Childhood and Adolescent Obesity: A Global Impact.

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The prevalence of childhood and adolescent obesity continues to rise dramatically worldwide. In the USA alone, nearly one third of American children are at least overweight and over 80% of these children will become obese adults. The reasons of this huge increase in obesity are multiple and directly related to the era of modernization. Changes in life style in the last few decades in the form of consumption of junk food and decrease physical activities led to the increase numbers of obese children. Electronic devices, also, have a major role in shifting children away from physical activities.

Obesity related health effects have been proven to affect obese children like adults. Many life threatening conditions are associated with obesity in children, including insulin resistance and diabetes, obstructive sleep apnea, nonalcoholic fatty liver diseases, dyslipidemia, hypertension, and metabolic syndrome. Childhood obesity potentially reverse the increasing life expectancy trend seen by prior generations. Probably, for the first time in history, children today may be the first to have a lower life expectancy than their parents due to obesity and related comorbidities. In addition, obese children suffer from reduced quality of life compared to their nonobese peers. Eventually, obese children carry these health related risks into adulthood.

Management of childhood obesity starts by prevention and education. Prevention and education on different levels at home, school, and on the media. Collaboration of authorities play a major role in prevention e.g. ministry of health and ministry of education. Further actions should be taken at higher levels to provide ideal environments for activities for children in addition to providing healthy food.

Due to possible metabolic etiologies and lack of commitment for treatment in this age group, obese children and their families are best managed by a specialized centers where necessary facilities and expertise are available. The child and his/her family are approached in multidisciplinary team (e.g. pediatrician, psychologist, dietitian, physical therapist, and a bariatric surgeon). The aim of such approach is to support the child and the family to achieve a good weight reduction, resolution of medical comorbidities, and to improve quality of life.

If a multidisciplinary approach failed to achieve these goals, bariatric surgery appears to be a viable option to achieve a weight loss in obese children and adolescents for whom all other interventions have failed. Pediatric bariatric surgery remains controversial due to concerns about safety, effectiveness, the ability of this age group to comply with postoperative monitoring visits, and the possibility for long-term complications and adverse effects on growth and maturation that may be associated with bariatric surgery. Moreover, the types of bariatric surgery that is suitable for children and adolescents is under debate. However, a balance must be made between the potential benefits and harms at individual case level. In multiple studies, bariatric surgery in obese children and adolescents is associated with a significant reduction in BMI and resolution of hypertension and type 2 diabetes. Weight loss is associated with clear improvements in metabolic and psychological outcomes.

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