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Handbook of Pediatric Obesity: Etiology, Pathophysiology, and Prevention

2005 Edition, November 29, 2005

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ISBN: 978-1-57444-912-9
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Product Details:

  • Revision: 2005 Edition, November 29, 2005
  • Published Date: November 29, 2005
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 380
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:

Preface

We are delighted to introduce this timely and significant collection of papers on the topic of childhood obesity. Over the past 20 years the percentage of overweight adolescents in the United States has increased more than threefold from 5 to 16%, and the percentage of overweight children aged 6 to 11 years increased from 5 to 15%. The prevalence of overweight is even more striking among certain ethnic groups. In the United States, for example, recent data show that 44% of Latino and 40% of African American adolescents (ages 12 to 19) are considered overweight (above the 85th percentile for age and gender), which is approximately double the prevalence in Caucasians.

The general significance and scope of the pediatric obesity health problem was summarized in the 2004 report from the Institute of Medicine:

Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality. Given this trajectory toward a healthier childhood, we begin the 21st century with a shocking development — an epidemic of obesity in children and youth. The increased number of obese children throughout the US during the past 25 years has led policymakers to rank it as one of the most critical public health threats of the 21st century.

When we first started working in this field 15 years ago, there was probably a handful of pediatric obesity experts. As the prevalence of childhood obesity continues to increase, and with the emergence of obesity-related diseases earlier in life, the number of investigators and studies in this area has proliferated, and the quality and sophistication of research in this area has evolved tremendously. We are extremely pleased to be able to present important summaries from some of the national leaders in this field of research. These investigators include a diverse group from multiple and complementary areas of expertise. This diversity reflects the nature and scope of the approaches that are required to understand and fix this societal problem at the level of social, behavioral, environmental, metabolic, and genetic factors. The chapters themselves are diverse, and within each chapter we purposefully attempted to assemble experts from many areas to provide a more comprehensive and balanced overview of the specific topic covered within each chapter.

In the first five chapters, we cover various topics related to the overall epidemiology of childhood obesity. In Chapter 1, Dr. Alison Field summarizes the epidemiology of obesity as well as its health and economic consequences. This chapter sets the stage by summarizing the overall scope of the problem at hand. In Chapter 2, Dr. Shumei Sun summarizes biological aspects of growth and development from birth through puberty. In Chapter 3, Dr. Dympna Gallagher and colleagues summarize current information related to ethnic differences in obesity and related outcomes. This is an important area of study because of the dramatic ethnic disparities, not only in the predisposition to obesity, but in the predisposition to obesity-related diseases. In Chapter 4, Dr. Barry Popkin and Dr. Penny Gordon-Larsen extend the epidemiological analysis to a more global perspective, with a focus on the complex interplay between economic and social factors, demonstrating that the burden of global obesity is shifting toward the poor and underserved. In Chapter 5, Dr. Stephen Daniels discusses the fascinating topic of critical periods for obesity during growth and development, covering aspects from before conception and in utero development, through early infancy and adolescence.

The second part of the book (Chapters 6 to 12) focuses on the etiology of childhood obesity, especially as it relates to the regulation of body weight and energy balance during growth and development. In Chapter 6, Dr. Nancy Butte and colleagues present an overview of genetic aspects of obesity and how they may be expressed at different stages of the life cycle. Genetic studies using various methodological approaches (twin studies, family studies, pedigree studies, candidate genes, genomic scans) are summarized, and there is a discussion on the various forms of monogenic obesity. Chapter 7, by Dr. Angelo Pietrobelli and Dr. David Fields, discusses methodological applications for the measurement of energy expenditure and body composition. This chapter is especially useful because it covers a wide range of applications and tools that are useful under different types of situations. Chapter 8, by Dr. Margarita Treuth and Dr. Linda Bandini, discusses the role of energy expenditure and physical activity in the regulation of body weight. This topic is relevant to the identification of factors that might predict the development of obesity, which has important implications for designing effective interventions. In Chapter 9, Dr. Cong Ning and Dr. Jack Yanovski cover endocrine factors and disorders associated with pediatric obesity. This discussion is especially relevant because the complex and dynamic changes in endocrine factors that occur during growth need to be accounted for when treating overweight and obesity. In Chapter 10, Dr. Paule Barbeau and colleagues provide a detailed overview of the interplay between physical activity and obesity in children, extending the discussion in Chapter 8 to incorporate obesity-related diseases and exercise-intervention studies.

Chapters 11 and 12 focus on obesity-related diseases in children. In particular, the incidence of pediatric type 2 diabetes has increased dramatically in the last 20 years, and in Chapter 11, Dr. Barbara Gower and Dr. Sonia Caprio discuss this finding, especially because this might relate to the observed changes in insulin dynamics that occur during puberty. In Chapter 12, Dr. Martha Cruz extends this discussion to cardiovascular disease risk factors and the metabolic syndrome, seen with increased frequency among obese children. Evidence from this chapter suggests that a state of insulin resistance associated with obesity during childhood may be responsible for the increased risk factors for type 2 diabetes and cardiovascular disease, as has been hypothesized in adults. Thus, preventive action should begin early in life and should perhaps focus on improving insulin resistance.

Chapters 13 to 15 focus in more detail on behavioral and environmental aspects. In Chapter 13, Dr. Tanja Kral and colleagues discuss behavioral aspects of food intake and how this may affect potential targets for preventing weight gain during growth and development. This chapter emphasizes modifiable factors that could serve as therapeutic targets. The discussion is presented at various levels of factors, including strategies related to food presentation (portion size, frequency of food exposure), food properties (energy density, sugar content, glycemic index), and familial patterns (family meals, TV dinners, snacking practices). In Chapter 14, Dr. Donna Spruijt-Metz and Dr. Brian Saelens present a similar discussion, this time based on an analysis of behavioral factors related to physical activity, and move toward considerations for the development of effective physical activity interventions that need to be based on sound theories of health behavior. In Chapter 15, Dr, Penny Gordon-Larsen and Dr. Kim Reynolds summarize the rapidly evolving area of research related to the influence of the built environment on obesity, especially those related to physical activity. The built environment incorporates factors in urban design and general land use (roadways, paths, access to parks and recreation, public transport). It has become clear that our environments can influence our physical activity levels in positive and negative ways, and therefore those developing strategies to increase physical activity and reduce obesity need to consider broader contexts in the environment and potentially reach a larger audience at the population level.

In the final four chapters (Chapters 16 to 19), we provide overviews on interventions for treatment and prevention. Chapter 16, by Dr. Leslie Lytle and Dr. Katie Schmitz, addresses community level influences and interventions. This chapter defines community and discusses ecological models and approaches for obesity prevention. Chapter 17, by Dr. Simone French and Dr. Mary Story, reviews school-based research and interventions, with a specific focus on obesity prevention based studies. Chapter 18, by Dr. Cara Ebbeling and Dr. David Ludwig, covers the broad topic of dietary approaches for obesity treatment and prevention. This chapter includes a fascinating review of how children's diets have changed over the past few decades and then summarizes various dietary intervention studies using conventional and popular approaches, ending with the suggestion that diets geared toward controlling postprandial glucose levels may be more effective than previous diets that used low calorie, low fat, and low carbohydrate approaches. In the final chapter, Dr. Elsie Taveras and Dr. Matthew Gillman review the link between breast-feeding and later risk of obesity, covering the epidemiological studies in this area and potential mechanisms, and ending with clinical and public health implications that may be useful for long-term obesity prevention.

In these chapters we can see why the topic of childhood obesity has become on the one hand so specialized and on the other so multidisciplinary. Trying to understand the numerous factors involved with body weight regulation and identifying interventions to prevent or treat the problem is an enormous task in and of it self. Addressing this issue in growing children is further complicated by numerous challenges specific to children, as discussed in these chapters.

For example, obesity is a moving target in growing children in that the growth process is associated with underlying increases in fat and fat free mass (i.e., growth itself requires energy imbalance to occur). This has implications for the definition and interpretation of data. Considering obesity as a dynamic condition provides a good model for studying it in children (i.e., growth is associated with a continual increase in body fatness, as opposed to adults, where obesity is generally a static model). The difficulty comes in trying to separate the changes in fat mass that are due to obesity (or obesity reduction) from those associated with growth itself.

The general philosophy underlying intervention approaches in children is also different for a number of reasons. First, pharmacological intervention is less of an option because of ethical concerns related to long-term drug use in children and because of unknown effects of pharmacological interventions on growth and development. Obesity treatment and prevention in children requires consideration of the specific social and environmental factors, such as family and school.

Despite these challenges, we have made considerable progress, and our goal was to summarize this progress. Because this is a rapidly evolving area of research, we are sure that we will need to modify this body of work in the not-too-distant future. We hope that you find this work as useful and as inspiring as we have in putting it together.

As a final note we would like to thank all of the authors and coauthors for their dedication and enthusiasm to the cause. None of the authors received an honorarium for this work. They contributed their chapters on the basis of an absolute commitment and enthusiasm for their research. To exemplify this outlook, the editors and authors have agreed to donate a portion of any royalties to the pediatric interest group of NAASO: The Obesity Society, a group that is committed to education and professional networking among pediatric obesity researchers and practitioners. It has been a wonderful and inspiring experience to have been able to collaborate with such a wonderful group who share a collective vision of a healthier and brighter outlook for future generations.