Prevention and Management of Overweight and Obesity in Children and Adolescents

Childhood obesity is one of the most serious public health challenges of the 21st century. The prevalence has increased at an alarming rate, affecting many low- and middle-income countries particularly in urban settings. In 2020, 144 million children were affected by stunting and 47 million children were wasted while 38.3 million children were overweight or obese (1).

Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in people who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease (2).

According to UNICEF report about childhood obesity in Egypt 2015, 39.6 % of males aged 5-9 years were overweight and 15.1% were obese, while 37.9% of females in the same age group were overweight and 11% were obese. In those aged 10-14 years, 34.4 % of males were overweight and 9.9% were obese while the percentage in females of the same age group was 35.4% and 8.5% respectively. In adolescents aged 15-19 years old the percentages of overweight and obese males were 29.4% and 4.9% respectively while 35.9% of females in the same age group were overweight and 8.7% were obese (3). Shafie et al. (4) in 2020, reported a 12.2 and 9.6 % prevalence of overweight and obesity among Egyptian primary school children, respectively.

The increasing prevalence of childhood obesity has led to the emergence of multiple serious obesity-related comorbidities that not only threaten the health of those affected but also promise to place a large strain on the health care system. In addition, obesity in childhood tracks strongly into adulthood, particularly in those with severe obesity and/or a strong family history of obesity (4,5).

Owing to the increasing rates of childhood obesity, the global life expectancy in the United States will, for the first time in recent history, decline, and the American Heart Association has reclassified obesity as a ‘major, modifiable risk factor’ for coronary heart disease (5,6).

Overweight and obesity are defined by WHO as abnormal or excessive fat accumulation that may impair health (6,7). WHO definitions for being overweight and obesity are based on both weight and length/height estimates, i.e. weight-for-length/height and body mass index (BMI) but not mid-upper arm circumference (1).

For children less than 5 years of age, overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median. Children and adolescents aged between 5–19 years, overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and obesity is greater than 2 standard deviations above the WHO Growth Reference median is widely accepted that increase in obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being closely associated with the lifestyle adopted and the dietary intake preferences

The genetic factor accounts for less than 5% of cases of childhood obesity. Therefore, while genetics can play a role in the development of obesity, it is not the cause of the dramatic increase in childhood obesity (8).

Childhood obesity can profoundly affect children’s physical health, social, and emotional wellbeing, and self-esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child (9).

Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects (1).

            Prevention and treatment of pediatric obesity and complications are key strategic goals, in order to reduce morbidity, mortality, and expected costs for the care of obese adults (10).

Given the multifactorial nature of obesity, preventive interventions should be designed to modify the environmental and social determinants. Health and non-health professionals should be involved in implementing healthy food education and promoting physical activity. To be effective, actions must be multicomponent, multilevel, building agreements, and alliances among many stakeholders, including families, community organizations such as nurseries, schools, sport institutions, health care providers, and teachers (11,12).

The main stay of management is behavior modification that should involve the whole  family. (9,13) Pharmacological therapy can only be applied after the failure of the multidisciplinary lifestyle intervention. Bariatric surgery is the ultimate solution in adolescents with morbid obesity and resistant to all other treatments, especially when serious complications are present (10).

This guideline was implemented in order to decrease the prevalence, to manage overweight and obesity and to prevent the future complications related to obesity among Egyptian children to raise a healthy generation.

Purpose and Scope

These guidelines have been developed to standardize the delivery of services and to implement the guidance on the prevention, diagnosis and management of Overweight and Obesity in Children and Adolescents.

It provides guidance to primary health care providers, pediatricians and specially trained nurses.

The guidelines aimed to:

1. Early detection of overweight and obesity in infants, children and adolescents.

2. Identification of infants, children and adolescents at high risk of developing overweight and obesity.
3. Proper diagnosis of overweight and obesity  in the targeted population.

This version of the guideline includes recommendations and good practice statements for

· Management of overweight and obesity in the targeted population. 

· Prevention of overweight and obesity in the targeted population.