ESPE Abstracts (2019) 92 CON1.2

Does Obesity Need Tertiary Care Provision? – Against !

Wieland Kiess


Leipzig university, Leipzig, Germany


In view of the high prevalence of obesity in childhood and adolescence treatments of obesity in young ages represent a major burden to the health care systems around the world. However, still treatments are ineffective largely, and little is being done to organize effective prevention and to enhance societal understanding of the complex etiology of the disease. In more developed and industrialized countries, and that is in all of Europe and in North America as well as in Australia and New Zealand, the majority of children and adolescents who are obese come from less educated and less affluent families. Low income and lower education of the families as well as polygenic traits are the major contributors for an individual child to develop obesity at a young age. In addition, societal conditions such as availability of cheap sugar-rich nutrition and sugar-containing beverages as well as lack of walkability in neighborhoods all contribute to the obesity epidemic. It is society not medicine who needs to understand the real causes of the majority of the obesity problem. It is only a small minority of children with obesity that suffer from obesity syndromes or carry monogenic traits such as MC4R defects, leptin receptor defects, POMC variants or leptin deficiency. Only these individuals need tertiary care facilities with comprehensive genetic testing, centers for rare diseases and facilities for clinical trials. It is being postulated, that extensive screening strategies involving public health facilities, primary care physicians and school doctors should be able to identify these few patients with non-primary obesity who eventually do need tertiary care facilities. Prevention and societal change on the other hand should be brought about through research, education and mass media based information to the general public. Herewith, not tertiary care but primary scientific work is needed. Flooding expensive tertiary care facilities with millions of obese children who suffer from societies´ ill conditions and bad environments cannot be afforded and does not help to contain the childhood obesity epidemic. Most importantly, little effects are being seen when treatment concepts even involving tertiary centers are put forward.

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