Obesity in Children and Adolescents
Obesity is a mixed, multifactorial condition influenced by individual genetic and non-genetic factors. Obesity in children and adolescents often results from a lack of physical activity, unhealthy diets that cause excessive energy intake, or a positive energy balance that results from a combination of the two. There are rare single gene defects that cause obesity. These gene defects are rare causes of early-onset pediatric obesity. Genetic mutations in the leptin signaling pathway and melanocortin-4 receptor defects are examples of these conditions. Early childhood obesity may be the result of certain genetic syndromes such as Prader-Wili syndrome, Bardet-Biedl syndrome, Alstrom syndrome, and WAGR syndrome. Some endocrinological diseases such as hypothyroidism, growth hormone deficiency and excess cortisol can also cause obesity.
Obesity is on the rise all over the world. In the last thirty years, while the number of obese individuals in developed countries has doubled in adults; increased threefold in children and adolescents. The increasing prevalence of childhood obesity has led to the emergence of obesity-related diseases at an early age. Childhood obesity can negatively affect almost every system and often causes serious consequences such as hypertension, insulin resistance, diabetes, obstructive sleep apnea, dyslipidemia, fatty liver and psychosocial complications. While type 2 diabetes was historically known as a disease that only affects adults, it has become a disease that can affect even 6-year-old children in the last 20-25 years, in parallel with the increasing prevalence of obesity in children. Child and adolescent obesity is a problem that has not been adequately addressed and awaits a solution.
Childhood obesity often persists into adulthood. Obese children and adolescents are at risk of developing obesity-related diseases early. Early treatment is essential to achieve weight loss and to prevent or treat obesity-related diseases. Therefore, the trend towards early treatment of obesity has increased.
Currently, pharmacotherapy (drug therapy) options for the treatment of childhood obesity are very limited. The first step in the treatment of obesity in children and adolescents is lifestyle changes. Lifestyle changes include behavioral and dietary changes. These treatments require a multidisciplinary approach, including a doctor, dietitian, psychologist and physiotherapist. Although these treatments are effective in the short term, their success rates are low in the long term. Bariatric & Metabolic surgeries (BMA) currently seem to be the most successful method for permanent weight control and treatment of obesity-related diseases. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), BMAs are indicated in adolescents with moderate to severe obesity, particularly in the presence of co-morbidities (1).
BMI ≥35 kg/m2 and concomitant obesity-related disease or BMI greater than 120% of the 95th percentile calculated for age and height
BMI ≥40 kg/m2 (even without comorbidity) or BMI greater than 140% of the 95th percentile calculated for age and height
Medically treatable obesity
Untreated alcohol substance abuse
Pregnancy planning within 12-18 months after the date of surgery
Having an active eating disorder
Cognitive and psychosocial condition unable to adapt to post-operative advice and lifestyle changes
In adults, BMAs have been shown to reduce BMI, improve obesity-related diseases, and reduce mortality. In parallel, these surgeries have also been applied to adolescents with severe obesity. There has been an increase in the number of BMAs in adolescents over the past few decades. Unknown long-term results, possible effects on growth and development, and the irreversible nature of all but LAGB are worrying points. However; Studies have shown that bariatric surgery is safe and effective in adolescents with severe obesity (2).
Bariatric surgeries such as laparoscopic adjustable gastric band (LAGB), Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) are performed in children and adolescents. LSG is currently the most commonly performed surgery in adolescents. The results are much more successful when compared to lifestyle changes.
With LAGB, BMI is approximately 11.6 kg/m2; With RYGB, BMI is approximately 16.6 kg/m2; With LSG, approximately 14.1 kg/m2 loss was achieved in BMI. These rates are quite high and successful compared to other non-surgical treatment methods. All three surgical techniques resulted in significant weight loss in the short to medium term and improvement in diseases related to overweight. Improvement in type 2 diabetes, insulin resistance, hypertension, dyslipidemia and abnormal kidney functions was observed in 65-95% of the operated patients. (3)
1. Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surge