Childhood Obesity

Childhood obesity is an issue of serious medical and social concern. In developing countries including India, it is a phenomenon seen in higher socioeconomic strata due to the adoption of a western lifestyle. Consumption of high calorie food, lack of physical activity and increased screen time are major risk factors for childhood obesity apart from other genetic, prenatal factors and socio-cultural practices. Obese children and adolescents are at increased risk of medical and psychological complications. Insulin resistance is commonly present especially in those with central obesity and manifests as dyslipidemia, type 2 diabetes mellitus, impaired glucose tolerance, hypertension, polycystic ovarian syndrome and metabolic syndrome. Obese children and adolescents often present to general physicians for management. The latter play a key role in prevention and treatment of obesity as it involves lifestyle modification of the entire family. This article aims at discussing the approach to diagnosis and work-up, treatment and preventive strategies for childhood obesity from a general physician’s perspective.     

儿童单纯性肥胖的诊断和治疗

关于肥胖的诊断国内外并尚无统一的判断标准，WHO认为10岁以下和10岁以上应有不同的评价标准，推荐10岁以下儿童使用身高别体质量，10～24岁采用体质量指数（BMI），国际肥胖问题工作组织（IOTF）认为BMI适宜用来判断儿童青少年超重和肥胖。WHO和IOTF提出的18岁BMI超重、肥胖标准完全一样，分别为25和30kg／m^2，而中国肥胖问题工作组（WGOC）制定的标准较比前二者低，18岁BMI超重和肥胖界值点分别为24和28kg／m^2。儿童肥胖的治疗不同于成人，成人期可使用的手术去脂、药物减肥、饥饿疗法、禁食等，在儿童时期均不宜使用。目前国内外公认儿童肥胖治疗方法包括行为矫正、饮食调整和运动等综合治疗方案。     

Health Consequences of Childhood Obesity

Objectives  

To evaluate the cardiovascular and endocrine effects of childhood obesity as well as prevalence of metabolic syndrome associated with it.     

Insulin Secretion in Childhood Obesity

In 132 severely obese children (72 boys and 60 girls) who underwent institutional therapy, oral glucose tolerance tests were carried out on admission, and these children were divided into groups with normal and high insulin levels, in terms of the I values obtained, on the basis of the reference value + 2SD calculated by Maruhama et al [8]. From these children, those who had diabetes mellitus (DM) and those in whom DM was suspected were distinguished according to the diagnostic criteria of USPHS (Drash et al [1]). The insulin levels were normal in 58 children and high in 64. Ten children were found to have DM, and 19 were suspected to have DM. Metabolism of the glucose load occurred at both normal and high insulin levels in some children. There was also a group of children in whom glucose metabolism was incomplete at high insulin levels and a group of children in whom glucose metabolism was not possible even at high insulin levels, showing an obvious DM reaction. These findings suggest that there is a difference in the sensitivity of the insulin receptors in these children. Age, severe obesity and a family history of DM were considered to be risk factors for DM. Although there was a moderate, positive correlation between I and the obesity index and between I and age, it seems that the level of insulin secretion varies considerably in obese children.     

Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach

Childhood obesity recommendations advise providers to use family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics.     

Prevention and Management of Childhood Obesity

Childhood obesity has been recognized as a global pandemic. Preventive strategies have proven to be the most effective public health intervention in curbing this pandemic. A multi-component approach involving dietary modification and advocacy for a healthy lifestyle comprising of regular physical activity, minimizing screen time and behavioral interventions have been found beneficial in preventing obesity. A life-cycle approach has been recommended where preventive interventions go as far back as affecting maternal, fetal and early childhood nutrition and lifestyle. Family, school and community involvement is important for long term results, so is the involvement of government in developing policies that help create an environment and opportunities for healthy diet and physical activity. Management of childhood obesity is challenging. It involves following a structured weight reduction programme individualized for every child, along with adoption of a healthy diet and life style. Anti-obesity drugs have a limited role in childhood years and are not recommended in younger children. Bariatric surgery is reserved for morbidly obese older adolescents but its long term safety data is limited in this age group.     

儿童再生障碍性贫血的临床诊断治疗

再生障碍性贫血(再障)是儿童期较为常见且严重的血液病之一。我国属于再障高发地区,儿童处于高发年龄段,且重型再障发病率高于成人,需要引起高度重视。现结合学习中华医学会《再生障碍性贫血诊断分型与疗效标准》和近年来国内外文献,总结以往经验,对儿童再障诊治目前可能存在的问题、诊断和鉴别诊断要点、治疗原则与具体措施,密切结合临床实际,提出具体诊治建议与措施。     

Childhood Obesity in India: A Meta-Analysis

Developing countries are now facing the double burden of childhood underweight and obesity. Childhood obesity is a recent epidemic with a high magnitude in India. Therefore, the authors decided to assess the prevalence of overweight and obesity among Indian children. Studies were identified through computer-based and manual searches. Estimates of prevalence were studied using random effects meta-analysis. Nine studies including 92,862 subjects were identified and analysed. The prevalence of overweight was estimated to be 12.64% (95% CI 8.48-16.80%) and that of obesity to be 3.39% (95% CI 2.58-4.21%). Current evidence suggests that policies and interventions for children should prioritize reduction of obesity and overweight.     

儿童肥胖与睡眠及相关激素的关系

儿童肥胖可以发展成为成年人肥胖,但迄今为止对发生肥胖的病理生理机制仍缺乏确切的了解。最新资料表明,睡眠不足可能是通过改变摄食行为及减少能量消耗,最终导致能量失衡和肥胖的发生。这可能同与食欲相关的几个激素有关:睡眠减少时血瘦素减少,血生长激素释放肽和食欲素增加,而瘦素是抑制食欲的激素,生长激素释放肽和食欲素是增加食欲的激素,慢性睡眠剥夺时这种激素的改变使食欲增加,导致肥胖。由于儿童睡眠时间是一较容易修正的风险因子,因此,研究儿童睡眠不足与肥胖的关系对预防和治疗肥胖具有积极的意义。该文就国外关于睡眠和肥胖之间的关系及相关激素的研究作一阐述。