Child and Adolescent Obesity by Inge Lissau, Tim J. Cole, and Walter Burniat


6658bfd418c7f81-261x361.jpg Author Inge Lissau, Tim J. Cole, and Walter Burniat
Isbn 9780521652377
File size 2MB
Year 2002
Pages 436
Language English
File format PDF
Category medicine


 

This page intentionally left blank Child and Adolescent Obesity This book addresses the ever-increasing problem of obesity in children and adolescents, the long-term health and social problems that arise from this, and approaches to prevention and management. This comprehensive survey of an important and growing medical problem will help inform, inXuence and educate those charged with tackling this crisis. It covers all aspects of obesity from epidemiology and prevention to recent developments in biochemistry and genetics, and to the varied approaches to management which are inXuenced by social and clinical need. A Foreword by William Dietz and a forward-looking ‘future perspectives’ conclusion by Philip James embrace an international team of authors, all with Wrst-hand experience of the issues posed by obesity in the young. Aimed at doctors, and all health-care professionals, it will be of interest to all those concerned about the increasing prevalence of obesity in children and adolescents. ‘The epidemic of obesity is not yet viewed with the urgency that it demands . . . The questions and challenges that the epidemic provokes provide us with an exciting and unique opportunity to shape a new Weld.’ William H. Dietz From the Foreword MMMM Child and Adolescent Obesity Causes and Consequences, Prevention and Management Edited by Walter Burniat University Hospital for Children ‘Queen Fabiola’, Free University of Brussels Tim J. Cole Institute of Child Health, London Inge Lissau National Institute of Public Health, Copenhagen Elizabeth M. E. Poskitt International Nutrition Group, London School of Hygiene and Tropical Medicine    Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge  , United Kingdom Published in the United States by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521652377 © Cambridge University Press 2002 This book is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2002 ISBN-13 978-0-511-06853-9 eBook (EBL) ISBN-10 0-511-06853-0 eBook (EBL) ISBN-13 978-0-521-65237-7 hardback ISBN-10 0-521-65237-5 hardback Cambridge University Press has no responsibility for the persistence or accuracy of s for external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Contents List of contributors Foreword William H. Dietz Preface xi xv xix Part I Causes 1 1 Measurement and deWnition 3 Tim J. Cole and Marie Franc¸oise Rolland-Cachera 1.1 Introduction 1.2 Natural history of adiposity 1.3 Measurement of body fat 1.4 Adiposity as proxy for later adiposity, morbidity and mortality 1.5 DeWnition of childhood obesity 1.6 Conclusions 1.7 References 2 Epidemiology 3 4 4 14 15 22 22 28 Miche`le Guillaume and Inge Lissau 2.1 Introduction 2.2 Epidemiology and methods 2.3 The scale of the problem 2.4 Conclusions 2.5 References 3 Molecular and biological factors with emphasis on adipose tissue development 28 28 34 44 45 50 Martin Wabitsch 3.1 Introduction 3.2 Regulation of body weight 3.3 Single gene defects 3.4 Regulation of body energy stores at adipose tissue level 3.5 Changes of body fat stores during development v 50 51 52 55 55 vi Contents 3.6 Changes at cellular level related to changes in body fat 3.7 Lipid storage in adipose tissue (lipogenesis) 3.8 Lipid mobilization (lipolysis) 3.9 Preadipocytes in human adipose tissue 3.10 Proliferation and diVerentiation of preadipocytes 3.11 Adipogenic activity of human serum 3.12 Hormonal and nutritional factors regulating adipose diVerentiation 3.13 Human adipocytes are secretory cells 3.14 Conclusions 3.15 References 4 Nutrition 57 58 59 60 60 60 62 65 66 66 69 Marie Franc¸oise Rolland-Cachera and France Bellisle 4.7 References 69 69 74 79 83 85 86 Physical Activity 93 4.1 Introduction 4.2 Secular trends of nutrition and obesity 4.3 Relationship between nutrition and adiposity 4.4 Qualitative assessment of intake behaviour 4.5 Lifestyle 4.6 Conclusions 5 Yves Schutz and Claudio Maffeis 5.1 Introduction 5.2 Energy expenditure assessment 5.3 Energy intake vs. energy expenditure 5.4 Components of total energy expenditure 5.5 Excess energy intake vs. low energy expenditure 5.6 Aerobic capacity (VO2 max) in obesity 5.7 Substrate oxidation and substrate balance 5.8 Conclusions 5.9 References 6 Psychosocial factors 93 93 94 95 98 101 102 104 105 109 Andrew J. Hill and Inge Lissau 6.1 Children’s social background 6.2 Attitudes to obesity 6.3 Children’s self-worth 6.4 Parents and peers 6.5 Conclusions 6.6 References 109 111 115 118 122 123 vii Contents Part II Consequences 129 Clinical features, adverse eVects and outcome 131 7 Karl F.M. Zwiauer, Margherita Caroli, Ewa Malecka-Tendera and Elizabeth M.E. Poskitt 7.1 Clinical Wndings and immediate adverse eVects 7.2 Intermediate medical consequences 7.3 Long-term consequences 7.4 References 8 The obese adolescent 131 142 145 147 154 Marie-Laure Frelut and Carl-Erik Flodmark 8.1 Biophysical factors 8.2 Psychological aspects 8.3 References 9 Prader–Willi and other syndromes 154 160 166 171 Giuseppe Chiumello and Elizabeth M.E. Poskitt 9.1 Introduction 9.2 Endocrine problems 9.3 Prader–Willi syndrome (PWS) 9.4 Other obesity syndromes 9.5 References 10 Hormonal and metabolic changes 171 171 174 180 184 189 Ewa Malecka-Tendera and De´nes Molna´r 10.1 Pituitary-adrenal axis 10.2 Pituitary–gonadal axis 10.3 Pituitary–thyroid axis 10.4 Growth hormone and insulin-like growth factors 10.5 Hyperinsulinaemia and insulin resistance 10.6 Leptin 10.7 References 11 Risk of cardiovascular complications 190 192 194 195 198 203 209 221 David S. Freedman, Sathanur R. Srinivasan and Gerald S. Berenson 11.1 Introduction 11.2 Secular trends 11.3 Associations with risk factors 11.4 Body fat patterning 11.5 Longitudinal analyses 11.6 Conclusions 11.7 References 221 223 224 230 234 235 235 viii Contents Part III Prevention and management 241 12 Prevention 243 Inge Lissau, Walter Burniat, Elizabeth M.E. Poskitt and Tim J. Cole 12.1 Prevention before management 12.2 Why prevention? 12.3 Prevention strategy 12.4 Responsibilities for prevention 12.5 Reduce sedentary activity 12.6 Reduce poor dietary habits 12.7 Prevention programmes 12.8 Monitoring and evaluation 12.9 Conclusions 12.10 References 13 Home-based management 243 243 245 248 252 257 263 264 264 265 270 Elizabeth M.E. Poskitt 13.1 Introduction 13.2 Principles of modifying lifestyles to encourage slimming in obese children 13.3 What can be recommended? 13.4 Eating and diet 13.5 Conclusions 13.6 References 14 Dietary management 270 273 275 277 280 280 282 Margherita Caroli and Walter Burniat 14.1 Introduction 14.2 History of dietary therapy 14.3 Aims of dietary treatment 14.4 Types of diet 14.5 Consequences of dieting 14.6 Guidelines for weight goals and dietetic treatments 14.7 Conclusions 14.8 References 15 Management through activity 282 282 283 284 290 299 301 302 307 Jana Parizkova, Claudio Maffeis and Elizabeth M.E. Poskitt 15.1 Introduction 15.2 Aims of the programmes 15.3 EYcacy of exercise in lowering fat mass 15.4 General principles 307 308 310 313 ix Contents 15.5 Physical activity and exercise programmes 15.6 How to improve compliance 15.7 The role of the family 15.8 Conclusions 15.9 References 16 Psychotherapy 314 320 321 322 323 327 Carl-Erik Flodmark and Inge Lissau 16.1 Obesity – a disease put into perspective 16.2 The treatment of obesity 16.3 Conclusions 16.4 References 17 Drug therapy 327 328 340 341 345 De´nes Molna´r and Ewa Malecka-Tendera 17.5 References 345 348 349 350 352 Surgical treatment 355 17.1 Appetite suppressants 17.2 Thermogenic agents 17.3 Digestive inhibitors 17.4 Hormone analogues and antagonists 18 Alessandro Salvatoni 18.1 Introduction 18.2 Surgical techniques and their complications 18.3 Bariatric surgery in adolescence 18.4 Conclusions 18.5 References 19 Interdisciplinary outpatient management 355 355 357 358 358 361 Beatrice Bauer and Claudio Maffeis 19.1. Goal and general philosophy 19.2 Multifaceted treatment programmes 19.3 Organizing team work 19.4 Acknowledgements 19.5 References 20 Interdisciplinary residential management 361 364 370 374 374 377 Marie-Laure Frelut 20.1 Historical background and implementation 20.2 A comprehensive approach 20.3 Results and outcome 377 378 385 x Contents 20.4 Conclusions 20.5 References 21 The future 386 386 389 W. Philip T. James 21.1 Introduction 21.2 Assessment of childhood obesity 21.3 Ethnic diVerences in children’s anthropometry 21.4 The Thrifty Genotype 21.5 The prevalence of childhood obesity 21.6 Weaning practices and early eating habits 21.7 The ‘obesogenic’ environment 21.8 Can policy initiatives work? 21.9 Devising and implementing new policies 21.10 References Index 389 389 391 393 394 395 396 397 399 401 403 Contributors Beatrice Bauer Centre for Eating Disorders (DIDASCO), via C. Abba 17, 37126 Verona, Italy. E-mail: [email protected] Giuseppe Chiumello Clinica Paediatrica III, Universita degli Studi di Milano, Via Olgettina 60, 20132 Milano, Italy. E-mail: [email protected] France Bellisle Hotel Dieu – Unite´ Inserm 341, Place du Parvis Notre Dame, 1, 75181 Paris Cedex 04, France. E-mail: [email protected] Tim J. Cole Department of Paediatric Epidemiology & Biostatistics, Institute of Child Health, London WC1N 1EH, UK. E-mail: [email protected] Gerald S. Berenson Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2140, New Orleans LA 70112-2715 USA. E-mail: [email protected] William H. Dietz Division of Nutrition and Physical Activity, Center for Disease Control and Prevention, 4770 Buford Hwy NE Mailstop K-24, Atlanta GA 30341 USA, E-mail: [email protected] Walter Burniat Department of Pediatrics, University Hospital for Children ‘Reine Fabiola’, Free University of Brussels, Av. J.J. Crocq, 15, 1020 Brussels, Belgium. E-mail: [email protected] Margherita Caroli Nutrition Unit, Department of Prevention AUSL BR1 (Brindisi) Italy. E-mail: [email protected] xi Carl-Erik Flodmark Department of Paediatrics, University Hospital in Malmo¨, Sweden. E-mail: [email protected] David S. Freedman Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, CDC Mailstop K-26, 4770 Buford Highway, Atlanta GA 30341-3724, USA. E-mail: [email protected] xii List of contributors Marie-Laure Frelut Robert Debre´ University Hospital Paris and Centre The´rapeutique Pe´diatrique 95580 Margency, France. E-mail: [email protected] De´nes Molna´r Department of Paediatrics, Medical Faculty, University of Pe´cs, Jo´zsef A. u.7, 7623 Pe´cs, Hungary. E-mail: [email protected] Miche`le Guillaume Department of Preventive Medicine, Province of Luxembourg, Chausse´e d’HouValize, 1 bis, 6600 Bastogne, Belgium. E-mail: [email protected] luxembourg.be Jana Parizkova Centre for the Management of Obesity, 3rd. Med. Dept., U Nemocnice 2, Prague 2, 12806 Czech Republic. E-mail: [email protected] Andrew J. Hill Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, Leeds LS2 9LT, UK. E-Mail: [email protected] Elizabeth M.E. Poskitt International Nutrition Group, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, UK. E-mail: [email protected] W. Philip T. James International Obesity TaskForce, 231–3 North Gower Street, London NW1 2NS, UK. E-Mail: [email protected] Marie Franc¸oise Rolland-Cachera Institut ScientiWque et Technique de la Nutrition et de l’Alimentation (ISTNA) – Conservatoire National des Arts et Me´tiers (CNAM) 2 rue Conte´, 75003 Paris, France. E-mail: [email protected] Inge Lissau National Institute of Public Health, 25 Svanemøllervej, 2100 Copenhagen OE, Denmark. E-mail: [email protected] Alessandro Salvatoni Paediatric Department, University of Insubria, Via F. del Ponte, 19, 21100 Varese, Italy. E-mail: [email protected] Claudio MaVeis Department of Paediatrics, University Hospital, Largo AL Scuro 34, Verona, Italy. E-mail: [email protected] Yves Schutz Institute of Physiology, University of Lausanne, Lausanne, Switzerland. E-mail: [email protected] Ewa Malecka-Tendera Department of Pathophysiology, Silesian School of Medicine, Medykow 18, 40 752 Katowice, Poland. E-mail: [email protected] Sathanur R. Srinivasan Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2140, New Orleans LA 70112-2715 USA. E-mail: [email protected] xiii List of contributors Martin Wabitsch Department of Paediatrics, University of Ulm, Prittwitzstr. 43, D-89075 Ulm, Germany. E-mail: [email protected] Karl F.M. Zwiauer Department of Paediatrics, General Hospital Saint Poelten, A-3100 Saint Poelten, Propst-Fuehrer Str. 4 – Austria. E-mail: [email protected] MMMM Foreword Childhood obesity has now become the most prevalent nutritional disease in developed countries. For example, the prevalence of obesity, deWned as a body mass index (BMI) equal to or above the 95th centile for children of the same age and sex, now aVects 10–15% of children and adolescents in the United States (Flegal et al., 1998). When the prevalence of obesity in the United States is compared across nationally representative surveys conducted over the last 30 years, the most rapid increases in prevalence occurred between 1980 and 1994. The greatest increases in body weight have occurred in children and adolescents in the upper half of the BMI distribution (Troiano & Flegal, 1998). Stated another way, the mean BMI for children of the same age and sex has increased more than the median. These observations suggest at least two possibilities. They may suggest that the genes that predispose to obesity occur in approximately 50% of the population. Alternatively, these observations suggest that the factors that inXuence the development of obesity are discrete, and act only on half of the population. Elsewhere in the world, obesity is also increasing rapidly. Nevertheless, the world-wide prevalence of obesity is generally lower than the prevalence observed among children and adolescents in the United States. The factors that account for the rapid changes in prevalence remain unclear. The rapidity of the changes in prevalence clearly excludes a genetic basis for the changes, because the gene pool remained unchanged between 1980 and 1994. Because obesity can only result from an imbalance of energy intake and expenditure, it may be useful to review the changes in diet and activity that occurred synchronously with the changes in prevalence. It should be clear throughout this discussion that no data yet exist that link obesity to any of the following behaviours. Nevertheless, these behavioural shifts oVer reasonable and testable hypotheses. For example, in the 1970s, the advent of the microwave oven made it possible for children to select and prepare their own meals without parental oversight. Likewise, substantial increases have occurred in food consumption outside the home. Currently, 35% of a family’s food expenditure in the United States is spent xv xvi Foreword on food consumed outside the home. Between 7% and 12% of children and adolescents skip breakfast. Few children consume a dietary pattern consistent with the food guide pyramid. The consumption of soft drinks has almost doubled in the last 15 years. Over 12 000 new food products are introduced annually in the United States. All of these dietary factors may increase the diYculty associated with the establishment and maintenance of a healthy body weight. Activity deserves equal attention. Marked declines in vigorous physical activity occur in adolescent girls, at a time when susceptibility to obesity is heightened (Heath et al., 1994). In the United States, the number of schools that oVer daily physical education has declined by almost 30% over the past decade. In addition, the percentage of children who watch Wve or more hours of television daily has increased to 30%. Increased numbers of working mothers and a perceived lack of neighbourhood safety may contribute further to increased levels of inactivity. Until quite recently, obesity in children was viewed as a cosmetic problem. The major risks associated with obesity in children and adolescents were those consequences that resulted when obesity persisted into adulthood. However, more recent experience indicates that signiWcant health risks are associated with obesity in childhood. For example, we have recently shown that 65% of overweight 5- to 10-year-olds have at least one cardiovascular disease risk factor, such as elevated blood pressure or lipid levels, and 25% have two or more risk factors (Freedman et al., 1999). Furthermore, type II diabetes mellitus now accounts for up to 30% of new diabetes cases in some paediatric clinics, and up to 3% of some paediatric populations, such as Native Americans, now suVer from this problem. The overwhelming majority of type II paediatric diabetic cases occur in obese patients. To summarize, obesity is prevalent, it appears to be increasing and signiWcant eVects are demonstrable in childhood. EVective treatment of aVected children, and prevention of obesity in children who are susceptible must become a priority. The challenge is how to accomplish both goals. Care for mildly to moderately overweight patients will require the service of primary care practitioners, and guidelines now exist to enhance these services (Barlow & Dietz, 1998). EVective treatment for severely obese children is essential and will probably require care in speciality clinics. However, eVective prevention of obesity in nonoverweight children may also help reduce body weight in children who are already overweight. As with nutritional deWciency diseases, where the addition of iodine to salt reduces goitre, or the addition of Xuoride to water reduces dental decay, environmental modiWcation may represent the most durable, eVective and cheapest intervention. Nevertheless, until the causes of obesity are better understood, the target of the environmental dietary intervention must be based on logic rather than science. In contrast to dietary interventions, eVorts that increase physical activity or xvii Foreword reduce inactivity appear warranted. Although we lack data to demonstrate that such measures eVectively reduce the incidence of obesity in the population, increased physical activity has demonstrated beneWt for the comorbidities of obesity, such as hypertension, diabetes and hyperlipidaemia. Prevention presents additional challenges. The epidemic of obesity is not yet viewed with the urgency that it demands. Paediatricians are poorly equipped to treat obesity, and methods that help primary-care providers target speciWc behaviours, like computer-based interactive questionnaires, are still in a developmental phase. EVective means to maintain weight in those who are gaining weight too rapidly or to reduce weight in those who are overweight must be established. Finally, the environmental infrastructure necessary to promote physical activity in the many settings that aVect children must be developed and evaluated. Rarely have we had the opportunity to observe an epidemic of chronic disease occur before our eyes. The questions and challenges that the epidemic provokes provide us with an exciting and unique opportunity to shape a new Weld. As Winston Churchill once said: Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning. RE F E R E N C E S Barlow, S.E. & Dietz, W.H. (1998). Obesity evaluation and treatment: expert committee recommendations. Pediatrics, 102, e29. Flegal, K.M., Carroll, M.D., Kuczmarski, R.J. & Johnson, C.L. (1998). Overweight and obesity in the United States: prevalence and trends, 1960–1994. International Journal of Obesity, 22, 39–47. Freedman, D.S., Dietz, W.H., Srinivasan, S.R. & Berenson, G.S. (1999). The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics, 103, 1175–82. Heath, G.W., Pratt, M., Warren, C.W. & Kann, L. (1994). Physical activity patterns in American high school students: results from the 1990 Youth Risk Behavior Survey. Archives of Pediatric and Adolescent Medicine, 148, 1131–6. Troiano, R.P. & Flegal, K.M. (1998). Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics, 101, 497–504. William H. Dietz MMMM

Author Inge Lissau, Tim J. Cole, and Walter Burniat Isbn 9780521652377 File size 2MB Year 2002 Pages 436 Language English File format PDF Category Medicine Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare This book addresses the ever-increasing problem of obesity in children and adolescents, the long-term health and social problems that arise from this, and approaches to prevention and management. It covers all aspects of obesity from epidemiology and prevention to recent developments in biochemistry and genetics, and to the varied approaches to management which are influenced by social and clinical need. A foreword by William Dietz and a forward looking “future perspectives” conclusion by Philip James embrace an international team of authors, all with first hand experience of the issues posed by obesity in the young.     Download (2MB) Global Dimensions of Childhood Obesity Handbook of Pediatric Obesity: Clinical Management Handbook of Pediatric and Adolescent Obesity Treatment Childhood Obesity: Contemporary Issues Clinical Obesity in Adults and Children Load more posts

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