Obesity in children and adolescents: epidemiology, causes, assessment, and management.
Obesity in children and adolescents: epidemiology, causes, assessment, and management.
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DOI：
10.1016/s2213-8587(22)00047-x
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发表时间：
2022-05
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本综述介绍了儿童和青少年肥胖的流行病学和原因，评估的考虑因素，目前的管理方法的现有知识。在COVID-19大流行之前，尽管严重肥胖的水平有所上升，但许多高收入国家的儿童及青少年肥胖患病率已趋于稳定。然而，在低收入和中等收入国家，肥胖症流行率有所上升。在大流行期间，一些司法管辖区的儿童和青少年体重增加。肥胖与心脏代谢和心理社会共病以及过早成人死亡有关。肥胖症的发展和延续在很大程度上是由生物社会生态学框架解释的，其中生物易感性，社会经济和环境因素相互作用，共同促进脂肪组织的沉积和增殖。一线治疗方法包括以家庭为基础的行为肥胖干预措施，解决饮食、体育活动、久坐行为和睡眠质量问题，并以行为改变战略为基础。强化饮食方法、药物治疗以及代谢和减肥手术作为补充疗法的证据正在出现;然而，在大多数司法管辖区，获得这些疗法的机会很少。仍然需要研究来告知儿童和青少年肥胖症治疗方法的个性化及其转化为临床实践。
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.