Obesidad

Abstract

Obesity is not defined by a single set of criteria, definition being based on increased BMI, which in pediatrics is related to age and sex. Obesity is becoming more prevalent in both developed and developing countries. In Spain, it affects between 14% and 17% of the population. This increasing prevalence is attributed to changes in eating habits and a trend towards a more sedentary lifestyle. Obesity involves changes in the expression of a large number of genes. The predominant form is nutritional or exogenous obesity. Fat accumulation is of major importance; intra-abdominal fat is more metabolically active, and is associated with cardiovascular disorders, insulin resistance and type 2 diabetes. Assessment of obesity in children is assessed with reference to the patient history, physical examination and anthropometric tests, a survey of eating habits to calculate estimated nutrient intake, and a study of physical activity, involving an estimate of baseline energy output. Overweight and obese children are at greater risk of atherogenic disorders, and are more likely to develop cardiovascular diseases in adulthood. Early complications are common, and include high blood pressure, dyslipemia and hyperinsulinism. Other associated disorders include striae, infections, acanthosis nigricans, asthma, sleep apnea, pseudotumor cerebri, formation of gall stones, polycystic ovarian syndrome, precocious puberty, proteinuria due to focal glomerulosclerosis, fatty liver, lipomastia, pseudohypogenitalism, changes in body image and psychological symptoms. The metabolic syndrome is present, though less expressive, in 30% of patients with prepubertal obesity. Adipose tissue serves as an endocrine gland, producing adipocytokines such as adiponectin, leptin, TNF-α and PAI-1. Treatment of obesity is based on correction of diet-related errors, active implementation of diet-related measures, encouragement of physical activity and behavioral therapy. Drugs and bariatric surgery are not indicated in children.