PEDIATRIC OBESITY: An Overview of Etiology and Treatment
Section snippets
DEFINITION OF PEDIATRIC OBESITY
Standardized definitions of obesity for infants and children have not been developed.72 Overweight is a weight greater than some “standard” weight and does not specify body composition; obesity is an excess of body fat. There are children who may be overweight because of increased muscle and bone (lean body mass). A variety of measurements can be made in children to determine the degree of overweight and the proportion and distribution of body fat. Plotting height and weight on the growth
PREVALENCE
Obesity affects between 20% and 27% of all children and adolescents and 33% of all adults. Data from the Third National Health and Nutrition Examination Survey (NHANES III) have demonstrated an increase in the prevalence of obesity of adults and adolescents.79 In NHANES II, 24% of men and 27% of women were obese. In NHANES III, 31% of men and 34% of women are obese. This trend is similar for adolescents. From 1976 to 1987, the prevalence of obesity in children 6 to 11 years has increased by 54%
CAUSES OF OBESITY
Obesity is a complex disease with genetic, behavioral, and environmental causes.147 Two primary concepts relating to the etiology of body weight regulation require emphasis. Substantial evidence shows that homeostatic mechanisms exist for controlling body fat mass. Secondly, understanding the biologic basis of obesity homeostasis may provide tools for therapy that are safe, effective, and exhibit long-term success, including high patient compliance.
Evidence that body fat mass exhibits
Medical
The medical consequences and comorbidities of childhood obesity are suffered during childhood and adulthood.6, 95, 110, 123, 129 Common childhood and adolescent medical consequences of obesity include increased growth then stunting, increased fat-free mass, early menarche, hyperlipidemia, increased heart rate and cardiac output, hepatic steatosis with elevated transaminases, and abnormal glucose metabolism associated with acanthosis nigricans. Less common childhood consequences include
TREATMENT
Health-care providers may recognize and initiate treatment in less than 20% of obese children.27 In addition, despite the prevalence of pediatric obesity, relatively few treatment programs are available. Most programs available for children are similar to available adult treatment programs; however, the goals of adult and pediatric treatment programs are somewhat different. Both strive to make lifestyle changes. In the past, adult programs promoted attaining ideal body weight. Given the
PREVENTION
Eighty percent of obese adolescents become obese adults. Once obese, adults have extremely limited success in losing weight and maintaining the reduction. It seems that adults' tendency to become obese is determined by genetic, intrauterine, childhood, and adolescent conditions. Critical periods for the development of obesity and its health sequelae have been postulated, including the period of gestation, the period of adiposity rebound (5–6 years), and adolescents. Children and families at
SUMMARY
Pediatric obesity is a chronic and growing problem for which new ideas about the biologic basis of obesity offer hope for effective solutions. Prevalence of pediatric and adult obesity is increasing despite a bewildering array of treatment programs and severe psychosocial and economic costs. The definition of obesity as an increase in fat mass, not just an increase in body weight, has profound influence on the understanding and treatment of obesity. In principle, body weight is determined by a
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Effect of high-intensity interval training in adolescents with asthma: The eXercise for Asthma with Commando Joe's® (X4ACJ) trial
2021, Journal of Sport and Health ScienceMitochondrial – nuclear genetic interaction modulates whole body metabolism, adiposity and gene expression in vivo
2018, EBioMedicineCitation Excerpt :It is a major risk factor for numerous maladies, including diabetes, cancer, and cardiovascular disease [4,5], and although obesity can occur at any age, metabolic and lifestyle changes associated with aging increase obesity risk. While caloric excess and lack of exercise are implicated as the major contributors to the rising incidence of obesity [17,19,20,40], 40–70% of inter-individual variability in body mass index (a common assessment of obesity) is genetic [44]. Multiple single gene mutations within the nuclear genome have been linked to morbid obesity and some features of the metabolic syndrome reviewed in [9], but the frequencies of these mutations are low and cannot account for the rising rates of obesity observed in the developed world.
Assessment of left ventricular mass index could predict metabolic syndrome in obese children
2016, Journal of the Saudi Heart AssociationCitation Excerpt :Obesity is currently regarded as a public health problem that affects both children and adults [1].
Age and sex differences in childhood and adulthood obesity association with phthalates: Analyses of NHANES 2007-2010
2014, International Journal of Hygiene and Environmental HealthCitation Excerpt :Given that more than 80% of obese adolescents become obese adults (Schonfeld-Warden and Warden, 1997) and that the prevalence of obesity in children and adolescents has nearly tripled from NHANES I to NHANES 2007–2008 (http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf), adolescents and children represent a growing focus in this epidemic. Many health effects have been associated with obesity including diabetes, hypertension, and nonalcoholic fatty liver disease (Schonfeld-Warden and Warden, 1997). Thus, this increase in obesity is a major public health concern.
Understanding academic clinicians' varying attitudes toward the treatment of childhood obesity in Canada: A descriptive qualitative approach
2013, Journal of Pediatric SurgeryCitation Excerpt :Non-experienced clinicians were selected from each region based on interest in the study. After exploring the multiple facets of pediatric obesity [5], an interview guide consisting of seven semi-structured questions were developed, piloted, and refined. Once the interview guide was finalized, we contacted potential participants through email and a follow-up telephone call.
Address reprint requests to Nancy Schonfeld-Warden, MD, Department of Pediatrics, University of California, Davis 2516 Stockton Boulevard Sacramento, CA 95817
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From the Department of Pediatrics, University of California, Davis Sacramento, California