Pediatric obesity remains an ongoing serious international health concern affecting about 17% of children and adolescents in the United States while worldwide over 41 million children under 5 years are overweight or obese, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Comorbidities are common in obese children and adolescents, as are long-term health complications. Clinicians should screen for obesity comorbidities in a hierarchal, logical manner so as to detect them early and prevent more costly complications. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling if indicated. The prevention of pediatric obesity before onset, via physical activity and a healthful diet and environment, should be a primary goal; once obesity occurs, it is difficult to treat effectively with lifestyle modifications. Although some behavioral and pharmacotherapy studies have reported modest success in preventing and/or treating pediatric obesity, there remains a need for substantial research in these areas. Treating children or adolescents with weight loss medications should be restricted to clinical trials. Increasing evidence indicates that bariatric surgery is effective in the most seriously affected mature teenagers who have failed lifestyle modification; however, this requires experienced teams with resources for long-term follow-up. Despite a significant increase in research in recent years, we need more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity versus another or to be free of comorbidities. Furthermore, we need continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity. We need to focus particular attention on finding ways to effect systemic changes in food environs and total daily mobility, as well as methods for sustaining healthy BMI changes.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology