No abstract

The prevalence of morbid obesity in adolescents is rising at an alarming rate. Comorbidities known to predispose to cardiovascular disease are increasingly being diagnosed in these children. Bariatric surgery has become an acceptable treatment alternative for morbidly obese adults, and criteria have been developed to establish center-of-excellence designation for adult bariatric surgery programs. Evidence suggests that bariatric surgical procedures are being performed with increasing numbers in adolescents. We have examined and compiled the current expert recommendations for guidelines and criteria that are needed to deliver safe and effective bariatric surgical care to adolescents.

Early-onset severe obesity in childhood presents a significant clinical challenge signaling an urgent need for effective and sustainable interventions. A large body of literature examines overweight and obesity, but little focuses specifically on the risk factors for severe obesity in children ages 5 and younger. This narrative review identified modifiable risk factors associated with severe obesity in children ages 5 and younger: nutrition (consuming sugar sweetened beverages and fast food), activity (low frequency of outdoor play and excessive screen time), behaviors (lower satiety responsiveness, sleeping with a bottle, lack of bedtime rules, and short sleep duration), and socio-environmental risk factors (informal child care setting, history of obesity in the mother, and gestational diabetes). The lack of literature on this topic highlights the need for additional research on potentially modifiable risk factors for early-onset severe obesity.

Obese children and adolescents have unique needs for specialized medical equipment while hospitalized and might require special diets and physical activity options as part of their medical treatment. It is important that patients with a diagnosis of obesity be identified on admission so that appropriate equipment and resources can be provided. We examined what components a healthy hospital environment should include and sought to determine if children's hospitals provide a healthy hospital environment that offers these components. In addition, we sought to determine if children's hospitals have policies in place to identify children with obesity so that appropriate resources and services can be offered to treat that diagnosis. We surveyed National Association of Children's Hospitals and Related Institutions member hospitals via a Web-based questionnaire and found that the majority of them do not have policies in place to identify patients with obesity. We did find that the majority of hospitals reported innovative programs or services to provide a healthy hospital environment for their patients, visitors, and staff but acknowledged limitations in providing some services. Specifically, children's hospitals can and should improve on their identification and management of obese pediatric patients.

ourteen million US children are affected by obesity, including 4.4 million with severe obesity. 1,2 Excess weight can put children and adolescents at risk for serious and costly short-and long-term adverse health outcomes, including, but not limited to, cardiovascular disease, type 2 diabetes mellitus, and nonalcoholic fatty liver disease. 3,4 Disparities in prevalence of obesity exist among different populations of children and adolescents. From 2015 to 2018, non-Hispanic black children and Mexican American youth 6-11 years of age had a higher prevalence of obesity (22.7% and 28.2%, respectively) than non-Hispanic white children (15.5%). 5 These disparities are often related to contextual differences and social determinants of health, including poverty and socioeconomic status, parental education, early adverse childhood events, and access to healthier food options and safe and affordable physical activity opportunities. [6][7][8][9] Childhood obesity is a multifactorial condition that requires multifaceted systemic approaches to address (1) the root causes of unhealthy weight and related chronic conditions, (2) barriers to access to healthy nutrition, active living, and effective treatment, and (3) disparate prevention and treatment efforts. Major advances in effective treatment of pediatric obesity have occurred over the past decade. 10 Many research trials show that pediatric weight management interventions (PWMIs), with a minimum of 26 hours of comprehensive family-based intervention delivered for a period of 2-12 months, are effective in improving health outcomes, including body mass index.