Clinical aspects of obesity in childhood and adolescence

Abstract

The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most common chronic disorder in industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoesostasis and food intake in relation to child health. Finally, one should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.

<![CDATA[Additional cardiovascular risk factors associated with excess weigth in children and adolescents: the Belo Horizonte heart study]]>

“…In order to compare our results with those of other studies previously conducted, and following the recommendations for epidemiologic inquiry evaluations for the prevalence of excess weight in children and adolescents, and inference of associations and risk of subsequent comorbidities, overweight was considered as a BMI between the 85th and 94th percentiles, and obesity equal to or higher than the 95th percentile according to age and gender 11,12 . In the present study, students were considered with "excess weight" when they were either overweight or obese, that is, anyone with a BMI over the 85th percentile.…”

“…Those considered with a "normal weight" had a BMI between the 5th and 85th percentiles. By defi ning the 85th percentile as the cut-off point for excess weight, overweight -a CVD risk factor 12 -was included in the data, and there was a much higher number of overweight students than obese students in the sample.…”

Female gender and wealth are associated to overweight among adolescents in La Paz, Bolivia

“…Both the short-and long-term adverse effects of overweight and underweight in childhood and adolescence have been well documented (Must et al, 1992;Must, 1996;Freedman and Perry, 2000;Kiess et al, 2001). However, adolescents have been set aside from many Population Health Surveys, as nutritional status is only assessed in children under 5 y and women who have had a child in the previous 3-5 y, justifying a specific call for research in this age group at a global level (de Onis and Blössner, 2000).…”

Breakfast skipping is associated with differences in meal patterns, macronutrient intakes and overweight among pre-school children

“…In Canada, 26 % of 2-17-year-olds were classified as overweight or obese in 2004 (4) . Furthermore, overweight and obesity in childhood has been shown to track into adulthood (5) , having significant impacts on overall psychosocial health (6) and predisposing individuals to many causes of morbidity and mortality including diabetes, CVD and hypertension (7,8) .Although causal mechanisms of childhood obesity remain unclear, it is well established that dietary factors play an important role in regulating an overall energy balance, thereby influencing body weight (9) . Breakfast eating is one aspect of diet proposed to play a role in the maintenance of a healthy body weight.…”