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NEW BIOMARKERS OF THE METABOLIC RISK ASSOCIATED TO CHILDHOOD OBESITY

By Head Consultant, Associate Professor, PhD Jens-Christian Holm, The Children’s Obesity Clinic, European Centre for Obesity Management, Holbaek University Hospital, Denmark.

Obesity in children and adolescents is a growing pandemic with enormous health related suffering and expenses. Our group has previously published that 50% of children and adolescents living with obesity and an average age of 11.5 years exhibit pre- or overt hypertension, 31% exhibit steatosis, 28% exhibit dyslipidaemia, 45% exhibit sleep apnoea, and 18% exhibit prediabetes.

The HOLBAEK model has been shown to reduce the degree of obesity in 75% of patients as well as reducing related complications including hypertension, dyslipidaemia, steatosis, sleep apnoea, parental degree of obesity, appetite, and bullying and increase quality of life, mood and body self-esteem. These results are based on an investment of 5 hours of healthcare professional time per patient per year. Further, results are independent on socioeconomic class, degree of obesity prior treatment, sugary intakes, impaired glucose tolerance, disturbed eating, a genetic risk score for obesity and familial predisposition.

Within the last decade, The HOLBAEK Study has accumulated +8.000 patients and controls in the paediatric age range and conducted multiple studies including the genome, virome, proteome, metagenome, and lipidome, utilizing machine learning techniques with an aim to predict disease and treatment outcomes. We have diagnosed patients having Melanocortin 4 receptor, leptin receptor and other mutations, and have generated genetic and polygenic risk scores, including a genetic risk score of steatosis associating with both steatosis and cardiometabolic risk factors in children. Furthermore, we have through consortia collaborations contributed to the identification of novel genes associating with obesity in childhood and cardiovascular disease in adulthood.

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Lifestyle modification therapy serves as the foundation of pediatric obesity treatment, yet many children and adolescents need additional help to manage their weight. Anti-obesity medications target core biological processes driving appetite, satiety, and cravings, allowing children and adolescents to better adhere to healthy lifestyle recommendations. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as an important class of anti-obesity medication, and liraglutide 3mg daily was recently approved by the European Medicines Agency and the United States Food and Drug Administration for the treatment of adolescent obesity. Additional GLP-1 RAs, which may offer greater weight loss, are currently being evaluated for safety and efficacy in adolescents with obesity. A recent trial in the United States evaluating the combination of phentermine and topiramate demonstrated clinically significant BMI reduction with an acceptable side effect profile, similar to results of adult obesity trials. Treatment responses to all types of obesity interventions, including pharmacotherapy, can be highly variable, and precision medicine approaches can help identify which anti-obesity medications are the safest and most effective for each individual patient.

Background and Aims

The COVID-19 pandemic has had wide effects on child health globally. Increased prevalence of childhood obesity has been observed during the pandemic. The absence of a formal societal lockdown during the pandemic, made Sweden stand out compared to other countries. This study aimed to examine changes in BMI among preschool children in Sweden before and during the COVID-19 pandemic.

Methods

Retrospective population based cross-sectional study, with longitudinal follow-up for a portion of the children. The study included 25049 children from three Swedish regions, with growth measures at three- (n=16237), four- (n=14437) and five-years of age (n=11 711). Care Need Index was used as a socioeconomic parameter at health centre level.

Results

There was an increase in BMI in children aged three (p=0.028), and four (p <.001) during the COVID-19 pandemic. Obesity in three-year-old girls increased from 2.8% to 3.9%. Four-year-olds increased in obesity (both sexes), overweight (girls) and the prevalence of underweight decreased in boys. No change in BMI was observed in five-year-olds. Children in areas with the lowest socioeconomic status had higher risk of obesity, increasing from 2.4% to 4.4% during the pandemic, overweight increased from 9.5% to 12.4%.

Conclusions

Overweight and obesity increased among three-four year old Swedish, especially for children attending child health centres in areas with lower socioeconomic status. The COVID-19 pandemic is likely to have affected health behaviours negatively in Swedish preschool children. Our results expose the need for extended efforts directed to prevent childhood obesity, especially targeting lower socioeconomic areas.