The effects of being overweight and obesity are widely recognized as one of the leading health concerns in the world, involving all ages and socioeconomic groups. The current obesity pandemic reflects the profound changes in society over the past 20-30 years that promote a sedentary and “obesogenic” lifestyle and the consumption of high fat, energy, and dense fructose diet. (Bjørklund et al., 2022; Sbaraini et al., 2021).
Obesity in children and adolescents is evaluated by the body-mass index (BMI), which is calculated as weight (kg) divided by height (m2) and compared to sex and age-adjusted charts. The 95th percentile of the BMI chart corresponds to overweight or excess weight, and above the 95th percentile is evaluated as obesity. In so-called “morbid obesity,” the BMI is >>95th percentile.
Obesity is a multisystemic disorder and is associated with several chronic diseases and conditions:
- Arterial hypertension
- Dyslipidemia, atherosclerosis
- Chronic irritation
- Metabolic syndrome
- Endothelium dysfunction
- Hyperinsulinemia, Diabetes mellitus type 2
- Polycystic ovary syndrome
- Non-alcoholic fatty liver disease
- Apnea
- Asthma
- Eating behavior impairment
- Psychological problems, depression, etc.
One of the main complications of obesity is impairment of carbohydrate metabolism, which is diagnosed based on oral glucose tolerance test (OGTT) results. Levels of glucose in the fasting state and after 2 hours after 1.75mg/kg glucose intake are measured.
| Prediabetes | OGTT Results |
| 1. Fasting hyperglycemia | fasting glycemia ≥ 6.1 mmol/l
after 2h after OGTT <7.8 mmol/l
|
| 2. Impaired glucose tolerance (OGTT) | fasting glycemia <6.1 mmol/l
after 2h after OGTT ≥ 7.8 mmol/l but <11.1mmol/l
|
| Diabetes Mellitus | fasting glycemia ≥ 7.0 mmol/l
after 2h after OGTT ≥ 11.1 mmol/l random measurement ≥ 11.1 mmol/l
|
Insulin- resistance (IR) is diagnosed based on HOMA-IR index calculation with the formula: Insulin х glucose/22.5. One of the clinical presentations of IR is acanthosis nigricans–thickened and hyperpigmented skin.
The diagnosis of Metabolic Syndrome (MS) in children is based on International Diabetes Federation (IDF) definitions (Zimmet et al., 2007):
- At the age of 6 to < 10 years in obese children, MS can not be diagnosed, but further measurements should be made if a family history of metabolic syndrome, type 2 diabetes, dyslipidemia, cardiovascular disease, hypertension, or obesity is positive.
- At the age 10 to < 16 years in obese patients MS is diagnosed if: triglycerides ≥1.7 mmol/L (≥ 151 mg/dL); HDL-cholesterol <1.03 mmol/L (<40 mg/dL); Systolic blood pressure ≥130 mmHg or Diastolic blood pressure ≥85 mmHg; glucose ≥5.6 mmol/L (≥ 101 mg/dL) (oral glucose tolerance test recommended).
- At the age > 16 years, MS is diagnosed using existing IDF criteria for adults.
Non-pharmacotherapeutic management of obesity:
1. Eating habits
- Calories (decrease at least 500 kcal/day from the daily calorie intake)
- Restriction of fat intake (>2 years old) and carbohydrate intake (sweets and fast food)
- Increase vegetable and fruit intake
- Eating regimen
2. Physical activity: not less than 50-60min/day.
3. Screen time restriction to a maximum of 2 hours/day.
Multicomponent lifestyle intervention (healthy eating plan, increased physical activity, and support for behavioral change) is the first approach. More intensive interventions such as very low-energy diets and medication can help some people to reduce weight further. The decision to use intensive interventions takes the individual’s situation into account and may require referral to healthcare professionals with expertise in obesity management. (August et al., 2008; “Corrigendum”, 2021).
Hope this helps!
Best regards,
Lusine V. Navasardyan, MD, Ph.D., Associate Professor,
YSMU, Endocrinology Chair, “Arabkir” Medical Center, Pediatric Endocrinologist “ArBeS” Healthcare Center
