Childhood Obesity: 5 Key Research Updates for Primary Care

As rates of adolescent obesity continue to rise, authors of a recent clinical update titled, “Treatment of Adolescent Obesity in 2020” published in JAMA, wrote, “Rather than proceeding by chronological stages or phases, treatment should occur as an integrated continuum of care that begins with the least invasive, yet appropriately intensive, treatment.” Obesity treatment options, the authors continue, should be discussed with the patient’s family and it is crucial for physicians to use “patient-first language” that children prefer like “BMI” instead of “fat.” The authors also address the evidence behind behavioral interventions, pharmacotherapy, and bariatric surgery. Primary care physicians already provide a significant portion of obesity management, so “there is a need for obesity medicine training throughout the continuum of medical education for primary care physicians…it is imperative that such educational programs are developed,” the authors concluded.

A new Dartmouth-led studyfollowed >500 children aged 3-5 years for 1 year and found that fast food consumption alone contributed to weight gain. Previous studies have shown a link between fast food intake and adolescent obesity, but evidence is lacking on whether fast food intake independently contributes. “Unlike with past research, we were able to adjust for other factors-such as exercise and screen time-that could possibly explain away this relationship,” said first author Jennifer Emond, PhD, MS, Geisel School of Medicine, Dartmouth College in a press release. The children’s parents reported their fast food intake frequency for the previous week from 11 chain fast food restaurants in 6 online follow-up surveys, completed at 2-month intervals. Mean fast food intake frequency was 2.1 times/week and, at baseline, approximately 18% of children were overweight and 10% were obese. More importantly, nearly 8% of children gained weight over the study period.

Metformin may be effective in reducing some measures of obesity in children, according to results of a new systemic review and meta-analysis published in Childhood Obesity. The authors searched the medical literature for clinical trials that examined the effect of metformin on obesity indices in children. Authors selected 38 randomized controlled trials that included 2199 participants (median age 13.66 years, 60.25% women). Overall, metformin was shown to significantly reduce body mass index (BMI), body weight, waist circumference, and fat mass, but not lean body mass. Researchers noted, however, that the decrease in BMI and waist circumference, “were not significant among participants who were overweight or obese.” More studies are needed, particularly among patients with specific health conditions, to confirm these findings the authors concluded.

Obesity is a known factor for several types of cancer, but most studies have only examined this link in adults, so where does that leave children with obesity? A recent study published in The Lancet reviewed medical and sociodemographic data for >2.2 million Israeli children whose height and weight were measured at age 17 for mandatory military service from 1967 to 2010. Adolescent obesity in men was significantly associated with midlife cancer incidence (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.18-1.35), but no association was found in women, driven by inverse associations of obesity with cervical and breast cancers. When those cancers were excluded, however, women had a similar adjusted HR to men (HR 1.27; 95% CI 1.13-1.44).