Pediatric Obesity: It’s Time to Act!

Di Sessa A and Marzuillo P*

Department of Woman, Seconda Università degli Studi di Napoli, Italy

*Corresponding author: Marzuillo P, Department of Woman, Seconda Università degli Studi di Napoli, Child and General and Specialized Surgery, Via L. De Crecchio 2, 80138, Naples, Italy

Received: March 24, 2016; Accepted: March 28, 2016; Published: March 28, 2016

Introduction

According to the World Health Organization, childhood obesity is one of the most serious public health challenges of the 21st century [1] and this translates into an increased childhood risk for numerous physiological [2] and subsequently long term medical complications [3-6] such as hypertension, dyslipidemia, type 2 diabetes, sleep apnea and musculoskeletal impairments- as well as psychosocial conditions (e.g.; stigmatization) [2-9]. Obese children and adolescents are also at greater risk for becoming obese adults [10], who in turn are at an increased risk for developing serious lifelong comorbidities (cardiovascular, metabolic disease and cancer) [3-6,11].

The “weight” of the problem

Globally, the prevalence of overweight and obesity increased by 28% in adults and 47% in children between 1980 and 2013 [12]. Current estimates suggest that there are nearly 2,1 billion people in the world who are either overweight or obese [12]. In the United States, approximately one third of children and adolescents are overweight or obese [12,13].

Mechanisms behind the obesity

Several factors [14,15] can contribute to the increased prevalence of childhood obesity. A combination of excessive calorie consumption, sugar-sweetened beverage [16], coupled with a lack of physical activity, excess screen time, as well as the excess use of electronic games creates an energy imbalance, which then leads to weight gain [17]. However, multiple other factors play a significant role in excess weight gain [18], such as genetic predisposition, socioeconomic factors and other various conditions (Table 1).

Table 1: Causes of obesity.




  
    Primary 
    Secondary 
  
  
    Environmental    factors (e.g.; caloric intake, sugar-sweetened beverages, physical inactivity    )
    Genetic    factors (e.g; monogenic obesity, syndromic obesity, predisposing    polymorphisms)
  
  
    Socioeconomic    factors ( e.g.; sedentary behaviors)
    Endocrine    diseases ( e.g.; Cushing syndrome, hypothyroidism)
  
  
    
    Medications    (e.g.; glucocorticoids, antidiabetics, antipsychotics, antidepressants
  
  
    
    Psychological    factors



Table 1:  Causes of obesity.

The consequences of obesity

Obesity is an independent risk factor for excess morbidity and mortality [19] and it represent the fifth leading cause of death [12]. Although exact numbers are difficult to define, in 2000, 15% of deaths in the United States were attributable to excess weight [19]. Obesity contributes to an estimated 111,909 to 365,000 deaths in the US and at least 2.8 million deaths worldwide each year [20,21]. For both women and men, obesity as an adult is associated with a significant reduction in life expectancy. In addition to the increased risk of overall mortality [22], overweight and obesity are associated with an increased risk for multiple morbidities [23] (Table 2). In fact, the risk of developing a chronic disease (hypertension, stroke, heart disease, gallstones and colon cancer) increases with increasing BMI [24,25]. One of the strongest associations is with diabetes mellitus: more than 80% of type 2 diabetes mellitus, in fact, is attributable to overweight and obesity [26]. Overweight individuals have a 3-fold higher risk and obese individuals have a 7-fold higher risk of developing type 2 diabetes compared with normal-weight peoples [27]. Obesity also increased the risk of certain cancers [28] in both men (renal, colon, thyroid, and esophageal cancers) and women (renal, gallbladder, and esophageal cancer) [29].

Table 2: Obesity related morbidities.




  
    System
    Disease
  
  
    Cardiovascular
    Hypertension, coronary disease, stroke
  
  
    Endocrine
    Impaired Glucose Tolerance, Insulin    Resistance, Dyslipidaemia Metabolic Syndrome, Type 2 Diabetes, Polycistic    Ovary Syndrome, menstrual irregolarities, precocious puberty,
  
  
    Gastrointestinal
    Gallstones, Gastroesophageal reflux,    Nonalcoholic fatty liver disorders
  
  
    Musculoskeletal
    Osteoartrithis, Flat feet, Tibia vara, Ankle    sprains, forearm fracture, slipped capital femoral epiphisis
  
  
    Neurologic
    Pseudotumor cerebri
  
  
    Psychological
    Depression , eating disorders, poor    self-esteem,body image disorder, social isolation and stigmatisation
  
  
    Pulmonary
    Asthma, obstructive sleep apnea, exercise    intolerance
  
  
    Renal
    Glomerulosclerosis



Table 2:  Obesity related morbidities.

Furthermore, obesity has a particularly strong relationship with cardiovascular disease [30,31], increasing the risk of stroke, hypertension, heart failure, coronary disease, atrial fibrillation, and lipid abnormalities. Stroke and ischemic heart disease are one of the leading causes of death around the world30. Multiple studies show an increased risk of ischemic stroke with increasing BMI [32-34]. Lipid abnormalities, including a reduction in high-density lipoprotein cholesterol along with an increase in low-density lipoprotein cholesterol, very low –density lipoprotein cholesterol, triglycerides, and total cholesterol, are associated with obesity [35].

Concurrent with the rising prevalence of childhood obesity in the last 30 years, Non-Alcoholic Fatty Liver Disease (NAFLD) [36,37]- which encompassing a wide spectrum of disorders such as simple steatosis, to Non Alcoholic Steato Hepatitis (NASH) and ultimately advanced fibrosis or cirrhosis- is the most common cause of chronic liver disease in pediatrics [37]. NAFLD is strongly associated with insulin resistance, glucose intolerance, and dyslipidemia and is currently regarded as the liver manifestation of the metabolic syndrome, a highly atherogenic condition even at a very early age [38,39]. At the present time, it involves between 3% and 11% of the pediatric population and affects about the 46% of overweight and obese children and adolescent [37,40]. Osteoarthritis increases with increasing BMI as well: obesity, in fact, represent, and the second risk factor after age- for development of osteoarthritis [41]. Excess mechanical forces lead to excessive joint loading and early osteoarthritis of the knee in obese people [42,43].

How can we challenge the obesity?

Dietary patterns, television viewing and other sedentary activities, and an overall lack of physical activity are predictors of obesity for both genders and therefore represent opportunities for intervention [44].

Overweight and obesity may be established as early as 2-5 years of age, highlighting the need for evidence-based effective prevention and treatment programs early in life [45]. Calls for the management of childhood obesity are urgent and frequent. Initiating and maintaining changes through lifestyle intervention, in order to prevent overweight and obesity progressing into adulthood, are major challenges [46]. The potential health consequences of lifestyle changes in young populations with overweight or obesity are well established, but treatments effects are modest, and sustainability has not been extensively researched. Family units and the home environment are recognized to have the greatest influence on child lifestyle habits and behaviors and hence serve as targets for prevention and treatment of obesity during childhood [47]. Parents have been acknowledged as the primary influence on the development of child eating and physical activity behaviors with their parenting styles also playing a role in development of healthy lifestyles. Thus, they are the primary focus for prevention efforts.

The decline of physical activity during adolescence occurs globally, and traditional approaches to weight management (information and advice) largely remain ineffective. Multidisciplinary approaches focusing on behavioral change techniques appear to be a suitable option. Specifically, recently more promising management of body weight occurred when behavioral lifestyle interventions replaced standard care. (e.g.; to reduce or eliminate intake of sugar-sweetened beverages, to reduce screen time, and track food and beverage intake).

In addition to traditional approaches to combating childhood obesity, web- and mobile phone- based interventions for weight management are promising [48-50]. Current advances in mobile technology may improve the attractiveness and accessibility of weight management support for children and adolescents with overweight or obesity. E-contact should be used for its significant capacity to prolong engagement and decrease withdrawal during sustainability phases that follow intensive intervention for weight management in young populations with a synergic effect. Internet-based intervention are effective on improving healthy behavioral changes and BMI z-score reduction [48-50], but additional researches are needed to design and test the effectiveness of the impact of mobile apps in pediatric weight loss programs.

Finally, bariatric surgery [51] is a limited therapy available for carefully selected adolescents.

The costs of the obesity

Calculating the exact cost of obesity is difficult. Beyond the global health concern is the fact that overweight and obesity are an economic burden. Medical obesity-related costs – associated with the diagnosis and treatment of obesity- are estimated to be as high as $209.7 billion [52-54], which represent approximately 21% of annual US health care expenditures. Estimates of the indirect costs from obesity [55] – related to morbidity and mortality and to events such a lost wages secondary to illness or disability and a loss of future gaining’s due to premature death- are as high as $66 billion per year, which yield total (direct and indirect) cost outcomes that may exceed $ 275 billion annually [55]. Much of the direct cost of obesity is attributable to treating high-cost comorbidities such as cardiovascular disease ($193-$315 billion) and type 2 diabetes ($105-$245 billion) [56].

If, however, costs associated with obesity stayed constant and did not increase from 2010-2030, savings in medical spending would total $549.5 billion [54,57].

Therefore, obesity imposes considerable external costs on society through health care expenses. Externalities associated with the current obesity epidemic merit adequate public interventions and policy change, with involvement at all levels of the health care system.

Conclusion

Obesity prevention across lifespan is vital and the main role is played by education. Behavioral change is difficult and takes time. However, a good working relationship between patient and provider, tailored information to individuals, and addressing motivational issues represent a potential effective tool to greatly reduce the incidence of obesity and improve the health. Early intervention is essential because of the widespread of childhood obesity: behavior modification and healthy lifestyle changes, however, remain the corner store to successful pediatric obesity prevention and treatment.

References

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Citation: Di Sessa A and Marzuillo P. Pediatric Obesity: It’s Time to Act!. Ann Obes Disord. 2016; 1(1): 1002.

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*System*	*Disease*
Cardiovascular	Hypertension, coronary disease, stroke
Endocrine	Impaired Glucose Tolerance, Insulin Resistance, Dyslipidaemia Metabolic Syndrome, Type 2 Diabetes, Polycistic Ovary Syndrome, menstrual irregolarities, precocious puberty,
Gastrointestinal	Gallstones, Gastroesophageal reflux, Nonalcoholic fatty liver disorders
Musculoskeletal	Osteoartrithis, Flat feet, Tibia vara, Ankle sprains, forearm fracture, slipped capital femoral epiphisis
Neurologic	Pseudotumor cerebri
Psychological	Depression , eating disorders, poor self-esteem,body image disorder, social isolation and stigmatisation
Pulmonary	Asthma, obstructive sleep apnea, exercise intolerance
Renal	Glomerulosclerosis