ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Int J Obes (2005) 2018; 42(11):1834–1844

This paper presents the results of a multidisciplinary expert workshop to identify current knowledge and more importantly current gaps in knowledge on the epidemiological and biopsychosocial determinants of obesity and its optimal treatment approaches.

Childhood obesity is a global medical and public health threat with high prevalence rates leading to numerous health problems and comorbidities (1). While in many countries there is a plateauing in the rise of obesity rates (2, 3), a continuous rise in the rate of extreme obesity can still be noted (4). This is of special concern as extreme obesity is an intractable disease (5) associated with multiple comorbidities (6, 7).

In line with the current Endocrine Society guidelines (2), the authors recommend lifestyle intervention as the primary therapy, even though most studies showed limited or no success for most adolescents with extreme obesity (8). Concerning pharmacotherapy and weight-reducing devices, the authors point out the limited data in the pediatric population especially concerning long-term safety and efficacy. Even for bariatric surgery, which has been studied in well-designed studies in this population and is by far most effective treatment with an average weight loss of 30% (9, 10), very-long-term data are still scarce. In addition, although responses to most weight loss interventions are overall small, they vary widely between individuals.

Therefore the authors call for a standardization of measures of obesity and treatment outcomes to make (intervention) studies more comparable. This starts with the establishment of valid and accepted BMI metrics. The authors also promote the “Accumulating Data to Optimally Predict Obesity Treatment” (ADOPT) project (11) which aims to create common processes and measures for obesity research. So far, identified determinants of body weight explain only a small proportion of variations in weight status. Therefore, the authors conclude that it is necessary to develop an integrated model to allow the identification of different biopsychosocial phenotypes that predict treatment responses and will provide the basis for patient-tailored novel treatments.

In summary, this article provides an excellent lecture for clinical researchers in childhood obesity, guiding toward precision medicine approaches to treat severe obesity in adolescents. The article also defines area for future research and encourages the development of comparable and reproducible data in this challenging field of medicine.

References: 1. Farpour-Lambert NJ, Baker JL, Hassapidou M, Holm JC, Nowicka P, O’Malley G, et al. Childhood Obesity Is a Chronic Disease Demanding Specific Health Care–a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). Obesity Facts. 2015;8(5):342–9.

2. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism. 2017;102(3):709–57.

3. Wabitsch M, Moss A, Kromeyer-Hauschild K. Unexpected plateauing of childhood obesity rates in developed countries. BMC Med 2014; 12:17.

4. Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007–2008 to 2015–2016. JAMA. 2018;319(16):1723–5.

5. Danielsson P, Kowalski J, Ekblom O, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Archives of Pediatrics & Adolescent Medicine. 2012;166(12):1103–8.

6. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128(15):1689–712.

7. Fox CK, Gross AC, Rudser KD, Foy AM, Kelly AS. Depression, Anxiety, and Severity of Obesity in Adolescents: Is Emotional Eating the Link? Clinical Pediatrics. 2016;55(12):1120–5.

8. Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatric Obesity. 2015;10(1):7–14.

9. Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. New England Journal of Medicine. 2016;374(2):113–23.

10. Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes & Endocrinology. 2017;5(3):174–83.

11. MacLean PS, Rothman AJ, Nicastro HL, Czajkowski SM, Agurs-Collins T, Rice EL, et al. The Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures Project: Rationale and Approach. Obesity (Silver Spring, Md). 2018;26 Suppl 2:S6–s15.