The effect of weight loss and weight gain on blood pressure in children and adolescents with obesity

Hagman, Emilia; Danielsson, Pernilla; Elimam, Amira; Marcus, Claude

doi:10.1038/s41366-019-0384-2

Cited by 27 publications

(23 citation statements)

References 33 publications

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“…This indicates that treatment of childhood obesity with lifestyle behavioral modification [17] fails to provide long-term protection against severe obesity and related co-morbidities in many individuals, and that many proceed with bariatric surgery in early adulthood. This is in agreement with our previous findings regarding the effect of behavioral treatment on blood pressure [26]. However, the effect of pediatric behavioral obesity treatment had a dose-response relationship with adult bariatric surgery.…”

Section: Discussionsupporting

confidence: 93%

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

Brissman

Lindberg

Beamish

et al. 2021

Surgery for Obesity and Related Diseases

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Background: Despite the modest effects of behavioral treatment on obesity in adolescence, bariatric surgery is rarely performed. Obesity often persists from childhood to adulthood, but it is not known how many individuals proceed with bariatric surgery in young adulthood. Objective: The aim of this study was to determine what proportion of individuals who received pediatric behavioral obesity treatment subsequently underwent bariatric surgery in early adulthood, and to identify predictors thereof. Setting: National registries, Sweden. Methods: In this prospective cohort study, the Swedish Childhood Obesity Treatment Register was linked to several national registers. Results: The childhood obesity cohort included 6502 (45% females) with a median age at follow-up of 21.7 years (interquartile range [IQR] 5.2). Of these, 8.2% underwent bariatric surgery at a median age of 20.9 years (IQR 4.2). The estimated cumulative incidence of bariatric surgery at age 30 was 21.5%. Obesity-related co-morbidities were identified in 31.7% before bariatric surgery in the childhood obesity cohort. Predictors of bariatric surgery were female sex, high body mass index standard deviation score (BMI SDS) at the start and end of treatment, poor treatment response, as well as own or parental cardiometabolic disease. Conclusions: More than a fifth are estimated to undergo bariatric surgery in early adulthood, despite having received pediatric behavioral obesity treatment. Our results indicate that for many children, behavioral treatment is insufficient in reducing obesity and preventing obesity-related co-morbidity. Therefore, it is reasonable to assume that more effective treatment of adolescents with severe obesity, including more rigorous behavioral support and pharmacologic treatment, but also more frequent use of bariatric surgery, would benefit this group of patients.

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Section: Discussionsupporting

confidence: 93%

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

Brissman

Lindberg

Beamish

et al. 2021

Surgery for Obesity and Related Diseases

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“…Obesity is a well‐established influencing factor of childhood hypertension . Hagman et al reported that the prevalence of hypertension was 15.3% and 5.5% for SBP and DBP in obese children, the SBP standard deviation score (SDS) decreased 0.41, and DBP SDS decreased 0.26 per BMI SDS unit reduction . This study found that the effect of weight loss on BP in obese children was limited and recommended considering additional pharmacological treatment.…”

Section: Discussionmentioning

confidence: 71%

Secular trends in hypertension and elevated blood pressure among Korean children and adolescents in the Korea National Health and Nutrition Examination Survey 2007‐2015

Cho

Kim

2020

J of Clinical Hypertension

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The prevalence of elevated blood pressure (BP) among US children and adolescents has reportedly declined over the past decade. As no Korean data have been analyzed, we aimed to determine recent trends in BP levels among Korean children and adolescents. This study examines data from the Korea National Health and Nutrition Examination Survey segregated into 3 time periods (2007‐2009, 2010‐2012, and 2013‐2015). A total of 7804 Korean children and adolescents aged 10‐18 years were included in the analysis. Hypertension (≥95th percentile) and elevated BP (>90th percentile) were defined using the sex‐, age‐, and height‐specific BP standards from 2017 American Academy of Pediatrics guidelines. Mean systolic BP from 2007‐2009 to 2013‐2015 increased by 3.9 mm Hg, and there was no significant change in diastolic BP. Body mass index (BMI) z‐scores significantly increased in the total population from 2007‐2009 to 2013‐2015. In 2013‐2015, the prevalence rates of elevated BP and hypertension were 8.8% and 9.0%, respectively. The prevalence of hypertension in 2013‐2015 increased in the total population compared with those in 2007‐2009, especially in the obese subgroup, in which the hypertension prevalence was 27.7% in 2013‐2015. The prevalence of elevated BP increased during these time period. Associated factors were sex, age, BMI z‐score, and survey period for elevated BP; and sex, age, and BMI z‐score for hypertension. During our study, mean systolic BP increased, and the prevalence of hypertension in 2013‐2015 increased in the pediatric population. A possible influencing factor is obesity, and further long‐term data are necessary.

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“…However, both somatic and psychological factors may play a role in the increased risk of mortality observed in individuals with obesity. Although it is known that successful obesity treatment in childhood, based on behavioral lifestyle modification including diet and physical activity, reduces risk factors that may influence risk of mortality [4,17,46], studies investigating effective obesity treatments in children and their impact on mortality risk itself are lacking. Due to the relatively limited number of deaths occurring in early adulthood, we were not able to examine the effect of obesity treatment response on risk of mortality.…”

Section: Children and Adolescents With Obesity And Premature Deathmentioning

confidence: 99%

“…Due to the relatively limited number of deaths occurring in early adulthood, we were not able to examine the effect of obesity treatment response on risk of mortality. However, it is well-established that weight loss has positive long-term health benefits [4,17,46], and has in adults been shown to reduce the risk of premature mortality [25]. Future research should investigate whether successful obesity treatment can lead to a reduction in the risk of early mortality.…”

Section: Children and Adolescents With Obesity And Premature Deathmentioning

confidence: 99%

“…The prevalence of obesity among children and adolescents has increased around the world [1], and it has been estimated that 91 million children will have obesity in 2025 [2]. Obesity in childhood is associated with somatic morbidity such as insulin resistance, liver disease, and hypertension [3][4][5][6]. Further, children with obesity may also experience emotional and psychological problems [7][8][9] and are often exposed to bullying by their peers [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study

et al. 2020

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Background Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group. Methods and findings In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3-17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of followup) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0-24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00-8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group.

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The effect of weight loss and weight gain on blood pressure in children and adolescents with obesity

Cited by 27 publications

References 33 publications

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

Secular trends in hypertension and elevated blood pressure among Korean children and adolescents in the Korea National Health and Nutrition Examination Survey 2007‐2015

Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study

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