Recommendations for bariatric surgery in adolescents in Australia and New Zealand

The prevalence of severe obesity and associated co-morbidities is increasing in adolescence. Although support for long-term whole-of-family lifestyle change is the mainstay of paediatric obesity treatment, there is increasing recognition of the place of other therapies,including bariatric surgery, in the management of severely obese adolescents. While there are rising numbers of reports of bariatric surgery in adolescents, there are as yet no Australian or New Zealand recommendations available to guide decisions as to which adolescents should receive such surgery and how they should best be managed. This paper presents a summary of the recommendations that are contained within the full position paper developed on behalf of the Royal Australasian College of Physicians Paediatric Policy and Advocacy Committee Working Party on Bariatric Surgery for Adolescents, working in conjunction with the Australia and New Zealand Association of Paediatric Surgeons and the Obesity Surgery Society of Australia and New Zealand.     

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??Children whose nutritional condition has been improved still face dual burden including malnutrition and overweight/ obesity in China. In early life??the nutritional status not only affects growth and development of children??but also has relation to disease and quality of life in adult period. Focusing on and investing in children nutrition??it is beneficial for not only individual development??but also public health and social improvement.     

Child and adolescent obesity

Childhood obesity has reached epidemic proportions worldwide. With adult obesity-related co-morbidities now appearing in obese children, there has been a big push to educate the population and establish effective weight-losing initiatives. However, the limited success of non-operative methods has led to the introduction of bariatric surgery in the under 18-year olds. Laparoscopic Roux-en-Y gastric bypass is the most commonly performed operation, followed by the adjustable gastric band and sleeve gastrectomy. This review seeks to present the current position of bariatric surgery in the treatment of obese adolescents, and reviews the available evidence on selection and outcome, as well as the inherent uncertainties, particularly within the UK.     

Epidemiology of childhood type 2 diabetes and obesity

Abstract:  Over the last decade, it has become apparent that type 2 diabetes extends not only into the young adult population but is also found in adolescents and even, occasionally, in children. The limited data that are currently available present a rather uncertain picture, with a rather wide range of prevalences and incidences of type 2 diabetes in children and adolescents. Not surprisingly, the majority of the cases, and the highest prevalences, have been found among ethnic groups known to be at high risk of adult type 2 diabetes. Nevertheless, even in European populations, where the prevalence of type 2 diabetes remains very low among children and adolescents and certainly is considerably smaller than type 1 diabetes, there are several cases reported. The risk factors for type 2 diabetes in children and adolescents are, as expected, similar to those seen in adults, with obesity being almost always present. In utero exposure to hyperglycemia now appears to be an additional risk factor to having a family history of diabetes and suggests that better management of diabetes in pregnancy and prevention of gestational diabetes may reduce the risk of diabetes developing in the offspring.     

Tertiary paediatric obesity services in Australia

Aim:   To examine the nature and availability of paediatric obesity services in tertiary care settings across the states/territories of Australia.
Methods:   Surveys were sent to all clinicians identified as offering obesity services to children and adolescents. Respondents were asked to identify other service providers in their area, who were also asked to complete the survey.
Results:   Sixteen clinicians responded to the survey, from 20 requests. The clinicians who responded identified nine services in three of the eight states/territories of Australia. Existing services are limited to children and adolescents with severe obesity, with an average of 12 new referrals per service each month and an average waiting time of 5 months for an appointment. Most services involve a multidisciplinary approach, although the mix of staff varies considerably and emphasises nutrition rather than physical activity approaches.
Conclusions:   Despite the public attention devoted to paediatric obesity, tertiary services in Australia are inadequate to meet the increasing incidence and prevalence of this complex condition. The development of tertiary services as part of service delivery arrangements for paediatric obesity and its associated morbidities must become a priority within the health system.     

Recruitment challenges and recommendations for adolescent obesity trials

Aim: To report our experiences with recruiting overweight and obese 13‐ to 16‐year‐olds for the Loozit® weight management randomised control trial (RCT) and to identify effective strategies for recruiting adolescents from the community to a treatment trial. Methods: The Loozit RCT is a two‐arm, community‐based, lifestyle intervention that aims to evaluate the effect of additional therapeutic contact provided via telephone coaching and electronic communications as an adjunct to the Loozit group programme. Strategic areas that were targeted to recruit adolescents included media, schools, health professionals and community organisations. The programme aimed to recruit a cohort of 12–16 adolescents (body mass index z‐score range 1.0–2.5) aged 13–16 years every 3 months over 3 years. Information regarding recruitment and eligibility to participate was initially assessed during a telephone screen. The relative cost effectiveness of recruitment strategies was determined based on recruitment rates and costs including administrative costs and research assistant time. Results: Out of 474 enquiries, 32% resulted in an enrolment to the RCT. Newspaper articles and school newsletters accounted for nearly 60% of enquiries and enrolments and were the most cost‐effective recruitment strategies. Common reasons for ineligibility for inclusion in the RCT were adolescents being too young (21%) and parents consenting but adolescents refusing to participate (17%). Conclusions: The most successful recruitment strategies for the Loozit RCT were local newspapers and school newsletters. Future studies should consider involving a Public Relations department and other potentially cost‐effective strategies such as peer recruitment.     

Effects of individual factors on adolescent obesity: Study in Turkey

Background: The aim of the present study was to investigate the effects of sociodemographic and lifestyle variables, eating habits, adolescent weight perception and weight changes on obesity in Turkish adolescents.
Methods: A total of 87 normal weight and 78 obese participants were included in the study. They were selected from adolescents who had no other health problems beside obesity. Underweight and overweight adolescents were excluded. Estimation of prevalence of overweight and obesity were based on cut-off points of the International Obesity Task Force (excess of the 85th and 95th percentiles, respectively). The prevalence of underweight was defined as the percentage of adolescents below the fifth percentiles of the US adolescents' age- and gender-specific body mass index. A structured questionnaire that included sociodemographic and lifestyle variables, eating habits, weight questions about adolescents' weight perception and weight changes was administered to the participants.
Results: In the obese group, the level of the mothers' and fathers' education was lower than in the normal group ( P  = 0.006; P  = 0.001, respectively). Obese adolescents had fewer obese people in their family ( P  = 0.001). There were statistically significant correlations between groups for fathers' occupation, joining in cultural activities, physical exercise, feeling about body shape and food preference ( P  = 0.014; P  = 0.001; P  = 0.003; P  = 0.001; P  = 0.001, respectively). Increase in weight was larger in the obese group ( P = 0.001) and those who wanted to loose weight but failed ( P  = 0.001).
Conclusions: There are associations between obesity and level of mothers' and fathers' education, number of obese people in family, fathers' occupation, joining in cultural activities, physical exercise and food preference in Turkish adolescents.     

不同参考标准下重庆城区儿童超重／肥胖检出率比较

目的比较3种筛查标准下重庆城区儿童超重/肥胖现况,寻求适宜的儿童肥胖筛查标准。方法按照整群抽样原则抽取本市3个城区的12534名2～18岁儿童作为调查对象,测量其身高及体质量。并分别采用WHO的身高标准体质量法标准(标准1)、国际肥胖工作组(IOTF)的超重/肥胖体质量指数(BMI)标准(标准2)和国立卫生统计中心/疾病预防控制中心(NCHS/CDC)的BMI标准(标准3)评价儿童的超重/肥胖。结果按照标准1、2和3的规定,重庆城区儿童的超重检出率分别为13.0%、9.8%、9.8%;肥胖检出率分别为9.8%、2.9%、6.0%,均有显著性差异(Pa<0.001),且男童超重/肥胖检出率均高于女童。3种标准间,健康儿童、超重儿童或肥胖儿童的BMI均值均有显著性差异(Pa<0.001)。采用标准1和2得到的超重检出率,或采用标准1和3得到的超重检出率均在6岁前和14岁后2个年龄段存在统计学差异(Pa<0.01)。在2～6岁各年龄组,采用标准1和3得到的儿童肥胖检出率比较无显著性差异;在6～18岁各年龄组,采用标准1得到的肥胖检出率均显著高于采用标准2和3得到的肥胖检出率(Pa<0.01);在3～6岁、8～10岁、13岁组采用标准2和3得到的儿童肥胖检出率比较有显著性差异。结论儿童肥胖已经成为重庆城区重要的健康问题之一。采用3种标准筛查的儿童超重/肥胖检出率在2～18岁各年龄组均有所不同,应谨慎使用。     

Association of adrenergic receptor gene polymorphisms with adolescent obesity in Taiwan

Background: Polymorphisms of β2‐adrenergic receptor (ADRB2) and β3‐adrenergic receptor (ADRB3) have been reported to be associated with obesity in adults and adolescents, although study results have been controversial. The aim of the present study was to investigate the association of polymorphisms of ADRB2 (Arg16Gly, Gln27Glu) and ADRB3 (Trp64Arg) with adolescent obesity in Taiwan. Methods: A total of 559 adolescent volunteers with equal numbers female and male were enrolled. Participants were divided into two groups: obese (body mass index [BMI]≥ 95th percentile) and normal weight (BMI 15th–85th percentile). Genomic DNA was extracted from buccal mucosa cells and genotyped in TaqMan assays. Genotype results and clinical subject characteristics were analyzed. Results: Among the three ADRB polymorphisms, only Arg16Gly polymorphism was found to be significantly correlated with adolescent obesity, especially in girls. Girls with genotype Gly/Gly had a lower probability of obesity than those with genotypes Arg/Gly or Arg/Arg (P= 0.006; Arg/Gly: odds ratio [OR], 2.57, 95% confidence interval [95%CI]: 1.22–5.41; Arg/Arg: OR, 3.03, 95%CI: 1.50–6.12). Girls with genotype Gly/Gly had lower BMI than those with genotype Arg/Arg (P= 0.049). Obese adolescents with genotype Gly/Gly had a lower probability of hypertension than those with genotype Arg/Gly or Arg/Arg (P= 0.005). Conclusions: Arg16Gly polymorphism of ADRB2 was significantly associated with obesity in female adolescents, and those with the Gly/Gly genotype were associated with a lower possibility of obesity and lower BMI. This polymorphism was also associated with a lower probability of hypertension in obese adolescents. The other two polymorphisms of ADRB (Gln27Glu and Trp64Arg) were not associated with adolescent obesity in Taiwan.     

Regional, socioeconomic and urban-rural disparities in child and adolescent obesity in China: a multilevel analysis

Aim: To study socio‐demographic patterns of obesity in Chinese children and adolescents. Methods: Data came from the 2005 cycle of the Chinese National Survey on Student’s Constitution and Health. In all, 231 326 subjects aged 7–18 years, distributed across 622 schools and 30 provinces, were analysed. Multilevel modelling was used to estimate variations at individual, school area and province levels. Results: The prevalence of obesity varied enormously across different areas. Young people living in high socioeconomic and urban areas had higher body mass index (BMI) and higher odds of overweight and obesity than those living in lower socioeconomic and rural areas. Subjects living in provinces with a higher standard of living, as indicated by less perinatal mortality, lower Engel coefficient, and higher personal expenditure on health had higher BMI and higher odds of overweight and obesity than those living in less affluent provinces. An interaction between gender and urbanicity revealed that boys in urban areas were especially prone to obesity. Conclusion: In contrast to most present‐day high income countries, obesity among young people in China is associated with affluence and urban residence. Intervention and strategy for obesity prevention should be targeting high socioeconomic families in urban areas, perhaps with particular focus on boys.     

Classification of Child and Adolescent Psychopathology

This review will consider some of the major issues in the classification of child and adolescent psychopathology. The central issue will be the value of classification systems in child and adolescent psychopathology research. Some comment will also be made on the value of the existing classifications in clinical practice.     

Action, prevention and epidemiology of paediatric obesity

The overall aim of this paper is to describe important issues regarding paediatric obesity as a public health problem. This paper focuses on actions taken, and on the prevalence of obesity in children, teens and adults in Denmark. In addition, the paper describes some important prevention studies, all of which are performed outside Denmark. Thus, this paper is not a classical review but rather a highlight of some aspects that the author finds important. The latest Danish national figures show a marked increase in the prevalence of obesity, especially among young men—a sevenfold increase from 1987 to 2000 (0.7 to 4.9%). Among young women aged 16–24, the increase is threefold in the same period. Among teens, the prevalence has increased by 2–3 times in recent decades. Nevertheless, compared to other European countries and the US, Denmark has a relatively low prevalence of obesity in adolescents. The present paper also covers results from prevention studies performed in both preschool and school settings. Some of these focus on the reduced intake of carbonated drinks, whereas others focus on both diet and physical exercise. Finally, this paper demonstrates that Denmark is at the forefront regarding a national action plan against obesity.
Conclusion: This paper highlights some important aspects of the epidemiology, prevention and actions in the field of paediatric obesity with special focus on Denmark.