nutritional disorders
Obesity
Special Populations in Obesity
Obesity is a particular concern in children and older adults. Obesity in children is defined as BMI greater than the 95th percentile. For children with obesity, complications are more likely to develop because the duration of the disorder is longer. More than 25% of children and adolescents meet overweight or obesity criteria. (See also Obesity in Adolescents .) Similar to adults, complications related to obesity in children include hypertension, dyslipidemia, diabetes and joint problems. Risk factors for obesity in infants are low birth weight ( Special populations references ) and After puberty, food intake increases; in boys, the extra calories are used to increase protein deposition, but in girls, fat storage is increased. For children with obesity, psychologic complications (eg, poor self-esteem, social difficulties, depression) and musculoskeletal complications can develop early. Some musculoskeletal complications, such as Slipped Capital Femoral Epiphysis (SCFE) , are specific to children. Other early complications may include Risk of obesity persisting into adulthood depends partly on when obesity first develops. In a meta-analysis of several large cohort studies, 55% of children with obesity continued to have obesity in adolescence, and 70% continued to have obesity over the age of 30 ( Special populations references ). Treatment of obesity in children and adolescents involves lifestyle modifications and, for children with severe obesity, Metabolic and Bariatric Surgery .. Participating in physical activities during childhood may promote a lifelong physically active lifestyle. Limiting sedentary activities (eg, watching TV, using the computer or handheld devices) can also help. Medications and surgery are avoided but, if complications of obesity are life threatening, may be warranted. Measures that control weight and prevent obesity in children may have the largest public health benefits. Such measures should be implemented in the family, schools, and primary care. However, lifestyle modifications often do not result in permanent weight loss. The 2023 updated guidelines from the American Academy of Pediatrics (AAP) recommend that children and adolescents who have severe obesity (defined as BMI ≥ 40 or BMI > 35 with significant health complications related to obesity) should be treated with Metabolic and Bariatric Surgery and treatment should involve a multidisciplinary team. The major metabolic and bariatric surgical societies have similar recommendations; however, metabolic and bariatric surgery is not often used in children and adolescents. Barriers include stigma against bariatric surgery in this population and lack of available centers and clinicians trained to take care of children and adolescents with obesity ( In the United States, the percentage of older people with obesity has been increasing. With age, body fat increases and is redistributed to the abdomen, and muscle mass is lost, largely because of physical inactivity, but decreased androgens and growth hormone (which are anabolic) and inflammatory cytokines produced in obesity may also play a role. Risk of complications depends on Body fat distribution (increasing with a predominantly abdominal distribution) Duration and severity of obesity Associated sarcopenia Increased waist circumference, suggesting abdominal fat distribution, predicts morbidity (eg, Hypertension , For older adults, physicians may recommend that caloric intake be reduced and physical activity be increased. However, if older patients wish to substantially reduce their caloric intake, their diet should be supervised by a physician. Physical activity also improves muscle strength, endurance, and overall well-being and reduces the risk of developing chronic disorders such as diabetes. Activity should include strengthening and endurance exercises. Metabolic and Bariatric Surgery has historically been used less frequently in older patients. In a large retrospective study comparing outcomes in patients < 65 with those of patients ≥ 65 having 1.Jornayvaz FR, Vollenweider P, Bochud M, et al: Low birth weight leads to obesity, diabetes and increased leptin levels in adults: The CoLaus study.Cardiovasc Diabetol15:73, 2016. doi: 10.1186/s12933-016-0389-2 2.Simmonds M, Llewellyn A, Owen ACG, Woolacott N: Predicting adult obesity from childhood obesity: A systematic review and meta-analysis.Obes Rev17 (2):95–107, 2016. doi: 10.1111/obr.12334 Epub 2015 Dec 23. 3.Elkhoury D, Elkhoury C, Gorantla VR. Improving access to child and adolescent weight loss surgery: A review of updated National and International Practice Guidelines.Cureus15 (4):e38117, 2023. doi: 10.7759/cureus.38117 4.Iranmanesh P, Boudreau V, Ramji K, et al: Outcomes of bariatric surgery in elderly patients: A registry-based cohort study with 3-year follow-up.Int J Obes (Lond)46 (3), 574–580 2022. https://doi.org/10.1038/s41366-021-01031-]] 