Elsevier

Obesity Medicine

Volume 3, September 2016, Pages 1-9
Obesity Medicine

Review
Current status on obesity in childhood and adolescence: Prevalence, etiology, co-morbidities and management

https://doi.org/10.1016/j.obmed.2016.05.005Get rights and content

Highlights

  • •

    Obesity and comorbidities are among the leading public health problems worldwide.

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    The rising prevalence of obesity in low and middle income countries are alarming.

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    Complex interactions of the genetic, social physical environment is of importance.

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    There are several windows of opportunity to intervene in preventing obesity.

Abstract

Obesity and its associated co-morbidities increased throughout the world in the last 50 years, mainly due to increased amount of consumption of calorie-dense food and sedentary lifestyle. It is essential to combat with obesity at all available means and levels, including medical, societal and international measures. Childhood obesity persists into adulthood depending on the presence of parental obesity and severity of obesity. There are several windows of opportunity for interventions starting from pre-conception, to in-utero nutritional environment, from early infancy to adolescence to prevent obesity. In this paper, epidemiology, etiopathogenesis, co-morbidities, prevention and treatment of obesity in children will be reviewed.

Section snippets

General scope and epidemiology (Fig. 1)

Obesity is simply defined as excess amount of body fat and associated with number of health risks including Type-2 diabetes and cardiovascular problems. Obesity-related co-morbidities are among the leading public health problems worldwide since prevalence of obesity in adults as well as in children has been in rise in many countries over the last decades. In clinical practice, body mass index [(BMI) = weight (kilograms)/height (meters) squared], is the most commonly used surrogate measure of

Etiopathogenesis

Obesity occurs as a result of complex interplay between genetic and environmental factors. Children with specific ethnic background such as American Indian, black, Mexican American and South Asians are more prone to develop obesity (Gurnani et al., 2015). Even in the same ethnic population, tendency to develop obesity varies among the families. Discerning genetic contribution to obesity is highly difficult since families share not only genetic material but also environments and nutritional

Risk factors for common (exogeneous) obesity (Fig. 2)

Environmental exposures during the fetal and early postnatal life could render the child to develop obesity by causing fetal metabolic programming via alteration of gene expression through epigenetic modifications. Mother's prepregnancy weight and weight gain during pregnancy is directly related to child's birthweight and/or weight during childhood (Lau et al., 2014). Small for gestational age or large for gestational age babies are more likely to develop obesity (Han et al., 2010). Studies

Complications, co-morbidities of childhood obesity (Fig. 3, Table 1)

As the prevalence of obesity increases, complications and comorbidities related to obesity also increases. These life-long risks will affect both life expectancy and life quality of the population besides putting a huge economic burden on the finances of the world which are already limited especially in developing countries. These complications affect all systems in the body. In a study on 774 obese children, Maggio et al. reported that orthopedic problems are the most frequently seen medical

Prevention and societal issues

Noncommunicable diseases (NCD) constitute one of the major challenges in the twenty-first century and have major social and economic impacts worldwide, particularly on developing countries. In the declaration of United Nation General Assembly in 2011, a concern on rising levels of obesity in different regions, particularly among children and youth was noted. It was also stated that obesity, an unhealthy diet and physical inactivity have strong linkages with the four main non-communicable

Treatment

Treatment of childhood obesity is mainly based on nonpharmacologic interventions. These include modification of diet, energy expenditure and use of behavioral strategies such as goal setting, reward systems, self-monitoring, stimulus control and contracting to enhance and provide maintenance of these changes.

Dietary intervention, supervised by a dietician if possible, is essential for weight management. A primary focus on health improvement rather than weight loss would be beneficial.

Conclusion

Obesity brings an enormous amount of problems in regard to personal and social life. Dealing with these complicated problems requires a huge medical, social and financial support. It is obvious that trying to prevent obesity would be more logical and cost-effective than to treat its complications. Unfortunately, no single intervention can halt the rising tide of obesity in childhood. The prevention requires a whole-of-government, inter-governmental actions in which policies regarding all the

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