OBESITY

Obesity is a rapidly growing problem worldwide and its prevalence among children and adolescents has been rising during the past decades; although in recent years the prevalence in most countries has reached a plateau. Currently, WHO estimates that 42 million children under the age of 5 years are obese. As a consequence, obesity in general has been declared as a disease by WHO in 1948, by the American Medical Association in 2013, and by the Canadian Medical Association in 2015.

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Internationally, 20 medical and psychosocial complications have been recognised to be associated with childhood obesity. In particular, complications such as hypertension, dyslipidaemia, fatty liver disease and prediabetes have been associated with a significant increased morbidity and mortality in adulthood. Earlier, these conditions were primarily seen in adults, but currently they are significant manifestations among obese children and adolescents. Thus, approximately 51 % of obese children and adolescents present with pre- or overt hypertension, 29 % have dyslipidaemia, 31% have more than 5% fat in the liver, 74 % have more than 5 % fat in the muscles, 15 % have prediabetes, and 50 % exhibit sleep apnea.

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Besides the physical complications, a considerable number of obese children suffer from psychosocial problems. These problems manifest as an example in the form of a reduced quality of life, where obese children has been shown to have a quality of life at the level of children suffering from cancer and have a pronounced tendency to exhibit loneliness, shame and depression.

Several studies have shown that childhood obesity has a genetic component. This is for instance shown in studies of adopted children, in which the weight status of the children are more closely related to their biological parents than their adoptive parents, which clearly demonstrates an important genetic influence besides the environmental impact.

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The recent years' progress in the mapping of the human genome has increased the scientific focus on hereditary forms of childhood obesity. Several major studies have identified genetic variations related to the development of obesity, and it is assumed that 50-70% of the heritability can be attributed to specific genes. However, only a small portion of the known genetic background of obesity can explain the prevalence of obesity.

At the same time, the manifestations of the degree of obesity and it’s related complications varies greatly among obese children and adolescents, which furthermore manifest in great variations of treatment responses. This marked variation in the development and course of obesity could potentially be caused by the influence of not just one but individual combinations of different genes.

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The treatment of obesity has traditionally been a difficult task and international studies have typically reported treatment rates of no more than 50% and drop-out rates of up to 80%. These high drop-out rates are not compatible with effective childhood treatment offers. It is imperative that childhood obesity is regarded as a chronic disease and that obese children are offered a health professional service according to the need.

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Jens-Christian Holm has developed a method and pedagogy that has led to a reduction in the degree of obesity among 70% of the obese children and adolescents enrolled at The Children’s Obesity Clinic in Holbæk (2000 children) and the method has been adopted at The Department of Paediatrics in Hillerød, who have recently published that 75% of the children and adolescents reduces their degree of obesity (315 children).

Both clinics present with relatively low drop-out rates and with an investment of approximately 5.4 hours of health professional time per child per year. Furthermore, the method has been adopted to 8 municipality primary care clinics where preliminary results show that 80% of 1,185 children reduced their degree of obesity.

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Recently, in consortia studies The Danish Childhood Obesity Biobank has contributed to identify three new genes explaining childhood BMI, 60 new genes influencing birth weight and adult diabetes and cardiovascular disease, as well as the influence of microbes transplanted from obese and lean children into mice, all published in high impact journals.

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At The Children’s Obesity Clinic, it is furthermore shown that concurrent with reduction in the degree of obesity this method resulted in reductions of 5 out of 5 cholesterol fractions, blood pressure, the degree of fatty liver and the quantity of the visceral fat. Lastly, in May 2015 The Children’s Obesity Clinic was declared as one of the leading excellence centres in Europe for the management of childhood obesity, accredited by EASO (European Association for the Study of Obesity).