Severe Obesity in Children and Adolescents: Metabolic Effects, Assessment, and Treatment

Abstract

This is a PDF file of an article accepted, but it is not yet the definitive version of record.2 Childhood obesity has been increasing steadily in recent decades, and severe childhood obesity has emerged as a major public health problem both nationally and internationally. A current concern is that lockdown due to the coronavirus disease 2019 (COVID-19) pandemic could exacerbate the spread of childhood obesity and increase the gap in obesity risk. Recent research results indicate the aggravation of obesity after school closures. The consequences of severe childhood obesity are more devastating than those of mild to moderate obesity. Children with severe obesity are at greater risk than others for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Accurately assessing and diagnosing a child with severe obesity is the key to implementing successful therapy. A detailed and accurate patient history and physical examination are important to discriminate monogenic obesity and metabolic syndrome diagnoses from severe obesity without an underlying cause. Psychosocial factors, including eating behaviors, should be assessed to facilitate better weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. However, lifestyle modification should be the priority. Although progress has been made, safe and effective treatment for severe pediatric obesity is still challenging. More efforts and innovations are needed to find a solution for the huge medical and emotional burden that these children and their families carry. Public health organizations also need to make efforts to encourage and normalize healthy eating habits and exercise to prevent severe obesity in childhood.

A Psychosocial And Lifestyle Assessment For Childhood Obesity: A Scoping Literature Review And Focus Groups With Healthcare Professionals

“…The 11 included articles are listed in Table 1. Two articles focused only on child factors (25,26), whereas the others also focused on parent and family factors as part of the assessment (27)(28)(29)(30)(31)(32)(33)(34)(35). Seven articles incorporated the broader healthcare process, including the assessment and the referral and treatment or weight management (26,29,30,(32)(33)(34)(35).…”

“…Although all articles described biomedical factors (e.g. anthropometric methods) as part of the assessment, these factors were not included in the present study (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). In general, the articles devoted greater attention to biomedical factors than to psychosocial factors.…”

“…Ten articles included the assessment of nutrition and physical activity as part of the lifestyle assessment (25)(26)(27)(28)(29)(30)(32)(33)(34)(35). The majority of the lifestyle assessments focused on the current lifestyle behaviour, and one article also focused on the adoption of desired healthy lifestyle behaviours by the entire family (nutrition education and physical activity) in addition to current lifestyle behaviour (25).…”

“…The focus on the psychological and social aspects of nutrition and physical activity varied, and these aspects were not considered in a literature review and a clinical guideline for the examination and treatment of children and adolescents with obesity (26,32). Psychological aspects of nutrition and physical activity were mentioned in six assessments and in relation to readiness to change and the level of con dence in the ability to make changes (self-e cacy) (25, 27,…”

“…Most of the articles did not describe sleep patterns as part of lifestyle factors, but often as part of the biomedical assessment. For example, some assessments included the identi cation of various sleep-related problems, including disordered sleep, obstructive sleep apnoea syndrome and disruptive snoring (25,26,(28)(29)(30)36).…”