Childhood Obesity: Pathogenesis, Prevention And Treatment

What is Obesity?

The body mass index (BMI) is the basis for it. Weight in kilograms divided by height in meters squared yields the body mass index (BMI). Among adults:  A BMI of 25 or higher is classified as overweight. BMIs more than or equal to 30 are classified as obese. BMI is used to determine the cut-off percentile for children. It will appear underweight if the BMI falls between the 85th and 95th percentiles. A BMI of greater than or equal to the 95th percentile will be classified as obese.

What is adiposity-rebound? 

When compared to height, the proportion of fat in newborns and early infants is much higher, resulting in a significantly high BMI.  As we age, fat starts to mobilize and our total amount of adipose tissues tends to decrease.  Adiposity rebound is the term used to describe the point at which adipose tissue begins to increase in proportion to BMI levels.  Adipose tissue exhibits a similar pattern to that of BMI, however it is not the same.

Why does the adipose tissue level decrease, but the body weight increases?

To offset the loss of adipose tissue, the mass of lean tissue (muscle and bone) tends to increase. Before puberty, lean muscle mass contributes to the creation of fat tissues rather than the synthesis of proteins.

Etiopathogenesis

It consists of a complex interplay of factors that are

1. Diet and Nutrition

Foods that are very high in calories, fat, and minimal fiber content ought to be avoided.  Quick cuisine that is deep-fried or has a mayonnaise basis.  Shakes and drinks made with fructose corn syrup.

2. Lifestyle and environmental factors

A part played by a reduction in physical activity. The development of a long-term sleep debt.

Sleep Debt 

When a youngster sleeps fewer than the recommended 8–9 hours, this 2-2.5 hour sleep period accumulates over time and causes an increase in appetite is caused by an increase in the hormone Ghrelin. The reduction in leptin hormone levels is the cause of the appetite decline, which also results in fluctuating insulin levels.

3. Neural and endocrine factors 

Role of Adiponectin 

Adipocytes release this hormone, which neither directly increases nor decreases hunger.  Low levels of Adiponectin have been linked in certain studies to an increased risk of childhood obesity and type 2 diabetes mellitus.  Adiponectin lowers the risk factors for obesity and is also involved in glycaemic management in youngsters.

4. Endocrine Diseases 

The endocrine diseases in children which increase the risk factors for obesity are -

• Cushing syndrome 
• Hyperinsulinism 
• Hypothyroidism 
• Growth hormone deficiency 
• Pseudohypoparathyroidism

5. Genetic mutation and Syndromes 

Among the genetic mutations and disorders are:  Melanocortin - 4 receptors (MC4R): Although uncommon, this is the most frequent monogenetic cause of childhood obesity.  A mutation in the FTO gene at 16q12.
A deficiency in pro-opiomelancortin (POMC) results in a decrease in MC4R activation, which in turn causes obesity. Typical syndromes linked to obesity risk factors include: Down syndrome, Turner syndrome, Prader-Willi syndrome, Bardet-Biedel syndrome, and Ehrlich syndrome are among them. 

6. Role of gut microbiota   

Firmicutes are the bacteria that contribute to the obesity risk factor.  There is a substantial correlation between the proportion of anaerobe Bacteroides and firmicutes, a gut bacterium, and an increased risk of obesity in adulthood.  The aforementioned occurrence and an increased quantity of firmicutes in children who develop obese are assessed in tiny case studies.

7. Drug - Induced Obesity 

The drugs which are related to the high risk of obesity are - 

• Corticosteroids
• Valproate 
• Lithium 
• Carbamazepine - A drug used in partial epilepsies.
• Olanzapine 
• Gabapentin - A drug used in chronic neuropathic pain.
• Cyproheptadine -    A strong appetite-stimulating agent mainly found in multivitamins.
• Propranolol 

Comorbidities of Childhood Obesity 

The co-morbidities that are associated with the risk factor for obesity are –

• Dyslipidaemia 
• Hypertension 
• Non-alcoholic fatty liver disease (NAFLD) 
• Metabolic syndrome 
• PCOD (Polycystic ovary disease in adolescent females)
• Pseudotumor cerebri / Raised Intracranial pressure.
• Blount disease/ Tibia Vara 
• Slipped capital femoral epiphysis (SCLFE)
• Asthma 
• Obstructive sleep apnoea 

Management of childhood obesity

1. Appropriate Caloric Intake 

The plan used for this is called the Traffic light plan. Family counselling and adherence are equally important as the diet.

2. Lifestyle Modification 

 A rise in physical activity;  Limitations on TV viewing and technological device use. 

3. Drug treatment 

Orlistat is the only FDA-approved medication for treating obesity in children under the age of sixteen. The medication causes a slight reduction in weight by acting to stop the absorption of fat. Side effects include spotting, greasy stools, and gas. 

The FDA has approved the following combination drugs for adults that have been shown to be effective: phentermine plus topiramate; amylin plus leptin; lorcaserin, a selective serotonin 2C receptor agonist that is not licensed for use in children.

 What is Setmelanotide?

As a result of its ability to bind and activate MC4R, it may have therapeutic benefits for kids who have POMC deficiencies, which are linked to obesity.

What childhood genetic syndromes have enzyme replacement therapy soon to be available?    

Two such treatments are on the horizon: Leptin deficiency, which is now offered. POMC shortage: Soon to be accessible.

Bariatric surgery in childhood

The American Association of Paediatrics (AAP) states that certain conditions must be met in order for the program to function.  The youngster ought to have reached adolescence, or skeletal maturity.  The child's BMI need to be between 40 and less.  For six months or a year, the child ought to have gotten multimodality treatment.  In cases when there are comorbidities or problems. 
There are two forms of bariatric surgery-Y gastric bypass surgery.
Gastric banding that is scalable.

Prevention of Childhood Obesity

1. Pregnancy 

 Refrain from smoking while expecting.  Level up the mother's BMI.
Keeping an eye on weight gain and maintaining glycaemic control during pregnancy.

2. Postpartum and Infancy 

The risk of obesity and food allergies increases with the premature introduction of outside food. • Exclusive breastfeeding should be continued for six months.

3. Post Infancy 

Encouraging the child to follow dietary guidelines and get enough exercise. 

4. Rohhad Syndrome

• RO - Rapid onset obesity 
• H - Hypothalamic dysfunction 
• H - Hypoventilation 
• AD - Autonomic dysregulation 

No consistent gene defect or familial connection has been discovered in relation to this syndrome.Two explanations explain this syndrome:
That the mutation is somatic. It indicates that different genes have similar phenotypes. Nowadays, there is less support for this view. 
It is a neurocristopathy syndrome spectrum, according to another idea. Neural crest derivatives are aberrant in this. It is connected to both ganglioneuroma and neuroblastoma. 

Diagnosis

Children under 1.5 years old are most commonly affected (18 months - 7 years).  The first and most prevalent symptom is obesity with a quick onset.  The primary symptom of hypothalamic dysfunction is altered thirst.  Hypoventilation develops later in the illness and need ventilator assistance;  An increase or reduction in thirst causes a water imbalance in the body that results in hypo- or hypernatremia. The pupillary reaction is the most prevalent anomaly in autonomic dysregulation.

Also Read: Infections of the Upper Airway- Common Cold and Sinusitis

Hope you found this blog helpful for your Nutrition and Nutritional Disorders for NEET SS preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.