Vascular risks and management of obesity in children and adolescents

Abstract

Childhood obesity has reached epidemic proportions in many countries. Pediatric obesity is associated with the development of cardiovascular (CV) risk factors including type 2 diabetes, hypertension, dyslipidemia, and the metabolic syndrome. It is also associated with an increased risk of CV disease (CVD) in adulthood. Moreover, obesity and CVD risk factors in obese youth tend to track into adulthood, further increasing the risk of adult CVD. Consequently, the treatment and prevention of childhood overweight and obesity has become a public health priority. Proper nutrition and increased physical activity are the main focus of these efforts; however, few studies have shown positive results. Treatment options for obesity in youth also include pharmacotherapy and surgery. While pharmacotherapy appears promising, additional evidence is needed, especially with respect to the long-term impact, before it becomes a widespread treatment option in the pediatric population.

Figure 1

Ranking of 34 countries according to the prevalence of overweight youth in 2001–2002 using the international classification system. Adapted from Janssen I, Katzmarzyk PT, Boyce WF, et al. 2005. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev, 6:123–32. Copyright © 2005.

Figure 2

Comparison between the Centers for Disease Control and Prevention (CDC) and International Obesity Task Force (IOTF) body mass index classification systems for overweight and obesity in youth.

Figure 3

Waist circumference growth curves for the 5th, 10th, 25th, 75th, 90th, and 95th percentiles for (a) males and (b) females 11–18 years of age. Data source was the 1981 Canada Fitness Survey. Katzmarzyk PT. 2004. Waist circumference percentiles for Canadian youth 11–18 y of age. Eur J Clin Nutr, 58:1011-15. Copyright © 2004.

Figure 4

Total cholesterol growth curves for the 50th and 75th percentiles for male and female children 8–15 years of age. Labarthe DR, Nichaman MZ, Harrist RB, et al. 1997. Development of cardiovascular risk factors from ages 8 to 18 in Project Heart Beat! Study design and patterns of change in plasma total cholesterol concentration. Circulation, 95:2636-42. Copyright © 1997.

Figure 5

The change in weight throughout a 52-week intervention of orlistat (• symbols) and placebo (○ symbols). Lifestyle modification was prescribed to both groups. Chanoine JP, Hampl S, Jensen C, et al. 2005. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA, 293:2873-83. Copyright © 2005.