Elsevier

The Lancet

Volume 375, Issue 9727, 15–21 May 2010, Pages 1737-1748
The Lancet

Seminar
Childhood obesity

https://doi.org/10.1016/S0140-6736(10)60171-7Get rights and content

Summary

Worldwide prevalence of childhood obesity has increased greatly during the past three decades. The increasing occurrence in children of disorders such as type 2 diabetes is believed to be a consequence of this obesity epidemic. Much progress has been made in understanding of the genetics and physiology of appetite control and from these advances, elucidation of the causes of some rare obesity syndromes. However, these rare disorders have so far taught us few lessons about prevention or reversal of obesity in most children. Calorie intake and activity recommendations need reassessment and improved quantification at a population level because of sedentary lifestyles of children nowadays. For individual treatment, currently recommended calorie prescriptions might be too conservative in view of evolving insight into the so-called energy gap. Although quality of research into both prevention and treatment has improved, high-quality multicentre trials with long-term follow-up are needed. Meanwhile, prevention and treatment approaches to increase energy expenditure and decrease intake should continue. Recent data suggest that the spiralling increase in childhood obesity prevalence might be abating; increased efforts should be made on all fronts to continue this potentially exciting trend.

Section snippets

Epidemiology

8 years have passed since the last Seminar on childhood obesity in The Lancet.1 Our goal is to review new information and outline some of the remaining challenges. A review of secular trends in the number of overweight or obese children concluded that prevalence had increased during the past two to three decades in most industrialised countries, apart from Russia and Poland, and in several low-income countries, especially in urban areas.2 Prevalence doubled or trebled between the early 1970s

Differential diagnosis and complications

Endocrine diseases, congenital and acquired hypothalamic defects, genetic syndromes, and use of drugs affecting appetite should be considered during assessment of paediatric patients with obesity (figure 2). Clinical history and examination should guide differential diagnosis. Onset of obesity during early infancy raises suspicion of function-changing genetic mutations affecting the leptin signalling pathway, but these disorders are very rare, with the most common, melanocortin-4-receptor

Prevention

Prevention, especially in young people, is universally viewed as the best approach to reverse the rising global prevalence of obesity. However, evidence about the most effective means of prevention of obesity development in children is scarce. Many prevention trials have had sample sizes too small for expected effect size or insufficient length of follow-up. Some trials have also been criticised for not being based on sound theories of behavioural change and for having inadequate feasibility

Non-pharmacological treatment

We recommend that children with BMI higher than the 95th percentile, or higher than the 85th percentile when accompanied by comorbidities, such as hypertension, hyperlipidaemia, or impaired glucose tolerance, be considered for treatment. Non-pharmacological approaches should be the foundation of all obesity treatments, especially in children, and should always be considered as first-line therapy. In a systematic review109 of randomised controlled trials of treatments for childhood obesity,

Pharmacological and surgical treatment

A Cochrane review109 identified ten randomised controlled trials of pharmacological treatments for obese children. Most of these trials had small sample sizes (range 24–539 participants, with 60% including fewer than 30 participants), but most were high quality. With one exception, all the pharmacological treatment trials were in older children or adolescents (minimum age 12 years); the exception enrolled individuals aged 9–18 years. Trials meeting criteria for pooled meta-analysis included

Conclusion

Much progress has been made in understanding of the genetics and physiology of appetite control and, from this, the elucidation of the causes of some very rare obesity syndromes. Much work remains to be done, however, since these rare disorders have so far taught us few lessons about how to prevent or reverse obesity in most children. No evidence-based, clinically meaningful definition of childhood obesity has been established. Calorie intake and activity recommendations need to be reassessed

Search strategy and selection criteria

We identified original research, reviews, and commentaries by searching PubMed using the search terms “paediatric obesity”, “childhood obesity”, “paediatric overweight”, “childhood overweight”, and “body mass index in children”. All dates and languages were considered. Articles published between 1962 and 2010 were included, but we directed special attention to reports published since 2002. Research developments and published work were also identified by discussions with specialists in

References (140)

  • R Alemzadeh et al.

    Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season

    Metabolism

    (2008)
  • BA Swinburn et al.

    Estimating the changes in energy flux that characterize the rise in obesity prevalence

    Am J Clin Nutr

    (2009)
  • MS Kramer et al.

    A randomized breast-feeding promotion intervention did not reduce child obesity in Belarus

    J Nutr

    (2009)
  • M-J Brion et al.

    Maternal macronutrient and energy intake in pregnancy and offspring intake at 10 y: exploring parental comparisons and prenatal effects

    Am J Clin Nutr

    (2010)
  • C Gonzalez-Suarez et al.

    School-based interventions on childhood obesity: a meta-analysis

    Am J Prev Med

    (2009)
  • JM Berkowitz et al.

    Did augmenting the VERB campaign advertising in select communities have an effect on awareness, attitudes, and physical activity?

    Am J Prev Med

    (2008)
  • ME Huhman et al.

    Evaluation of a national physical activity intervention for children: VERB campaign, 2002–2004

    Am J Prev Med

    (2007)
  • JA Yamamoto et al.

    Adolescent fast food and restaurant ordering behavior with and without calorie and fat content menu information

    J Adolesc Health

    (2005)
  • Y Wang et al.

    Worldwide trends in childhood overweight and obesity

    Int J Pediatr Obes

    (2006)
  • CL Ogden et al.

    High body mass index for age among US children and adolescents, 2003–2006

    JAMA

    (2008)
  • RR Kipping et al.

    Obesity in children. Part 1: epidemiology, measurement, risk factors, and screening

    BMJ

    (2008)
  • E Sundblom et al.

    Childhood overweight and obesity prevalences levelling off in Stockholm but socioeconomic differences persist

    Int J Obes (Lond)

    (2008)
  • TJ Cole et al.

    Establishing a standard definition for child overweight and obesity worldwide: international survey

    BMJ

    (2000)
  • RP Troiano et al.

    Overweight prevalence and trends for children and adolescents. The national health and nutrition examination surveys, 1963 to 1991

    Arch Pediatr Adolesc Med

    (1995)
  • JV Neel

    Diabetes mellitus: a “thrifty” genotype rendered detrimental by “progress”?

    Am J Hum Genet

    (1962)
  • DR Bassett

    Physical activity of Canadian and American children: a focus on youth in Amish, Mennonite, and modern cultures

    Appl Physiol Nutr Metab

    (2008)
  • S Farooqi et al.

    Genetics of obesity in humans

    Endocr Rev

    (2006)
  • E Feigerlova et al.

    Hyperghrelinemia precedes obesity in Prader-Willi syndrome

    J Clin Endocrinol Metab

    (2008)
  • DE Cummings et al.

    Elevated plasma ghrelin levels in Prader Willi syndrome

    Nat Med

    (2002)
  • S Seo et al.

    Requirement of Bardet-Biedl syndrome proteins for leptin receptor signaling

    Hum Mol Genet

    (2009)
  • JC Han et al.

    Brain-derived neurotrophic factor and obesity in the WAGR syndrome

    N Engl J Med

    (2008)
  • CJ Willer et al.

    Six new loci associated with body mass index highlight a neuronal influence on body weight regulation

    Nat Genet

    (2009)
  • J Campion et al.

    Individuality and epigenetics in obesity

    Obes Rev

    (2009)
  • DN Long et al.

    Body mass index differences in pseudohypoparathyroidism type 1a versus pseudopseudohypoparathyroidism may implicate paternal imprinting of Galpha(s) in the development of human obesity

    J Clin Endocrinol Metab

    (2007)
  • JU Weaver

    Classical endocrine diseases causing obesity

    Front Horm Res

    (2008)
  • RH Lustig et al.

    Octreotide therapy of pediatric hypothalamic obesity: a double-blind, placebo-controlled trial

    J Clin Endocrinol Metab

    (2003)
  • M Lee et al.

    Review of physiology, clinical manifestations, and management of hypothalamic obesity in humans

    Pituitary

    (2009)
  • D Dabelea

    The predisposition to obesity and diabetes in offspring of diabetic mothers

    Diabetes Care

    (2007)
  • DA Lawlor et al.

    Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort

    Diabetologia

    (2010)
  • JG Kral et al.

    Large maternal weight loss from obesity surgery prevents transmission of obesity to children who were followed for 2 to 18 years

    Pediatrics

    (2006)
  • DA Lawlor et al.

    Exploring the developmental overnutrition hypothesis using parental-offspring associations and FTO as an instrumental variable

    PLoS Med

    (2008)
  • KK Ong et al.

    Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions

    Acta Paediatr

    (2006)
  • RW Taylor et al.

    Early adiposity rebound: review of papers linking this to subsequent obesity in children and adults

    Curr Opin Clin Nutr Metab Care

    (2005)
  • CG Owen et al.

    Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence

    Pediatrics

    (2005)
  • LA Moreno et al.

    Dietary risk factors for development of childhood obesity

    Curr Opin Clin Nutr Metab Care

    (2007)
  • D Jimenez-Pavon et al.

    Associations between objectively measured habitual physical activity and adiposity in children and adolescents: systematic review

    Int J Pediatr Obes

    (2010)
  • SJ Marshall et al.

    Relationships between media use, body fatness and physical activity in children and youth: a meta-analysis

    Int J Obes Relat Metab Disord

    (2004)
  • A Al Mamun et al.

    Do childhood sleeping problems predict obesity in young adulthood? Evidence from a prospective birth cohort study

    Am J Epidemiol

    (2007)
  • RL Atkinson et al.

    Human adenovirus-36 is associated with increased body weight and paradoxical reduction of serum lipids

    Int J Obes (Lond)

    (2005)
  • PJ Turnbaugh et al.

    A core gut microbiome in obese and lean twins

    Nature

    (2009)
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