Pathophysiology, comorbidities and interventions related to childhood obesity

In a recent study published in Frontiers in Pediatricsresearchers discuss the psychological and physiological impacts of obesity on pediatric populations, as well as possible intervention strategies that could help prevent obesity-related problems.

Study: Childhood and adolescent obesity: a review. Image Credit: Africa Studio / Shutterstock.com

Background

Childhood obesity is a growing concern worldwide and has been classified as an epidemic. Research indicates that obesity cannot be reduced to a specific cause; rather, it is the result of complex interactions between genetic, behavioral, environmental, developmental, and biological factors.

Recent studies have also shown that the gut microbiome, epigenetic factors, intrauterine environment, small size at gestational age, early incorporation of protein into infant diets, and reliance on formula milk instead than breast milk are associated with a higher likelihood of childhood obesity.

Various co-occurring problems have been associated with childhood obesity and represent an increasing public health burden.

For example, obese children are at higher risk of early onset of puberty, sleep disturbances, menstrual complications in girls, prediabetes, complications associated with high cholesterol, metabolic syndrome, hypertension, type 2 diabetes and non-alcoholic fatty liver disease. . Childhood obesity also leads to psychological issues such as body image issues, eating disorders, anxiety, depression, and low self-esteem.

Despite the various behavioral, pharmacological, dietary and surgical interventions practiced, childhood obesity continues to have adverse effects on the psychological and physiological health of adolescents and children.

The pathophysiology of obesity

Obesity is the result of complex interactions between various factors at societal and individual levels, with biological, genetic, behavioral and environmental influences on the individual. Socioeconomic factors, as well as family and community influences, can also contribute to weight gain.

Hormonal and neural systems regulate feelings of satiety and hunger, with the hypothalamus regulating appetite under the control of various hunger-stimulating or ordemanding and appetite-suppressing or anorectic hormones. Stress and disruption of sleep cycles due to emotional upheavals associated with psychiatric disorders can also upset the balance between anorectic and orectic hormones, resulting in emotional eating.

Another major biological factor that can contribute to weight gain is the gut microbiota, which is also affected by a wide range of factors such as environment, genetics, lifestyle, diet, gestational age at birth, the use of formula milk during the neonatal and infant stages. , feeding practices, age of introduction of solid foods and use of antibiotics. Dysbiosis, defined as an imbalance in the proportion and diversity of gut microbiota, can influence energy dynamics and fat production.

The genetic factors of obesity can be categorized as monogenic or polygenic, with the latter being more common. Monogenic factors include mutations in specific genes, such as leptin and tyrosine kinase receptor genes, or genetic disorders such as Prader-Willi syndrome.

Polygenic factors involve an interaction between the environment and genetic variants that increase an individual’s susceptibility to obesity. Behaviors that increase the risk of obesity during developmental stages include eating larger portions, eating energy-dense and processed foods, and sedentary lifestyles with limited physical exercise, which are also related to cultural and parental pressures.

Comorbidities

In children, obesity is associated with various comorbidities such as hyperinsulinemia, leptin resistance, precocious puberty and obstructive sleep apnea with associated neurocognitive dysfunction and behavioral abnormalities. Alcohol-free fatty liver and slipped capital femoral epiphysis are other comorbidities seen in obese children.

Obesity in teenage girls can cause irregularities in their menstrual cycle, thus increasing the risk of polycystic ovary disorder. The risk of metabolic syndrome involving hypertension, central adiposity, hypertriglyceridemia and hyperglycemia, as well as sleep disturbances, is also higher in obese adolescents.

Speeches

Preventative measures include preventive counseling for children and their families to avoid unhealthy eating practices and sedentary habits and to increase physical activity levels. Family involvement in the weight loss process is particularly effective in treating obesity in children between the ages of two and six. An interdisciplinary approach to weight management involving a psychologist, dietitian, and physician has also been associated with positive results.

Other interventions include pharmacological options such as orlistat, metformin, and glucagon-like peptide 1 agonist, as well as interventions such as hydrogel technology to target different levels of the gut-liver axis. The roles of docosahexaenoic acid (DHA), vitamin E and probiotics in the fight against obesity are also explored.

Bariatric surgery including procedures such as Roux-en-Y gastric bypass, gastric banding, and laparoscopic sleeve gastrectomy, as well as extended care from a mental health provider, are also effective options for children with severe obesity.

conclusion

Obesity is a complex disorder that is influenced by a multitude of biological, genetic, environmental and lifestyle factors. While preventive counseling and the involvement of families in the weight loss process, as well as a multidisciplinary approach that addresses dietary, physiological and mental health, have shown promise, cases of severe obesity continue to require pharmacological and surgical interventions.