Chapter
2.2 Epidemiology and methods
What is done in practice?
2.3 The scale of the problem
2.3.2 Trends in obesity and overweight prevalence
2.3.3 What can we learn from the BMI distribution?
Critical periods of growth
3 Molecular and biological factors with emphasis on adipose tissue development
3.2 Regulation of body weight
3.3.1 Congenital leptin deficiency
3.3.2 Leptin receptor defect
3.3.3 Prohormone convertase 1 (PC 1) defect
3.3.5 Melanocortin-4-receptor defect
3.3.6 Peroxisome-proliferator-activated receptor Gama-2 (PPARGama-2) defect
3.4 Regulation of body energy stores at adipose tissue level
3.5 Changes of body fat stores during development
3.6 Changes at cellular level related to changes in body fat
3.7 Lipid storage in adipose tissue (lipogenesis)
3.8 Lipid mobilization (lipolysis)
3.9 Preadipocytes in human adipose tissue
3.10 Proliferation and differentiation of preadipocytes
3.11 Adipogenic activity of human serum
3.12 Hormonal and nutritional factors regulating adipose differentiation
3.13 Human adipocytes are secretory cells
4.2 Secular trends of nutrition and obesity
4.3 Relationship between nutrition and adiposity
4.3.1 Relationship between nutrition and total adiposity
Retrospective analysis and longitudinal studies
4.3.2 Relationship between macronutrient intake and body fat distribution
4.4 Qualitative assessment of intake behaviour
4.4.1 Circadian distribution of food intake and adiposity
4.4.5 Other behavioural symptoms
5.2 Energy expenditure assessment
5.3 Energy intake vs. energy expenditure
5.4 Components of total energy expenditure
5.4.1 Basal metabolic rate
5.4.2 Meal-induced thermogenesis
5.5 Excess energy intake vs. low energy expenditure
5.5.1 Reduced energy expenditure as a predictor of weight gain
5.5.2 The impact of television
5.6 Aerobic capacity… in obesity
5.7 Substrate oxidation and substrate balance
6.1 Children’s social background
6.2.1 Children’s perception of obesity
6.2.2 Attributions of health and social class effects
6.3 Children’s self-worth
6.3.1 Self-perception and self-esteem
6.3.2 Self-esteem conceptualization and assessment
6.3.3 Psychological health
6.4.1 Parental control of eating
6.4.2 Family interaction and functioning
7 Clinical features, adverse effects and outcome
7.1 Clinical findings and immediate adverse effects
Acanthosis nigricans (AN)
Polycystic ovary (Stein–Leventhal) syndrome
7.1.4 Orthopaedic problems
Slipped capital femoral epiphysis (SCFE)
7.1.5 Gastrointestinal problems
7.1.6 Respiratory and sleep-related problems
7.1.7 Neurological problems
Pseudotumor cerebri (PTC)
7.1.8 Immunological problems
7.1.10 Psychosocial problems
7.2 Intermediate medical consequences
7.2.1 Persistence of obesity
7.2.2 Psychosocial problems
7.2.3 Cardiovascular consequences
7.3 Long-term consequences
8.1.3 Body composition and energy expenditure
8.1.5 Genetic background and critical periods
8.1.6 Cardiovascular risk factors
8.1.7 Other endocrinological disorders and contraception
8.1.8 Vitamin and mineral status
8.2 Psychological aspects
8.2.1 The adolescent psyche
8.2.2 What is important for the obese adolescent?
8.2.3 How to approach the obese adolescent
8.2.4 The severely obese adolescent with problems
8.2.5 Day-care programmes
8.2.6 Eating disorders and obesity
9 Prader–Willi and other syndromes
9.2.2 Cushing’s syndrome and hyperadrenocorticism
9.2.3 Growth hormone deficiency
9.3 Prader–Willi syndrome (PWS)
9.3.3 Endocrinological anomalies
9.4 Other obesity syndromes
9.4.1 Bardet–Biedl syndrome (BBS)
9.4.2 Laurence–Moon syndrome
9.4.5 Borjeson–Forssman–Lehmann syndrome (BFLS)
9.4.7 Cohen syndrome (or Pepper syndrome)
9.4.8 Single-gene defects affecting leptin synthesis and metabolism
10 Hormonal and metabolic changes
10.1 Pituitary–adrenal axis
10.2 Pituitary–gonadal axis
10.3 Pituitary–thyroid axis
10.4 Growth hormone and insulin-like growth factors
10.5 Hyperinsulinaemia and insulin resistance
10.6.1 Leptin and obesity
10.6.2 Leptin and body fat distribution
10.6.3 Leptin and sexual dimorphism
10.6.4 Leptin and puberty
10.6.5 Other functions of leptin
11 Risk of cardiovascular complications
11.1.1 Classification of overweight
11.3 Associations with risk factors
11.3.1 Overweight and lipid testing
11.5 Longitudinal analyses
11.5.1 Tracking of overweight and obesity
11.5.2 Relation of childhood overweight to subsequent disease
Part III Prevention and management
12.1 Prevention before management
12.2.1 Primary prevention
12.2.2 The target population
12.3.1 Increase energy expenditure
12.3.2 Reduce energy intake
12.3.3 Reduce television watching
12.3.4 Side effects of prevention
12.4 Responsibilities for prevention
12.4.3 Health professionals
12.5 Reduce sedentary activity
12.5.3 Health professionals
12.6 Reduce poor dietary habits
12.7 Prevention programmes
12.8 Monitoring and evaluation
13.1.2 Can we do any good by formalizing slimming?
13.1.3 The part played by the family
13.1.4 Risks of treatment
13.2 Principles of modifying lifestyles to encourage slimming in obese children
13.2.1 What are the aims of slimming programmes?
Energy expenditure must exceed energy intake
Success is some fat loss rather than loss of all excess fat
Slimming is fat loss but not always weight loss
Avoid overindulgence in weighing
‘Slimming’ should not damage family dynamics
13.3 What can be recommended?
13.3.2 Suggestions for increasing energy expenditure without dramatic lifestyle changes
13.4.1 Lifestyle changes in feeding patterns which may help fat reduction
13.4.2 Changing the family diet
13.4.3 Changes in the energy content of diets which have little impact on the volume of food consumed
14.2 History of dietary therapy
14.3 Aims of dietary treatment
14.4.1 Simple nutritional counselling or balanced normal-calorie diet
14.4.2 Balanced low-calorie diet
14.4.3 Very-low-calorie diet
14.5 Consequences of dieting
14.5.1 Positive consequences
Fat mass reduction and healthier body fat distribution
Reduced plasma lipids and apolipoprotein levels
14.5.2 Negative consequences
Reduced linear-growth velocity
Anorexia and binge-eating disorders
14.6 Guidelines for weight goals and dietetic treatments
15 Management through activity
15.2 Aims of the programmes
15.3 Efficacy of exercise in lowering fat mass
15.5 Physical activity and exercise programmes
15.5.2 The choice of exercise for the obese child
15.5.3 Details of some progressive postural exercises
Exercising individual parts of the body
15.6 How to improve compliance
15.7 The role of the family
16.1 Obesity – a disease put into perspective
16.1.1 Psychosocial aspects of society
16.2 The treatment of obesity
16.2.1 Why do we need new treatments?
16.2.2 Psychodynamic therapy – an early perspective
16.2.3 Behavioural and cognitive therapies – a traditional and a new approach
16.2.4 Group therapy – more research is needed
16.2.5 School-based treatments – the basic approach
16.2.6 Early treatment – the treatment of choice
16.2.7 Family therapy – a new view on treatment
16.2.8 The questions are the answers
16.2.9 Perspective on different psychotherapies
17.1 Appetite suppressants
17.1.1 Noradrenergic agents
17.1.2 Serotoninergic agents
Noradrenergic/serotoninergic agent (sibutramine)
17.2.1 Ephedrine and xanthines
17.2.2 Atypical Beta-adrenoreceptor agonists
17.3 Digestive inhibitors
17.4 Hormone analogues and antagonists
18.2 Surgical techniques and their complications
18.2.1 Plastic surgery in obesity
18.2.2 Gastrointestinal bariatric surgery in adults
18.3 Bariatric surgery in adolescence
19 Interdisciplinary outpatient management
19.1 Goal and general philosophy
19.2 Multifaceted treatment programmes
19.2.4 Behaviour management
19.2.6 Assertiveness training and social-skills training
19.2.7 Psychiatric Intervention
19.3 Organizing team work
19.3.1 Organizational aspects of the therapeutic process
The individually tailored approach: an illusion of interdisciplinary treatment?
The standardized treatment: interdisciplinary management running through the programme
Integrating the two approaches: interdisciplinarity embedded in the organization
19.3.2 Collaboration problems
20 Interdisciplinary residential management
20.1 Historical background and implementation
20.2 Acomprehensive approach
20.2.2 Interdisciplinary management
21.2 Assessment of childhood obesity
21.3 Ethnic differences in children’s anthropometry
21.4 The Thrifty Genotype
21.5 The prevalence of childhood obesity
21.6 Weaning practices and early eating habits
21.7 The ‘obesogenic’ environment
21.8 Can policy initiatives work?
21.9 Devising and implementing new policies
Child and Adolescent Obesity
：Causes and Consequences, Prevention and Management
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