Childhood obesity

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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 medical condition that affects children. Overweight and obesity are defined by the World Health Organization (WHO) as abnormal or excessive fat accumulation that may impair health. Childhood Obesity is a Body Mass Index (BMI) at or above the 95th percentile for children of the same gender and age. Childhood and adolescent obesity is an epidemic in the United States.

Historical Perspective

  • The word obesity is a Latin word which was first used in 1611 by Randle Cotgrade.[1]
  • In 450 B.C., it was first recognized as a medical disorder by the ancient Greeks. Hippocrates quoted "Corpulence is not only a disease itself, but the harbinger of others”.[2]
  • In 550 B.C., obesity was linked to heart disease and diabetes by the Indian surgeon Shushruta.[3]

Classification

Pathophysiology

  • The pathogenesis of childhood obesity is characterized by energy imbalance
  • This energy imbalance is the result of excess energy intake and/ or decreased energy expenditure.
  • It has been suggested that a dysfunction in the ghrelin/leptin hormonal pathway may contribute to abnormal appetite control and increased energy intake.

Causes

Childhood obesity may be caused by poor eating habits, lack of physical activity, genetic causes, an underlying medical condition or medications.

Lifestyle and 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. [4] In addition, they are consuming large amounts of sugar-sweetened beverages which has been directly associated with obesity in multiple reviews.[5] [6] Physical inactivity, excess use of screen time and inadequate sleep also contribute to the obesity epidemic.[7]

Environmental factors

Eating habits of the child are also affected by demographics, lunch policies at schools and work demands on parents.[8]

Psychological factors

These factors influence a child's eating habits and 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, it has been suggested that there may be a genetic (inherited) predisposition toward being obese, although this is as yet unproven and research is ongoing.

Medical conditions

There are genetic syndromes and hormonal disorders that may be associated with weight gain and obesity in children including: hypothyroidism, cushing syndrome, growth hormone deficiency, growth hormone resistance, leptin deficiency or resistance to leptin action, polycystic ovary syndrome (PCOS), precocious puberty, prolactin-secreting tumors, turner syndrome, down syndrome, cohen syndrome, prader-Willi syndrome, pseudohypoparthyroidism and laurence-moon-biedl syndrome.[9]

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. [10]

Hypothalamic obesity

Weight gain may occur after acquired hypothalamic lesions following surgery, cranial radiation or diencepahlic tumors. It can also be a result of cranial trauma or inflammation of the hypothalamus. [11]

Complications

Without a change in diet or exercise patterns, childhood obesity can lead to medical conditions including Type 2 diabetes, high blood pressure, high cholesterol, heart disease, asthma, obstructive sleep apnea, fatty liver disease, gall stones, glucose intolerance, insulin resistance and other disorders.[12] [8] Studies have shown that obese children are more likely to grow up to be obese adults.[13] Obese children often suffer from weight stigma, teasing and bullying amongst their peers.[14] They experience descrimination in the society. These children are more likely to suffer from low self esteem, anxiety and depression.[15]

Differentiating 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.[16]
  • In 2015-2016, the prevalence of Childhood Obesity among children aged 2-19 years was estimated to be 13.7 million cases (18.5%) in USA.[17]

Age

  • Children of all age groups may develop Childhood Obesity.
  • Childhood Obesity is more commonly observed among children aged 12 to 19 years old in the USA. This is followed by children aged 6 to 11 years old and then children aged 2 to 5 years of age.

Gender

  • Childhood Obesity prevalence by gender is different depending on the region.
  • Males are more commonly affected than females 5 to 19 years of age in most high and upper middle-income countries.[18]

Race

  • Obesity prevalence was higher among Hispanics and non-Hispanic blacks than non-Hispanic whites and non-Hispanic Asians.[19]

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

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.
  • 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.

Surgery

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

Prevention

See also

References

  1. http://histowiki.com/history/health/2375/the-history-of-obesity-timeline/#:~:text=The%20Greeks%20were%20the%20first%20to%20recognize%20obesity,obesity%20as%20the%20result%20of%20a%20character%20flaw.
  2. http://histowiki.com/history/health/2375/the-history-of-obesity-timeline/#:~:text=The%20Greeks%20were%20the%20first%20to%20recognize%20obesity,obesity%20as%20the%20result%20of%20a%20character%20flaw.
  3. http://histowiki.com/history/health/2375/the-history-of-obesity-timeline/#:~:text=The%20Greeks%20were%20the%20first%20to%20recognize%20obesity,obesity%20as%20the%20result%20of%20a%20character%20flaw.
  4. https://www.cdc.gov/nchs/products/databriefs/db375.htm
  5. 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.
  6. 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.
  7. 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.
  8. 8.0 8.1 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.
  9. https://emedicine.medscape.com/article/985333-overview#a5
  10. https://emedicine.medscape.com/article/985333-overview#a5
  11. https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2816%2930595-X
  12. https://www.cdc.gov/obesity/childhood/causes.html
  13. https://www.cdc.gov/vitalsigns/pdf/2013-08-vitalsigns.pdf
  14. 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.
  15. 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.
  16. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  17. https://www.cdc.gov/obesity/data/childhood.html
  18. https://nutrition.bmj.com/content/bmjnph/early/2020/09/07/bmjnph-2020-000074.full.pdf
  19. https://www.cdc.gov/nchs/data/databriefs/db288.pdf
  20. https://www.cdc.gov/obesity/childhood/causes.html
  21. https://emedicine.medscape.com/article/985333-overview#a5
  22. https://emedicine.medscape.com/article/985333-overview#a5
  23. https://emedicine.medscape.com/article/985333-overview#a5
  24. https://emedicine.medscape.com/article/985333-overview#a5
  25. https://ihcw.aap.org/Documents/Assessment%20%20and%20Management%20of%20Childhood%20Obesity%20Algorithm_FINAL.pdf
  26. https://emedicine.medscape.com/article/985333-overview

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