Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

Abstract

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.

Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis

“…Single interventions are not likely to be successful for all patients due to the complexity in behaviour change, highlighting the need for a multimodal and interdisciplinary approach (van Middelkoop et al, 2017). A multimodal approach should implement cognitive-behavioural change strategies to improve eating behaviour, reduce energy intake, increase levels of physical activity, and decrease inactivity (Styne et al, 2017).…”

Risk Factors for Obesity in Adolescents of Ethnic Groups in Rural Areas of the Republic of Buryatia: a Cross-Sectional Study

“…Оценка росто-весовых параметров под-ростков проводилась с использованием референсных значений ВОЗ при помощи калькулятора AnthroPlus. Масса тела считалась избыточной при ИМТ > 85-го про-центиля распределения для данного пола и возраста, ожирение устанавливали при ИМТ у 95-го процентиля [6]. Для роста и ИМТ были определены значения стан-дартного отклонения от средних популяционных значе-ний (standard deviation score, SDS).…”

“…Ожирение является мультифакториальным наруше-нием, развивающимся в результате сложного взаимо-действия генетических и средовых факторов, приво-дящих к формированию дисбаланса между расходом и потреблением энергии [6]. Роль этих факторов варьиру-ет в странах с разным экономическим уровнем развития [1,5], а также в зависимости от типа населенного пункта (город, село) [7][8][9].…”

“…Роль этих факторов варьиру-ет в странах с разным экономическим уровнем развития [1,5], а также в зависимости от типа населенного пункта (город, село) [7][8][9]. Имеют значение также и этнокульту-ральные особенности [1,6]. Важно, что в азиатских попу-ляциях кардиометаболические осложнения ожирения развиваются при меньшем избытке веса, чем в евро-пейских [10].…”

Results of the use of physical therapy for metabolic syndrome according to anthropometric studies

“…It is proved that the formation of MS begins in childhood long before the manifestation of type 2 diabetes mellitus and coronary heart disease and for a long time is almost asymptomatic. In this regard, according to D. M. Styne, S. A. Arslanian, et al, (2017) MS is becoming recognized not only as an important social, but also as a paediatric problem.…”