ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This large cohort study of 27,997 individuals aged 3-18 years with obesity in Sweden examined the effect of obesity severity and obesity treatment on growth. Prepubertal individuals with class II (more severe) obesity were had higher height-for age and growth velocity than children with class I obesity. After onset of puberty, these individuals and especially boys, showed slower height velocity and a blunted growth spurt. The final height z score in this study population was slightly lower than in the Swedish reference population. Successful obesity treatment “normalized” the accelerated growth velocity pattern in children with obesity.

These results provide important understanding into how childhood obesity impacts on growth. Childhood BMI is an important modifier of childhood and pubertal growth (1-4). Advanced early linear growth in children with obesity (2, 3) has been associated with negative cardiovascular health outcomes (4). Healthcare providers managing children with obesity should be aware of these distinct growth patterns in order to prevent them from unnecessary examinations. In other cases, a different than expected growth pattern could suggestive another etiology (syndromic or endocrine disorder). These authors suggest that a height z score <0.0 in children age <10 years with obesity may indicate growth impairment that needs further evaluation. Previously reported height reference values for children with obesity allow for appropriate assessments (2).

Large prospective and longitudinal studies in real-world settings assessing how obesity treatment outcome affect long-term growth are lacking. These data show for the first time that a successful obesity treatment (defined as BMI z score reduction ≤0.25 units after 1-year) could “normalize” the growth pattern of children with obesity. The cutoff of 0.25 units was chosen because a BMI z score reduction of 0.25+ units is associated with improvements in obesity-related consequences in previous research (5, 6). Further research on longitudinal data of growth after obesity treatment in children is needed to confirm this clinically important finding.

References: 1. Holmgren A, Martos-Moreno G, Niklasson A, Martínez-Villanueva J, Argente J, Albertsson-Wikland K. The pubertal growth spurt is diminished in children with severe obesity. Pediatr Res. 2021;90(1):184-90.2. Kempf E, Vogel M, Vogel T, Kratzsch J, Landgraf K, Kühnapfel A, et al. Dynamic alterations in linear growth and endocrine parameters in children with obesity and height reference values. EClinicalMedicine. 2021;37:100977.3. He Q, Karlberg J. Bmi in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res. 2001;49(2):244-51.4. Antonisamy B, Vasan SK, Geethanjali FS, Gowri M, Hepsy YS, Richard J, et al. Weight Gain and Height Growth during Infancy, Childhood, and Adolescence as Predictors of Adult Cardiovascular Risk. J Pediatr. 2017;180:53-61.e3.5. Reinehr T, Kleber M, Toschke AM. Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence. Atherosclerosis. 2009;207(1):174-80.6. Putri RR, Casswall T, Hagman E. Risk and protective factors of non-alcoholic fatty liver disease in paediatric obesity: A nationwide nested case-control study. Clin Obes. 2022;12(2):e12502.