The objective is to formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity.
Abstract
Cosponsoring Associations:
The European Society of ...Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society.
Objective:
To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity.
Participants:
The participants include an Endocrine Society–appointed Task Force of 6 experts, a methodologist, and a medical writer.
Evidence:
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
Consensus Process:
One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline.
Conclusion:
Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.
Objective:
The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).
Participants:
An Endocrine Society-appointed Task Force of experts, a ...methodologist, and a medical writer developed the guideline.
Evidence:
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.
Consensus Process:
One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence.
Conclusions:
We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.
Once-Weekly Semaglutide in Adolescents with Obesity Weghuber, Daniel; Barrett, Timothy; Barrientos-Pérez, Margarita ...
New England journal of medicine/The New England journal of medicine,
12/2022, Letnik:
387, Številka:
24
Journal Article
Recenzirano
Odprti dostop
In this trial, adolescents with obesity assigned to weekly subcutaneous semaglutide plus lifestyle intervention had a greater reduction in BMI than those who received lifestyle intervention alone.
Adolescents with obesity and a poor response to lifestyle therapy alone were randomly assigned to receive either liraglutide or placebo subcutaneously once daily, in addition to lifestyle therapy. ...The use of liraglutide led to a significantly greater reduction in the standard-deviation score for the body-mass index than placebo.
The incidence of youth type 2 diabetes (T2D), linked with obesity and declining physical activity in high‐risk populations, is increasing. Recent multicenter studies have led to a number of advances ...in our understanding of the epidemiology, pathophysiology, diagnosis, treatment, and complications of this disease. As in adult T2D, youth T2D is associated with insulin resistance, together with progressive deterioration in β cell function and relative insulin deficiency in the absence of diabetes‐related immune markers. In contrast to adult T2D, the decline in β cell function in youth T2D is three‐ to fourfold faster, and therapeutic failure rates are significantly higher in youth than in adults. Whether the more aggressive nature of youth T2D is driven by genetic heterogeneity or physiology/metabolic maladaptation is yet unknown. Besides metformin, the lack of approved pharmacotherapeutic agents for youth T2D that target the pathophysiological mechanisms is a major barrier to optimal diabetes management. There is a significant need for effective therapeutic options, in addition to increased prevention, to halt the projected fourfold increase in youth T2D by 2050 and the consequences of heightened diabetes‐related morbidity and mortality at younger ages.
Although all types of diabetes result in hyperglycemia, the pathophysiology of each type of diabetes is different. These guidelines summarize available data specific to the comprehensive care of ...youth with type 2 diabetes. The objective is to enrich the recognition of type 2 diabetes in youth, its risk factors, its pathophysiology, its management, and the prevention of associated complications.
Obesity in Adolescents Hannon, Tamara S.; Arslanian, Silva A.
The New England journal of medicine,
07/2023, Letnik:
389, Številka:
3
Journal Article
Recenzirano
Management of obesity in adolescents should routinely include intensive treatment with regard to lifestyle and diet, with antiobesity medications and bariatric surgery considered if indicated.
Obesity in Adolescents. Reply Hannon, Tamara S; Arslanian, Silva A
The New England journal of medicine,
10/2023, Letnik:
389, Številka:
14
Journal Article
This trial compared once-weekly dulaglutide, a GLP-1 receptor agonist, with placebo for glycemic control in youths with type 2 diabetes who may have been receiving metformin or basal insulin. ...Dulaglutide was superior at 26 weeks.
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