Research Paper on Pediatric Obesity: Causes, Symptoms, Prevention and Treatment

Abstract

Pediatric or childhood obesity is the most prevalent nutritional disorder among children and adolescents worldwide. Approximately 43 million individuals are obese, 21-24% children and adolescents are overweight, and 16-18% of individuals have abdominal obesity. The prevalence of obesity is highest among specific ethnic groups. Obesity increases the risk of heart diseases in children and adults. Childhood obesity predisposes the individual to insulin resistance and type 2 diabetes, hypertension, hyperlipidemia, liver and kidney diseases and causes reproductive dysfunction in adults. Obesity in children is a major health concern of the developed world. The National Health and Nutrition Examination Survey has reported that the prevalence of obesity is on the increase in all the pediatric age groups, in males and females, and in various ethnic and racial groups. Factors, such as eating habits, genetics, environment, metabolism, and lifestyle play an important role in the development of obesity. Over 90% of obesity cases are idiopathic and less than 10% are associated with genetic and hormonal causes. Obesity occurs when the body consumes more calories than it burns, through overeating and underexercising. The symptoms of obesity include breathing disorders, sleep apnea, chronic obstructive pulmonary disease, certain types of cancer such as prostate, bowel, breast and uterine, coronary heart disease, diabetes (type 2 in children), depression, liver and gallbladder problems, gastro-esophageal reflux disease, high blood pressure, high cholesterol, stroke, and joint diseases such as osteoarthritis, pain in knees and lower back. Environmental, behavioral such as consumption of convenience foods, genetic, and family factors contribute to pediatric obesity. Obesity can be countered through lower calorie consumption, weight loss and diet programs, as well as increased physical activity. A number of endogenous molecules including leptin, hypothalamic melanocortin 4 receptor, and mitochondrial uncoupling proteins, are known to affect body weight. These molecules serve as potential targets for the pharmacological manipulation of obesity. Sibutramine and orlistat are primariliy used for the treatment of adult obesity, which produces modest weight loss, of 3-8% compared to placebo. For children and obese adolescents, metformin is used in the case of insulin resistance and hyperinsulinemia. Octreotide is used for hypothalamic obesity. Bariatric surgery is performed for the treatment of severe childhood obesity. The causes, symptoms, prevention and treatment of pediatric obesity are described in the present review.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Introduction

Pediatric or childhood obesity is a growing global epidemic that requires attention due to the burden placed on the healthcare system for children and adults (1). Consumption of fatty foods and a high sugar diet, as well as tobacco smoking, and no exercise qualify as the main reasons for obesity among children and adults. Obesity affects 34% of children in the USA, and is considered a top public health concern due to the high level of morbidity and mortality. Medical costs for obesity care have escalated, which accounted for 40% of the healthcare budget in 2006, with billions of dollars being spent on health care annually (1). For the pediatric health care delivery system, expenses were $179 per year higher in obese children versus children with a normal body mass index (BMI) (?). Pediatric obesity affects all the organs in the body and has an increasing prevalence in young diabetic children. Childhood obesity is connected with an increased risk of various diseases such as diabetes, cardiovascular, stroke, certain types of cancer later in life, social problems and depression among youth (2). As an increasing number of children are becoming overweight, health professionals need to search for effective methods for the prevention and treatment of obesity. In the past 30 years, pediatric obesity has more than doubled in children and tripled in adolescents worldwide (3). Among children aged 6-11 years, the rate of obesity has increased from 7% in 1980 to 18% in 2010. This trend was observed among teenagers aged 12-19 years where the rate of obesity increased from 5 to 18% during the same period of time. Obesity may be defined as having excess body fat and can be determined by the BMI percentage using a growth chart (3). Individuals with an 85-95% BMI are classified as overweight and those with 95% BMI are classified as obese. Growth charts can be used to monitor growth over time. These charts are divided by percentile curves to demonstrate the distribution of body measurements. The growth charts are provided by the Centers for Disease Control and Prevention and can be used for obesity.

Causes of Childhood Obesity

Obesity occurs when the body consumes more calories than it burns through overeating and underexercising. Childhood obesity is caused by excessive food consumption and drinking of high-calorie sweetened beverages, no exercise or physical activity, as well as genetic factors. The body weight is regulated by various physiological mechanisms that maintain the balance between energy intake and energy expenditure. These regulatory systems under normal conditions, e.g., a positive energy balance of only 500 kJ (120 kcal) per day (approximately one serving of sugar-sweetened soft drink) would produce a 50 kg increase in body mass over 10 years. Therefore, factors that can raise energy intake or decrease energy expenditure cause obesity in the long term. Genetic factors have a significant impact on individual predisposition, but other factors of behavior and environment may also play a role in childhood obesity.

Symptoms and Complications of Obesity

Symptoms and complications of obesity as well as health risks include, breathing disorder such as sleep apnea and chronic obstructive pulmonary disease, and certain types of cancer such as prostate, bowel in men, breast and uterine cancer in women, coronary heart disease, diabetes (type 2 in children), depression, liver and gall bladder problems, gastro-esophageal reflux disease, high blood pressure, high cholesterol, stroke, and diseases of joints such as osteoarthritis, pain in knees and lower back (4). Obese individuals are likely to have more medical and health problems. Additionally, they are likely to have an accumulation of abdominal fat.

Genetic, Behavioral and Environmental Factors of Obesity

A number of factors contribute to pediatric or childhood obesity. These can be divided into genetic, behavioral and environmental factors. Genetic factors stem from the genes of parents, frequently leading to children becoming overweight (5). Behavioral factors include food consumption and drinking of high-calorie sugar-sweetened beverages that are of low nutritional value, which are readily available for children. Consumption of the latter in particular has been associated with obesity (5).

Lack of physical activity also contributes to obesity. Children spend a large amount of time using technology such as cell phones, television, computers or video games. On average, children of 8-18 years spend 7.5 h per day using these gadgets and do not participate in physical activities and active play (5). Concerning environmental factors, the home, school, and community environments all play an important role in a child's development and maintenance of a healthy diet and involvement in physical activity. The majority of young children are enrolled in schools providing an optimum environment whose aim is to reinforce healthy eating and physical activity behaviors. When not in school, experiences in a child care or home setting continue to shape dietary and physical activity behaviors. Another crucial factor is the communities in which children reside as they provide opportunities for physical activity and access to affordable and healthy foods.

Obese children are more likely to become overweight in adulthood than healthy-weight children. This increase in weight constitutes a health risk later in life when, as adults, they present with problems such as heart disease, diabetes (type 2), stroke, various types of cancer and osteoarthritis (5). In addition, obese children are more likely to have cardiovascular risk factors such as high cholesterol or high blood pressure, and are more likely to have pre-diabetes, which places them at a high risk for developing diabetes later in life (5). Thus maintaining a healthy diet and involvement in physical activity are important for preventing obesity and other diseases.

The dietary and physical activity behaviors of children and adolescents are affected by communities, schools, child care settings, faith-based institutions, government agencies, families, the media, as well as the food and beverage industries. the impact of the last factor led to the US Better Business Bureau established the Children's Food and Beverage Advertising Initiative (5). This initiative is a voluntary self-regulated program that includes many of the largest food and beverage companies in the USA. The purpose of this initiative is to encourage the choice of following a healthy diet and healthy lifestyle among children by shifting the types of food and beverages advertised to children under the age of 12 years. Schools play an important role in establishing an environment that supports healthy lifestyle habits. Policies within schools can be established to encourage healthy eating and regular physical activity for children. Schools have the opportunity to both educate students about these behaviors and provide an opportunity for the practice thereof. In an effort to increase the number of fruits and vegetables served in schools, programs such as 'Let's Move Salad Bars to Schools and the National Farm to School Network' have been introduced (6). In response to the childhood obesity epidemic, the 'Let's Move Salad Bars to Schools' campaign was established by Michelle Obama, the First Lady of the USA (6). The treatment for childhood obesity depends on the age of the child and existing medical conditions.

Treatments for obesity include changes to the diet and level of physical activity of the child. The purpose of the treatment for obesity involves weight maintenance as opposed to weight loss. The growth of children primarily is measured as height, and not weight, leading to a decrease of BMI per age point, into a healthier range. However, in the case of obesity, depending on the health conditions of children, treatment may involve a multidisciplinary team including the family physician, dietitian, counselor or physical therapist. Specific plans for diet and physical activity have been developed where general guidance is ineffective. In most cases, a low-calorie diet and weight loss drugs may be administered to control individuals becoming overweight or exhibiting abdominal obesity.

A review on childhood obesity by Pulgaron has focused on the increased risk for physical and psychological comorbidities (4). Approximately 43 million children worldwide are estimated to be encountering a problem of obesity, and this number is on the increase. An initial search of the terms obesity and comorbidity yielded >5,000 published articles. The limits were set to include studies on children and adolescents that were published in journals between 2002 and 2012. These limits narrowed the search to 938 articles, 79 of...