The harsh reality of severe obesity

A Narrative Review of Medical and Genetic Risk Factors among Children Age 5 and Younger with Severe Obesity

Severe obesity defined as an age- and gender-specific body mass index ≥120% of the 95th percentile in children younger than 5 years is well recognized as a significant challenge for prevention and treatment. This article provides an overview of the prevalence, classification of obesity severity, patterns of weight gain trajectory, medical and genetic risk factors, and comorbid disorders among young children with an emphasis on severe obesity. Studies suggest rapid weight gain trajectory in infancy, maternal smoking, maternal gestational diabetes, and genetic conditions are associated with an increased risk for severe obesity in early childhood. Among populations of young children with severe obesity seeking care, co-morbid conditions such as dyslipidemia and fatty liver disease are present and families report behavioral concerns and developmental delays. Children with severe obesity by age 5 represent a vulnerable population of children at high medical risk and need to be identified early and appropriately managed.

Socioenvironmental, Personal, and Behavioral Correlates of Severe Obesity among an Ethnically/Racially Diverse Sample of US Adolescents

BACKGROUND

Severe obesity among adolescents, also known as class 2 and 3 obesity, is increasing in prevalence, yet, little is known about adolescents with severe obesity. The objective of this study was to identify the socioenvironmental, personal, and behavioral correlates of severe obesity among an ethnically/racially diverse sample of US adolescents.

METHODS

A cross-sectional analysis of data from participants in the EAT 2010 study (n = 2706) was conducted. Adolescents completed in-class surveys, and height and weight were measured. Severe obesity was defined as a BMI ≥120% of the 95th percentile or ≥35 kg/m²; class 1 obesity as a BMI ≥95th percentile but below severe obesity cut points, overweight as a BMI <95th percentile but ≥85th percentile, and normal weight as a BMI <85th but >5th percentile. General linear models were used to identify differences between adolescents by weight status, adjusted for covariates.

RESULTS

Nine percent of adolescents had severe obesity. Compared with peers of other weight statuses, a greater proportion of adolescents with severe obesity reported parental encouragement to diet and peer weight teasing. Adolescents with severe obesity also reported lower self-esteem and body satisfaction. Binge eating was three times as prevalent among adolescents with severe obesity compared with peers of normal weight and twice as prevalent as among peers with class 1 obesity.

CONCLUSIONS

Adolescents with severe obesity report several unique socioenvironmental, personal, and behavioral concerns that may diminish quality of life and may predict increased weight gain over time.

Stability of relative weight category and cardiometabolic risk factors among moderately and severely obese middle school youth

OBJECTIVE

To examine the stability of severe pediatric obesity relative to moderate obesity and associated changes in cardiometabolic risk from the beginning of 6th to the end of 8th grade.

METHODS

Participants in HEALTHY, a multi-site, cluster randomized school-based study designed to mitigate risk for type 2 diabetes, completed standardized assessments of height, weight, glucose, insulin, lipids, and blood pressure at the beginning of 6th grade and the end of 8th grade. Youth were classified as moderately obese (100-119% of the 95th percentile of BMI for age and gender) or severely obese (≥120% of the 95th percentile of BMI for age and gender). Generalized linear mixed models (GLMM) that controlled for relevant covariables were used to examine the relation between baseline demographic and cardiometabolic risk factors and BMI status, as well as changes in relative weight category and risk factors during middle school.

RESULTS

Severe obesity was more likely to endure over the course of middle school than was moderate obesity, and was associated with significantly higher levels of cardiometabolic risk.

CONCLUSIONS

Research with a specific focus on understanding, preventing, and treating severe obesity in children is warranted.

Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy

BACKGROUND

Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents.

METHODS

Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions.

RESULTS

The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively.

CONCLUSION

LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.