Metabolic syndrome and obesity in childhood and adolescence

Abstract

This book is the 19th volume in the series ‘Pediatric and Adolescent Medicine’. It presents an exhaustive review of various aspects of obesity and the closely related metabolic syndrome, which are undoubtedly amongst the most rapidly emerging and challenging clinical problems affecting all age groups in the current time. It is well established that childhood and adolescent obesity tracks into adulthood. Since the obesogenic behaviours and lifestyle patterns are established during childhood, it is important to focus on this period, both to enhance our understanding of genesis of obesity, and aid in devising means of preventing it. Also, the seeds for major cardiovascular and metabolic sequelae that are a major cause of morbidity and mortality during adulthood are sowed during this period. The content of the book is categorized under five sections namely, Definitions and Clinical Aspects, Causes, Consequences, Societal Aspects and Prevention, and Obesity Management. The chapter on definition brings out the complexities involved in defining metabolic syndrome in children and gives reference values for individual components. The next chapter on hypothalamic obesity describes the defects in hypothalamic energy regulating pathways in various acquired hypothalamic disorders as well as single gene mutations and genetic syndromes associated with obesity. The first chapter in the section, ‘Causes’ deals with the genetics of obesity and current state of information related to both individual genes as well as genome wide linkage scans. Subsequent chapters in this section are dedicated to the role of nutrition and sedentary lifestyle in the genesis of obesity. The last chapter on the socio-economic aspects brings out elegantly how socio-economic differences in lifestyle, weight and health result from unequal distribution of resources and opportunities within a society. The section, ‘Consequences’ presents updated information about the impact of obesity on its consequences like carbohydrate metabolism, pubertal development and orthopedic complications. In addition, a chapter is devoted to the less frequently recognized and discussed urogenital complications including renal disease, urolithiasis, enuresis and stress urinary incontinence. The next section, ‘Societal Aspects and Prevention’ deals with the less frequently discussed aspects of obesity - environmental conditions promoting obesity and dietary characteristics associated with metabolic syndrome. The chapter on the economic perspective provides an insight into cost of obesity and the cost-effectiveness of interventions to prevent/manage it. The chapter on obesity prevention, discusses the barriers in the management of obesity. It brings out a novel approach to obesity management- shifting the focus of responsibility away from target individuals, to modification of the environment, by development of community-wide health-promoting infrastructure that would promote sustainable implementation of a healthy lifestyle for all community members. The last section, ‘Obesity Management’ has a chapter dedicated to the role and efficacy of comprehensive treatment programmes focussing on diet, exercise and behaviour therapy. Another chapter presents the current information and experience with bariatric surgery during adolescence. Obesity is a global problem affecting both the developed and the developing countries. Thus, including the developing world's perspective would have enriched this book further. Also, there is no mention of the role of drugs (or lack of it) in the management of childhood obesity. It would have been good to include a chapter on the efficacy and safety of various drugs tried for management of adolescent obesity and metabolic syndrome and the current status of their clinical use. Overall this book presents a holistic view of the complex problems of obesity and metabolic syndrome, not just the medical issues. Authors with expertise and personal experience in a wide variety of domains including endocrinology, paediatrics, nutrition, orthopaedics, social sciences, and environmental health have contributed. The content is well organised and presented in a logical sequence, in a lucid and crisp manner. Apart from clinicians and nutritionists dealing with obese children and adolescents, the book would be of interest to, social scientists and economists interested in understanding the phenomenal rise in global prevalence of obesity. It would also help researchers in the above fields in identifying current gaps in our knowledge and developing appropriate research protocols to fill them.