Weight loss surgery eligibility according to various BMI criteria among adolescents

Characterizing severe obesity in children and youth referred for weight management

Background

Severe obesity (SO) in pediatrics has become increasing prevalent in recent decades.

The objective of our study was to examine differences in demographic, anthropometric, cardiometabolic, and lifestyle variables in children and youth with SO versus their less overweight/obese (OW/OB) peers.

Methods

A retrospective medical record review of 6-19 year old participants enrolled in an outpatient pediatric weight management clinic was conducted. SO (body mass index [BMI] ≥99^th percentile) and OW/OB (BMI ≥85^th and <99^th percentile) groups were created according to Centers for Disease Control and Prevention definitions. Demographic, anthropometric, cardiometabolic and lifestyle data reported at baseline (pre-intervention) were retrieved.

Results

Of the 345 participants, most were girls (56.2%), Caucasian (78.7%), and had family incomes > $50,000/year (65.7%). The SO group (n = 161) had lower HDL-cholesterol and higher liver enzymes, insulin resistance and blood pressure than the OW/OB group (n = 184; all p < 0.01). They also reported higher total energy intakes, fewer steps/day, less moderate-to-vigorous physical activity, and more leisure time screen time (all p < 0.02) than their leaner peers. Compared to the OW/OB group, a higher proportion of individuals in the SO group possessed cardiometabolic risk factors, including high triglycerides (45.8% vs 58.5%), alanine aminotransferase (55.4% vs 81.4%), insulin resistance (55.6% vs 82.1%), systolic blood pressure (11.5% vs 27.3%), diastolic blood pressure (17.8% vs 30.0%), and low HDL-cholesterol (44.6% vs 64.6%; all p < 0.02). Aside from the ~75% of participants (groups combined) who met the daily recommended intakes of grain and meat products, <50% of boys and girls met any of the remaining nutrition and physical activity-related recommendations. Compared to the OW/OB group, greater proportions of children and youth in the SO group failed to meet moderate-to-vigorous physical activity (48.4% vs 31.9%) and leisure-time-screen-time recommendations (43.4% vs 28.3%; both p < 0.05).

Conclusion

Children and youth with SO have a worse cardiometabolic profile and less favorable lifestyle habits than their OW/OB peers. These differences emphasize the heightened obesity-related health risks associated with SO in the pediatric years.

Obese and overweight children and adolescents: an algorithmic clinical approach

Obesity in children and adolescents is a hot issue throughout the world. Numerous complications are related to childhood obesity, such as cardiovascular disease, diabetes, insulin resistance and psychological problems. Therefore, identification and treatment of this problem have an important role in the health system. In this clinical approach, we have provided a general overview of the assessment and management of obesity in children and adolescents, including definitions, history-taking, physical examinations, and laboratory testing for general practitioners and pediatricians. Furthermore, conventional therapies (physical activity, eating habits and behavioral modification) and non-conventional treatments (drugs and surgery options) have been discussed.

Vitamin D status is linked to biomarkers of oxidative stress, inflammation, and endothelial activation in obese children

OBJECTIVE

To examine vitamin D, parathyroid hormone, and serum calcium-phosphorus levels relationships to biomarkers of oxidative/nitrosative stress, inflammation, and endothelial activation, potential contributors for vascular complications in obese children.

STUDY DESIGN

Cross-sectional clinical study of 66 obese Caucasian children aged 7 to 14 years. Cardiovascular risk factors were assessed. Malondialdehyde and myeloperoxidase as measures of oxidative stress, and plasma nitrite+nitrate, urinary nitrate, and 3-nitrotyrosine as markers of nitrosative stress were measured. Adipocytokines, inflammatory molecules (high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-α), endothelial activation molecules (soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule 1 [sVCAM-1]), E-selectin, and vascular endothelial growth factor were also investigated. Serum 25-hydroxy-cholecalciferol [25(OH)D], intact parathormone, and calcium-phosphorus levels were determined in these children and in a comparison group of 39 non-obese children.

RESULTS

Obese children had a significantly lower 25(OH)D level (P = .002) and a higher intact parathormone (P = .011) than non-obese children. Phosphorus and the calcium-phosphorus product were also significantly higher (P < .0001). Insufficient serum concentrations of 25(OH)D (<20 ng/mL) were detected in 5% of normal children and in 30% of the obese children. In the obese children with vitamin D insufficiency, malondialdehyde, myeloperoxidase, 3-nitrotyrosine, interleukin-6, and sVCAM-1 were substantially elevated. A partial correlation analysis showed an inverse relationship of 25(OH)D levels with 3-nitrotyrosine (r = -0.424, P = .001), and sVCAM-1 (r = -0.272, P = .032).

CONCLUSIONS

Insufficient 25(OH)D levels were detected in severely obese children with increased markers of oxidative/nitrosative stress, inflammation, and endothelial activation.

Practical approaches to the treatment of severe pediatric obesity

Pediatric obesity is a major public health threat. Obese children and adolescents are at increased risk for many medical and surgical conditions. These conditions may affect their quality of life and life expectancy. The rapidly progressive nature of type 2 diabetes mellitus within the first 5 years of obesity diagnosis is particularly concerning. Because health risk increases with degree of obesity, adolescents who may be eligible for more aggressive obesity treatment should be identified and counseled.

The causes, prevalence, and treatment of obesity revisited in 2009: what have we learned so far?

Obesity is a chronic disease that is increasing in prevalence in the United States and worldwide and is often accompanied by multiple comorbidities that lead to type 2 diabetes and cardiovascular disease. In April 2009, the American Society for Nutrition hosted the symposium "An Integrative View of Obesity" at Experimental Biology 2009 in New Orleans, LA. The presentations addressed the causes of the obesity epidemic and notably discussed a combination of genetics, obesogenic environment, cultural and racial concerns, and treatment modalities based on what we have learned from research into the physiology and neuroendocrine regulation of appetite and satiety. The fat cell as an endocrine organ, in addition to contributions from the gut and pancreas, has helped us to understand the origins of this neuroendocrine regulation as a survival advantage in human ancestry, with obesogenic ramifications in today's toxic food environment. Suggestions for the reversal of the obesity epidemic were offered, including public health campaigns, community and medical programs, and industry-supported change in our food supply, eating patterns, and lifestyle. Community-structured programs for exercise and work-related physical activity could also engage a healthier lifestyle into the typical day for the average American as well as for individuals in other countries.

Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts

BACKGROUND

The 2000 Centers for Disease Control and Prevention (CDC) growth charts included lambda-mu-sigma (LMS) parameters intended to calculate smoothed percentiles from only the 3rd to the 97th percentile.

OBJECTIVE

The objective was to evaluate different approaches to describing more extreme values of body mass index (BMI)-for-age by using simple functions of the CDC growth charts.

DESIGN

Empirical data for the 99th and the 1st percentiles of BMI-for-age were calculated from the data set used to construct the growth charts and were compared with estimates extrapolated from the CDC-supplied LMS parameters and to various functions of other smoothed percentiles. A set of reestimated LMS parameters that incorporated a smoothed 99th percentile were also evaluated.

RESULTS

Extreme percentiles extrapolated from the CDC-supplied LMS parameters did not match well to the empirical data for the 99th percentile. A better fit to the empirical data was obtained by using 120% of the smoothed 95th percentile. The empirical first percentile was reasonably well approximated by extrapolations from the LMS values. The reestimated LMS parameters had several drawbacks and no clear advantages.

CONCLUSIONS

Several approximations can be used to describe extreme high values of BMI-for-age with the use of the CDC growth charts. Extrapolation from the CDC-supplied LMS parameters does not provide a good fit to the empirical 99th percentile values. Simple approximations to high values as percentages of the existing smoothed percentiles have some practical advantages over imputation of very high percentiles. The expression of high BMI values as a percentage of the 95th percentile can provide a flexible approach to describing and tracking heavier children.

Milk-Based Nutritional Supplements in Conjunction With Lifestyle Intervention in Overweight Adolescents

There are limited data on successful weight management approaches among adolescents from underserved communities. The primary aim of this study was to obtain preliminary data on the efficacy, safety, and acceptability of a lifestyle intervention with milk-based supplements among adolescents from underserved communities. The secondary aims of this study were to assess change in adiposity indices and metabolic indices and to measure compliance. The authors conducted a 12-week open-labeled lifestyle intervention. Adolescents were taught a structured meal plan, including the use of 2 milk-based supplements daily, and participated in weekly lifestyle counseling. Overweight was defined as a body mass index >85th percentile. Percent total body fat was estimated using bioelectric impedance. Fasting blood samples were used to measure insulin indices and other biochemical safety tests. The sample consisted of 40 adolescents (70% girls, 83% minority). Although there was no significant change in body mass index (median [Q1, Q3]; -0.10 [-0.91, 0.61] kg/m(2), P = .26), participants showed a decrease in body mass index z score (-0.03 [-0.08, 0.01] SD, P = .01]), weight z score (-0.04 [-0.11, 0.02] SD, P = .001), and percent total body fat (-1.20 [-2.55, -0.12]%, P = .0001). No new onset of type 2 diabetes mellitus was reported, and plasma vitamin D increased (P < .01). Consumption of milk-based drinks increased from a median of 4.5 to 13.5 servings per week, whereas sugary beverages decreased from 8.0 to 3.8 servings per week. A lifestyle intervention that includes milk-based supplements may safely improve some adiposity indices and decrease intake of sugary beverages among overweight adolescents from underserved areas.