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CHAPTER 1: Epidemiology & Prevention Across Europe
Although there are several different methods and approaches to the measurement of obesity and overweight in children, all the available surveys have one particular feature: they show a substantial and rapid increase in the numbers of children affected, in most regions of the world. In more developed economies child obesity prevalence levels have doubled and in some cases trebled in the period from the late 1970s to the end of the century [1] and is highest among lower income households and some minority ethnic groups. In less developed economies child obesity levels have also risen rapidly, especially since the 1990s, and especially in urban areas and among children in better-off households [2]….
The prevalence of obesity in children is increasing in most regions of the world1, 2, 3, 4. Recent data indicate that this trend has levelled off in some developed countries like the US, Australia, and some European countries5, 6, 7, 8, 9, but the level is still too high. As the causal pathway leading to obesity already starts early in life it is important to understand the causes and mechanisms leading to this disorder and to find a way for effective primary prevention interventions in young children….
Childhood obesity continues to be a major challenge for almost all countries in the European Region. The statistics are disturbing, with rising rates of overweight and obesity reported in many countries of the Region during the past few decades 1. Where trends have recently started to flatten out, it is at very high rates with a strong social gradient. The World Health Assembly recently adopted a global target for all countries to renew their efforts…
CHAPTER 2: Society, Communication, Environment & Obesity
The concept of mass media refers collectively to all media technologies, which are used for mass communication as well as to all social organisations which control these technologies. Mass-media technologies may be divided into two major groups: traditional media: newspapers, books, magazines and radio, television which are characterised as providing one-way transmission of messages from sender to audience…
Until recently, obesity research has mainly focused on biological and behavioral factors. However, there is growing agreement among researchers that the social and physical environment may play an important role as well. Certain aspects of the environment may promote or discourage physical activity and therefore have an influence on children’s body weight. The purpose of this chapter is to give an overview…
The WHO Action Plan on the Prevention and Control of Non-Communicable Diseases (NCDs) for 2013-2020 recognizes that legal instruments have a role to play in reaching the 2025 voluntary targets Member States have unanimously endorsed, including the halt in the rise of childhood obesity and Type II diabetes. Even though it does not detail how the law could come into play, it nonetheless identifies a range of areas…
Childhood obesity is currently one of the biggest burdens of our society, not only in the West, but worldwide. According to a 2014 study, roughly 110 million children in the world can be considered as obese and a further 200 million as overweight [1]. These depressing figures cannot be ignored and they call for immediate actions by governments to find appropriate solutions…
CHAPTER 3: Growth Charts & Body Composition
The definition of obesity in children was originally based on the definition used for undernutrition. Weight-for-age and weight-for-height indices are still recommended to define overweight in children. The use of skinfold and circumferences is also recommended. For many reasons, the use of the body mass index (BMI) is increasing. It is based on weight and height which are easily available and reliable measurements…
Childhood overweight and obesity are major public health problems worldwide (1,2). Traditionally, a heavy child meant a healthy child, and the concept “bigger is better” was widely accepted. Today, this perception has drastically changed based on evidence that overweight and obesity in childhood are associated with a wide range of serious health complications and increased risk of premature illness and death later in life…
CHAPTER 4: Biology
Adipocytes are characterized by the abundance of cytoplasmic lipid droplets (1). White adipocytes show a unique large spherical lipid droplet (unilocular adipocytes) that predominate its general morphology FIG 1. In fact a thin rim of cytoplasm surrounding the lipid droplet and including a crescent shaped nucleus forms the rest of the cell. Thus, the size of the cell is tightly related to the size of the lipid droplet….
Central and autonomic nervous systems are involved in the regulation of whole body energy by regulating its different components: intake, expenditure and storage. The different functions (metabolic, secretory, plasticity) of adipose tissues are indeed deeply controlled by the autonomic nervous system. In most mammals, two types of adipose tissue, white and brown, are present. Both are able to store energy in the form of triacylglycerols…
Human intestine is a complex ecosystem maintained by interactions of numerous species of microbiota, human organism and the ingested substrates. It’s estimated that number of bacterial cells colonizing human intestine exceeds the number of human cells in the rest of the body. Between 10 to 100 trillion of bacteria existing inside the intestine belong to 10 phyla and at least 15000 recognized species….
There is increasing interest in non-genetic and non-cultural mechanisms transferring a memory of parental exposure to various environments and determining the reactivity of subsequent generations to their environment during their lifetimes. However, fundamental questions remain about the nature, roles and relative importance of epigenetic marks and processes, non-coding RNAs, or other mechanisms, and their persistence over generations…
During the last decades there has been a dramatic increase in obesity world-wide. There are several reasons for such an increase, including diet and lifestyle. Recently toxicological and epidemiological evidence pointed to a likely contribution of environmental pollutants which has led to the obesogen concept. Perinatal exposure to several endocrine disruptors leads to increased body weight later in life as well as to several metabolic disorders…
Childhood obesity is increasing at epidemic proportions and is a massive public health concern. Obesity is associated with chronic inflammation and alteration in immune responses. This chronic low grade sterile or “cold” inflammation has been proposed to underpin the development of obesity related co-morbidites including insulin resistance, type 2 diabetes mellitus and cardiovascular disease.
There is growing interest in the role of early experience in the aetiology of obesity. In particular, prenatal life may be of importance as a ‘critical period’ when the risk of development and persistence of overweight and obesity is increased. At present developmental influences on obesity in humans are poorly understood, although there is increasing evidence of links between prenatal factors and adiposity in childhood…
CHAPTER 5: Nutrition, Food Choices & Eating Behavior
Eating behavior is a complex, essentially learned activity critical for development and survival. It can be broken down into several components: when, how, what and how much to eat. We will mainly describe in this chapter the important periods and factors associated with the development of “what” to eat, or in other words, food preferences and choice. Other aspects relevant to the early development…
Nutritional sciences have found a new perspective of nutrition in recent years when it became clear that nutritional deficiencies may have long-term consequences even if treated and corrected in later life. Critical life periods were identified- like infancy and early childhood or the prenatal period where nutrition plays a special role producing a so called programming effect- long-term metabolic…
In recent years many studies have correlated the nutrition of the first one thousand days of life to the development of non-communicable diseases and in particular to the development of obesity (1-4). This hypothesis therefore radically shifts the goals of dietary recommendations for six months old infants from promoting growth in the short term within the limits of the reference curves and preventing any nutritional deficiency…
The identification of risk factors is the key to prevention, however, until recently evidence on risk factors for childhood obesity was limited. The first studies were mainly cross sectional, and failed to identify associations between the child behaviour and the constitution of obesity. More recently, awareness is increasing for the importance of the environment in early life. The early adiposity rebound recorded in most obese subjects…
Understanding the links between taste perception and obesity would help authorities cope with obesity, which diminishes the health of human populations. This has been highlighted by a study of the impact of programs intended to educate obese adolescents about healthy diets (Pasquet et al., 2007)1. We present and discuss the results of this study in this chapter…
Subjective experience of appetite and learnt preferences for foods are important determinants of food choice and intake in children impacting upon what is eaten, how much and when. All of these drive consumption and potentially lead to excessive energy intake. While the operation of appetite can be considered asymmetrical, in that it defends against energy deficit rather than energy excess…
Binge eating is the most common type of disordered eating behavior among obese children and adolescents. Because of its association with elevated levels of psychosocial distress, the experience of binge eating adds to the burden caused by obesity. In the current chapter, an overview will be provided of the conceptualization, prevalence, development and course of binge eating in obese youth….
CHAPTER 6: Psychological Assesment & Disturbances
Research demonstrated that the eating behaviour of obese individuals consists of a wide variety of patterns like eating caloric rich food to compensate for negative feelings, vomiting after overeating, eating at night, restrained eating, meal skipping. It may be difficult to grasp and treat these eating behaviours specifically when they are related to psychological factors…
The Ecological Systems Theory is an interesting framework that captures the multicausal interaction of hereditary, environmental and child characteristics that place a child at risk for overweight. This theory serves as a guideline for the multidisciplinary assessment of obesity in childhood and for the treatment. The benefits of a multidisciplinary approach focusing on healthy eating habits, moderate exercise and cognitive-behavioural…
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)1, Attention-Deficit/Hyperactivity Disorder (ADHD) is defined by persistent, age inappropriate and impairing levels of inattention and/or hyperactivity-impulsivity. DSM-5 defines four presentations of ADHD: “predominantly inattentive”, “predominantly hyperactive-impulsive”, “combined”, and “not otherwise specified”…
Overweight and obesity have become a global health problem both in low and middle income countries and high income countries affecting all socioeconomic and age groups. Given the severe consequences on both physical and psychosocial health, prevention of overweight/obesity in children and adolescents is warranted. Several health behaviour models and frameworks..
CHAPTER 7: Clinics & Complications
The leptin/melanocortin pathway plays a key role in the hypothalamic control of food intake. It is activated following the systemic release of the adipokine leptin (LEP) and its subsequent interaction with the leptin receptor (LEPR) located on the surface of neurons of the arcuate nucleus region in the hypothalamus (figure 1). The downstream signals that regulate satiety and energy homeostasis are then propagated..
The leptin/melanocortin pathway plays a key role in the hypothalamic control of food intake. It is activated following the systemic release of the adipokine leptin (LEP) and its subsequent interaction with the leptin receptor (LEPR) located on the surface of neurons of the arcuate nucleus region in the hypothalamus…
Half of the population has by definition a size below average, 25 % below the 25th centile of reference growth curves and 3 % below the third centile. The 25th centile or – 2 standard deviations (SD) in height is a commonly accepted definition of short stature. Major differences in height are noticeable among populations around the world making the choice of the reference curves critical (see corresponding chapter)…
Postnatal linear growth is controlled by genetic, endocrine and nutrition factors. Although adequate nutrition is essential for normal growth of the child, excessive fat tissue accumulation may cause abnormalities in the trajectory of linear growth. Obesity in children and adolescents has been long associated with tall stature. First studies presenting the hypothesis that overnutrition accelerates linear growth were published in 1960s…
In order to develop normally, children spend long hours of the day sleeping, around 12-13 hours/day for pre-schoolers (age 3-5 years), 10-11 hours/day for school-aged (age 5-10 years) and 8-10 hours/day for adolescents (age 14-16 years). Although all the functions of sleep remain unfully understood, sleep is vital for restoration of body systems, energy conservation, brain development and memory consolidation…
Insulin resistance (IR) is one of the most common metabolic alterations related to obesity, representing a key element of metabolic syndrome. Mechanisms linking obesity to IR and diabetes are multiple, sharing several molecular and genetic bases. Both obesity and type 2 diabetes are associated with insulin resistance, but fortunately, most obese, insulin-resistant individuals do not develop hyperglycemia…
Cardiovascular diseases (CVD) develop slowly over the life since fetal life and they are considered the main cause of death worldwide. In 2010 the American Heart Association defined a new concept of ideal cardiovascular health as the presence of both, ideal health behaviours (non-smoking, ideal BMI, physical activity and healthy diet) and ideal health factors (total cholesterol concentration, blood pressure and fasting glucose within the normal range)…
Non alcoholic fatty liver disease (NAFLD) is nowadays one of the leading causes of chronic liver disease in children (1). It is defined by hepatic fat infiltration >5% hepatocytes, as assessed by liver biopsy, in the absence of excessive alcohol intake…
Obesity occurs when energy intake exceeds energy expenditure. Energy balance, hunger and satiety are regulated by neurotransmitters synthezised by the brain, into the region called the hypothalamus…
Obesity is defined as an excess fat mass. Its occurrence requires that food intakes exceed energy expenditure. Nutritional status of the obese child and adolescent seem a paradoxical question which needs to be raised for at least four reasons…
Neuroregulation of weight control and pubertal initiation are interrelated. We will examine the factors that regulate appetite and satiety, as well as energy homeostasis and we will elaborate on the influence that these factors exert on the hypothalamo-pituitary-gonadal (HPG) axis system. Leptin plays a key role in this regulation…
The objective of this paper is the presentation of obesity-related musculoskeletal problems in childhood while a) focusing on the prevention of anticipated discomforts in adulthood and b) providing information on how best to address such complications in children who are obese. One of the most common problems found in young people is, in particular, the strain on the lower extremities…
The origins, and metabolic and physical outcomes of early onset of obesity are largely described in previous chapters. This section focuses on the oral cavity of children who are overweight or obese. Epidemiological and case-control studies have determined orofacial features specific to children of this population…
CHAPTER 8: Energy Expenditure & Physical Activity
Obesity often results from an imbalance between energy intake and energy expenditure. Daily energy intake can be determined both quantitatively and qualitatively. By contrast, estimation of daily energy expenditure in free-living conditions requires qualified personnel and sophisticated technical methods. Daily energy expenditure (EE) can be distributed between a number of interdependent factors…
It can be understood from the literature that physical activity during childhood is imperative in order to ensure normal health and development. Increasing play, activity and fitness are key elements in the treatment and prevention of childhood obesity. TO promote successful treatment of obesity and it is crucial that physical and psychosocial limitations to moving be addressed…
Obese children and adolescents usually have lower overall physical abilities and especially lower cardiorespiratory fitness (CRF) when compared to their normal-weight peers. This is mainly because of the increased effort required to move their larger body mass and carry an excessive amount of body fat. It is only among extremely obese children that the lower CRF can partly result from impaired lung function…
Childhood obesity and its related metabolic complications are associated with insufficient physical activity, excessive sedentary time, unhealthy eating behaviors, these factors all constituting an unhealthy lifestyle. Primary prevention programs, often based on interventions in schools, promote the positive effects of physical activity and healthy eating behaviors. These interventions targeting the general population…
CHAPTER 9: Treatment
Dietetics is an important part of the therapeutic approach in pediatric obesity. In this section, we shall first study the general principles of the dietary approach. We will then present more concrete points for usual practice….
While child and adolescent obesity prevalence are worsening in many countries around the world or tend to stabilize at high levels, therapeutic approach in Europe remains limited to either…
Children and adolescents today show “the same aversion to overweight children and adolescents” as was found in a 1961 study. Adolescents are especially at risk for forming these negative opinions during puberty. During this time, high emotional instability leads to vulnerability in personal, sexual, and social development…