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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 -
Frontiers in Endocrinology 2020Excess adiposity in childhood may affect bone development, ultimately leading to bone frailty. Previous reports showing an increased rate of extremity fractures in... (Review)
Review
Excess adiposity in childhood may affect bone development, ultimately leading to bone frailty. Previous reports showing an increased rate of extremity fractures in children with obesity support this fear. On the other hand, there is also evidence suggesting that bone mineral content is higher in obese children than in normal weight peers. Both adipocytes and osteoblasts derive from multipotent mesenchymal stem cells (MSCs) and obesity drives the differentiation of MSCs toward adipocytes at the expense of osteoblast differentiation. Furthermore, adipocytes in bone marrow microenvironment release a number of pro-inflammatory and immunomodulatory molecules that up-regulate formation and activation of osteoclasts, thus favoring bone frailty. On the other hand, body adiposity represents a mechanical load, which is beneficial for bone accrual. In this frame, bone quality, and structure result from the balance of inflammatory and mechanical stimuli. Diet, physical activity and the hormonal milieu at puberty play a pivotal role on this balance. In this review, we will address the question whether the bone of obese children and adolescents is unhealthy in comparison with normal-weight peers and discuss mechanisms underlying the differences in bone quality and structure. We anticipate that many biases and confounders affect the clinical studies conducted so far and preclude us from achieving robust conclusions. Sample-size, lack of adequate controls, heterogeneity of study designs are the major drawbacks of the existing reports. Due to the increased body size of children with obesity, dual energy absorptiometry might overestimate bone mineral density in these individuals. Magnetic resonance imaging, peripheral quantitative CT (pQCT) scanning and high-resolution pQCT are promising techniques for the accurate estimate of bone mineral content in obese children. Moreover, no longitudinal study on the risk of incident osteoporosis in early adulthood of children and adolescents with obesity is available. Finally, we will address emerging dietary issues (i.e., the likely benefits for the bone health of polyunsaturated fatty acids and polyphenols) since an healthy diet (i.e., the Mediterranean diet) with balanced intake of certain nutrients associated with physical activity remain the cornerstones for achieving an adequate bone accrual in young individuals regardless of their adiposity degree.
Topics: Adolescent; Bone Density; Bone Development; Bone and Bones; Child; Exercise; Humans; Osteoporosis; Pediatric Obesity; Puberty
PubMed: 32390939
DOI: 10.3389/fendo.2020.00200 -
The Lancet. Global Health Mar 2023The increasing prevalence of childhood obesity has contributed to the growing global burden of chronic diseases over the life course, which has been largely attributed... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The increasing prevalence of childhood obesity has contributed to the growing global burden of chronic diseases over the life course, which has been largely attributed to obesogenic environments. This giant-scale review was done to translate existing obesogenic environmental studies into evidence-based governance for fighting childhood obesity and promoting life-course health.
METHODS
Following a standard strategy of literature search and inclusion, all obesogenic environmental studies, published since the inception of the electronic databases, were reviewed to identify the evidence on associations with childhood obesity of 16 obesogenic environmental factors, including 10 built environmental factors or indices (ie, land-use mix, street connectivity, residential density, speed limit, urban sprawl, and access to green space, public transport, bike lanes, sidewalks, and neighbourhood aesthetics) and six food environmental factors (ie, access to convenience stores, supermarkets, grocery stores, full-service restaurants, fast-food restaurants, and fruit and vegetable markets). A meta-analysis was conducted to quantify the influence of each factor with sufficient studies on childhood obesity.
FINDINGS
A total of 24 155 search results were found and filtered, with 457 studies included in the analysis. All built environmental factors, except speed limit and urban sprawl, were negatively associated with childhood obesity by encouraging physical activity while discouraging sedentary behaviours; the access to all food venues, except convenience stores and fast-food restaurants, was negatively associated with childhood obesity by encouraging their healthy eating behaviours. There were some globally consistent associations, such as between greater access to fast-food restaurants in the neighbourhood and more fast-food consumption, between better access to bike lanes and more physical activity, between better access to sidewalks and reduced sedentary behaviours, and between greater access to green space and more physical activity and less TV or computer screen time.
INTERPRETATION
Findings have formed the unprecedentedly inclusive evidence for policy making and the establishment of the future research agenda regarding the obesogenic environment.
FUNDING
National Natural Science Foundation of China, Chengdu Technological Innovation R&D Project, Sichuan Provincial Key R&D Program, and Wuhan University Specific Fund for Major School-level Internationalization Initiatives.
Topics: Child; Humans; Pediatric Obesity; China; Databases, Factual; Exercise; Fast Foods
PubMed: 36866484
DOI: 10.1016/S2214-109X(23)00092-X -
International Journal of Environmental... Dec 2022Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in... (Review)
Review
Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.
Topics: Adolescent; Humans; Child; Adult; Pediatric Obesity; Exercise; Body Weight; Posture; Comorbidity
PubMed: 36554608
DOI: 10.3390/ijerph192416728 -
Obesity Reviews : An Official Journal... Feb 2021Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours... (Meta-Analysis)
Meta-Analysis
Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours while encouraging the exposure to unhealthful food venues and hence the compensatory intake of unhealthy food option. A literature search was conducted in the PubMed, Web of Science, and Embase for articles published until 1 January 2019 that analysed the association between access to FFRs and weight-related behaviours and outcomes among children aged younger than 18. Sixteen cohort studies and 71 cross-sectional studies conducted in 14 countries were identified. While higher FFR access was not associated with weight-related behaviours (eg, dietary quality score and frequency of food consumption) in most studies, it was commonly associated with more fast-food consumption. Despite that, insignificant results were observed for all meta-analyses conducted by different measures of FFR access in the neighbourhood and weight-related outcomes, although 17 of 39 studies reported positive associations when using overweight/obesity as the outcome. This systematic review and meta-analysis revealed a rather mixed relationship between FFR access and weight-related behaviours/outcomes among children and adolescents.
Topics: Adolescent; Child; Cross-Sectional Studies; Fast Foods; Humans; Overweight; Pediatric Obesity; Restaurants
PubMed: 31507064
DOI: 10.1111/obr.12944 -
Current Obesity Reports Jun 2016This paper describes the epidemiologic evidence linking parent-child relationships, self-regulation, and weight status with a focus on early childhood. The emotional... (Review)
Review
This paper describes the epidemiologic evidence linking parent-child relationships, self-regulation, and weight status with a focus on early childhood. The emotional quality of parent-child interactions may influence children's risk for obesity through multiple pathways. Prospective studies linking observer ratings of young children's self-regulation, particularly inhibitory control, to future weight status are discussed. Although findings are preliminary, promoting positive relationships between parents/caregivers and young children holds promise as a component of efforts to prevent childhood obesity. Multi-disciplinary collaborations between researchers with training in developmental science and child health should be encouraged.
Topics: Child, Preschool; Energy Intake; Feeding Behavior; Food Preferences; Humans; Inhibition, Psychological; Parent-Child Relations; Parenting; Pediatric Obesity; Prospective Studies; Social Environment
PubMed: 27037572
DOI: 10.1007/s13679-016-0208-9 -
JAMA Pediatrics Jun 2020Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least 4-fold over the last 35 years. Most... (Review)
Review
IMPORTANCE
Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least 4-fold over the last 35 years. Most youths with obesity carry their excess adiposity into adulthood, which places them at increased risk for developing obesity-driven complications, such as type 2 diabetes and cardiovascular disease, and negatively affects social and emotional health. Given that adolescence is a unique transition period marked by significant physiologic and developmental changes, obesity-related complications can also negatively affect adolescent growth and developmental trajectories.
OBSERVATIONS
Provision of evidence-based treatment options that are tailored and appropriate for the adolescent population is paramount, yet complex. The multifactorial etiology of obesity along with the significant changes that occur during the adolescent period increasingly complicate the treatment approach for adolescent obesity. Treatment practices discussed in this review include an overview of evidence supporting currently available behavioral, pharmacologic, surgical, and device interventions for obesity. However, it is important to note that these practices have not been effective at reducing adolescent obesity at the population level.
CONCLUSIONS AND RELEVANCE
Because adolescent obesity requires lifelong treatment, effectively addressing this disease will require significant resources, scientific rigor, and the provision of access to quality care similar to other chronic health conditions. Effective and less invasive therapies, effective adjuncts, and comprehensive centers that offer specialized treatment are critical. This considerable need for increased attention to obesity care calls for dedicated resources in both education and research for treatment of obesity in youths.
Topics: Adolescent; Forecasting; Humans; Pediatric Obesity; Prevalence; Risk Factors
PubMed: 32202626
DOI: 10.1001/jamapediatrics.2020.0085 -
Pediatrics Jan 2019: media-1vid110.1542/5849572910001PEDS-VA_2018-0994 OBJECTIVES: Physical activity (PA) is presumed to decline during childhood and adolescence, but only few long-term... (Randomized Controlled Trial)
Randomized Controlled Trial
UNLABELLED
: media-1vid110.1542/5849572910001PEDS-VA_2018-0994 OBJECTIVES: Physical activity (PA) is presumed to decline during childhood and adolescence, but only few long-term studies about PA development during this period of life exist. We assessed PA and sedentary behavior (SB) over a 5-year period to gain a better understanding of the extent of change in activity and potential influencing factors.
METHODS
PA and SB of 600 children from the Childhood Obesity Project were objectively measured with the SenseWear Armband 2 at the ages of 6, 8, and 11 years, resulting in 1254 observations. Longitudinal changes of total PA, moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and SB were modeled with mixed-effects models.
RESULTS
Total PA revealed a significant quadratic decline with age ( < .001), resulting in a change of total PA by -75.3 minutes per day from 6 to 11 years. LPA linearly declined ( < .001) by 44.6 minutes per day, MVPA quadratically declined ( < .001) by an overall 30.7 minutes, whereas SB increased significantly (+107 minutes; = .001). Boys showed a steeper decline in LPA ( = .003) and MVPA ( < .001) than did girls. Higher fat mass index and BMI scores were associated with lower levels of total PA and MVPA and higher levels of SB (all < .001).
CONCLUSIONS
We showed that PA decreased, and SB increased in earlier years than previously thought. MVPA remained relatively stable until 8 years, but revealed a drop-off at 11 years, identifying this period as a crucial time for intervention.
Topics: Accelerometry; Age Factors; Body Mass Index; Child; Double-Blind Method; Exercise; Female; Humans; Longitudinal Studies; Male; Pediatric Obesity; Sedentary Behavior
PubMed: 30509928
DOI: 10.1542/peds.2018-0994 -
The Journal of Pediatrics Oct 2019To determine the magnitude of risk of factors that contribute to the emergence of childhood obesity among low-income minority children. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine the magnitude of risk of factors that contribute to the emergence of childhood obesity among low-income minority children.
STUDY DESIGN
We conducted a prospective cohort analysis of parent-child pairs with children aged 3-5 years who were nonobese (n = 605 pairs) who participated in a 3-year randomized controlled trial of a healthy lifestyle behavioral intervention. After baseline, height and weight were measured 5 times over 3 years to calculate body mass index (BMI) percentiles and classify children as normal, overweight, or obese. Multivariable logistic regression was used to estimate the odds of obesity after 36 months. Predictors included age, sex, birth weight, gestational age, months of breastfeeding, ethnicity, baseline child BMI, energy intake, physical activity, food security, parent baseline BMI, and parental depression.
RESULTS
Among this predominantly low-income minority population, 66% (398/605) of children were normal weight at baseline and 34% (n = 207/605) were overweight. Among normal weight children at baseline, 24% (85/359) were obese after 36 months; among overweight children at baseline, 55% (n = 103/186) were obese after 36 months. Age at enrollment (OR 2.11, 95% CI 1.64-2.72), child baseline BMI (OR 3.37, 95% CI 2.51-4.54), and parent baseline BMI (OR for a 6-unit change 1.36, 95% CI 1.09-1.70) were significantly associated with the odds of becoming obese for children.
CONCLUSIONS
The combination of child age, parent BMI, and child overweight as predictors of child obesity suggest a paradigm of family-centered obesity prevention beginning in early childhood, emphasizing the relevance of child overweight as a phenotype highly predictive of child obesity.
TRIAL REGISTRATION
Clinicaltrials.gov: NCT01316653.
Topics: Age Factors; Body Mass Index; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Minority Groups; Pediatric Obesity; Poverty; Prospective Studies; Risk Factors; Vulnerable Populations
PubMed: 31353040
DOI: 10.1016/j.jpeds.2019.06.031 -
Indian Pediatrics Dec 2023The last guidelines for pediatric obesity were released in 2004 by Indian Academy of Pediatrics (IAP). Since then, there has been an alarming increase in prevalence and... (Review)
Review
JUSTIFICATION
The last guidelines for pediatric obesity were released in 2004 by Indian Academy of Pediatrics (IAP). Since then, there has been an alarming increase in prevalence and a significant shift in our understanding in the pathogenesis, risk factors, evaluation, and management of pediatric obesity and its complications. Thus, it was decided to revise and update the previous recommendations.
OBJECTIVES
To review the existing literature on the burden of childhood obesity and its underlying etiology and risk factors. To recommend evaluation of childhood obesity and suggest optimum prevention and management strategies of childhood obesity.
PROCESS
The following IAP chapters (Pediatric and Adolescent Endocrinology, Infant and Young Child feeding, Nutrition, Non-Communicable Disease and Adolescent Health Academy) were invited to nominate members to become part of the writing committee. The Committee held discussions on various aspects of childhood obesity through online meetings between February and August, 2023. Recommendations were then formulated, which were analyzed, revised and approved by all members of the Committee.
RECOMMENDATIONS
Exogenous or primary obesity accounts for the majority of cases of childhood obesity. It is important to differentiate it from endogenous or secondary obesity as evaluation and management changes depending on the cause. In Indian, in children under 5 years of age, weight for length/height using WHO charts, and in children 5-18 years, BMI using IAP 2015 charts is used to diagnose overweight and obesity. Waist circumference should be routinely measured in all overweight and obese children and plotted on India specific charts, as it is a key measure of cardio-metabolic risk. Routine evaluation for endocrine causes is not recommended, except in short and obese children with additional diagnostic clues. All obese children more than ten years old should be evaluated for comorbidities like hypertension, dyslipidemia, hyperglycemia and non-alcoholic fatty liver disease/metabolic dysfunction associated steatotic liver disease (NAFLD/ MASLD). Prevention and management of childhood obesity mainly involves healthy diet practices, daily moderate to vigorous physical activity and reduced screen time. Pharmacotherapy may be offered as an addition to lifestyle interventions only in cases of class 3 obesity or if there are any life-threatening comorbidities. Finally, surgical management may be offered in children older than 12 years of age with class 2 obesity and associated comorbidities or class 3 obesity with/without comorbidities, only after failure of a proper trial of intense lifestyle modifications and pharmacotherapy for at least 6 months.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Comorbidity; Nutritional Status; Overweight; Pediatric Obesity; Risk Factors
PubMed: 38087786
DOI: No ID Found