In a recent review published in the journal Frontiers in Pediatrics, researchers at the Medical College of Wisconsin presented an overview of the pathophysiological mechanisms, health implications, and management options for obesity among children and adults.
Study: Childhood and Adolescent Obesity: A Review. Image Credit: ChameleonsEye / Shutterstock
Background
Being obese is a significant health concern due to the associated burden of chronic medical diseases. The etiology is multifactorial, so an interdisciplinary approach is required for treatment and improved quality of life. Diet limitations and increasing physical exercise are age-old treatments; however, their efficacy in treating severe obesity is limited, warranting the development of other effective weight-loss agents.
About the review
In the present review, researchers summarized existing data on obesity-associated factors, pathophysiology, effects on health, and weight loss strategies for the pediatric and adult population.
Pathophysiology and health implications of obesity
Obesity is a chronic condition with a multifactorial etiology involving developmental, biological, genetic, environmental, and behavioral factors. These factors contribute to an energy imbalance, with energy (caloric) intake greater than energy expenditure.
Adiposity rebounds during early childhood and enhances the risk of obesity during adulthood. Societal obesity-associated factors include the influence of family members, communities, and the availability of health resources to manage obesity.
Unhealthy dietary practices may result from eating disorders such as binge-eating disorders, bulimia nervosa, anorexia nervosa, and night-eating syndrome. Epigenetic modifications, intestinal microbiome dysbiosis (especially altered short-chain fatty acid pathways), small for gestational age (SGA) status during birth, formula-based (high-protein) feeding instead of breastfeeding during infancy, use of nutritional supplements during infancy and the introduction of proteins early in infant diet also contribute to obesity.
The intestine-brain axis is critically involved in satiety and hunger. The hypothalamus of the brain, particularly the hypothalamic arcuate nucleus (ARC), controls food intake and is primarily controlled by two hormones, ghrelin, the orexigenic hormone that stimulates hunger, and leptin, the anorexigenic hormone, which has opposite effects.
The stomach secretes ghrelin, whereas leptin is secreted by adipose tissue. By altering the basal metabolic rate and emotional dysfunction by increasing stress and altering biological rhythms and eating patterns, thyroid pathologies could result in weight gain.
Genetic causes of obesity include Bardet-Biedl syndrome, Prader-Willi syndrome, and Alström syndrome. Polygenic obesity may stem from altered gene-environment interactions (GEI) and single nucleotide polymorphisms (SNPs). Epigenetic changes may be triggered by adverse childhood experiences (ACE) and poor maternal nutrition during the prenatal or initial postnatal periods.
Obesity is associated with several comorbidities, such as hypertension, type 2 diabetes mellitus, obstructive sleep apnea (OSA), dyslipidemia, and non-alcoholic fatty liver disease (NAFLD). Obesity increases the risk of precocious puberty, menstrual irregularities, and cardiometabolic disorders.
In addition, poor body image may worsen mental health, resulting in anxiety and depression. Obese children may have elevated insulin levels, accelerated linear growth, and advanced bone age, and obese girls may be at an increased risk of hirsutism and polycystic ovary syndrome (PCOS).
Management options for obesity
Lifestyle modifications such as dietary changes, restricting high-calorie and sugar-sweetened food and beverages, and increased physical activity have been modestly effective in weight loss. Pharmacotherapies for obesity include orlistat, metformin, phentermine/topiramate combination, and GLP-1 agonists such as liraglutide. Surgical options include bariatric surgeries such as gastric banding, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass.
Screen time must be reduced, and children must be encouraged to engage in outdoor activities. Taxing unhealthy and processed foods, banning advertisements of unhealthy, high-calorie fast foods, reducing meal portions, and increasing accessibility to playgrounds and open spaces could improve dietary intake among children and adults, reducing body mass index (BMI) values commonly used to evaluate obesity.
Healthcare professionals must provide anticipatory guidance regarding nutritional counseling without judging or stigmatizing parents for their child’s obesity. In addition, effective provider-patient interactions using motivational interviews could aid in encouraging behavioral changes.
Educating families on nutritional diets, encouraging physical fitness, and reducing sedentary-type activities may help manage obesity. Weight loss approaches must be family-oriented and not individual-oriented for more effective results. For individuals with severe obesity, multidisciplinary strategies involving physicians, psychologists, and dieticians may be used.
Interventions such as hydrogel technology and probiotic supplements to restore intestinal microbiome balance have been tried. Studies have reported that pregnant females who received docosahexaenoic acid (DHA) gave birth to less obese children. Vitamin E has been used to reduce obesity-associated comorbidities.
Conclusions
Based on the review findings, obesity is a population health concern associated with many cardiometabolic, endocrinal, and psychological disorders originating from various modifiable and non-modifiable causes.
Pediatric obesity could continue into adulthood, so the condition must be identified early to initiate prompt therapy. This includes lifestyle modifications, such as restricting sugary, calorie-dense foods, increasing fruit and vegetable consumption, increasing physical activity, and ensuring adequate sleep. Breastfeeding rather than formula feeding lowers the risk of obesity.
Novel management options include pharmacotherapeutic and surgical options to lower weight among those with severe obesity and/or associated comorbidities. Healthcare professionals must screen children for obesity by evaluating body mass index or other weight assessments and educate parents to prevent and manage the same, to reduce the consequences of obesity during adulthood.
Obesity crisis in the U.S. expected to worsen by 2050