eating behaviors are highly prevalent, increasing the risk of developing eating disorders. The most frequently observed in subjects with obesity are bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors. Various are the mechanisms overlying the interaction including environmental and individual ones, and different are the approaches to reduce the consequences. Evidence-based treatments for obesity and eating disorders in childhood include as first line approaches weight loss with nutritional management and lifestyle modification via behavioral psychotherapy, as well as treatment of psychiatric comorbidities if those are not a consequence of the eating disorder. Drugs and bariatric surgery need to be used in extreme cases. Future research is necessary for early detection of risk factors for prevention, more precise elucidation of the mechanisms that underpin these problems and, finally, in the cases requiring therapeutic intervention, to provide tailored and timely treatment. Collective efforts between the fields are crucial for reducing the factors of health disparity and improving public health.
Topics: Adolescent; Behavior Therapy; Child; Feeding Behavior; Feeding and Eating Disorders; Female; Humans; Male; Nutrition Therapy; Pediatric Obesity; Weight Reduction Programs
PubMed: 34959873
DOI: 10.3390/nu13124321 -
Primary Care Sep 2021Childhood obesity is a pathologic process with multifactorial causes. The reasons range widely. Obesity leads to chronic health conditions, increasing morbidity. The... (Review)
Review
Childhood obesity is a pathologic process with multifactorial causes. The reasons range widely. Obesity leads to chronic health conditions, increasing morbidity. The management of obesity must include the patient, family, school, community, and even government for policy changes. Lifestyle changes are the mainstay of treatment, including a healthy diet and increased physical activity. Medications and bariatric surgery may have a role in certain severe cases. Community and policy changes concerning food and physical activities may facilitate practical strategies against the increasing obesity epidemic. It will help families and health care systems tackle childhood obesity effectively.
Topics: Bariatric Surgery; Child; Chronic Disease; Exercise; Humans; Life Style; Pediatric Obesity
PubMed: 34311854
DOI: 10.1016/j.pop.2021.04.002 -
Journal of Clinical Research in... Sep 2014Obesity among children, adolescents and adults has emerged as one of the most serious public health concerns in the 21st century. The worldwide prevalence of childhood... (Review)
Review
Obesity among children, adolescents and adults has emerged as one of the most serious public health concerns in the 21st century. The worldwide prevalence of childhood obesity has increased remarkably over the past 3 decades. The growing prevalence of childhood obesity has also led to appearance of obesity-related comorbid disease entities at an early age. Childhood obesity can adversely affect nearly every organ system and often causes serious consequences, including hypertension, dyslipidemia, insulin resistance, dysglycemia, fatty liver disease and psychosocial complications. It is also a major contributor to increasing healthcare expenditures. For all these reasons, it is important to prevent childhood obesity as well as to identify overweight and obese children at an early stage so they can begin treatment and attain and maintain a healthy weight. At present, pharmacotherapy options for treatment of pediatric obesity are very limited. Therefore, establishing a comprehensive management program that emphasizes appropriate nutrition, exercise and behavioral modification is crucial. The physician's role should expand beyond the clinical setting to the community to serve as a role model and to advocate for prevention and early treatment of obesity.
Topics: Adolescent; Adolescent Behavior; Age Distribution; Age Factors; Animals; Child; Child Behavior; Child, Preschool; Comorbidity; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Life Style; Male; Pediatric Obesity; Prevalence; Preventive Health Services; Prognosis; Risk Factors; Risk Reduction Behavior
PubMed: 25241606
DOI: 10.4274/Jcrpe.1471 -
Current Obesity Reports Dec 2018This review summarizes our current understanding of factors associated with childhood obesity, including latest prevalence rates, effectiveness of intervention... (Review)
Review
PURPOSE OF REVIEW
This review summarizes our current understanding of factors associated with childhood obesity, including latest prevalence rates, effectiveness of intervention strategies, and risk for concomitant disease later in life.
RECENT FINDINGS
Obesity has reached global dimensions, and prevalence of childhood obesity has increased eightfold since 1975. Interventions for obesity prevention have mainly focused on behavioral settings to date, i.e., interventions that have focused on behavioral changes of the individuum such as increasing daily physical exercise or optimizing diet. However, effects have been very limited worldwide and could not stop the increase of obesity prevalence so fare. Thus, community-based/environment-oriented measures are urgently needed, such as promotion of healthy food choices by taxing unhealthy foods, mandatory standards for meals in kindergarten and schools, increase of daily physical activity at kindergartens, and schools as well as ban on unhealthy food advertisement for children. Restructuring obesity interventions towards community-based/environment-oriented measures to counteract an obesogenic environment is mandatory for sustainable success and to stop the obesity epidemy. There is need to move fast, as already moderate overweight before the start of puberty is associated with significantly increased risk for type 2 diabetes and cardiovascular disease in midlife.
Topics: Adolescent; Cardiovascular Diseases; Child; Child, Preschool; Diabetes Mellitus, Type 2; Female; Humans; Male; Pediatric Obesity; Prevalence; Risk Factors
PubMed: 30315490
DOI: 10.1007/s13679-018-0320-0 -
Nutrients Sep 2021Several dietary interventions have been conducted to prevent/reduce childhood obesity, but most of them are known to have failed in tackling the obesity epidemic. This... (Meta-Analysis)
Meta-Analysis Review
Several dietary interventions have been conducted to prevent/reduce childhood obesity, but most of them are known to have failed in tackling the obesity epidemic. This study aimed to review the existing literature on dietary interventions for the prevention of childhood obesity and their effectiveness. A literature search was conducted using PubMed Central. Only articles published between 2009 and 2021, written in English, conducted in humans, and including children and/or adolescents (<18 years old) were considered. The majority of studies were school-based interventions, with some addressing the whole community, and including some interventions in the food sector (e.g., taxation of high fat/sugar foods, front-of-pack labelling) and through mass media (e.g., restrictions on food advertising for children) that directly or indirectly could help to manage childhood obesity. Most of the programs/interventions conducted focus mainly on person-based educational approaches, such as nutrition/diet education sessions, allied to the promotion of physical activity and lifestyles to students, parents, and school staff, and less on environmental changes to offer healthier food choices. Only a few trials have focused on capacity building and macro-policy changes, such as the adaptation of the built environment of the school, serving smaller portion sizes, and increasing the availability and accessibility of healthy foods and water in schools, and restricting the access to vending machines, for example. Overall, most of the intervention studies showed no consistent effects on changing the body mass index of children; they have only reported small weight reductions, clinically irrelevant, or no effects at all. Little is known about the sustainability of interventions over time.
Topics: Adolescent; Child; Child, Preschool; Diet; Diet, Healthy; Early Intervention, Educational; Exercise; Female; Health Behavior; Humans; Infant; Male; Mass Media; Pediatric Obesity; Residence Characteristics; Schools
PubMed: 34684448
DOI: 10.3390/nu13103447 -
Jornal de Pediatria 2022To describe the participation of the environment in the childhood obesity epidemic, since childhood obesity currently represents a great challenge, with high prevalence... (Review)
Review
OBJECTIVE
To describe the participation of the environment in the childhood obesity epidemic, since childhood obesity currently represents a great challenge, with high prevalence worldwide, including in Brazil.
DATA SOURCE
Survey of articles published in the last 10 years in PubMed, evaluating the interface between the environment and childhood obesity.
DATA SYNTHESIS
Recent studies show that the environment is very important in the etiopathogenesis of obesity and its comorbidities. Therefore, factors such as air pollution, exposure to chemical substances that interfere with the metabolism, excessive consumption of ultra-processed foods, changes in the intestinal microbiota, and sedentary lifestyle are associated with increased obesity, insulin resistance, type 2 diabetes, and changes in lipid metabolism. These factors have a greater impact on some stages of life, such as the first thousand days, as they affect the expression of genes that control the adipogenesis, energy expenditure, and the mechanisms for hunger/satiety control.
CONCLUSIONS
Environmental aspects must be taken into account in the prevention and treatment of childhood obesity, both from the individual and the population point of view, with adequate and comprehensive public health policies.
Topics: Child; Diabetes Mellitus, Type 2; Energy Metabolism; Fast Foods; Humans; Pediatric Obesity; Sedentary Behavior
PubMed: 34780713
DOI: 10.1016/j.jped.2021.10.002