Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

Giuliana Valerio, Claudio Maffeis, Giuseppe Saggese, Maria Amalia Ambruzzi, Antonio Balsamo, Simonetta Bellone, Marcello Bergamini, Sergio Bernasconi, Gianni Bona, Valeria Calcaterra, Teresa Canali, Margherita Caroli, Francesco Chiarelli, Nicola Corciulo, Antonino Crinò, Procolo Di Bonito, Violetta Di Pietrantonio, Mario Di Pietro, Anna Di Sessa, Antonella Diamanti, Mattia Doria, Danilo Fintini, Roberto Franceschi, Adriana Franzese, Marco Giussani, Graziano Grugni, Dario Iafusco, Lorenzo Iughetti, Adima Lamborghini, Maria Rosaria Licenziati, Raffaele Limauro, Giulio Maltoni, Melania Manco, Leonardo Marchesini Reggiani, Loredana Marcovecchio, Alberto Marsciani, Emanuele Miraglia Del Giudice, Anita Morandi, Giuseppe Morino, Beatrice Moro, Valerio Nobili, Laura Perrone, Marina Picca, Angelo Pietrobelli, Francesco Privitera, Salvatore Purromuto, Letizia Ragusa, Roberta Ricotti, Francesca Santamaria, Chiara Sartori, Stefano Stilli, Maria Elisabeth Street, Rita Tanas, Giuliana Trifiró, Giuseppina Rosaria Umano, Andrea Vania, Elvira Verduci, Eugenio Zito, Giuliana Valerio, Claudio Maffeis, Giuseppe Saggese, Maria Amalia Ambruzzi, Antonio Balsamo, Simonetta Bellone, Marcello Bergamini, Sergio Bernasconi, Gianni Bona, Valeria Calcaterra, Teresa Canali, Margherita Caroli, Francesco Chiarelli, Nicola Corciulo, Antonino Crinò, Procolo Di Bonito, Violetta Di Pietrantonio, Mario Di Pietro, Anna Di Sessa, Antonella Diamanti, Mattia Doria, Danilo Fintini, Roberto Franceschi, Adriana Franzese, Marco Giussani, Graziano Grugni, Dario Iafusco, Lorenzo Iughetti, Adima Lamborghini, Maria Rosaria Licenziati, Raffaele Limauro, Giulio Maltoni, Melania Manco, Leonardo Marchesini Reggiani, Loredana Marcovecchio, Alberto Marsciani, Emanuele Miraglia Del Giudice, Anita Morandi, Giuseppe Morino, Beatrice Moro, Valerio Nobili, Laura Perrone, Marina Picca, Angelo Pietrobelli, Francesco Privitera, Salvatore Purromuto, Letizia Ragusa, Roberta Ricotti, Francesca Santamaria, Chiara Sartori, Stefano Stilli, Maria Elisabeth Street, Rita Tanas, Giuliana Trifiró, Giuseppina Rosaria Umano, Andrea Vania, Elvira Verduci, Eugenio Zito

Abstract

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.

Keywords: Consensus; Diagnosis; Pediatric obesity; Prevention; Treatment.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Spinelli A, Nardone P, Buoncristiano M, Lauria L, Pierannunzio D. Centro nazionale per la prevenzione delle malattie e la promozione della salute, Cnapps-Iss. OKkio alla Salute: i dati nazionali. 2016;
    1. Valerio G, Licenziati MR, Manco M, et al. Health consequences of obesity in children and adolescents. Minerva Pediatr. 2014;66:381–414.
    1. Società Italiana di Pediatria Obesità del bambino e dell’adolescente: Consensus su prevenzione, diagnosi e terapia . Argomenti di Pediatria 1/06. Milano: Istituto Scotti Bassani; 2006.
    1. Programma nazionale Linee Guida Manuale metodologico. Come produrre, diffondere e aggiornare raccomandazioni per la pratica clinica. Maggio. 2002. .
    1. WHO Multicentre Growth Reference Study Group WHO child growth standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76–85.
    1. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull WHO. 2007;85:660–667.
    1. Cacciari E, Milani S, Balsamo A, et al. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr) J Endocrinol Investig. 2006;29:581–593. doi: 10.1007/BF03344156.
    1. Valerio G, Balsamo A, Baroni MG, et al. Childhood obesity classification systems and cardiometabolic risk factors: a comparison of the Italian, World Health Organization and international obesity task force references. It J Pediatr. 2017;43(Suppl 1):19. doi: 10.1186/s13052-017-0338-z.
    1. Barlow SE, Expert Committee Recommendations regarding the prevention, assessment and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Suppl 4):S164–S192. doi: 10.1542/peds.2007-2329C.
    1. de Onis M, Lobstein T. Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J Pediatr Obes. 2010;5:458–460. doi: 10.3109/17477161003615583.
    1. de Onis M, Martínez-Costa C, Núñez F, Nguefack-Tsague G, Montal A, Brines J. Association between WHO cut-offs for childhood overweight and obesity and cardiometabolic risk. Public Health Nutr. 2013;16:625–630. doi: 10.1017/S1368980012004776.
    1. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR, American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128:1689–1712. doi: 10.1161/CIR.0b013e3182a5cfb3.
    1. Martos-Moreno GÁ, Barrios V, Muñoz-Calvo MT, Pozo J, Chowen JA, Argente J. Principles and pitfalls in the differential diagnosis and management of childhood obesities. Adv Nutr. 2014;5:299S–305S. doi: 10.3945/an.113.004853.
    1. Mason K, Page L, Balikcioglu PG. Screening for hormonal, monogenic, and syndromic disorders in obese infants and children. Pediatr Ann. 2014;43:e218–e224. doi: 10.3928/00904481-20140825-08.
    1. Angulo MA, Butler MG, Cataletto ME. Prader-Willi syndrome: a review of clinical, genetic, and endocrine findings. J Endocrinol Investig. 2015;38:1249–1263. doi: 10.1007/s40618-015-0312-9.
    1. Khan SA, Muhammad N, Khan MA, Kamal A, Rehman ZU, Khan S. Genetics of human Bardet–Biedl syndrome, an updates. Clin Genet. 2016;90:3–15. doi: 10.1111/cge.12737.
    1. Marshall JD, Muller J, Collin GB, et al. Alström syndrome: mutation spectrum of ALMS1. Hum Mutat. 2015;36:660–668. doi: 10.1002/humu.22796.
    1. Douzgou S, Petersen MB. Clinical variability of genetic isolates of Cohen syndrome. Clin Genet. 2011;79:501–506. doi: 10.1111/j.1399-0004.2011.01669.x.
    1. Mangelsdorf M, Chevrier E, Mustonen A, Picketts DJ. Börjeson-Forssman-Lehmann syndrome due to a novel plant homeodomain zinc finger mutation in the PHF6 gene. J Child Neurol. 2009;24:610–614. doi: 10.1177/0883073808327830.
    1. Twigg SR, Lloyd D, Jenkins D, et al. Mutations in multidomain protein MEGF8 identify a carpenter syndrome subtype associated with defective lateralization. Am J Hum Genet. 2012;91:897–905. doi: 10.1016/j.ajhg.2012.08.027.
    1. Basil JS, Santoro SL, Martin LJ, Healy KW, Chini BA, Saal HM. Retrospective study of obesity in children with Down syndrome. J Pediatr. 2016;173:143–148. doi: 10.1016/j.jpeds.2016.02.046.
    1. Bojesen A, Kristensen K, Birkebaek NH, et al. The metabolic syndrome is frequent in Klinefelter's syndrome and is associated with abdominal obesity and hypogonadism. Diabetes Care. 2006;29:1591–1598. doi: 10.2337/dc06-0145.
    1. Calcaterra V, Brambilla P, Maffè GC, et al. Metabolic syndrome in turner syndrome and relation between body composition and clinical, genetic, and ultrasonographic characteristics. Metab Syndr Relat Disord. 2014;12:159–164. doi: 10.1089/met.2013.0075.
    1. Albuquerque D, Stice E, Rodríguez-López R, Manco L, Nóbrega C. Current review of genetics of human obesity: from molecular mechanisms to an evolutionary perspective. Mol Gen Genomics. 2015;290:1191–1121. doi: 10.1007/s00438-015-1015-9.
    1. Huvenne H, Dubern B, Clément K, Poitou C. Rare genetic forms of obesity: clinical approach and current treatments in 2016. Obes Facts. 2016;9:158–173. doi: 10.1159/000445061.
    1. Genovesi S, Antolini L, Giussani M, et al. Hypertension, prehypertension, and transient elevated blood pressure in children: association with weight excess and waist circumference. Am J Hypertens. 2010;23:756–761. doi: 10.1038/ajh.2010.50.
    1. Friedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AM. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ. 2012;345:e4759. doi: 10.1136/bmj.e4759.
    1. Lo JC, Chandra M, Sinaiko A, et al. Severe obesity in children: prevalence, persistence and relation to hypertension. Int J Pediatr Endocrinol. 2014;2014:3. doi: 10.1186/1687-9856-2014-3.
    1. Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension. 2013;62:247–254. doi: 10.1161/HYPERTENSIONAHA.111.00831.
    1. Wirix AJ, Nauta J, Groothoff JW, et al. Is the prevalence of hypertension in overweight children overestimated? Arch Dis Child. 2016;101:998–1003. doi: 10.1136/archdischild-2015-309969.
    1. Strambi M, Giussani M, Ambruzzi MA, et al. Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors. Ital J Pediatr. 2016;42:69. doi: 10.1186/s13052-016-0277-0.
    1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–576. doi: 10.1542/peds.114.2.S2.555.
    1. Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34:1887–1920. doi: 10.1097/HJH.0000000000001039.
    1. Spagnolo A, Giussani M, Ambruzzi AM, et al. Focus on prevention, diagnosis and treatment of hypertension in children and adolescents. Ital J Pediatr. 2013;39:20. doi: 10.1186/1824-7288-39-20.
    1. Estrada E, Eneli I, Hampl S, et al. Children’s hospital association consensus statements for comorbidities of childhood obesity. Child Obes. 2014;10:304–317. doi: 10.1089/chi.2013.0120.
    1. Di Bonito P, Moio N, Sibilio G, et al. Cardiometabolic phenotype in children with obesity. J Pediatr. 2014;165:1184–1189. doi: 10.1016/j.jpeds.2014.08.007.
    1. Pieruzzi F, Antolini L, Salerno FR, et al. The role of blood pressure, body weight and fat distribution on left ventricular mass, diastolic function and cardiac geometry in children. J Hypertens. 2015;33:1182–1192. doi: 10.1097/HJH.0000000000000552.
    1. American Diabetes Association Classification and diagnosis of diabetes. Sec. 2. In standards of medical Care in Diabetes-2016. Diabetes Care. 2016;39(Suppl. 1):S13–S22.
    1. Zhang X, Gregg EW, Williamson DF, et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care. 2010;33:1665–1673. doi: 10.2337/dc09-1939.
    1. Kester LM, Hey H, Hannon TS. Using hemoglobin A1c for prediabetes and diabetes diagnosis in adolescents: can adult recommendations be upheld for pediatric use? J Adolesc Health. 2012;50:321–323. doi: 10.1016/j.jadohealth.2012.02.009.
    1. Springer SC, Silverstein J, Copeland K, et al. Management of type 2 diabetes mellitus in children and adolescents. Pediatrics. 2013;131:e648–e664. doi: 10.1542/peds.2012-3496.
    1. Kapadia CR. Are the ADA hemoglobin a(1c) criteria relevant for the diagnosis of type 2 diabetes in youth? Curr Diab Rep. 2013;13:51–55. doi: 10.1007/s11892-012-0343-y.
    1. Di Bonito P, Pacifico L, Chiesa C, et al. Impaired fasting glucose and impaired glucose tolerance in children and adolescents with overweight/obesity. J Endocrinol Investig. 2017;40(4):409–416. doi: 10.1007/s40618-016-0576-8.
    1. Maffeis C, Pinelli L, Brambilla P, et al. Fasting plasma glucose (FPG) and the risk of impaired glucose tolerance in obese children and adolescents. Obesity (Silver Spring) 2010;18:1437–1442. doi: 10.1038/oby.2009.355.
    1. Bedogni G, Gastaldelli A, Manco M, et al. Relationship between fatty liver and glucose metabolsim: a cross-sectional study in 571 obese children. Nutr Metab Cardiovasc Dis. 2012;22:120–126. doi: 10.1016/j.numecd.2010.05.003.
    1. Morandi A, Maschio M, Marigliano M, et al. Screening for impaired glucose tolerance in obese children and adolescents: a validation and implementation study. Pediatr Obes. 2014;9:17–25. doi: 10.1111/j.2047-6310.2012.00136.x.
    1. Manco M, Grugni G, Di Pietro M, et al. Triglycerides-to-HDL cholesterol ratio as screening tool for impaired glucose tolerance in obese children and adolescents. Acta Diabetol. 2016;53:493–498. doi: 10.1007/s00592-015-0824-y.
    1. Korsten-Reck U, Kromeyer-Hauschild K, Korsten K, Baumstark MW, Dickhuth HH, Berg A. Frequency of secondary dyslipidemia in obese children. Vasc Health Risk Manag. 2008;4:1089–1094. doi: 10.2147/VHRM.S2928.
    1. Casavalle PL, Lifshitz F, Romano LS, et al. Prevalence of dyslipidemia and metabolic syndrome risk factor in overweight and obese children. Pediatr Endocrinol Rev. 2014;12:213–223.
    1. Morrison JA, Glueck CJ, Woo JG, Wang P. Risk factors for cardiovascular disease and type 2 diabetes retained from childhood to adulthood predict adult outcomes: the Princeton LRC follow-up study. Int J Pediatr Endocrinol. 2012;2012:6. doi: 10.1186/1687-9856-2012-6.
    1. National Institutes of Health National Heart, Lung, and Blood Institute Expert panel on integrated pediatric guideline for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128:S1–S446. doi: 10.1542/peds.2010-3724B.
    1. Peterson AL, McBride PE. A review of guidelines for dyslipidemia in children and adolescents. WMJ. 2012;111:274–281.
    1. Campagna F, Martino F, Bifolco M, et al. Detection of familial hypercholesterolemia in a cohort of children with hypercholesterolemia: results of a family and DNA-based screening. Atherosclerosis. 2008;196:356–364. doi: 10.1016/j.atherosclerosis.2006.11.015.
    1. Pacifico L, Bonci E, Andreoli G, et al. Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents. Nutr Metab Cardiovasc Dis. 2014;24:737–743. doi: 10.1016/j.numecd.2014.01.010.
    1. Di Bonito P, Valerio G, Grugni G, et al. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis. 2015;25:489–494. doi: 10.1016/j.numecd.2015.01.012.
    1. Di Bonito P, Moio N, Scilla C, et al. Usefulness of the high triglyceride-to-HDL cholesterol ratio to identify cardiometabolic risk factors and preclinical signs of organ damage in outpatient children. Diabetes Care. 2012;35:158–162. doi: 10.2337/dc11-1456.
    1. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118:1388–1393. doi: 10.1542/peds.2006-1212.
    1. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut. 2009;58:1538–1544. doi: 10.1136/gut.2008.171280.
    1. 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;138:1357–1364. doi: 10.1053/j.gastro.2009.12.052.
    1. Koot BG, van der Baan-Slootweg OH, Tamminga-Smeulders CL, et al. Lifestyle intervention for non alcoholic fatty liver disease: prospective cohort study of its efficacy and factors related to improvement. Arch Dis Child. 2011;96:669–674. doi: 10.1136/adc.2010.199760.
    1. Vajro P, Lenta S, Socha P, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN hepatology committee. J Pediatr Gastroenterol Nutr. 2012;54:700–713. doi: 10.1097/MPG.0b013e318252a13f.
    1. Nobili V, Alkhouri N, Alisi A, et al. Retinol-binding protein 4: a promising circulating marker of liver damage in pediatric nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7:575–579. doi: 10.1016/j.cgh.2008.12.031.
    1. Lebensztejn DM, Wierzbicka A, Socha P, et al. Cytokeratin-18 and hyaluronic acid levels predict liver fibrosis in children with non-alcoholic fatty liver disease. Acta Biochim Pol. 2011;58:563–566.
    1. Alkhouri N, Mansoor S, Giammaria P, Liccardo D, Lopez R, Nobili V. The development of the pediatric NAFLD fibrosis score (PNFS) to predict the presence of advanced fibrosis in children with nonalcoholic fatty liver disease. PLoS One. 2014;9:e104558. doi: 10.1371/journal.pone.0104558.
    1. Marzuillo P, Grandone A, Perrone L, Miraglia Del Giudice E. Controversy in the diagnosis of pediatric non-alcoholic fatty liver disease. World J Gastroenterol. 2015;21:6444–6450. doi: 10.3748/wjg.v21.i21.6444.
    1. Goyal NP, Schwimmer JB. The progression and natural history of pediatric nonalcoholic fatty liver disease. Clin Liver Dis. 2016;20:325–338. doi: 10.1016/j.cld.2015.10.003.
    1. Maffeis C, Banzato C, Rigotti F, et al. Biochemical parameters and anthropometry predict NAFLD in obese children. J Pediatr Gastroenterol Nutr. 2011;53:590–593.
    1. Kaechele V, Wabitsch M, Thiere D, et al. Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. J Pediatr Gastroenterol Nutr. 2006;42:66–70. doi: 10.1097/01.mpg.0000187816.31213.06.
    1. Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. Pediatrics. 2012;129:e82–e88. doi: 10.1542/peds.2011-0579.
    1. Heida A, Koot BG, vd Baan-Slootweg OH, et al. Gallstone disease in severely obese children participating in a lifestyle intervention program: incidence and risk factors. Int J Obes. 2014;38:950–953. doi: 10.1038/ijo.2014.12.
    1. Svensson J, Makin E. Gallstone disease in children. Semin Pediatr Surg. 2012;21:255–265. doi: 10.1053/j.sempedsurg.2012.05.008.
    1. Koebnick C, Smith N, Black MH, et al. Pediatric obesity and gallstone disease. J Pediatr Gastroenterol Nutr. 2012;55:328–333. doi: 10.1097/MPG.0b013e31824d256f.
    1. Fradin K, Racine AD, Belamarich PF. Obesity and synmptomatic cholelithiasis in childhood: epidemiologic and case-control evidence for a strong relationship. J Pediatr Gastroenterol Nutr. 2014;58:102–106. doi: 10.1097/MPG.0b013e3182a939cf.
    1. Størdal K, Johannesdottir GB, Bentsen BS, Carlsen KC, Sandvik L. Asthma and overweight are associated with symptoms of gastro-oesophageal reflux. Acta Paediatr. 2006;95:1197–1201. doi: 10.1080/08035250600589041.
    1. Malaty HM, Fraley JK, Abudayyeh S, et al. Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children. Clin Exp Gastroenterol. 2009;2:31–36. doi: 10.2147/CEG.S4715.
    1. Pashankar DS, Corbin Z, Shah SK, Caprio S. Increased prevalence of gastroesophageal reflux symptoms in obese children evaluated in an academic medical center. J Clin Gastroenterol. 2009;43:410–413. doi: 10.1097/MCG.0b013e3181705ce9.
    1. Teitelbaum JE, Sinha P, Micale M, Yeung S, Jaeger J. Obesity is related to multiple functional abdominal diseases. J Pediatr. 2009;154:444–446. doi: 10.1016/j.jpeds.2008.09.053.
    1. Koebnick C, Getahun D, Smith N, Porter AH, Der-Sarkissian JK, Jacobsen SJ. Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study. Int J Pediatr Obes. 2011;6:e257–e263. doi: 10.3109/17477166.2010.491118.
    1. Davies I, Burman-Roy S, Murphy MS. Guideline development group. Gastro-oesophageal reflux disease in children: NICE guidance. BMJ. 2015;350:g7703. doi: 10.1136/bmj.g7703.
    1. Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Hum Reprod. 2004;19:41–47. doi: 10.1093/humrep/deh098.
    1. Azziz R, Carmina E, Dewailly D, et al. Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. J Clin Endocrinol Metab. 2006;91:4237–4245. doi: 10.1210/jc.2006-0178.
    1. Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group Consensus on women’s health aspects of polycystic ovary syndrome (PCOS) Hum Reprod. 2012;27:14–24. doi: 10.1093/humrep/der396.
    1. Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol. 2010;203:201–205. doi: 10.1016/j.ajog.2010.03.008.
    1. Conway G, Dewailly D, Diamanti-Kandarakis E, et al. European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS special interest Group's questionnaire.; ESE PCOS special interest group. Eur J Endocrinol. 2014;171:489–498. doi: 10.1530/EJE-14-0253.
    1. Santamaria F, Montella S, Pietrobelli A. Obesity and pulmonary disease: unanswered questions. Obes Rev. 2012;13:822–833. doi: 10.1111/j.1467-789X.2012.01008.x.
    1. Delgado J, Barranco P, Quirce S. Obesity and asthma. J Investig Allergol Clin Immunol. 2008;18:420–425.
    1. Verhulst SL, Aerts L, Jacobs S, et al. Sleep-disordered breathing, obesity, and airway inflammation in children and adolescents. Chest. 2008;34:1169–1175. doi: 10.1378/chest.08-0535.
    1. Kang KT, Weng WC, Lee PL, Hsu WC. Central sleep apnea in obese children with sleep-disordered breathing. Int J Obes. 2014;38:27–31. doi: 10.1038/ijo.2013.105.
    1. Boxer GH, Bauer AM, Miller BD. Obesity-hypoventilation in childhood. Am J Acad Child Adolesc Psychiatry. 1988;27:552–558. doi: 10.1097/00004583-198809000-00006.
    1. Rosen CL. Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol. 1999;27:403–409. doi: 10.1002/(SICI)1099-0496(199906)27:6<403::AID-PPUL7>;2-8.
    1. American Academy of Pediatrics Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:713–756. doi: 10.1542/peds.2012-2183B.
    1. Gachelin E, Reynaud R, Dubus JC, Stremler-Le BN. Detection and treatment of respiratory disorders in obese children: obstructive sleep apnea syndrome and obesity hypoventilation syndrome. Arch Pediatr. 2015;22:908–915. doi: 10.1016/j.arcped.2015.06.012.
    1. McLachlan CR, Poulton R, Car G, et al. Adiposity, asthma, and airway inflammation. J Allergy Clin Immunol. 2007;119:634–639. doi: 10.1016/j.jaci.2006.10.029.
    1. Santamaria F, Montella S, De Stefano S, et al. Asthma, atopy, and airway inflammation in obese children. J Allergy Clin Immunol. 2007;120:965–967. doi: 10.1016/j.jaci.2007.06.002.
    1. Vitelli O, Tabarrini A, Miano S, et al. Impact of obesity on cognitive outcome in children with sleep-disordered breathing. Sleep Med. 2015;16:625–630. doi: 10.1016/j.sleep.2014.12.015.
    1. Wearing SC, Hennig EM, Byrne NM, Steele JR, Hills AP. Musculoskeletal disorders associated with obesity: a biomechanical perspective. Obes Rev. 2006;7:239–50. doi: 10.1111/j.1467-789X.2006.00251.x.
    1. Chan G, Chen CT. Musculoskeletal effects of obesity. Curr Opin Pediatr. 2009;21:65–70. doi: 10.1097/MOP.0b013e328320a914.
    1. Bhatia NN, Pirpiris M, Otsuka NY. Body mass index in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 2006;26:197–199. doi: 10.1097/01.bpo.0000218526.36362.3f.
    1. Loder RT, Skopelja EN. The epidemiology and demographics of slipped capital femoral epiphysis. ISRN Orthop. 2011;2011:486512.
    1. Sabharwal S. Blount disease: an update. Orthop Clin North Am. 2015;46:37–47. doi: 10.1016/j.ocl.2014.09.002.
    1. Bout-Tabaku S, Shults J, Zemel BS, et al. Obesity is associated with greater valgus knee alignment in pubertal children, and higher body mass index is associated with greater variability in knee alignment in girls. J Rheumatol. 2015;42:126–133. doi: 10.3899/jrheum.131349.
    1. Jankowicz-Szymanska A, Mikolajczyk E. Genu valgum and flat feet in children with healthy and excessive body weight. Pediatr Phys Ther. 2016;28:200–206. doi: 10.1097/PEP.0000000000000246.
    1. Stolzman S, Irby MB, Callahan AB, Skelton JA. Pes planus and paediatric obesity: a systematic review of the literature. Clin Obes. 2015;5:52–59. doi: 10.1111/cob.12091.
    1. Loder RT, Aronsson DD, Weinstein SL, Breur GJ, Ganz R, Leunig M. Slipped capital femoral epiphysis. Instr Course Lect. 2008;57:473–498.
    1. Harris EJ, Vanore JV, Thomas JL, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg. 2004;43:341–373. doi: 10.1053/j.jfas.2004.09.013.
    1. Taylor ED, Theim KR, Mirch MC, et al. Orthopedic complications of overweight in children and adolescents. Pediatrics. 2006;117:2167–2174. doi: 10.1542/peds.2005-1832.
    1. Lazar-Antman MA, Leet AI. Effects of obesity on pediatric fracture care and management. J Bone Joint Surg Am. 2012;94:855–861. doi: 10.2106/JBJS.J.01839.
    1. Valerio G, Gallè F, Mancusi C, et al. Prevalence of overweight in children with bone fractures: a case control study. BMC Pediatr. 2012;12:166. doi: 10.1186/1471-2431-12-166.
    1. Skaggs DL, Loro ML, Pitukcheewanont P, Tolo V, Gilsanz V. Increased body weight and decreased radial cross-sectional dimensions in girls with forearm fractures. J Bone Miner Res. 2001;16:1337–1342. doi: 10.1359/jbmr.2001.16.7.1337.
    1. Bachrach LK, Sills IN. Section on endocrinology. Bone densitometry in children and adolescents. Pediatrics. 2011;127:189–194. doi: 10.1542/peds.2010-2961.
    1. Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008;73:19–33. doi: 10.1038/sj.ki.5002586.
    1. Savino A, Pelliccia P, Chiarelli F, Mohn A. Obesity-related renal injury in childhood. Horm Res Pædiatrics. 2010;73:303–311. doi: 10.1159/000308161.
    1. Filler G, Reimão SM, Kathiravelu A, Grimmer J, Feber J, Drukker A. Pediatric nephrology patients are overweight: 20 years’ experience in a single Canadian tertiary pediatric nephrology clinic. Int Urol Nephrol. 2007;39:1235–1240. doi: 10.1007/s11255-007-9258-y.
    1. Espinoza R, Gracida C, Cancino J, Ibarra A. Effect of obese living donors on the outcome and metabolic features in recipients of kidney transplantation. Transplant Proc. 2006;38:888–889. doi: 10.1016/j.transproceed.2006.02.044.
    1. Burgert TS, Dziura J, Yeckel C, et al. Microalbuminuria in pediatric obesity: prevalence and relation to other cardiovascular risk factors. Int J Obes. 2006;30:273–280. doi: 10.1038/sj.ijo.0803136.
    1. Hirschler V, Molinari C, Maccallini G, Aranda C. Is albuminuria associated with obesity in school children? Pediatr Diabetes. 2010;11:322–330. doi: 10.1111/j.1399-5448.2009.00599.x.
    1. Savino A, Pelliccia P, Giannini C, et al. Implications for kidney disease in obese children and adolescents. Pediatr Nephrol. 2011;26:749–758. doi: 10.1007/s00467-010-1659-y.
    1. Franchini S, Savino A, Marcovecchio ML, Tumini S, Chiarelli F, Mohn A. The effect of obesity and type 1 diabetes on renal function in children and adolescents. Pediatr Diabetes. 2015;16:427–433. doi: 10.1111/pedi.12196.
    1. Goknar N, Oktem F, Ozgen IT, et al. Determination of early urinary renal injury markers in obese children. Pediatr Nephrol. 2015;30:139–144. doi: 10.1007/s00467-014-2829-0.
    1. Stevenson SB. Pseudotumor cerebri: yet another reason to fight obesity. J Pediatr Health Care. 2008;22:40–43. doi: 10.1016/j.pedhc.2007.05.004.
    1. Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol. 2016;15:78–91. doi: 10.1016/S1474-4422(15)00298-7.
    1. Paley GL, Sheldon CA, Burrows EK, Chilutti MR, Liu GT, McCormack SE. Overweight and obesity in pediatric secondary pseudotumor cerebri syndrome. Am J Ophthalmol. 2015;159:344–352. doi: 10.1016/j.ajo.2014.11.003.
    1. Brara SM, Koebnick C, Porter AH, Langer-Gould A. Pediatric idiopathic intracranial hypertension and extreme childhood obesity. J Pediatr. 2012;161:602–607. doi: 10.1016/j.jpeds.2012.03.047.
    1. Salpietro V, Chimenz R, Arrigo T, Ruggieri M. Pediatric idiopathic intracranial hypertension and extreme childhood obesity: a role for weight gain. J Pediatr. 2013;162:1084. doi: 10.1016/j.jpeds.2013.01.048.
    1. Stiebel-Kalish H, Serov I, Sella R, Chodick G, Snir M. Childhood overweight or obesity increases the risk of IIH recurrence fivefold. Int J Obes. 2014;38:1475–1477. doi: 10.1038/ijo.2014.44.
    1. Bassan H, Berkner L, Stolovitch C, Kesler A. Asymptomatic idiopathic intracranial hypertension in children. Acta Neurol Scand. 2008;118:251–255. doi: 10.1111/j.1600-0404.2008.01007.x.
    1. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159–1165. doi: 10.1212/WNL.0b013e3182a55f17.
    1. Ravid S, Shahar E, Schiff A, Gordon S. Obesity in children with headaches: association with headache type, frequency, and disability. Headache. 2013;53:954–961. doi: 10.1111/head.12088.
    1. Oakley CB, Scher AI, Recober A, Peterlin BL. Headache and obesity in the pediatric population. Curr Pain Headache Rep. 2014;18:416. doi: 10.1007/s11916-014-0416-5.
    1. Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology. 2010;75:712–717. doi: 10.1212/WNL.0b013e3181eee244.
    1. Verrotti A, Agostinelli S, D'Egidio C, et al. Impact of a weight loss program on migraine in obese adolescents. Eur J Neurol. 2013;20:394–397. doi: 10.1111/j.1468-1331.2012.03771.x.
    1. Anderson SE, Cohen P, Naumova EN, Jacques PF, Must A. Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosom Med. 2007;69:740–747. doi: 10.1097/PSY.0b013e31815580b4.
    1. Roth B, Munsch S, Meyer A, Isler E, Schneider S. The association between mothers psychopatology, childrens’ competences and psychopatological well-being in obese children. Eat Weight Disord. 2008;13:129–136. doi: 10.1007/BF03327613.
    1. Vander Wal JS, Mitchell ER. Psychological complications of pediatric obesity. Pediatr Clin N Am. 2011;58:1393–1401. doi: 10.1016/j.pcl.2011.09.008.
    1. Latzer Y, Stein D. A review of the psychological and familial perspectives of childhood obesity. J Eat Disord. 2013;1:7. doi: 10.1186/2050-2974-1-7.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington: American Psychiatric Association; 2013.
    1. Glasofer DR, Tanofsky-Kraff M, Eddy KT, et al. Binge eating in overweight treatment-seeking adolescents. J Pediatr Psychol. 2007;32:95–105. doi: 10.1093/jpepsy/jsl012.
    1. Sonneville KR, Calzo JP, Horton NJ, et al. Childhood hyperactivity/inattention and eating disturbances predict binge eating in adolescence. Psychol Med. 2015;22:1–10.
    1. Amianto F, Ottone L, Abbate Daga G, Fassino S. Binge-eating disorder diagnosis and treatment: a recap in front of DSM-5. BMC Psychiatry. 2015;15:70. doi: 10.1186/s12888-015-0445-6.
    1. Astrup A, Raben A, Geiker N. The role of higher protein diets in weight control and obesity-related comorbidities. Int J Obes. 2015;39:721–726. doi: 10.1038/ijo.2014.216.
    1. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA. 1990;264:2519–2523. doi: 10.1001/jama.1990.03450190051027.
    1. Golan M, Weizman A. Familial approach to the treatment of childhood obesity: conceptual model. J Nutr Educ Behav. 2001;33:102–107. doi: 10.1016/S1499-4046(06)60173-5.
    1. Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res. 2004;12:357–361. doi: 10.1038/oby.2004.45.
    1. Hollands GJ, Shemilt I, Marteau TM, et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database Syst Rev 2015; 9:CD011045.
    1. Barlow SE, Expert Committee Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Suppl 4):S164–S192. doi: 10.1542/peds.2007-2329C.
    1. Burrows TL, Martin RJ, Collins CE. A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water. J Am Diet Assoc. 2010;110:1501–1510. doi: 10.1016/j.jada.2010.07.008.
    1. Burke LE, Wang J, Sevick AM. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;111:92–102. doi: 10.1016/j.jada.2010.10.008.
    1. Jääskeläinen A, Schwab U, Kolehmainen M, Pirkola J, Järvelin MR, Laitinen J. Associations of meal frequency and breakfast with obesity and metabolic syndrome traits in adolescents of northern Finland birth cohort 1986. Nutr Metab Cardiovasc Dis. 2013;23:1002–1009. doi: 10.1016/j.numecd.2012.07.006.
    1. Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr. 1992;55:645–651. doi: 10.1093/ajcn/55.3.645.
    1. Spear BA, Barlow SE, Ervin C, et al. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics. 2007;120(Suppl 4):S254–S288. doi: 10.1542/peds.2007-2329F.
    1. James J, Thomas P, Cavan D, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ. 2004;328:1237. doi: 10.1136/.
    1. Taveras EM, Gortmaker SL, Hohman KH, et al. Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the high five for kids study. Arch Pediatr Adolesc Med. 2011;165:714–722. doi: 10.1001/archpediatrics.2011.44.
    1. Kovács E, Siani A, Konstabel K, et al. Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study. Int J Obes. 2014;38(Suppl 2):S144–S151. doi: 10.1038/ijo.2014.145.
    1. Maximova K, Ambler KA, Rudko JN, Chui N, Ball GD. Ready, set, go! Motivation and lifestyle habits in parents of children referred for obesity management. Pediatr Obes. 2015;10:353–360. doi: 10.1111/ijpo.272.
    1. Savage JS, Fisher JO, Marini M, Birch LL. Serving smaller age-appropriate entree portions to children aged 3-5 y increases fruit and vegetable intake and reduces energy density and energy intake at lunch. Am J Clin Nutr. 2012;95:335–341. doi: 10.3945/ajcn.111.017848.
    1. Birch LL, Savage JS, Fischer JO. Right sizing prevention. Food portion size effects on children's eating and weight. Appetite. 2015;88:11–16. doi: 10.1016/j.appet.2014.11.021.
    1. Società Italiana di Nutrizione Umana. Livelli di assunzione di riferimento di nutrienti ed energia per la popolazione italiana (LARN). IV Revisione. Milano: SICsS Editore; 2014.
    1. Suskind RM, Sothern MS, Farris RP, et al. Recent advances in the treatment of childhood obesity. Ann N Y Acad Sci. 1993;699:181–199. doi: 10.1111/j.1749-6632.1993.tb18849.x.
    1. Academy of Nutrition and Dietetics. Pediatric weight management: dietary interventions. Summary for pediatric weight management evidence-based nutrition practice guidelines 2007. .
    1. Sothern M, Udall JN, Suskind RM, Vargas A, Blecker U. Weight loss and growth velocity in obese children after very low calorie diet, exercise, and behavior modification. Acta Paediatr. 2000;89:1036–1043. doi: 10.1111/j.1651-2227.2000.tb03347.x.
    1. Epstein LH, Squires S. The stoplight diet for children: an eight week program for parents and children. Boston: Little Brown & Co; 1988.
    1. Epstein LH, Paluch RA, Beecher MD, et al. Increasing healthy eating vs. reducing high energy-dense foods to treat pediatric obesity. Obesity (Silver Spring) 2008;16:318–326. doi: 10.1038/oby.2007.61.
    1. Esfahani A, Wong JM, Mirrahimi A, Villa CR, Kendall CW. The application of the glycemic index and glycemic load in weight loss: a review of the clinical evidence. IUBMB Life. 2011;63:7–13. doi: 10.1002/iub.418.
    1. Kirk S, Brehm B, Saelens BE, et al. Role of carbohydrate modification in weight management among obese children: a randomized clinical trial. J Pediatr. 2012;161:320–327. doi: 10.1016/j.jpeds.2012.01.041.
    1. Mirza NM, Palmer MG, Sinclair KB, et al. Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: a randomized controlled trial. Am J Clin Nutr. 2013;97:276–285. doi: 10.3945/ajcn.112.042630.
    1. Atlantis E, Barnes EH, Singh MA. Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Int J Obes. 2006;30:1027–1040. doi: 10.1038/sj.ijo.0803286.
    1. McGovern L, Johnson JN, Paulo R, et al. Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab. 2008;93:4600–4605. doi: 10.1210/jc.2006-2409.
    1. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40. doi: 10.1186/1479-5868-7-40.
    1. Brambilla P, Pozzobon G, Pietrobelli A. Physical activity as the main therapeutic tool for metabolic syndrome in childhood. Int J Obes. 2011;35:16–28. doi: 10.1038/ijo.2010.255.
    1. Kelley GA, Kelley KS, Pate RR. Exercise and BMI in overweight and obese children and adolescents: a systematic review and trial sequential meta-analysis. Biomed Res Int. 2015;2015:704539.
    1. Stoner L, Rowlands D, Morrison A, et al. Efficacy of exercise intervention for weight loss in overweight and obese adolescents: meta-analysis and implications. Sports Med. 2016;46:1737–1751. doi: 10.1007/s40279-016-0537-6.
    1. Ho M, Garnett SP, Baur LA, et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr. 2013;167:759–768. doi: 10.1001/jamapediatrics.2013.1453.
    1. García-Hermoso A, Sánchez-López M, Martínez-Vizcaíno V. Effects of aerobic plus resistance exercise on body composition related variables in pediatric obesity: a systematic review and meta-analysis of randomized controlled trials. Pediatr Exerc Sci. 2015;27:431–440. doi: 10.1123/pes.2014-0132.
    1. Strong WB, Malina RM, Blimkie CJ, et al. Evidence based physical activity for school-age youth. J Pediatr. 2005;146:732–737. doi: 10.1016/j.jpeds.2005.01.055.
    1. Janssen I. Physical activity guidelines for children and youth. Appl Physiol Nutr Metab. 2007;32:S109–S121. doi: 10.1139/H07-109.
    1. LeBlanc AG, Spence JC, Carson V, et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years) Appl Physiol Nutr Metab. 2012;37:753–772. doi: 10.1139/h2012-063.
    1. Velde SJT, van Nassau F, Uijtdewilligen L, et al. Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Obes Rev. 2012;13:56–74. doi: 10.1111/j.1467-789X.2011.00960.x.
    1. de Rezende LF, Rodrigues Lopes M, Rey-López JP, Matsudo VK, Luiz OC. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9:e105620. doi: 10.1371/journal.pone.0105620.
    1. Pearson N, Braithwaite RE, Biddle SJ, van Sluijs EM, Atkin AJ. Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis. Obes Rev. 2014;15:666–675. doi: 10.1111/obr.12188.
    1. Pearson N, Biddle SJ. Sedentary behavior and dietary intake in children, adolescents, and adults a systematic review. Am J Prev Med. 2011;41:178–188. doi: 10.1016/j.amepre.2011.05.002.
    1. Azevedo LB, Ling J, Soos I, Robalino S, Ells L. The effectiveness of sedentary behaviour interventions for reducing body mass index in children and adolescents: systematic review and meta-analysis. Obes Rev. 2016;17:623–635. doi: 10.1111/obr.12414.
    1. Lamboglia CM, da Silva VT, de Vasconcelos Filho JE, et al. Exergaming as a strategic tool in the fight against childhood obesity: a systematic review. J Obes. 2013;2013:438364. doi: 10.1155/2013/438364.
    1. Gao Z, Chen S. Are field-based exergames useful in preventing childhood obesity? A systematic review. Obes Rev. 2014;15:676–691. doi: 10.1111/obr.12164.
    1. McGuire S, Willems ME. Physiological responses during multiplay exergaming in young adult males are game-dependent. J Hum Kinet. 2015;46:263–271. doi: 10.1515/hukin-2015-0054.
    1. Gribbon A, McNeil J, Jay O, Tremblay MS, Chaput JP. Active video games and energy balance in male adolescents: a randomized crossover trial. Am J Clin Nutr. 2015;101:1126–1134. doi: 10.3945/ajcn.114.105528.
    1. McNarry MA, Mackintosh KA. Investigating the relative exercise intensity of exergames in prepubertal children. Games Health J. 2016;5:135–140. doi: 10.1089/g4h.2015.0094.
    1. Staiano AE, Marker AM, Beyl RA, Hsia DS, Katzmarzyk PT, Newton RL. A randomized controlled trial of dance exergaming for exercise training in overweight and obese adolescent girls. Pediatr Obes. 2017;12:120–128. doi: 10.1111/ijpo.12117.
    1. Vignolo M, Rossi F, Bardazza G, et al. Five year follow-up of a cognitive-behavioural lifestyle multidisciplinary programme for childhood obesity outpatient treatment. Eur J Clin Nutr. 2008;62:1047–1057. doi: 10.1038/sj.ejcn.1602819.
    1. Valerio G, Licenziati MR, Tanas R, et al. Management of children and adolescents with severe obesity. Minerva Pediatr. 2012;64:413–431.
    1. Altman M, Wilfley DE. Evidence update on the treatment of overweight and obesity in children and adolescents. J Clin Child Adolesc Psychol. 2015;44:521–537. doi: 10.1080/15374416.2014.963854.
    1. Wilfley DE, Stein RI, Saelens BE, et al. Efficacy of maintenance treatment approaches for childhood overweight: a randomized controlled trial. JAMA. 2007;298:1661–1673. doi: 10.1001/jama.298.14.1661.
    1. West F, Sanders MR, Cleghorn GJ, Davies PS. Randomized clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change. Behav Res Ther. 2010;48:1170–1179. doi: 10.1016/j.brat.2010.08.008.
    1. Boutelle KN, Cafri G, Crow SJ. Parent-only treatment for childhood obesity: a randomized controlled trial. Obesity. 2011;19:574–580. doi: 10.1038/oby.2010.238.
    1. Serra-Paya N, Ensenyat A, Castro-Viñuales I, et al. Effectiveness of a multi-component intervention for overweight and obese children (Nereu program): a randomized controlled trial. PLoS One. 2015;10:e0144502. doi: 10.1371/journal.pone.0144502.
    1. Ho M, Garnett SP, Baur L, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130:e1647–e1671. doi: 10.1542/peds.2012-1176.
    1. Golan M, Kaufman V, Shahar DR. Childhood obesity treatment: targeting parents exclusively v. Parents and children. Br J Nutr. 2006;95:1008–1015. doi: 10.1079/BJN20061757.
    1. Epstein LH, Paluch RA, Wrotniak BH, et al. Cost effectiveness of family-based group treatment for child and parental obesity. Child Obes. 2014;10:114–121. doi: 10.1089/chi.2013.0123.
    1. Iaccarino Idelson P, Zito E, Mozzillo E, et al. Changing parental style for the management of childhood obesity: a multi-component group experience. Int J Child Health Nutr. 2015;4:213–218. doi: 10.6000/1929-4247.2015.04.04.3.
    1. Tanas R, Marcolongo R, Pedretti S, Gilli G. A family-based education program for obesity: a three-year study. BMC Pediatr. 2007;7:33. doi: 10.1186/1471-2431-7-33.
    1. Lagger G, Pataky Z, Golay A. Efficacy of therapeutic patient education in chronic diseases and obesity. Patient Educ Couns. 2010;79:283–286. doi: 10.1016/j.pec.2010.03.015.
    1. Albano MG, Golay A, Vincent DA, Cyril Crozet C, d’Ivernois JF. Therapeutic patient education in obesity: analysis of the 2005–2010 literature. Ther Patient Educ. 2012;4:S101–S110. doi: 10.1051/tpe/2012011.
    1. Bloom T, Sharpe L, Mullan B, Zuccker N. A pilot evalutation of appetite-awareness training in the treatment of childhood overweight and obesity: a preliminary investigation. Int J Eat Dis. 2013;46:47–51. doi: 10.1002/eat.22041.
    1. Boutelle KN, Zucker N, Peterson CB, Rydell S, Carlson J, Harnack LJ. An intervention based on Schachter’s externality theory for overweight children: the regulation of cues pilot. J Pediatr Psychol. 2014;39:405–417. doi: 10.1093/jpepsy/jst142.
    1. Bryant M, Ashton L, Brown J, et al. Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity. Health Technol Assess. 2014;18:1–380. doi: 10.3310/hta18510.
    1. Reinehr T, Lass N, Toschke C, Rothermel J, Lanzinger S, Holl RW. Which amount of BMI-SDS reduction is necessary to improve cardiovascular risk factors in overweight children? J Clin Endocrinol Metab. 2016;101:3171–3179. doi: 10.1210/jc.2016-1885.
    1. Maffeis C, Banzato C, Talamini G, Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr. 2008;152:207–213. doi: 10.1016/j.jpeds.2007.09.021.
    1. Taylor RW, Williams SM, Grant AM, Taylor BJ, Goulding A. Predictive ability of waist-to-height in relation to adiposity in children is not improved with age and sex-specific values. Obesity (Silver Spring) 2011;19:1062–1068. doi: 10.1038/oby.2010.217.
    1. Brambilla P, Bedogni G, Heo M, Pietrobelli A. Waist circumference-to-height ratio predicts adiposity better than body mass index in children and adolescents. Int J Obes. 2013;37:943–946. doi: 10.1038/ijo.2013.32.
    1. Hunt LP, Ford A, Sabin MA, Crowne EC, Shield JP. Clinical measures of adiposity and percentage fat loss: which measure most accurately reflects fat loss and what should we aim for? Arch Dis Child. 2007;92:399–403. doi: 10.1136/adc.2006.103986.
    1. Finne E, Reinehr T, Schaefer A, Winkel K, Kolip P. Changes in self-reported and parent-reported health-quality of life in overweight children and adolescents participating in an outpatient training: findings from a 12-month follow-up study. Health Qual Life Outcomes. 2013;11:1. doi: 10.1186/1477-7525-11-1.
    1. Kolotourou M, Radley D, Chadwick P, et al. Is BMI alone a sufficient outcome to evaluate interventions for child obesity? Child Obes. 2013;9:350–356. doi: 10.1089/chi.2013.0019.
    1. Oude LH. Interventions for treating obesity in children. Cochrane Database Sys Rev. 2009;1:CD0001872.
    1. Reinehr T, Kleber M, Toschke AM. Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence. Atherosclerosis. 2009;207:174–180. doi: 10.1016/j.atherosclerosis.2009.03.041.
    1. Reinher T, Widhalm K, l'Allemand D, Wiegand S, Wabitsch M, Holl RW. Two year follow-up in 21.784 overweight children and adolescents with lifestyle intervention. Obesity. 2009;17:1196–1199.
    1. Fairburn CG, Welch SL, Doll HA, Davies BA, O'Connor ME. Risk factors for bulimia nervosa. A community-based case-control study. Arch Gen Psychiatry. 1997;54:509–517. doi: 10.1001/archpsyc.1997.01830180015003.
    1. Fairburn CG, Doll HA, Welch SL, Hay PJ, Davies BA, O'Connor ME. Risk factors for binge eating disorder: a community-based, case-control study. Arch Gen Psychiatry. 1998;55:425–432. doi: 10.1001/archpsyc.55.5.425.
    1. Hilbert A, Pikeb KM, Goldschmidtc AB, et al. Risk factors across the eating disorders. Psychiatry Res. 2014;220:500–506. doi: 10.1016/j.psychres.2014.05.054.
    1. Swenne I. Influence of premorbid BMI on clinical characteristics at presentation of adolescent girls with eating disorders. BMC Psychiatry. 2016;16:81. doi: 10.1186/s12888-016-0788-7.
    1. Lebow J, Sim LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. J Adolesc Health. 2015;56:19–24. doi: 10.1016/j.jadohealth.2014.06.005.
    1. Golden NH, Schneider M, Wood C, AAP Commitee on nutrition Preventing obesity and eating disorders in adolescents. Pediatrics. 2016;138:e20161649. doi: 10.1542/peds.2016-1649.
    1. Sim LA, Lebow J, Billings M. Eating disorders in adolescents with a history of obesity. Pediatrics. 2013;132:e1026–e1030. doi: 10.1542/peds.2012-3940.
    1. Speiser PW, Rudolph MC, Anhalt H, et al. Childhood obesity. J Clin Endocrinol Metab. 2005;90:1871–1887. doi: 10.1210/jc.2004-1389.
    1. August GP, Caprio S, Fennoy I, et al. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. 2008;93:4576–4599. doi: 10.1210/jc.2007-2458.
    1. Lau DC, Douketis JD, Morrison KM, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ. 2007;176:S1–13. doi: 10.1503/cmaj.061409.
    1. National Health and Medical Research Council . Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council; 2013.
    1. Sherafat-Kazemzadeh R, Yanovski SZ, Yanovski JA. Pharmacotherapy for childhood obesity: present and future. J Obes. 2013;37:1–15. doi: 10.1038/ijo.2012.144.
    1. Padwal R, Li SK, Lau DC. Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int J Obes Relat Metab Disord. 2003;27:1437–1446. doi: 10.1038/sj.ijo.0802475.
    1. Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107:1755–1767. doi: 10.1016/j.jada.2007.07.017.
    1. Iughetti L, Berri R, China MC, Predieri B. Current and future drugs for appetite regulation and obesity treatment. Recent Pat Endocr, Metab Immune Drug Discovery. 2009;3:102–128. doi: 10.2174/187221409788452345.
    1. Iughetti L, China MC, Berri R, Predieri B. Pharmacological treatment of obesity in children and adolescent: present and future. J Obes. 2011;2011:928165. doi: 10.1155/2011/928165.
    1. Norgren S, Danielsson P, Jurold R, Lötborn M, Marcus C. Orlistat treatment in obese prepubertal children: a pilot study. Acta Paediatr. 2003;92:566–570.
    1. McDuffie JR, Calis KA, Uwaifo GI, et al. Efficacy of orlistat as adjunct to behavioral treatment in overweight African and Caucasian adolescents with obesity-related co-morbid conditions. J Pediatr Endocrinol Metab. 2004;17:307–319. doi: 10.1515/JPEM.2004.17.3.307.
    1. Chanoine JP, Hampl S, Jensen C, et al. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA. 2005;293:2873–2883. doi: 10.1001/jama.293.23.2873.
    1. Zhi J, Moore R, Kanitra L. The effect of short-term (21-day) orlistat treatment on the physiologic balance of six selected macrominerals and microminerals in obese adolescents. J Am Coll Nutr. 2003;22:357–362. doi: 10.1080/07315724.2003.10719318.
    1. Michalsky M, Reichard K, Inge T, Pratt J, Lenders C. American Society for Metabolic and Bariatric Surgery: ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis. 2012;8:1–7. doi: 10.1016/j.soard.2011.09.009.
    1. Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24:42–55. doi: 10.1007/s11695-013-1079-8.
    1. Nobili V, Vajro P, Dezsofi A, et al. Indications and limitations of bariatric intervention in severely obese children and adolescents with and without nonalcoholic steatohepatitis: ESPGHAN hepatology committee position statement. J Pediatr Gastroenterol Nutr. 2015;60:550–561. doi: 10.1097/MPG.0000000000000715.
    1. Thakkar RK, Michalsky MP. Update on bariatric surgery in adolescence. Curr Opin Pediatr. 2015;27:370–376. doi: 10.1097/MOP.0000000000000223.
    1. Black JA, White B, Viner RM, Simmons RK. Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis. Obesity Rev. 2013;14:634–644. doi: 10.1111/obr.12037.
    1. Hofman B. Bariatric surgery for obese children and adolescents: a review of the moral challenges. BMC Medical Ethics. 2013;14:18. doi: 10.1186/1472-6939-14-18.
    1. Brei MN, Mudd S. Current guidelines for weight loss surgery in adolescents: a review of the literature. J Pediatr Health Care. 2014;28:288–294. doi: 10.1016/j.pedhc.2013.04.005.
    1. Ells LJ, Mead E, Atkinson G, et al. Surgery for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev. 2015;6:CD011740.
    1. Olbers T, Gronowitz E, Werling M, et al. Two-year outcome of laparoscopic roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide study (AMOS) Int J Obes. 2012;36:1388–1395. doi: 10.1038/ijo.2012.160.
    1. Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg. 2012;256:266–273. doi: 10.1097/SLA.0b013e318251e92b.
    1. Lennerz BS, Wabitsch M, Lippert H, et al. Bariatric surgery in adolescents and young adults--safety and effectiveness in a cohort of 345 patients. Int J Obes. 2014;38:334–340. doi: 10.1038/ijo.2013.182.
    1. Alqahtani A, Elahmedi M, Qahtani AR. Laparoscopic sleeve gastrectomy in children younger than 14 years: refuting the concerns. Ann Surg. 2016;263:312–319. doi: 10.1097/SLA.0000000000001278.
    1. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374:113–123. doi: 10.1056/NEJMoa1506699.
    1. Paulus GF, de Vaan LE, Verdam FJ, Bouvy ND, Ambergen TA, van Heurn LW. Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis. Obes Surg. 2015;25:860–878. doi: 10.1007/s11695-015-1581-2.
    1. Beamish AJ, Olbers T. Bariatric and metabolic surgery in adolescents: a path to decrease adult cardiovascular mortality. Curr Atheroscler Rep. 2015;17:53. doi: 10.1007/s11883-015-0532-7.
    1. Manco M, Mosca A, De Peppo F, et al. The benefit of sleeve gastrectomy in obese adolescents on nonalcoholic steatohepatitis and hepatic fibrosis. J Pediatr. 2016;180:31–37. doi: 10.1016/j.jpeds.2016.08.101.
    1. Dietz WH, Baur LA, Hall K, et al. Management of obesity: improvement of health-care training and systems for prevention and care. Lancet. 2015;385:2521–2533. doi: 10.1016/S0140-6736(14)61748-7.
    1. Fitch A, Fox C, Bauerly K, et al. Prevention and management of obesity for children and adolescents. Bloomington: Institute for Clinical Systems Improvement (ICSI); 2013.
    1. National Clinical Guideline Centre (UK) NICE clinical guidelines. London: National Institute for Health and Care Excellence; 2014. Obesity: identification, assessment and management of overweight and obesity in children, young people and adults: partial update of CG43.
    1. Ebbeling CB, Antonelli RC. Primary care interventions for pediatric obesity: need for an integrated approach. Pediatrics. 2015;135:757–758. doi: 10.1542/peds.2015-0495.
    1. Tuah NA, Amiel C, Qureshi S, Car J, Kaur B, Majeed A. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2011;10:CD008066.
    1. Borrello M, Pietrabissa G, Ceccarini M, Manzoni GM, Castelnuovo G. Motivational interviewing in childhood obesity treatment. Front Psychol. 2015;6:1732. doi: 10.3389/fpsyg.2015.01732.
    1. Barnes RD, Ivezaj V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev. 2015;16:304–318. doi: 10.1111/obr.12264.
    1. Resnicow K, McMaster F, Bocian A, et al. Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics. 2015;135:649–657. doi: 10.1542/peds.2014-1880.
    1. Sargent GM, Pilotto LS, Baur LA. Components of primary care interventions to treat childhood overweight and obesity: a systematic review of effect. Obes Rev. 2011;12:e219–e235. doi: 10.1111/j.1467-789X.2010.00777.x.
    1. Daniels SR, Hassink SG. Committee in Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136:e275–e292. doi: 10.1542/peds.2015-1558.
    1. Sim LA, Lebow J, Wang Z, Koball A, Murad MH. Brief primary care obesity interventions: a meta-analysis. Pediatrics. 2016;138:e20160149. doi: 10.1542/peds.2016-0149.
    1. Mitchell TB, Amaro CM, Steele RG. Pediatric weight management interventions in primary care settings: a meta-analysis. Health Psychol. 2016;35:704–13. doi: 10.1037/hea0000381.
    1. Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes MG, Sherwood NE. A review of primary care-based childhood obesity prevention and treatment interventions. Curr Obes Rep. 2015;4:157–173. doi: 10.1007/s13679-015-0160-0.
    1. Bhuyan SS, Chandak A, Smith P, Carlton EL, Duncan K, Gentry D. Integration of public health and primary care: a systematic review of the current literature in primary care physician mediated childhood obesity interventions. Obes Res Clin Pract. 2015;9:539–552. doi: 10.1016/j.orcp.2015.07.005.
    1. Ministero della Salute Piano d’indirizzo per la Riabilitazione. Gruppo di Lavoro sulla Riabilitazione. . 2011.
    1. Viner RM, White B, Barrett T, et al. Assessment of childhood obesity in secondary care: OSCA consensus statement. Arch Dis Child Educ Pract Ed. 2012;97:98–105. doi: 10.1136/edpract-2011-301426.
    1. Donini LM, Cuzzolaro M, Spera G, et al. Consensus. Obesity and eating disorders. Indications for the different levels of care. An Italian expert consensus document. Eating Weight Disord. 2010;15:1–31. doi: 10.1007/BF03325273.
    1. Ahnert J, Löffler S, Müller J, Lukasczik M, Brüggemann S, Vogel H. Paediatric rehabilitation treatment standards: a method for quality assurance in Germany. J Public Health Res. 2014;3:275. doi: 10.4081/jphr.2014.275.
    1. Rank M, Wilks DC, Foley L, et al. Health-related quality of life and physical activity in children and adolescents 2 years after an inpatient weight-loss program. J Pediatr. 2014;165:732–737. doi: 10.1016/j.jpeds.2014.05.045.
    1. Sauer H, Krumm A, Weimer K, et al. PreDictor research in obesity during medical care - weight loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study. J Eat Disord. 2014;2:7. doi: 10.1186/2050-2974-2-7.
    1. Grugni G, Licenziati MR, Valerio G, et al. The rehabilitation of children and adolescents with severe or medically complicated obesity. An ISPED expert opinion document. Eat Weight Disord. 2017;22:3–12. doi: 10.1007/s40519-016-0305-5.
    1. Rosen DS, Blum RW, Britto M, Sawyer SM, Siegel DM. Transition to adult health care for adolescents and young adults with chronic conditions: position paper of the Society for Adolescent Medicine. J Adolesc Health. 2003;33:309–311. doi: 10.1016/S1054-139X(03)00208-8.
    1. Schwartz LA, Daniel LC, Brumley LD, Barakat LP, Wesley KM, Tuchman LK. Measures of readiness to transition to adult health care for youth with chronic physical health conditions: a systematic review and recommendations for measurement testing and development. J Pediatr Psychol. 2014;39:588–601. doi: 10.1093/jpepsy/jsu028.
    1. Campbell F, Biggs K, Aldiss SK, et al. Transition of care for adolescents from paediatric services to adult health services. Cochrane Database Syst Rev. 2016;4:CD009794.
    1. Shrewsbury VA, Baur LA, Nguyen B, Steinbeck KS. Transition to adult care in adolescent obesity: a systematic review and why it is a neglected topic. Int J Obes. 2014;38:475–479. doi: 10.1038/ijo.2013.215.
    1. Bambra CL, Hillier FC, Moore HJ, Cairns-Nagi JM, Summerbell CD. Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity among adults. Syst Rev. 2013;2:27. doi: 10.1186/2046-4053-2-27.
    1. Novak NL, Brownell KD. Role of policy and government in the obesity epidemic. Circulation. 2012;126:2345–2352. doi: 10.1161/CIRCULATIONAHA.111.037929.
    1. Farpour-Lambert NJ, Baker JL, Hassapidou M, et al. Childhood obesity is a chronic disease demanding specific health care - a position statement from the childhood obesity task force (COTF) of the European Association for the Study of obesity (EASO) Obes Facts. 2015;8:342–349. doi: 10.1159/000441483.
    1. The Regional Office for Europe of the World Health Organization. The challenge of obesity in the WHO European Region and the strategies for response. Summary. Branca F, Nikogosian H, Lobstein T, editors. World Health Organization; 2007.
    1. Kamath CC, Vickers KS, Ehrlich A, et al. Behavioral interventions to prevent childhood obesity: a systematic review and meta-analyses of randomized trials. J Clin Endocrinol Metab. 2008;93:4606–4615. doi: 10.1210/jc.2006-2411.
    1. Waters E, de Silva-Sanigorski A, Hall BJ, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;12:CD001871.
    1. Gerards SM, Sleddens EF, Dagnelie PC, de Vries NK, Kremers SP. Interventions addressing general parenting to prevent or treat childhood obesity. Int J Pediatr Obes. 2011;6:e28–e45. doi: 10.3109/17477166.2011.575147.
    1. Showell NN, Fawole O, Segal J, Wilson RF, et al. A systematic review of home-based childhood obesity prevention studies. Pediatrics. 2013;132:e193–e200. doi: 10.1542/peds.2013-0786.
    1. Golden H, Schneider M, Wood CAAP. Committee on nutrition. Preventing obesity and eating disorders in adolescents. Pediatrics. 2016;138:e20161649. doi: 10.1542/peds.2016-1649.
    1. Oken E, Gillman MW. Fetal origins of obesity. Obes Res. 2003;11:496–506. doi: 10.1038/oby.2003.69.
    1. Ludwig DS, Rouse HL, Currie J. Pregnancy weight gain and childhood body weight: a within-family comparison. PLoS Med. 2013;10:e1001521. doi: 10.1371/journal.pmed.1001521.
    1. Kaar JL, Crume T, Brinton JT, Bischoff KJ, McDuffie R, Dabelea D. Maternal obesity, gestational weight gain, and offspring adiposity: the exploring perinatal outcomes among children study. J Pediatr. 2014;165:509–515. doi: 10.1016/j.jpeds.2014.05.050.
    1. Mamun AA, Mannan M, Doi SA. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2014;15:338–347. doi: 10.1111/obr.12132.
    1. Williams CB, Mackenzie KS, Gahagan S. The effect of maternal obesity on the offspring. Clin Obstet Gynecol. 2014;57:508–515. doi: 10.1097/GRF.0000000000000043.
    1. Starling AP, Brinton JT, Glueck DH, et al. Associations of maternal BMI and gestational weight gain with neonatal adiposity in the healthy start study. Am J Clin Nutr. 2015;101:302–309. doi: 10.3945/ajcn.114.094946.
    1. Hillier TA, Pedula KL, Vesco KK, Oshiro CE, Ogasawara KK. Impact of maternal glucose and gestational weight gain on child obesity over the first decade of life in normal birth weight infants. Matern Child Health J. 2016;20:1559–1568. doi: 10.1007/s10995-016-1955-7.
    1. Institute of Medicine . Weight gain during pregnancy: reexamining the guidelines. Washington: National Academies Press; 2009.
    1. Mund M, Louwen F, Klingelhoefer D, Gerber A. Smoking and pregnancy--a review on the first major environmental risk factor of the unborn. Int J Environ Res Public Health. 2013;10:6485–6499. doi: 10.3390/ijerph10126485.
    1. Møller SE, Ajslev TA, Andersen CS, Dalgård C, Sørensen TI. Risk of childhood overweight after exposure to tobacco smoking in prenatal and early postnatal life. PLoS One. 2014;9:e109184. doi: 10.1371/journal.pone.0109184.
    1. Baidal WJA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50:761–779. doi: 10.1016/j.amepre.2015.11.012.
    1. Gale C, Logan KM, Santhakumaran S, Parkinson JRC, Hyde MJ, Modi N. Effect of breastfeeding compared with formula feeding on infant body composition: a systematic review and meta-analysis. Am J Clin Nutr. 2012;95:656–669. doi: 10.3945/ajcn.111.027284.
    1. Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014;14:1267. doi: 10.1186/1471-2458-14-1267.
    1. Horta BL, de Mola CL, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure, and type-2 diabetes: systematic review and meta-analysis. Acta Paediatr Suppl. 2015;104:30–37. doi: 10.1111/apa.13133.
    1. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475–490. doi: 10.1016/S0140-6736(15)01024-7.
    1. Seach KA, Dharmage SC, Lowe AJ, Dixon JB. Delayed introduction of solid feeding reduces child overweight and obesity at 10 years. Int J Obes. 2010;34:1475–1479. doi: 10.1038/ijo.2010.101.
    1. Huh SY, Rifas-Shiman SL, Taveras EM, et al. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127:e544–e551. doi: 10.1542/peds.2010-0740.
    1. Weng ST, Redsell SA, Swift JA, Yang M, Glazebrook CP. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child. 2012;97:1019–1026. doi: 10.1136/archdischild-2012-302263.
    1. Pearce J, Taylor MA, Langley-Evans SC. Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review. Int J Obesity (Lond) 2013;37:1295–1306. doi: 10.1038/ijo.2013.99.
    1. Vail B, Prentice P, Dunger DB, Hughes IA, Acerini CL, Ong KK. Age at weaning and infant growth: primary analysis and systematic review. J Pediatr. 2015;167:317–324. doi: 10.1016/j.jpeds.2015.05.003.
    1. Fewtrell M, Bronsky J, Campoy C, et al. Complementary feeding: a position paper by the European Society for Paediatric Gastroenterology, hepatology, and nutrition (ESPGHAN) committee on nutrition. J Pediatr Gastroenterol Nutr. 2017;64:119–132. doi: 10.1097/MPG.0000000000001454.
    1. Pearce J, Langley-Evans SC. The types of food introduced during complementary feeding and risk of childhood obesity: a systematic review. Int J Obes. 2013;37:477–485. doi: 10.1038/ijo.2013.8.
    1. Patro-Golab B, Zalewski BM, Kouwenhoven SMP, et al. Protein concentration in milk formula, growth, and later risk of obesity: a systematic review. J Nutr. 2016;146:551–564. doi: 10.3945/jn.115.223651.
    1. Foterek K, Hilbig A, Kersting M, et al. Age and time trends in the diet of young children: results of the Donald study. Eur J Nutr. 2016;55:611–620. doi: 10.1007/s00394-015-0881-6.
    1. Voortman T, Braun KV, Kiefte-de Jong JC, et al. Protein intake in early childhood and body composition at age of 6 years: the generation R study. Int J Obes (London) 2016;40:1018–1025. doi: 10.1038/ijo.2016.29.
    1. Niinikoski H, Lagström H, Jokinen E, et al. Impact of repeated dietary counseling between infancy and 14 years of age on dietary intakes and serum lipids and lipoproteins the STRIP study. Circulation. 2007;116:1032–1040. doi: 10.1161/CIRCULATIONAHA.107.699447.
    1. Pan L, Li R, Park S, Galuska DA, Sherry BL, Freedman DS. A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years. Pediatrics. 2014;134(Suppl 1):S29–S35. doi: 10.1542/peds.2014-0646F.
    1. Cameron SL, Heath LM, Taylor RW. How feasible is baby led weaning as an approach to infant feeding? A review of the evidence. Nutrients. 2012;2:1575–1609. doi: 10.3390/nu4111575.
    1. Daniels L, Heath AL, Williams SM, et al. Baby-led introduction to SolidS (BLISS) study: a randomised controlled trial of a baby-led approach to complementary feeding. BMC Pediatr. 2015;15:179. doi: 10.1186/s12887-015-0491-8.
    1. Brown A, Lee MD. Early influences on child satiety-responsiveness: the role of weaning style. Pediatr Obes. 2015;10:57–66. doi: 10.1111/j.2047-6310.2013.00207.x.
    1. World Health Organization . Consideration of the evidence on childhood obesity for the commission on ending childhood obesity: report of ad hoc working group on science and evidence for ending childhood obesity. Geneva: WHO; 2016. Global strategy on diet, physical activity and health. What can be done to fight the childhood obesity epidemic?
    1. Casas R, Sacanella E, Urpí-Sardà M, et al. Long-term immunomodulatory effects of a Mediterranean diet in adults at high risk of cardiovascular disease in the PREvención con DIeta MEDiterránea (PREDIMED) randomized controlled trial. J Nutr. 2016;146:1684–1693. doi: 10.3945/jn.115.229476.
    1. D’Alessandro A, De Pergola G. Mediterranean diet pyramid: a proposal for Italian people. Nutrients. 2014;6:4302–4316. doi: 10.3390/nu6104302.
    1. French SA, Story M, Neumark-Sztainer FJA, Hannan P. Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychological variables. Int J Ob Relat Metab Disord. 2001;25:1823–1833. doi: 10.1038/sj.ijo.0801820.
    1. Cobb LK, Appel LJ, Franco M, Jones-Smith JC, Nur A, Anderson CA. The relationship of the local food environment with obesity: a systematic review of methods, study quality, and results. Obesity (Silver Spring) 2015;23:1331–1344. doi: 10.1002/oby.21118.
    1. Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 2013;14:606–619. doi: 10.1111/obr.12040.
    1. Bucher Della Torre S, Keller A, Laure Depeyre J, Kruseman M. Sugar-sweetened beverages and obesity risk in children and adolescents: a systematic analysis on how methodological quality may influence conclusions. J Acad Nutr Diet. 2016;116:638–659. doi: 10.1016/j.jand.2015.05.020.
    1. Malik VS, Pan A, C Willett W, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98:1084–1102. doi: 10.3945/ajcn.113.058362.
    1. te Velde SJ, van Nassau F, Uijtdewilligen L, et al. Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Obes Rev. 2012;13(Suppl 1):56–74. doi: 10.1111/j.1467-789X.2011.00960.x.
    1. Pate RR, O'Neill JR, Liese AD, et al. Factors associated with development of excessive fatness in children and adolescents: a review of prospective studies. Obes Rev. 2013;14:645–658. doi: 10.1111/obr.12035.
    1. Parikh T, Stratton G. Influence of intensity of physical activity on adiposity and cardiorespiratory fitness in 5-18 year olds. Sports Med. 2011;41:477–488. doi: 10.2165/11588750-000000000-00000.
    1. Ortega FB, Ruiz JR, Castillo MJ, Sjöström M. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes. 2008;32:1–11. doi: 10.1038/sj.ijo.0803774.
    1. De Bock F, Genser B, Raat H, et al. A participatory physical activity intervention in preschools. Am J Prev Med. 2013;45:64–74. doi: 10.1016/j.amepre.2013.01.032.
    1. Thompson DA, Christakis DA. The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics. 2005;116:851–856. doi: 10.1542/peds.2004-2788.
    1. Council on Communications and Media. Brown A. Media use by children younger than 2 years. Pediatrics. 2011;128:1040–1045. doi: 10.1542/peds.2011-1753.
    1. Tremblay MS, LeBlanc AG, Kho ME, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2015. 2011;8:98. doi: 10.1186/1479-5868-8-98.
    1. Fröberg A, Raustorp A. Objectively measured sedentary behaviour and cardio-metabolic risk in youth: a review of evidence. Eur J Pediatr. 2014;173:845–860. doi: 10.1007/s00431-014-2333-3.
    1. Zhang G, Wu L, Zhou L, Lu W, Mao C. Television watching and risk of childhood obesity: a meta-analysis. Eur J Pub Health. 2016;26:13–18. doi: 10.1093/eurpub/ckv213.
    1. Schmidt ME, Haines J, O'Brien A, et al. Systematic review of effective strategies for reducing screen time among young children. Obesity (Silver Spring) 2012;20:1338–1354. doi: 10.1038/oby.2011.348.
    1. Cauchi D, Glonti K, Petticrew M, Knai C. Environmental components of childhood obesity prevention interventions: an overview of systematic reviews. Obes Rev. 2016;17:1116–1130. doi: 10.1111/obr.12441.
    1. Benatti FB, Ried-Larsen M. The effects of breaking up prolonged sitting time: a review of experimental studies. Med Sci Sports Exerc. 2015;47:2053–2061. doi: 10.1249/MSS.0000000000000654.
    1. Fisher A, Mc Donald LM, van CHN J, et al. Sleep and energy intake in early childhood. Int J Obes (Lond) 2014;38:926–929. doi: 10.1038/ijo.2014.50.
    1. Koren D, Dumin M, Gozal D. Role of sleep quality in the metabolic syndrome. Diabetes Metab Syndr Obes. 2016;9:281–310. doi: 10.2147/DMSO.S95120.
    1. Fatima Y, Doi SA, Mamun AA. Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2015;16:137–149. doi: 10.1111/obr.12245.
    1. Yoong SL, Chai LK, Williams CM, Wiggers J, Finch M, Wolfenden L. Systematic review and meta-analysis of interventions targeting sleep and their impact on child body mass index, diet, and physical activity. Obesity (Silver Spring) 2016;24:1140–1147. doi: 10.1002/oby.21459.
    1. Paruthi S, Brooks LJ, D'Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of sleep medicine. J Clin Sleep Med. 2016;12:785–786. doi: 10.5664/jcsm.5866.
    1. Effective Health Care Program . Childhood obesity prevention programs: comparative effectiveness review and meta-analysis. Comparative effectiveness review number 115. Rockville: AHRQ; 2013.
    1. Wang Y, Cai L, Wu Y, et al. What childhood obesity prevention programs work. A systematic review and meta-analysis. Obes Rev. 2015;16:547–565. doi: 10.1111/obr.12277.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren