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CAUSES AND MANAGEMENT OF CHILDHOOD OBESITY
1
...
Each year, there are more and
more children who are overweight or obese (Louise, et al
...
The World Health Organization
(WHO) estimates that more than 1 billion people worldwide—650 million adults, 340 million
adolescents, and 39 million children—are obese
...
According to WHO,
167 million individuals, both adults and children, would be less healthy by 2025 as a result of
being overweight or obese (WHO
...
According to a new World Health Organization (WHO)
estimate, if strong action is not taken to buck the trend, one in five people and one in ten children
and teens in 10 high-burden African nations would be obese by December 2023
...
H
...
, 2022)
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6% to 31%, while it will range from 5% to 16
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Additionally, an increasing issue with childhood obesity exists
throughout Africa (W
...
O
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24 percent of the world's overweight children under 5 lived on
the continent in 2019
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(UNICEF, 2019)
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8% and
5
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The percentage of overweight and obese girls under 20 was
12
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2%, respectively (Omololu, 2021)
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The quality of life and mental and physical health are all significantly
impacted by these diseases
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It is also obvious that if the proportion of obese children is reduced, this should help to lower the
prevalence of obesity in adults
...
Although lifestyle therapies
have been demonstrated to be effective in some patients, the overall trend toward increased
prevalence of this issue indicates that they are insufficient (Lv, et al
...
Even though there is
insufficient data on these drugs in children and adolescents, there is possibility that they could be
a useful adjuvant in the management of obesity in children and adolescents
...
, 2022)
...
0

DEFINITION

Adipose tissue that has accumulated an excessive amount of fat is what defines obesity
...
The degree of adiposity does not correspond with BMI in those with surplus muscle, but
for the majority of people, BMI is believed to be a reliable indicator of adiposity and, consequently,
obesity (Louise, et al
...
Adults are considered obese if their BMI is 30 kg/m2, and overweight
if their BMI is 25 kg/m2 (WHO, 2021)
...
There
are reference height and weight charts used in many nations
...
Overweight is defined by the World Health Organization (WHO) as having a BMI for
age that is more than one standard deviation above the median for growth, and obesity is defined

as having a BMI that is more than two standard deviations above the median for growth
...
1

Obesity and energy expenditure

Obesity is frequently characterized as an imbalance in energy that results from consuming more
calories than is necessary to sustain life and carry out physical labor
...
In instance, it is frequently misrepresented that
preventing obesity is just a matter of balancing calorie intake and expenditure (Levine, 2017)
...
1
...
It is the rise in metabolic rate that is
seen for several hours after eating a meal
...
There is a definite hierarchy among the
macronutrients, with protein leading to a bigger increase in energy expenditure than carbohydrate,
which is greater than that of fat, even though the actual mechanisms underpinning the thermic
effect of meals are not entirely known
...

2
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2 Resting Energy Expenditure
The largest portion of daily energy expenditure is usually accounted for by REE, which stands for
residual energy expenditure
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It has long been understood that body fat is less of a contributor to REE than fatfree mass, which makes up the body's metabolically active tissues
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The enhanced REE associated
with obesity is generally in accordance with what is anticipated for the body weight and
composition because REE is linearly related to both fat-free mass and body fat across a wide range
of weights (Kevin & Juen, 2017)
...
As a result, the REE residual standard deviation for a
given body composition is approximately 300 kcal/d
...
Organ sizes have been measured using magnetic resonance imaging techniques, and REE
prediction models that add the individual metabolic rates of different organs account for around
80% of the REE variability (Kevin & Juen, 2017)
...
1
...

The length and intensity of physical activity, in relation to total body weight, affect the amount of
energy expended (Kevin & Juen, 2017)
...
2

Complication of childhood obesity

Obesity in children has a higher likelihood of persisting into adulthood (Louise, et al
...

Children who are obese are more likely to suffer from a variety of illnesses
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o

Apneic sleep
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o

elevated blood pressure (hypertension)
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o

heart illness
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o

diseases of the muscles and bones, such as osteoarthritis
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o

obese liver
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, 2022)
...
0

Causes of childhood obesity

Obesity in children is a complex condition with numerous underlying causes
...
Children's growth and development require a particular number of calories
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Many of the same factors that contribute to adult obesity also affect children
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3
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The ratio of calories expended to calories taken affects how much weight your child is at
...
Vitamins,
minerals, and other essential nutrients are typically lacking in these foods and beverages
...

The number of hours spent inactively may rise as the popularity of video games, tablets, and
smartphones rises
...
2

Socioeconomics and community

The likelihood that your child will become obese can directly relate to where they reside
...
They also contribute to the daily amount of exercise your child receives
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Your network or system of friends, restricted access to local parks, leisure centers, or other safe
locations to exercise
...
3

Cultural factors

Advertising for unhealthy snack items and fast food restaurants may be a factor in childhood
obesity
...
These
foods frequently have high calorie counts and/or big serving sizes
...
Another risk factor for
childhood obesity is hormonal imbalances
...
The probability of a medical problem will be ruled out by a physical
examination and some blood tests
...

3
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The use of
medications like steroids and some antidepressants might result in weight gain
...

3
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, 2022)

•

The risk of obesity has been linked to eating late
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, 2022)

•

ALK4 expression in adipose tissue rises in response to nutritional overload and correlates
favorably with body weight and fat depot mass, pointing to a potential function in the
hyperplasia of adipose tissue during obesity
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4
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1

Nonpharmacological interventions

The current recommendations from the National Institute for Health and Care Excellence (NICE)
call for lifestyle modification as the main treatment for pediatric obesity (NICE, 2019)
...
According to NICE
recommendations, restricted and nutritionally imbalanced diets shouldn't be promoted because
they are potentially dangerous and unsuccessful over the long term
...

Children and young adults with abdominal obesity can successfully lower their BMI standard
deviation score (SDS) with intensive lifestyle intervention (moderate hypocaloric diet, exercise,
and nutritional education) according to Ojeda-Rodrguez et al
...

It is not surprising that factors such as skipping breakfast, consuming more fat and
carbohydrates, and eating less foods that are better for you (such fruit, vegetables, and dairy) have
been linked to childhood obesity (Louise, et al
...

According to research (Gungor, 2016), children who consume sugar-sweetened beverages
are more likely to be overweight or obese, and there is a link between lower sugar content and
lower BMI (Louise, et al
...
In 2015, the WHO issued recommendations that both adults and
children should consume less sugar (Anderson, 2018)
...
(BMJ
...

Children should exercise for 60 minutes each day in a moderate-to-vigorous manner,
according to current national recommendations (Anderson, 2018; NICE, 2019)
...
Studies have shown that attending school significantly reduces the
risk of obesity in children and adolescents and serves as an important motivator for them to engage
in physical activity
...
Additionally, it demonstrated that providing greater opportunities for physical activity
in both the home and at school benefits kids who are obese (Wang, et al
...

Changes in lifestyle are currently the first line of defense against childhood obesity (Louise, et al
...
For the best results, this should ideally be done in conjunction with increasing physical
activity and diet (Louise, et al
...

The medical effects of pediatric obesity are well documented in literature, and more
recently, the emotional and psychological effects of obesity have drawn increased attention
...
, 2017; Louise, et al
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The stress levels of obese children are 4
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, 2017)
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As a result, the issues with
mental health and dietary habits that lead to obesity are further reinforced
...

4
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4
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1 Medications approved for childhood obesity
Orlistat
The US Food and Drug Administration (FDA) has approved orlistat for the treatment of obesity in

teenage patients above the age of 12
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If there are substantial physical or
psychological comorbidities in this age group, NICE guidelines now advise beginning orlistat
treatment (NICE, 2019)
...
According to a recent meta-analysis
of orlistat's effectiveness, it can lower BMI by 0
...
2 kg/m2 when compared to a placebo
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Additionally, studies have indicated that those
using orlistat are 2
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Diarrhoea, faecal incontinence, flatulence, and abdominal pain are some of orlistat's
negative effects
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Supplementing with vitamins A, D, E, and K is advised because orlistat
inhibited the absorption of dietary fat-soluble vitamins in addition to its gastrointestinal side effects
(Styne, et al
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, 2018)
...
, 2018)
...
, 2018)
...
, 2018)
...
, 2018) Due to dipeptidyl peptidase 4's quick
degradation of GLP-1, the half-life is 2 minutes (DPP-4)
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, 2018)
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, 2018)
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There is mounting evidence that the
DPP-4 resistant GLP-1 analogues, each of which is discussed below, may be useful in reducing
childhood obesity
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8 mg) has been approved by the FDA (FDA, 2019; CHMP, 2021)
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Setmelanotide
For patients with a proopiomelanocortin (POMC) mutation and perhaps other hereditary disorders,
the melanocortin 4 receptor (MC4R) agonist setmelanotide has showed promise (Baskaran &
Kandemir, 2018)
...
Tachycardia and/or hypertension had previously been concerns with MCR4 agonists, but
Collet et al did not identify any of these side effects after a 4-week period
...
According to Clément et al
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(Clément, et al
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Both the POMC and LEPR deficient groups experienced
considerably lower hunger scores (Clément et al
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In light of these findings, the FDA and EMA authorized setmelanotide in November 2020 and July
2021, respectively (Rhythm pharmaceuticals, 2020)
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Metreleptin
Patients with leptin insufficiency have employed metreleptin, a synthetic, recombinant analogue
of leptin, to lose weight (Meehan, et al
...
It has approval for the treatment of generalized
lipodystrophy and congenital leptin insufficiency in both the United Kingdom and the United
States (Meehan, et al
...
Numerous studies have demonstrated the effectiveness of utilizing
metreleptin in pediatric patients with leptin insufficiency (Brown, et al
...
Similarly, when
metreleptin is administered to patients with lipodystrophy, the results are favorable (Brown, et al
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At this time, metreleptin is not advised for the treatment of patients with obesity unrelated
to leptin insufficiency
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T-cell
lymphoma (reported in patients with lipodystrophy), exhaustion, hypoglycemia, and weight loss
are side effects of metreleptin therapy (Chan, et al
...

5

CONCLUSIONS

Effective and thoroughly studied treatment options are crucial for managing the escalating public
health concern brought on by the rising prevalence of pediatric obesity worldwide
...

As the first line of treatment for managing children and young people with obesity, lifestyle and
behavioral modification is currently supported by rather weak evidence
...


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