Obesity in children
1-introduction:
Obesity is abnormal or excessive fat accumulation
that presents a risk to health. In the last few decades
obesity have become more common in children and
adolescents, which is an alarming bell for the
increasing risk on humanity’s health. It’s a critical
topic for research in order to limit its growing threat.
Obesity rates have increased due to the more
comfortable lifestyles of the modern world and lack
of physical activities. Obesity is highly connected to
cardiovascular, metabolic and even physiological
diseases. However, it can be prevented by Increasing
physical activities and eating more healthy food.
2-) review goals :
1-define obesity and discuss it’s measurement.
2-reasons for increasing rates of obesity in children.
3-health complications from obesity in children.
4-influence of home environment on development of
obesity in children.
4-discuss how to prevent obesity in children.
5-discuss interventions for treating obesity in
children.
3-literature review:
Whether obesity should be declared as a
disease is controversial. recently, the World Obesity
Federation argued that ‘obesity was considered as a
chronic, relapsing, progressive, disease process’ that
requires intervention. By contrast, although the
biological basis of obesity (e.g. so-called obesity
genes, biology of fat cells) and pathological changes
associated with the disease process have been
characterized, obesity was not declared as a disease
because there is no scientifically applicable
definition of a disease. Taking a public health point
of view, many authorities again argued in favour of
obesity as a non-communicable disease resulting
from environmental drivers and host responses.
Finally, considering the benefits and harms arising
from declaring obesity as a disease (i.e. taking an
utilitarian point of view) also gave evidence to
declare obesity as a disease. One of the major
criticisms against defining obesity as a disease is its
definition ad diagnosis. Obesity has been defined as
an ‘abnormal and excessive fat accumulation that
may impair health’. In practice, obesity is diagnosed
by body mass index (BMI), which is taken as a
surrogate of percentage fat mass. However, BMI has
some obvious limitations related to the assessment
of fat mass as well as the diagnosis of overweightand obesity-related disturbances. BMI was
introduced into research and clinical practice on the
basis of the association between BMI and mortality
(which is U- or J-shaped, with minimal mortality
toward the middle of the distribution), with a
‘healthy’ BMI range associated with the lowest
mortality, which is in the range between 18.5 and
25 kg/m2. This range varies, for example, by age,
ethnicity and chronic diseases. Then, BMI values
exceeding 25 kg/m2, i.e. between 25 and 29.9 kg/m2
and above 30 kg/m2, were defined as overweight
and obese, respectively. Obviously, obesity is
defined based on statistical criteria, which may not
have a biological meaning. BMI is a score rather
than objectively measured fat mass (or fat massrelated mechanical and metabolic disturbances).
Neither is it biologically sound nor does it reflect a
suitable phenotype worthwhile to study. In fact,
detailed analyses revealed considerable interindividual variances in the associations between
BMI and either subcutaneous adipose tissue (SAT)
or visceral adipose tissue (VAT) or skeletal muscle
mass or biomarkers of insulin resistance and
inflammation or the adipocyte secretory activity. It is
obvious that BMI can define neither ‘excessive fat
accumulation’ nor functional impairments related to
it. Consequently, Sharma et al. Proposed a redefinition of obesity based on the health status of the
individual. The latter is characterized by clinical
assessment, laboratory and endocrine testing, as well
as detailed body composition analysis. As Sharma et
al. Noted themselves, it still remains to be proven
that even in the case of a detailed assessment
possible health deficits identified have to be related
to excess fat to provide a rationale of specific
obesity treatment strategies.
The mechanism of obesity development is not
fully understood and it is believed to be a disorder
with multiple causes. Environmental factors,
lifestyle preferences, and cultural environment play
pivotal roles in the rising prevalence of obesity
worldwide. In general, overweight and obesity are
assumed to be the results of an increase in caloric
and fat intake. On the other hand, there are
supporting evidence that excessive sugar intake by
soft drink, increased portion size, and steady decline
in physical activity have been playing major roles in
the rising rates of obesity all around the world. It is
widely accepted that increase in obesity results from
an imbalance between energy intake and
expenditure, with an increase in positive energy
balance being closely associated with the lifestyle
adopted and the dietary intake preferences.
However, there is increasing evidence indicating that
an individual’s genetic background is important in
determining obesity risk. Research has made
important contributions to our understanding of the
factors associated with obesity. The ecological
model, as described by Davison et al., suggests that
child risk factors for obesity include dietary intake,
physical activity, and sedentary behaviour.[17] The
impact of such risk factors is moderated by factors
such as age, gender. Family characteristics parenting
style, parents’ lifestyles also play a role.
Environmental factors such as school policies,
demographics, and parents’ work-related demands
further influence eating and activity behaviours.
Genetics are one of the biggest factors examined as a
cause of obesity. Some studies have found that BMI
is 25–40% heritable.[18] However, genetic
susceptibility often needs to be coupled with
contributing environmental and behavioural factors
in order to affect weight.[19] The genetic factor
accounts for less than 5% of cases of childhood
obesity.[18] Therefore, while genetics can play a
role in the development of obesity, it is not the cause
of the dramatic increase in childhood obesity.
Basal metabolic rate has also been studied as a
possible cause of obesity. Basal metabolic rate, or
metabolism, is the body’s expenditure of energy for
normal resting functions. Basal metabolic rate is
accountable for 60% of total energy expenditure in
sedentary adults. It has been hypothesized that obese
individuals have lower basal metabolic rates.
However, differences in basal metabolic rates are not
likely to be responsible for the rising rates of
obesity.
Medical consequences can be broadly
classified into Mechanical or metabolic
complications. The 2 main Mechanical
complications are obstructive sleep apnoea
Syndrome and orthopaedic problems such as genu
varus And valgus deformity of the knees, Blount’s
disease and Slipped capitate femoral epiphysis.
Metabolic consequences of obesity have been
extensively studied in obese adults, And in recent
years the problem is increasingly recognised
In obese children. While the complications may not
become apparent until years later, these metabolic
derangements may be in progress and continue to
stress the body, and may even be evident already in
some obese children. Childhood obesity is
associated with insulin resistance, Which in turn
leads to glucose intolerance (impaired fasting
glucose, impaired glucose tolerance and diabetes
mellitus), Dyslipidaemia and hypertension, and also
implicated in the Pathogenesis of polycystic ovarian
syndrome and non-alcoholic steatohepatitis.
Unfortunately, few successful models exist
for the prevention of childhood and adolescent
obesity: Family practices affect the behaviour
patterns associated with physical activity. Time
spent viewing television has been related to the
prevalence of obesity, and both clinical and schoolbased studies have demonstrated that reductions in
the amount of time spent watching television
reduced weight gain in 9-year-old children and
reduced weight among overweight young
adolescents. Although video and computer use might
be expected to contribute to obesity because they are
sedentary behaviours, no data yet support a causal
relationship. A recent study indicates no relationship
between video and computer use and obesity
prevalence, despite a substantial relationship
between level of broadcast television viewing and
obesity. Family practices related to food
consumption can affect food choice, food
preparation, and food consumption. Choosing to
breast-feed an infant rather than use formula may
prevent subsequent obesity. With respect to food
choice, the qualities of foods brought into the home
can increase caloric intake. For example, such
calorie-dense foods as regular milk, sugar-sweetened
beverages, high-fat foods, and fast foods represent
potential sources of excess caloric intake. Likewise,
consumption of fruits, vegetables, and whole grains
may potentially offset high-calorie intake. In rats and
humans, exposure to a variety of foods results in an
increase in caloric intake and may lead to obesity.
Combined behavioural lifestyle
interventions compared to standard care or self‐help
can produce a significant and clinically meaningful
reduction in overweight in children and adolescents.
In obese adolescents, consideration should be given
to the use of either orlistat or sibutramine, as an
adjunct to lifestyle interventions, although this
approach needs to be carefully weighed up against
the potential for adverse effects.
Treatment approaches used to date are
generally impotent, but some promising short-term
results have been achieved with some forms of
dietary counselling, exercise programs, total
environmental management, and behaviour therapy.
But even with these strategies, clinically significant
weight loss is rare and advances during treatment are
rarely maintained. Radical departures from current
treatment strategies are needed in the form of more
structured and intensive treatments, family
involvement, and training in problem solving. Closer
adherence to sound scientific methodology might at
least provide a foundation from which more
effective treatments might be developed.
Psychological interventions have been
employed in an effort to achieve long-term
maintenance of behavioural change. Childhood
obesity treatments should involve a combination of
lifestyle changes including strategies to reduce
energy intake, increase physical activity, reduce
sedentary activities, facilitate family involvement
and change behaviours associated with eating and
physical activity. However, drug therapy in obese
children must not be used as isolated treatment but
as complementary to the traditional treatments of
diet, physical activity and lifestyle changes. Besides,
surgical procedures have been used to treat severe
morbid obesity in children and adolescents when
more conservative treatments have proven to be
inadequate.
At present, bariatric surgery is the only
therapeutic modality that can produce sustained
weight loss and halt or resolve comorbidities. This
success results from the ability to perform the
operation reliably, usually laparoscopically, with
low mortality. The most commonly performed
operation is Roux-en-Y gastric bypass.Purely
restrictive operations, especially adjustable gastric
banding, have a lower risk but are somewhat less
effective.
4-Conclusion:
Obesity is a dangerous disease that occurs due
the accumulation of fats in the body and is
diagnosed by BMI. It results in several Long-term
impairments in the body and several other diseases
as diabetes mellitus. It can be prevented by
maintaining a healthy diet and proper levels of
physical activity. Obesity can be treated with
acquiring them , as well as medical drugs and
surgeries
5-refrences:
1-Müller J.M. and Geisler C. , (2017): Defining
obesity as a disease. European Journal of Clinical
Nutrition 71 (11): 1256-1258, (Paragraph 1)
2-Sahoo K. et al,. (2015): Childhood obesity:
causes and consequences. J family med prime care
4(2): 187-192, (Paragraph 2)
3-Lee S.Y. , (2009): Consequences of childhood
obesity. Ann Acad Med Singapore 38 (1): 75-80,
(Paragraph 3)
4-Dietz H.W. and Gortmaker L.S. , (2001):
Preventing obesity in children and adolescents.
Annual review of public health 22 (1), 337-353,
(paragraph 4)
5-Luttikhuis O.H. et al., (2009): Cochrane review:
Interventions for treating obesity in children.
Evidence‐Based Child Health: A Cochrane Review
Journal 4 (4), 1571-1729,(paragraph 5)
6-Coates J.T. and Thoresen E.C. , (1978):
Treating obesity in children and adolescents: a
review. American Journal of Public Health 68 (2),
143-151, , (Paragraph 6)
7-Bueno G. , (2013): Interventions for treating
obesity in children. Evidence-Based Research in
Pediatric Nutrition 108, 98-106, (paragraph 7)
8-Crookes F.P. , (2006): Surgical Treatment of
Morbid Obesity. Annual Review of Medicine Vol.
57: 243-264, (paragraph 8)