Pediatrics. Consilium MedicumPediatrics. Consilium MedicumПедиатрия. Consilium Medicum2658-66302658-6622Consilium Medicum10063810.26442/26586630.2021.4.201354ArticlesСтатьиReview ArticleObesity is an important paediatric problem that paediatricians and endocrinologists should address togetherОжирение – важная педиатрическая проблема, которой педиатры и эндокринологи должны заниматься вместеhttps://orcid.org/0000-0001-5684-7575BerezhnayaIrina V.БережнаяИрина Владимировна
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, доц. каф. педиатрии

berezhnaya-irina26@yandex.ruhttps://orcid.org/0000-0002-7994-3751SimakovaMariia A.СимаковаМария Александровна
Russian Federation

Graduate Student

аспирант каф. педиатрии

simakova131@mail.ruhttps://orcid.org/0000-0003-4200-4598ZakharovaIrina N.ЗахароваИрина Николаевна
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, проф., зав. каф. педиатрии

zakharova-rmapo@yandex.ruRussian Medical Academy of Continuous Professional EducationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России1512202143463501302202213022022Copyright ©; 2021, Consilium MedicumCopyright ©; 2021, ООО "Консилиум Медикум"2021Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://pediatria.orscience.ru/2658-6630/article/view/100638

The increasing incidence of obesity in children and adolescents with its negative health consequences is one of the global problems of paediatrics and paediatric endocrinology. Approaches to the management of obese children are being developed and scientific and practical programmes for prevention and treatment are being established. Correctly assessing the risks of obesity in the long term and knowing how to influence them can help to reduce these risks. The primary care physician's priority is to make a diagnosis of overweight and obesity in children and to determine appropriate screening and treatment according to current clinical guidelines and known scientific evidence. The aim of this review is to briefly describe the risk factors, current epidemiological features of obesity and to provide a primary screening plan for children with exogenous obesity to assist the practicing paediatrician and paediatric endocrinologist.

Рост частоты ожирения у детей и подростков с его негативными последствиями для здоровья является одной из глобальных проблем педиатрии и детской эндокринологии. Разрабатываются подходы к ведению детей с ожирением, создаются научно-практические программы профилактики и лечения. Правильная оценка рисков ожирения в перспективе и знание способов влияния на них могут помочь снизить эти риски. Первоочередной задачей врача первичного звена являются постановка диагноза избыточной массы тела и ожирения у детей и определение грамотной тактики обследования и лечения в соответствии с действующими клиническими рекомендациями, известными научными данными. Цель данного обзора – краткое описание факторов риска, современных эпидемиологических особенностей ожирения, а также предоставление плана первичного обследования детей с экзогенно-конституциональным ожирением в помощь практикующему врачу-педиатру и детскому эндокринологу.

obesitychildrenepidemiology of childhood obesityrisk factors for childhood obesityfollow-up of obese childrenexamination of obese childrenожирениедетиэпидемиология детского ожиренияфакторы риска ожирения у детейнаблюдение детей с ожирениемобследование детей с ожирениемФедеральные клинические рекомендации (протоколы) по ведению детей с эндокринными заболеваниями. Под ред. И.И. Дедова, В.А. Петерковой. М.: Практика, 2014 [Federal'nye klinicheskie rekomendatsii (protokoly) po vedeniiu detei s endokrinnymi zabolevaniiami. Pod red. II Dedova, VA Peterkovoi. Moscow: Praktika, 2014 (in Russian)].Петеркова В.А., Безлепкина О.Б., Болотова Н.В., и др. Клинические рекомендации «Ожирение у детей». Проблемы эндокринологии. 2021;67 (5):67-83 [Peterkova VA, Bezlepkina OB, Bolotova NV, et al. Klinicheskie rekomendatsii "Ozhirenie u detei". Problemy endokrinologii. 2021;67(5):67-83 (in Russian)].NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627-42.Latest WHO data on child obesity shows that southern European countries have the highest rate of childhood obesity. Report Dr Joao Breda 25 ЕСО. May 2018, Austria. Available at: https://www.eurekalert.org/news-releases/564718. Accessed: 14.07.2021.Ларионова М.А., Коваленко Т.В. Эпидемиологические особенности ожирения у детей и подростков в Удмуртской Республике. Ожирение и метаболизм. 2019;16(1):47-54 [Larionova MA, Kovalenko TV. Epidemiologicheskie osobennosti ozhireniia u detei i podrostkov v Udmurtskoi Respublike. Ozhirenie i metabolizm. 2019;16(1):47-54 (in Russian)].Ануфриева Е.В., Неупокоева Л.Ю., Ковтун О.П. Тенденции распространенности ожирения у детей и подростков в Свердловской области. Российский педиатрический журнал. 2020;1(2):5-9 [Anufrieva EV, Neupokoeva LIu, Kovtun OP. Tendentsii rasprostranennosti ozhireniia u detei i podrostkov v Sverdlovskoi oblasti. Rossiiskii pediatricheskii zhurnal. 2020;1(2):5-9 (in Russian)].Лир Д.Н., Козлов А.И., Вершубская Г.Г., и др. Избыточная масса тела и ожирение у детей 7–17 лет северо-запада РФ и Приуралья. Вестник Московского университета. Антропология. 2018;3(23):55-60 [Lir DN, Kozlov AI, Vershubskaia GG, et al. Izbytochnaia massa tela i ozhirenie u detei 7–17 let severo-zapada RF i Priural'ia. Vestnik Moskovskogo universiteta. Antropologiia. 2018;3(23):55-60 (in Russian)].Мартынова И.Н., Винярская И.В., Терлецкая Р.Н., и др. Вопросы истинной заболеваемости и распространенности ожирения среди детей и подростков. Российский педиатрический журнал. 2016;19(1):23-8 [Martynova IN, Viniarskaia IV, Terletskaia RN, et al. Voprosy istinnoi zabolevaemosti i rasprostranennosti ozhireniia sredi detei i podrostkov. Rossiiskii pediatricheskii zhurnal. 2016;19(1):23-8 (in Russian)].Weihrauch-Blüher S, Schwarz P, Klusmann JH. Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood. Metabolism. 2019;92:147-52.Lennerz BS, Moss A, von Schnurbein J, et al. Do adolescents with extreme obesity differ according to previous treatment seeking behavior? The Youth with Extreme obesity Study (YES) cohort. Int J Obes (Lond). 2019;43(1):103-15.Berenson GS; Bogalusa Heart Study group. Health consequences of obesity. Pediatr Blood Cancer. 2012;58(1):117-21.Abdullah A, Stoelwinder J, Shortreed S, et al. The duration of obesity and the risk of type 2 diabetes. Public Health Nutr. 2011;14:119-26.Tirosh A, Shai I, Afek A, et al. Adolescent BMI trajectory and risk of diabetes versus coronary disease. N Engl J Med. 2011;364(14):1315-25.Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and cancer – viewpoint of the IARC working group. N Engl J Med. 2016;375:794-8.Shamriz O, Leiba M, Levine H, et al. Higher body mass index in 16-19 year-old Israeli adolescents of North African, Middle Eastern, and European origins is a predictor of acute myeloid leukemia: a cohort of 2.3 million Israelis. Cancer Causes Control. 2017;28(4):331-9.Polfuss ML, Duderstadt KG, Kilanowski JF, et al. Childhood Obesity: Evidence-Based Guidelines for Clinical Practice-Part One. J Pediatr Health Care. 2020;34(3):283-90.National Institute for Clinical Excellence [NICE]. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and childrend Clinical Guideline 43. 2006. Available at: www.nice.org.uk/guidance/Cg43. Accessed: 14.07.2021.Tyson N, Frank M. Childhood and adolescent obesity definitions as related to BMI, evaluation and management options. Best Pract Res Clin Obstet Gynaecol. 2018;48:158-64.Bravo J, Raimundo AM, Santos DA, et al. Abdominal obesity in adolescents: Development of age-specific waist circumference cut-offs linked to adult IDF criteria. Am J Hum Biol. 2017;29(6).Bjerregaard LG. Are we approaching a better definition of childhood obesity? Lancet Child Adolesc Health. 2019;3(11):752-4.Styne DM, Arslanian SA, Connor EL, et al. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709-57.Александров А.А., Бубнова М.Г., Кисляк О.А., и др. Профилактика сердечно-сосудистых заболеваний в детском и подростковом возрасте. Российские рекомендации. Российский кардиологический журнал. 2012;17(6);Прил. 1 [Aleksandrov AA, Bubnova MG, Kisliak OA, et al. Profilaktika serdechno-sosudistykh zabolevanii v detskom i podrostkovom vozraste. Rossiiskie rekomendatsii. Rossiiskii kardiologicheskii zhurnal. 2012;17(6);Pril. 1 (in Russian)].Агапитов Л.И., Александров А.А., Баранов А.А., и др. Артериальная гипертензия у детей. Клинические рекомендации МЗ РФ, 2016. Режим доступа: https://minzdrav29.ru/health/normativnye-pravovye-dokumenty/klinical_protokols/%D0%9A%D0%A0571.pdf. Ссылка активна на 14.07.2021 [Agapitov LI, Aleksandrov AA, Baranov AA, et al. Arterial'naia gipertenziia u detei. Klinicheskie rekomendatsii MZ RF, 2016. Available at: https://minzdrav29.ru/health/normativnye-pravovye-dokumenty/klinical_protokols/KR571.pdf. Accessed: 14.07.2021.Schwimmer JB, Dunn W, Norman GJ, et al. SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology. 2010;138:1357-64.e1-2.Mayer-Davis EJ, Kahkoska AR, Jefferies C, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018;19(Suppl. 27):7-19.Hamilton D, Dee A, Perry IJ. The lifetime costs of overweight and obesity in childhood and adolescence: a systematic review. Obes Rev. 2018;19(4):452-63.Williams CB, Mackenzie KC, Gahagan S. The effect of maternal obesity on the offspring. Clin Obstet Gynecol. 2014;57(3):508-15.Taveras EM, Rifas-Shiman SL, Belfort MB, et al. Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics. 2009;123(4):1177-83.Marchi J, Berg M, Dencker A, et al. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16:621-38.Yuan C, Gaskins AJ, Blaine AI, et al. Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood. JAMA Pediatr. 2016;170(11):e162385.Kuhle S, Tong OS, Woolcott CG. Association between caesarean section and childhood obesity: a systematic review and meta-analysis. Obes Rev. 2015;16:295-303.Li HT, Zhou YB, Liu JM. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. Int J Obes. 2013;37:893-9.Mínguez-Alarcón L, Rifas-Shiman SL, Sordillo JE, et al. Association of Mode of Obstetric Delivery With Child and Adolescent Body Composition. JAMA Netw Open. 2021;4(10):e2125161.Rasmussen KM, Yaktine AL. Weight gain during pregnancy: Reexamining the guidelines. Institute of Medicine, 2009. DOI:10.17226/12584von Kries R, Chmitorz A, Rasmussen KM, et al. Late pregnancy reversal from excessive gestational weight gain lowers risk of childhood overweight – a cohort study. Obesity (Silver Spring). 2013;21(6):1232-7.Horiuchi S, Shinohara R, Otawa S, et al.; Japan Environment And Children's Study Group. Influence of Maternal Active and Secondhand Smoking during Pregnancy on Childhood Obesity at 3 Years of Age: A Nested Case-Control Study from the Japan Environment and Children's Study (JECS). Int J Environ Res Public Health. 2021;18(23):12506.Skouteris H, Nagle C, Fowler M, et al. Interventions designed to promote exclusive breastfeeding in high-income countries: a systematic review. Breastfeed Med. 2014;9(3):113-27.Ventura AK. Does breastfeeding shape food preferences? Links to obesity. Ann Nutr Metab. 2017;70(Suppl. 3):8-15.Soldateli B, Vigo A, Giugliani ER. Effect of pattern and duration of breastfeeding on the consumption of fruits and vegetables among preschool children. PLoS One. 2016;11:e0148357.Cheng H, Chen R, Milosevic M, et al. Interventions Targeting Bottle and Formula Feeding in the Prevention and Treatment of Early Childhood Caries, Overweight and Obesity: An Integrative Review. Int J Environ Res Public Health. 2021;18(23):12304.Locke AE, Kahali B, Berndt SI, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015;518(7538):197-206.Hemmingsson E. Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication. Curr Obes Rep. 2018;7(2): 204-9.Flodmark CE. Prevention Models of Childhood Obesity in Sweden. Obes Facts. 2018;11(3):257-62.Anderson SE, Keim SA. Parent-Child Interaction, Self-Regulation, and Obesity Prevention in Early Childhood. Curr Obes Rep. 2016;5(2):192-200.Weihrauch-Blüher S, Wiegand S. Risk Factors and Implications of Childhood Obesity. Curr Obes Rep. 2018;7(4):254-9.Rollins BY, Savage JS, Fisher JO, Birch LL. Alternatives to restrictive feeding practices to promote self-regulation in childhood: a developmental perspective. Pediatr Obes. 2016;11(5):326-32.