Childhood obesity: Difference between revisions

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*The prevalence of children who are overweight or obese worldwide is approximately 38 million in children under the age of 5 in 2019 and more than 340 million between 5 and 19 years old in 2016.<ref>https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight</ref>
*The prevalence of children who are overweight or obese worldwide is approximately 38 million in children under the age of 5 in 2019 and more than 340 million between 5 and 19 years old in 2016.<ref>https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight</ref>


*In 2015-2016, the prevalence of [[Childhood Obesity]] in USA was estimated to be 13.9% among children aged 2 to 5 years, 18.4% among children aged 6 to 11 and 20.6% among adolescents aged 12 to 19 years. <ref>https://www.cdc.gov/nchs/products/databriefs/db288.htm#:~:text=The%20prevalence%20of%20obesity%20was%2039.8%%20among%20adults,20%E2%80%9339%20overall%20and%20in%20both%20men%20and%20women<ref>.
*In 2015-2016, the prevalence of [[Childhood Obesity]] in USA was estimated to be 13.9% among children aged 2 to 5 years, 18.4% among children aged 6 to 11 and 20.6% among adolescents aged 12 to 19 years.<ref>https://www.cdc.gov/nchs/products/databriefs/db288.htm#:~:text=The%20prevalence%20of%20obesity%20was%2039.8%%20among%20adults,20%E2%80%9339%20overall%20and%20in%20both%20men%20and%20women<ref>.


===Age===
===Age===

Revision as of 18:58, 1 February 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iman Djarraya, BMedSci, MBChB, MPH[2]

Synonyms and keywords: obesity in kids, obesity in children, childhood obesity, pediatric obesity


Overview

Childhood obesity is a Body Mass Index (BMI) at or above the 95th percentile for children of the same gender and age. It is a serious health problem that can result in health complications. Childhood obesity can be caused by lifestyle factors, underlying medical conditions, genetic causes or certain medications. It is important to differentiate obesity due to lifestyle factors from obesity due to medications or an underlying medical condition. Obesity in general may present with high blood pressure, insulin resistance, excess facial hair or irregular menstruation. The presence of polyuria and polydipsia suggests possible diabetes, excess facial hair, insulin resistance and irregular menstruation in adolescent girls may be due to polycystic ovary syndrome (PCOS) and dry skin, constipation and intolerance to cold suggest hypothyroidism. laboratory tests indicated depend on the clinical presentation. Management of obesity includes the treatment of any underlying medical conditions and lifestyle modification.

Historical Perspective

Classification

Pathophysiology

Causes

Childhood obesity may be caused by unhealthy dietary intake[8], unhealthy lifestyle [9], environmental factors[10], psychological factors[11], endocrine causes [12], genetic causes [12], medication-induced [12] or cerebral injury. [12]

Dietary intake

Children and adolescents are consuming low nutrient high-calorie foods and beverages at home, school and other places. They are consuming more fast food which is low in nutrients and high in calories, fat and sodium. CDC reports that children and adolescents in the U.S. consumed an average of 13.8% of their daily calories from fast food during 2015-2018.[13] In addition, they are consuming large amounts of sugar-sweetened beverages which has been directly associated with obesity in multiple reviews.[14] [15]

Lifestyle factors

Physical inactivity, excess use of screen time and inadequate sleep also contribute to the obesity epidemic.[9] [16] Eating habits of the child are also affected by demographics, lunch policies at schools and work demands on parents.[17]

Psychological factors

Many children eat in response to stress and or negative emotions such as boredom, anger, sadness, anxiety or depression.

Genetic factors

Often, a child whose parents are overweight or obese will also be overweight or obese. Although this is often caused by shared unhealthy eating habits in the household, several genetic causes have been identified as a cause of obesity.[7] These can be divides into monogenic causes, syndromic obesity and polygenic obesity. [7] Monogenic obesity is caused of a mutation to a single gene including Leptin (LEP) mutations, Leptin Receptor (LEPR) mutations, Pro-opio melanocortin (POMC) mutations, MC4R deficiency, Proconvertase (PC1/2) deficiency, SIM1 deficiency, NTRK2/BDNF mutations and SH2B1 mutations. [7] Syndromic obesity include Prader Willi Syndrome (PWS), Cohen syndrome [7], Turner syndrome [18], down syndrome, and Laurence moon biedl syndrome.[19]

Medical conditions

There are hormonal disorders that may be associated with weight gain and obesity in children including: hypothyroidism, cushing's syndrome, growth hormone deficiency, growth hormone resistance, leptin deficiency or resistance to leptin action, polycystic ovary syndrome (PCOS), precocious puberty, prolactin-secreting tumors, and pseudohypoparthyroidism.[20]

Medications

Medications that may cause weight gain in children include cortisol and other glucocorticoids, tricyclic antidepressants, sulfonylureas, monoamine oxidase inhibitors, risperidone, clozapine, oral contraceptives, insulin (in excessive doses) and thiazolidinediones. [21]

Cerebral injury

Obesity can occur after acquired hypothalamic lesions following surgery, meningitis or ischemic injury. [12]

Differentiating childhood obesity due to lifestyle factors from other Diseases

Epidemiology and demographics

  • The prevalence of children who are overweight or obese worldwide is approximately 38 million in children under the age of 5 in 2019 and more than 340 million between 5 and 19 years old in 2016.[22]
  • In 2015-2016, the prevalence of Childhood Obesity in USA was estimated to be 13.9% among children aged 2 to 5 years, 18.4% among children aged 6 to 11 and 20.6% among adolescents aged 12 to 19 years.

Race

  • Obesity prevalence was higher among Hispanics and non-Hispanic blacks than non-Hispanic whites and non-Hispanic Asians.[23]

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

  • The diagnosis of childhood obesity is made when the calculated Body Mass Index (BMI) is at or above the 95th percentile on the BMI-for-age growth chart.[27]

History and Symptoms

Physical Examination

  • Physical examination may be remarkable for:

Laboratory Findings

Treatment

Medical therapy

  • Management of obesity in children focuses on reducing BMI of the child safely, preventing and managing complications.[34]
  • The mainstay of therapy for obesity in children is diet and exercise.
  • Setmelanotide, a melanocortin-4-receptor agonist was approved by the U.S. Food and Drug Administration (FDA) for children age 6 and older with obesity caused by rare genetic disorders.[35]

Surgery

  • Bariatric surgery are performed in some adolescents with severe obesity.[36]

Prevention

See also

References

  1. ↑ https://pmj.bmj.com/content/75/879/7.full
  2. ↑ https://pmj.bmj.com/content/75/879/7.full
  3. ↑ Bauer KW, Marcus MD, Larson N, Neumark-Sztainer D (2017). "Socioenvironmental, Personal, and Behavioral Correlates of Severe Obesity among an Ethnically/Racially Diverse Sample of US Adolescents". Child Obes. 13 (6): 470–478. doi:10.1089/chi.2017.0067. PMC 5724580. PMID 28650206.
  4. ↑ https://www.who.int/dietphysicalactivity/childhood_why/en/
  5. ↑ https://www.who.int/dietphysicalactivity/childhood_why/en/
  6. ↑ Klok MD, Jakobsdottir S, Drent ML (2007). "The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review". Obes Rev. 8 (1): 21–34. doi:10.1111/j.1467-789X.2006.00270.x. PMID 17212793.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Thaker VV (2017). "GENETIC AND EPIGENETIC CAUSES OF OBESITY". Adolesc Med State Art Rev. 28 (2): 379–405. PMC 6226269. PMID 30416642.
  8. ↑ https://www.nhs.uk/conditions/obesity/causes/
  9. ↑ 9.0 9.1 {{cite journal| author=Ren H, Zhou Z, Liu WK, Wang X, Yin Z| title=Excessive homework, inadequate sleep, physical inactivity and screen viewing time are major contributors to high paediatric obesity.<ref name="pmid27759894">Ren H, Zhou Z, Liu WK, Wang X, Yin Z (January 2017). "Excessive homework, inadequate sleep, physical inactivity and screen viewing time are major contributors to high paediatric obesity". Acta Paediatr. 106 (1): 120–127. doi:10.1111/apa.13640. PMC 6680318 Check |pmc= value (help). PMID 27759894.
  10. ↑ https://www.cdc.gov/obesity/childhood/causes.html#:~:text=Childhood%20Obesity%20Causes%20&%20Consequences%201%20Behavior.%20Behaviors,Community%20Environment.%20...%203%20Consequences%20of%20Obesity.
  11. ↑ https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2816%2930595-X
  12. ↑ 12.0 12.1 12.2 12.3 12.4 Kleinendorst L, Abawi O, van der Voorn B, Jongejan MHTM, Brandsma AE, Visser JA; et al. (2020). "Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center". PLoS One. 15 (5): e0232990. doi:10.1371/journal.pone.0232990. PMC 7209105 Check |pmc= value (help). PMID 32384097 Check |pmid= value (help).
  13. ↑ https://www.cdc.gov/nchs/products/databriefs/db375.htm
  14. ↑ Keller A, Bucher Della Torre S (2015). "Sugar-Sweetened Beverages and Obesity among Children and Adolescents: A Review of Systematic Literature Reviews". Child Obes. 11 (4): 338–46. doi:10.1089/chi.2014.0117. PMC 4529053. PMID 26258560.
  15. ↑ Hu FB, Malik VS (2010). "Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence". Physiol Behav. 100 (1): 47–54. doi:10.1016/j.physbeh.2010.01.036. PMC 2862460. PMID 20138901.
  16. ↑ Morrissey B, Allender S, Strugnell C (2019). "Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children". Int J Environ Res Public Health. 16 (10). doi:10.3390/ijerph16101778. PMID 31137502.
  17. ↑ Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS (2015). "Childhood obesity: causes and consequences". J Family Med Prim Care. 4 (2): 187–92. doi:10.4103/2249-4863.154628. PMC 4408699. PMID 25949965.
  18. ↑ Lebenthal Y, Levy S, Sofrin-Drucker E, Nagelberg N, Weintrob N, Shalitin S; et al. (2018). "The Natural History of Metabolic Comorbidities in Turner Syndrome from Childhood to Early Adulthood: Comparison between 45,X Monosomy and Other Karyotypes". Front Endocrinol (Lausanne). 9: 27. doi:10.3389/fendo.2018.00027. PMC 5811462. PMID 29479339.
  19. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  20. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  21. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  22. ↑ https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  23. ↑ https://www.cdc.gov/nchs/data/databriefs/db288.pdf
  24. ↑ https://www.cdc.gov/obesity/childhood/causes.html
  25. ↑ Kang NR, Kwack YS (2020). "An Update on Mental Health Problems and Cognitive Behavioral Therapy in Pediatric Obesity". Pediatr Gastroenterol Hepatol Nutr. 23 (1): 15–25. doi:10.5223/pghn.2020.23.1.15. PMID 31988872.
  26. ↑ Di Cesare M, Sorić M, Bovet P, Miranda JJ, Bhutta Z, Stevens GA; et al. (2019). "The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action". BMC Med. 17 (1): 212. doi:10.1186/s12916-019-1449-8. PMID 31760948.
  27. ↑ https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833
  28. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  29. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  30. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  31. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  32. ↑ https://ihcw.aap.org/Documents/Assessment%20%20and%20Management%20of%20Childhood%20Obesity%20Algorithm_FINAL.pdf
  33. ↑ https://emedicine.medscape.com/article/985333-overview
  34. ↑ https://emedicine.medscape.com/article/985333-treatment
  35. ↑ https://imcivree.com/?gclid=874d3996a7691ffd325a599b11d9fcac&gclsrc=3p.ds&msclkid=874d3996a7691ffd325a599b11d9fcac
  36. ↑ https://www.mayoclinic.org/medical-professionals/endocrinology/news/bariatric-surgery-in-adolescents/mac-20429497
  37. ↑ Rito AI, Buoncristiano M, Spinelli A, Salanave B, Kunešová M, Hejgaard T; et al. (2019). "Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative - COSI 2015/2017". Obes Facts. 12 (2): 226–243. doi:10.1159/000500425. PMC 6547266 Check |pmc= value (help). PMID 31030194.

External links


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