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Journal of Clinical Pharmacology Oct 2018Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17%... (Review)
Review
Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of U.S. children and adolescents. Severe obesity (≥120% of the 95th percentile of body mass index (BMI) for age, or a BMI ≥ 35 kg/m ) is the fastest-growing subgroup and now approaches 6% of all U.S. youth. Health consequences (eg, type 2 diabetes, coronary heart disease) are related in a dose-dependent manner to severity of obesity. Because therapeutic interventions are less effective in severe obesity, prevention is a high priority. Treatment plans involving combinations of behavioral therapy, nutrition, and exercise achieve limited success. Only one drug, orlistat, is U.S. Food and Drug Administration approved for long-term obesity management in adolescents 12 years and older. As part of comprehensive medication management, clinicians should consider the propensity for a given drug to aggravate weight gain and to consider alternatives that minimize weight impact. Medication management must take into account developmental changes as well as the pathophysiology of obesity and comorbidities. Despite expanding insight into obesity pathophysiology, there are gaps in its translation to therapeutic application. The historical construct of obesity as simply a fat-storage disorder is fundamentally inaccurate. The approach to adjusting doses based solely on body size and extrapolating from therapeutic knowledge of adult obesity may be based on assumptions that are not fully substantiated. Classes of drugs commonly prescribed for comorbidities associated with obesity should be prioritized for clinical research evaluations aimed at optimizing dosing regimens in pediatric obesity.
Topics: Adolescent; Anti-Obesity Agents; Body Weight; Child; Comorbidity; Hospitalization; Humans; Pediatric Obesity; Prevalence
PubMed: 30248198
DOI: 10.1002/jcph.1092 -
Obesity Reviews : An Official Journal... Feb 2021The increasing prevalence of obesity in youth has contributed to the growing global burden of chronic diseases (e.g. diabetes, cardiovascular diseases and cancers),...
The increasing prevalence of obesity in youth has contributed to the growing global burden of chronic diseases (e.g. diabetes, cardiovascular diseases and cancers), which has been largely accounted for by obesogenic behaviours and environments. Previous studies have focused on the influences on obesity of multidimensional environmental indicators, which have mixed effects, for example, built environmental factors, food environmental factors and neighbourhood safety. After a thorough search of all databases, I found a limited body of reviews on the associations of basic environmental factors. A basic environmental factor, from a perspective of geographic information systems, is an indicator constructed by only one-step spatial function, without ambiguous effects on obesity. In contrast to basic obesogenic environmental factors, an example of mixed environmental factor is neighbourhood safety, which is a complex measure of night light, crime rate, traffic volume, speed limit, smoothness of roads and many other factors of injury. Without a sufficient, up-to-date understanding of the roles of basic obesogenic environmental factors in obesity, the uncertainties will propagate and lead to more uncertainties in the association between indicators and obesity.
Topics: Adolescent; Child; Chronic Disease; Geographic Information Systems; Humans; Pediatric Obesity; Prevalence; Residence Characteristics
PubMed: 33258179
DOI: 10.1111/obr.13158 -
Pharmacological Research Feb 2023Asthma affects more than 300 million people of all ages worldwide, including about 10-15% of school-aged children, and its prevalence is increasing. Severe asthma (SA)... (Review)
Review
Asthma affects more than 300 million people of all ages worldwide, including about 10-15% of school-aged children, and its prevalence is increasing. Severe asthma (SA) is a particular and rare phenotype requiring treatment with high-dose inhaled corticosteroids plus a second controller and/or systemic glucocorticoid courses to achieve symptom control or remaining "uncontrolled" despite this therapy. In SA, other diagnoses have been excluded, and potential exacerbating factors have been addressed. Notably, obese asthmatics are at higher risk of developing SA. Obesity is both a major risk factor and a disease modifier of asthma in children and adults: two main "obese asthma" phenotypes have been described in childhood with high or low levels of Type 2 inflammation biomarkers, respectively, the former characterized by early onset and eosinophilic inflammation and the latter by neutrophilic inflammation and late-onset. Nevertheless, the interplay between obesity and asthma is far more complex and includes obese tissue-driven inflammatory pathways, mechanical factors, comorbidities, and poor response to corticosteroids. This review outlines the most recent findings on SA in obese children, particularly focusing on inflammatory pathways, which are becoming of pivotal importance in order to identify selective targets for specific treatments, such as biological agents.
Topics: Humans; Pediatric Obesity; Asthma; Comorbidity; Adrenal Cortex Hormones; Inflammation
PubMed: 36642111
DOI: 10.1016/j.phrs.2023.106658 -
Current Opinion in Pediatrics Oct 2019We aim to describe current concepts on childhood and adolescent obesity with a strong focus on its sequela. Childhood obesity is a national epidemic with increasing... (Review)
Review
PURPOSE OF REVIEW
We aim to describe current concepts on childhood and adolescent obesity with a strong focus on its sequela. Childhood obesity is a national epidemic with increasing prevalence over the past three decades placing children at increased risk for many serious comorbidities, previously felt to be only adult-specific diseases, making this topic both timely and relevant for general pediatricians as well as for subspecialists.
RECENT FINDINGS
Childhood obesity develops through an interplay of genetics, environment, and behavior. Treatment includes lifestyle modification, and now metabolic and bariatric surgery is more commonly considered in carefully selected adolescents. The off-label use of adjunct medications for weight loss in childhood and adolescent obesity is still in its infancy, but will likely become the next logical step in those with lifestyle modification refractory obesity. Obesity can lead to several comorbidities, which can persist into adulthood potentially shortening the child's lifespan.
SUMMARY
Efforts should be focused primarily on reducing childhood and adolescent obesity, and when indicated treating its sequela in effort to reduce future morbidity and mortality in this precious population. VIDEO ABSTRACT: http://links.lww.com/MOP/A36.
Topics: Adolescent; Child; Comorbidity; Humans; Pediatric Obesity
PubMed: 31145127
DOI: 10.1097/MOP.0000000000000786 -
Pediatric Obesity Aug 2021The prevalence of childhood obesity has risen sharply over the last several decades and poses a significant threat to the health and well-being of today's youth.... (Review)
Review
The prevalence of childhood obesity has risen sharply over the last several decades and poses a significant threat to the health and well-being of today's youth. Childhood-onset obesity is associated with a number of cardiometabolic consequences, which contribute to diminished quality of life. Metabolic and bariatric surgery offers a powerful treatment paradigm with positive long-term health effects. A growing body of literature supports the notion that earlier intervention in younger patients results in long-term health benefits. The development of a multidisciplinary care model and best practice guidelines are central to providing optimal care for this vulnerable patient population. Although the outcomes of metabolic and bariatric surgery in pediatric patients are reassuring and support the ongoing utilization of this important treatment paradigm, a number of significant challenges remain regarding access to care. As the literature continues to support earlier intervention for youth with severe obesity, future efforts should address these challenges to ensure that eligible patients are referred in timely fashion.
Topics: Adolescent; Bariatric Surgery; Child; Humans; Pediatric Obesity
PubMed: 34041862
DOI: 10.1111/ijpo.12794 -
Pediatric Clinics of North America Aug 2020Telehealth is well positioned to address the common challenges of providing high-quality care to children and adolescents with obesity. The potential benefits of... (Review)
Review
Telehealth is well positioned to address the common challenges of providing high-quality care to children and adolescents with obesity. The potential benefits of telehealth for pediatric obesity are applicable across the full spectrum of care from diagnosis and assessment to ongoing management. This article reviews the emerging field of telehealth for the treatment of pediatric obesity. The challenges of the current approach to pediatric obesity care are explored, and the potential benefits of incorporating and implementing telehealth in this field are presented. The care of pediatric patients with obesity is particularly well suited for telehealth.
Topics: Adolescent; Child; Humans; Mobile Applications; Observational Studies as Topic; Pediatric Obesity; Quality of Health Care; Randomized Controlled Trials as Topic; Rural Population; Telemedicine; Text Messaging
PubMed: 32650862
DOI: 10.1016/j.pcl.2020.04.007 -
Archives of Endocrinology and Metabolism Oct 2021Obesity is a complex and multifactorial disease that is influenced by physiological, environmental, socioeconomic, and genetic factors. In recent decades, this serious... (Review)
Review
Obesity is a complex and multifactorial disease that is influenced by physiological, environmental, socioeconomic, and genetic factors. In recent decades, this serious disease has impacted a large number of adolescents as a result of lifestyle factors. A lack of exercise and the consumption of excessive calories from an inadequate diet are the main contributors to adolescent obesity. However, genetic and hormonal factors might also play a role. The short- and long-term consequences of this disease include chronic issues such as type 2 diabetes and cardiovascular disorders and an increase in early mortality rates. Although it is a serious disease, obesity in adolescents can be controlled with diet and exercise. When these lifestyle changes do not obtain the expected results, we can intensify the treatment by adding medication to the practice of diet and exercise. Additionally, for more severe cases, bariatric surgery can be an option. The purpose of this review is to clarify the current epidemiology, risks, and comorbidities and discuss news about the main treatments and the necessary improvements in this context.
Topics: Adolescent; Diabetes Mellitus, Type 2; Diet; Exercise; Humans; Life Style; Pediatric Obesity
PubMed: 34591402
DOI: 10.20945/2359-3997000000393 -
West African Journal of Medicine Feb 2022
Topics: Adolescent; Child; Humans; Pediatric Obesity
PubMed: 35271229
DOI: No ID Found -
Hospital Pediatrics Dec 2022Despite obesity's effect on pediatric patient health, the role of hospitalizations in recognizing and diagnosing pediatric obesity is poorly explored.
BACKGROUND AND OBJECTIVES
Despite obesity's effect on pediatric patient health, the role of hospitalizations in recognizing and diagnosing pediatric obesity is poorly explored.
METHODS
We performed a retrospective cohort study of pediatric inpatients aged 2 to 18 years utilizing CERNER Health Facts database to determine the: (1) prevalence of obesity in a large, multicenter inpatient database, (2) appropriate International Classification of Diseases, 10th Revision, obesity diagnosis proportion, and (3) variables associated with appropriate obesity diagnosis. Covariates included patient demographics and hospital descriptors, which were summarized using frequencies, and differences across groups were compared using χ Square testing.
RESULTS
Of the hospitalized children with obesity (19.5%), only 13.2% had an appropriate obesity diagnosis. Appropriate obesity diagnosis increased with higher obesity class and was least common in the South census region at only 8.5%.
CONCLUSIONS
Despite pediatric hospitalizations being a potential area for recognition and intervention of obesity, the majority of hospitalized children do not receive an appropriate obesity diagnosis.
Topics: Child; Humans; United States; Inpatients; Retrospective Studies; Hospitalization; Pediatric Obesity; Child, Hospitalized
PubMed: 36325803
DOI: 10.1542/hpeds.2022-006723 -
The Lancet. Diabetes & Endocrinology Nov 2016
Review
Topics: Child; Humans; Meals; Parent-Child Relations; Patient Education as Topic; Pediatric Obesity; Risk Reduction Behavior
PubMed: 26928651
DOI: 10.1016/S2213-8587(15)00517-3