Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Abstract

espite recent data suggesting that the rate of increase of obesity among children and adolescents has slowed and overall prevalence has possibly begun to plateau, 1,2 a worrisome trend has emerged in the form of severe pediatric obesity. As the fastest-growing subcategory of obesity in children and adolescents, 1,3,4 severe obesity afflicts between 4% and 6% of all youth in the United States 3-7 and has both immediate and long-term health consequences. Recent data further Abstract-Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing.Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behaviorbased treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks. (Circulation. 2013;128:1689-1712.)

Ideal Cardiovascular Health and Adiposity: Implications in Youth

“…Centers for Disease Control and Prevention definitions of sex‐ and age‐based BMI percentiles (2–20 years of age) were used 25. Study BMI categories were defined as the following: normal weight: BMI <85th percentile; overweight/obese: BMI 85th percentile to <1.2 times the 95th percentile, and severely obese: BMI ≥1.2 times the 95th percentile or BMI ≥35 kg/m 2 14. Seated blood pressures were taken using a manual sphygmomanometer, using an appropriately fitted cuff.…”

“…Despite a potential plateau in overall obesity rates, the prevalence of severe obesity in children and adolescents 2 to 19 years of age has increased from 4% in 1999 to 2004,10 to >8% in 2013 to 2014 7. Severe obesity in youth is associated with increased cardiometabolic risk factors,11 vascular dysfunction,12 increased oxidative stress,13 and risk factors for chronic disease 14. Recent evidence suggests that cardiovascular mortality in adulthood was 3.5 times higher (95% confidence interval, 2.9–4.1) for individuals classified as having obesity as adolescents.…”

“…Given that pediatric cohort studies report an absence of ICH in children4, 22 and secular trends show increases in severe obesity prevalence,14 the clinical utility of the ICH metric could be improved with a greater focus on adiposity status. Furthermore, it is unclear whether categorizing biologically continuous risk factors for ICH estimation is the ideal approach 23, 24.…”

Protocol for: The Use of Intra-Gastric Balloons as an Adjunct to a Lifestyle Support Programme to Promote Weight Loss in Severely Obese Adolescents

“…Here in the United Kingdom, UK, obesity rose amongst 2-10 years old to 13% in 2010-2012, with 18.7% of older children aged 11-15year obese and 35% overweight and obese [3]. Consequences of severe obesity at an early age include; orthopaedic complications, type 2 diabetes, increased risk of cardiovascular disease and hypertension [4]. Worryingly, the majority of these medical concerns have traditionally only presented in adults [2,4] and as Reilly and Kelly (2011) reviewed, a large body of evidence now confirms obesity in childhood and adolescence can lead to premature mortality and physical morbidity in later life [2].…”

“…Consequences of severe obesity at an early age include; orthopaedic complications, type 2 diabetes, increased risk of cardiovascular disease and hypertension [4]. Worryingly, the majority of these medical concerns have traditionally only presented in adults [2,4] and as Reilly and Kelly (2011) reviewed, a large body of evidence now confirms obesity in childhood and adolescence can lead to premature mortality and physical morbidity in later life [2]. The psychopathology of obesity in young people is a concern with overweight and obese children experiencing poor quality of life, lower self-esteem [5,6] and an enhanced risk of being socially isolated than their healthy weight counterparts [7].…”