Strategies in the Management of Adolescent Obesity

Management of adolescent obesity in developing countries: A systematic review

Background: Adolescent obesity is a menace that demands a multi-factorial approach to its management and prevention. Aim: The purpose of this review was to assess interventions used in the management of adolescent obesity in developing countries. Methods: Electronic search were conducted between January 2000 and December 2022 on six databases: Pubmed, GoogleScholar, CINAHL, SCOPUS, Cochrane Library and Science Direct and three clinical trial registries: Pan African Clinical Trial, World Health Organization and clinicalTrial.gov. The quality of the included studies was assessed using the Effective Public Health Practice Project. Results: Eighteen studies met the inclusion criteria. The studies were conducted in Africa (N = 7), Asia (N = 6) and South America (N = 5). The sample size ranged from 10 to 4003 at baseline. The studies were carried out in schools (N = 13) and hospitals (N = 5) with four main varied designs: controlled trial (N = 7), quasi-experimental (N = 3), cohort (N = 3) and longitudinal (N = 4). The duration of the interventions ranged from six weeks to three years. The interventions were nutrition education (NE) and physical education (PE) (N = 11), PE only (N = 3), Surgery/NE (N = 1), Surgery/NE/PE (N = 1) and psychotherapy/NE/PE (N = 2). Three studies that used NE and PE and five studies that used same reported significant differences in body mass index for-age z score (zBMI) and waist circumference, respectively. Studies that included surgeries in the interventions reported significant differences in weight, zBMI and waist-to-hip ratio. Conclusions: Few intervention studies have been done on management of adolescent obesity in developing countries and largely effective. All interventions prioritized nutrition and/or PE. The studies were largely school-based.

Does an increased preoperative body mass index (BMI) affect adolescent idiopathic scoliosis surgery outcomes and complications? A meta-analysis

OBJECTIVE

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. With obesity reaching unprecedented levels in adolescents, we aimed to perform a meta-analysis examining the impact of increased Body Mass Index (BMI) on AIS corrective surgery.

METHODS

Cochrane, PubMed, and Google Scholar (pages 1-20) were searched up to July 2024. The inclusion criteria consisted of studies comparing increased BMI patients with patients having a normal BMI (BMI < 25 OR < 85th percentile) in the setting of corrective surgery for AIS. Investigations consisting of non-comparative studies, or studies with non-relevant outcomes were excluded.

RESULTS

Twelve retrospective studies met inclusion criteria and were included in this meta-analysis. There were significantly fewer complications (OR = 0.44, p = 0.002), readmissions (OR = 0.39, p = 0.05), and wound-related complications (OR = 0.32, p = 0.005) in patients with normal BMI. In addition, the patients with normal BMI had a shorter operative time (MD = - 15.43, p = 0.005) as well as a smaller pre- and post-operative major curve (MD = - 1.54; p = 0.01, MD = - 2.45; p = 0.002) and thoracic kyphosis (MD = - 4.87; p < .001, MD = - 2.67; p < .001).

CONCLUSION

Patients undergoing AIS surgery with an increased preoperative BMI may be associated with less favorable outcomes. Although the elevated BMI alone may be the cause of the increased complications in some patients, obese patients also presented with larger curves and more kyphosis, thus potentially explaining an additional contributor to the increased complication rate. Curves may be less noticeable in obese patients as compared to normal weight patients, thus delayed diagnosis may be occurring. Optimized scoliosis screening in obese patients, and also studies assessing the benefits of preoperative weight management in AIS surgery are needed.

Dietary Habits and Determinants of Overnutrition Among Secondary and Preparatory School Adolescents: A Multi-Center Unmatched Case-Control Study

Background: Overnutrition is characterized by abnormal or excessive fat buildup in the body's fatty tissue, leading to potential health issues associated with overweight or obesity. These conditions pose significant public health challenges for adolescents and are strong indicators of future obesity, illness, and even death. As a result, this study sought to examine the dietary behaviors and factors contributing to overnutrition in secondary and preparatory school students in Debre Berhan Town, Ethiopia. Methods: An institutional-based unmatched case-control study was conducted among 285 adolescents from March 18 to April 20, 2021. The data collection was carried out using standardized interviewer-administered semi-structured questionnaires, which were adapted from previous studies. A general survey was conducted to identify cases and controls. The cases and controls were selected using simple random sampling methods. Data was entered using Epi-data 4.2 software and exported to SPSS v25. Descriptive statistics were done based on the nature of the data. Bivariable and multivariable logistic regression analysis was performed. World Health Organization AnthroPlus software was used to analyze anthropometric data into body mass index for age with z-score. Adjusted odds ratio with a 95% confidence interval and P-value <.05 was considered statistical significance. Result: In this study, eating habits while reading (AOR = 3.87;95% CI: 1.95-7.686), sedentary behavior, (AOR = 2.52; 95% CI: 1.278-4.97), vigorous type of physical exercise for <75 min per week (AOR = 2.38; 95% CI: (1.149-4.92), <6 sleeping hour per day (AOR = 5.68; 95% CI: 2.08-15.48) and earning an average family income of ≥227 USD (AOR = 2.67; 95% CI: 1.214-5.9) were significantly associated with overnutrition among school adolescents. Conclusion: Overnutrition is a significant emerging public health concern among school adolescents, with various factors contributing to its prevalence. This study underscores the importance of promoting an active lifestyle, reducing sedentary behavior, and fostering healthy eating habits as crucial national public health priorities. Early interventions targeting modifiable risk factors are essential for mitigating the incidence of overnutrition among adolescents. It is recommended that educational programs addressing overnutrition and its associated health implications commence early in school settings to prevent the escalating prevalence of this issue. Public health initiatives aimed at increasing awareness of risk factors for overnutrition among adolescents are warranted to alleviate the future burden of obesity-related chronic non-communicable diseases.

Parental Perceptions of Medication Use for the Treatment of Obesity in Youth

Background: This survey-based study identified views on antiobesity medications in youth referred to a weight management program. Methods: One parent completed a 14-item Research Electronic Data Capture (REDcap) survey regarding openness to medication use in youth with obesity at their first visit in a weight management program. Medical data were extracted from the medical records of all responders. Results: Ninety-four percent (116/125) of parents approached completed the survey (youths' demographic: mean age = 14.1 years old, 46.8% female, 68.8% Hispanic). Results indicate that 75% of parents surveyed were open to medication use. There was no difference in sex, age, insurance, severity of obesity, or family history between parents who were and were not open to medication (all p > 0.05). Hispanic ethnicity was associated with greater openness to medication use (odds ratio: 3.4, 95% confidence interval: 1.4-8.5, p = 0.007). Conclusions: These results highlight the importance of parental perceptions of medication use for obesity treatment and suggest a need for improved education about the role of medication in the management of pediatric obesity.

The treatment of obesity in children and adolescents: consensus position statement of the Italian society of pediatric endocrinology and diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery

This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.

Association Between Weight Promoting Medication Use and Weight Status Among Children and Adolescents in the United States

OBJECTIVES

The objectives of this study were to 1) examine the prevalence of prescription medication use overall and 2) examine the association between weight promoting medication (WPM) use by therapeutic class and weight status among a nationally representative sample of the children and adolescents in the United States. This study also further investigated antidepressant medication use among this population.

METHODS

This cross-sectional study used data from the National Health and Nutrition Examination Survey from 2013 to 2018. Children and adolescents ages 2 to 19 years were included in this study.

RESULTS

Of the 68,057,468 derived participants (34,507,154 [50.7%] male; 33,564,059 [49.3%] aged 2-10 years; 34,905,058 [51.3%] non-Hispanic White), 14,895,618 (22.2%) used a prescription medication in the prior 30 days, 21.7% (3,235,323) of which were considered weight promoting. There was no significant difference between weight status and WPM use for overall prescription medication use. Nevertheless, for overall antidepressant medication use, those with obesity were less likely to be prescribed antidepressant WPM when compared to those with normal weight (adjusted odds ratios 0.4; 95% confidence interval 0.2-0.7).

CONCLUSIONS

These findings suggest that although there was no significant association between WPM use and weight status overall when examining the association by therapeutic class, most children with obesity were not using antidepressant WPM. This is reassuring and potentially an active attempt at avoiding the use of medications that have an exacerbating effect on weight gain. When choosing antidepressant medications, providers, parents, and patients consider the WPM effects and appropriately choose a medication best suited to the child's health status.

Medical treatment of weight loss in children and adolescents with obesity

Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.

Bariatric Surgery in Adolescents: To Do or Not to Do?

Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.

Sex-Dependent Dyslipidemia and Neuro-Humoral Alterations Leading to Further Cardiovascular Risk in Juvenile Obesity

Objective: Childhood obesity is a growing concern as the World Health Organization (WHO) states that ~10% of adolescents worldwide are overweight or obese. This condition is the reflex of energy imbalance between the calories consumed and those expended. Sex-related responses associated with dyslipidemia, hormonal alterations, and neuro-humoral disruptions in childhood obesity are the focus of the present investigation. Methods: Ninety-two Brazilian adolescents were enrolled and divided between obese and eutrophic groups. Obesity was assessed using body mass index Z-score according to age and weight. Anthropometrical analyses, blood pressure, blood lipids, metabolism-regulating hormones, and neuropeptides were carried out. Results: Systolic blood pressure was higher in female and male patients with obesity. Obese females presented alterations in lipid profile and an augment of cardiovascular disease prediction ratios TC/HDL, TG/HDL, LDL/HDL, and VLDL/HDL. The levels of leptin, GIP, and neuropeptide showed sex-dimorphism in obesity. The obese adolescents presented increased levels of circulating insulin, c-peptide, amylin, glucagon, and GLP-1. Correlation analysis showed significant linearity between body mass index, blood pressure, lipids, lipoproteins, hormones, and neuropeptides content. Conclusions: Our data support an existing link associating hypertension, dyslipidemia, and neuro-hormonal imbalance in childhood obesity. We also described a sex-dependent pattern in childhood obesity-associated dyslipidemia and blood pressure in female patients with obesity solely.