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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 -
Italian Journal of Pediatrics Jul 2020Pediatric obesity is one of the most relevant health issues of the last century. Obesity-related short and long-term consequences are responsible of a large amount of... (Review)
Review
Pediatric obesity is one of the most relevant health issues of the last century. Obesity-related short and long-term consequences are responsible of a large amount of economic cost. In addition, the different therapeutic strategies, such as lifestyle correction, drug, and bariatric surgery have displayed low effectiveness. Considering this evidence, prevention appears to be more promising than treatment in contrasting obesity epidemic. In this review, we summarize obesity pathogenesis with the aim of highlight the main obesity risk factors that can be addressed as target of preventive interventions. Moreover, we report the evidence about effectiveness of different interventions targeting family, school, and community. A multiple-component intervention, addressing different targets and settings, might be desirable, however more studies are needed to confirm long-term efficacy and to direct policy interventions.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Pediatric Obesity
PubMed: 32709246
DOI: 10.1186/s13052-020-00868-7 -
Pediatric Annals Feb 2023In 1997, the World Health Organization declared obesity a global epidemic. Despite multiple efforts, obesity rates have been exponentially increasing for the past few... (Review)
Review
In 1997, the World Health Organization declared obesity a global epidemic. Despite multiple efforts, obesity rates have been exponentially increasing for the past few decades. In the last few years, obesity rates have reached an alarming number. Multiple factors play a role in pediatric obesity, such as diet, sedentarism, and poor sleep, as well as psychosocial and environmental factors. Pediatricians and primary care providers are key in the management of overweight and obesity. They have the advantage of observing children over a long period of time, having a family centered perspective, and often being seen as a reliable source of information. Studies have shown that not only is obesity underdiagnosed, but there is a lack of knowledge among physicians and available resources regarding pediatric obesity. This article reviews the principles of prevention in a primary care outpatient setting. Additionally, it discusses some of the challenges commonly faced when addressing pediatric obesity. .
Topics: Child; Humans; Pediatric Obesity; Primary Health Care; Diet; Physicians
PubMed: 36779884
DOI: 10.3928/19382359-20230102-04 -
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 -
Current Obesity Reports Dec 2023Review latest data regarding the intersection of pediatric obesity epidemic with telemedicine expansion to meet the need of equitable obesity care in children. (Review)
Review
PURPOSE OF REVIEW
Review latest data regarding the intersection of pediatric obesity epidemic with telemedicine expansion to meet the need of equitable obesity care in children.
RECENT FINDINGS
Prevalence of pediatric obesity in the USA continues to worsen particularly in rural, underserved areas. Although there is an increasing number of obesity medicine specialists over the last decade, availability varies by geographic location. Pre-pandemic centers were limited, rarely located in rural areas, and required in-person visits for reimbursement. Telemedicine changes, responding to pandemic needs, provided increase in telemedicine utilization and acceptance with similar or improved obesity care outcomes. Given pediatric obesity prevalence and need for chronic, effective obesity care, leveraging telemedicine to expand reach and decrease access barriers provides a critical and creative remedy. Data cites similar outcomes between telemedicine and in-person care. The time to reimagine a full spectrum of care delivery for pediatric obesity is now.
Topics: Child; Humans; Pediatric Obesity; Telemedicine; Pandemics
PubMed: 37940835
DOI: 10.1007/s13679-023-00537-w -
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 -
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 -
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 -
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 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