Abstract
Recent increases in the prevalence of childhood obesity have created an urgent need for preventive strategies, but such strategies in turn depend on an improved understanding of the etiology of pediatric obesity. There is a dearth of evidence of the cause of pediatric obesity at present, with much of the literature of limited quality, inconclusive, and contradictory. The present review highlights the paradox of energy imbalance—its apparent simplicity but actual complexity—and the difficulties in etiologic research that arise from this complexity. The review identifies a number of emerging problems for etiologic studies. The review also makes a number of proposals that might improve future etiologic studies and provides a framework for integrating the diverse body of evidence of etiology that will become available in future. Gathering improved evidence of etiology, and then integrating and interpreting it, will take many years. In the meantime, an emphasis on developing more effective preventive interventions is necessary.
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Abbreviations
- ALL:
-
acute lymphoblastic leukemia
- ALSPAC:
-
Avon Longitudinal Study of Parents and Children
- DEXA:
-
dual energy x-ray absorptiometry
- DLW:
-
doubly labeled water method
- NEAT:
-
nonexercise activity thermogenesis
- REE:
-
resting energy expenditure
- TEE:
-
total energy expenditure
- Z score:
-
SD score
References
Reilly JJ 2006 Diagnostic accuracy of the BMI for age in paediatrics. Int J Obes (Lond) 30: 595–597
Lobstein T, Baur L, Uauy R 2004 Obesity in children and young people: a crisis in public health. Obes Rev 5: 4–85
Jackson-Leach R, Lobstein T 2006 Estimated burden of paediatric obesity and co-morbidities in Europe I. Part 1. The increase in the prevalence of childhood obesity is itself increasing. Int J Pediatr Obes 1: 26–32
Cole TJ, Freeman JV, Preece MA 1995 Body mass index reference curves for the UK, 1990. Arch Dis Child 73: 25–29
Reilly JJ 2006 Tackling the obesity epidemic: new approaches. Arch Dis Child 91: 724–726
Reilly JJ, Dorosty A 1999 Epidemic of obesity in UK children. Lancet 354: 1874–1875
McCarthy HD, Jarrett KV, Emmett PM, Rogers I 2005 Trends in waist circumference in young British children: a comparative study. Int J Obes (Lond) 29: 157–162
Ruxton CH, Reilly JJ, Kirk TR 1999 Body composition of healthy 7–8 year old children and a comparison with the ‘reference child'. Int J Obes Relat Metab Disord 23: 1276–1281
Wells JC, Coward WA, Cole TJ 2002 The contribution of fat and fat-free tissue to body mass index in contemporary children and the reference child. Int J Obes Relat Metab Disord 26: 1323–1328
Watkins DC, Murray LJ, McCarron P, Boreham CA, Cran GW, Young IS, McGartland C, Robson PJ, Savage JM 2005 Ten-year trends for fatness in Northern Irish adolescents: the Young Hearts Projects—repeat cross-sectional study. Int J Obes (Lond) 29: 579–585
Thompson AM, Baxter-Jones AD, Mirwald RL 2002 Secular trends in the development of fatness in childhood and adolescence. Am J Hum Biol 14: 669–679
Flegal KM 1993 Defining obesity in children and adolescents: epidemiologic approaches. Crit Rev Food Sci Nutr 33: 307–312
Lohman TG 1993 The prevalence of obesity in children in the United States. In: Lohman TG, (ed) Advances in Body Composition Assessment. Human Kinetics Publishers, Champaign, IL, pp 307–312
Summerbell CD, Kelly S, Waters E, Edmunds L 2005 Interventions for preventing obesity in children. Cochrane Database Syst Rev 20; 3: CD001871
Managing obesity in children and young people, a national clinical guideline: Scottish Intercollegiate Guidelines Network (SIGN) guideline no 69. Available at: www.sign.ac.uk. Accessed November 15, 2006
Reilly JJ, Kelnar CJ, Alexander DW, Hacking B, Stewart L, McDowell Z, Methven E 2003 Health consequences of obesity: systematic review and critical appraisal. Arch Dis Child 88: 748–752
Goran MI 2001 Metabolic precursors and effects of obesity in children—a decade of progress, 1990–1999. Am J Clin Nutr 73: 158–171
Hill JO, Wyatt HR, Reed GW, Peters JC 2003 Obesity and the environment: where do we go from here?. Science 299: 853–855
Leibel RL, Rosenbaum M, Hirsch J 1995 Changes in energy expenditure resulting from altered body weight. N Engl J Med 332: 621–628
Stubbs RJ, Hughes DA, Johnstone AM, Horgan GW, King N, Blundell JE 2004 A decrease in physical activity affects appetite, energy, and nutrient balance in lean men feeding ad libitum. Am J Clin Nutr 79: 62–69
Kumanyika SK 2001 Mini-symposium on obesity: overview and some strategic considerations. Annu Rev Public Health 22: 293–308
Dietz WH 2001 Breast-feeding may help prevent childhood overweight. JAMA 285: 2506–2507
Reilly JJ 2002 Understanding chronic malnutrition in childhood and old age: role of energy balance research. Proc Nutr Soc 61: 321–327
Reilly JJ, Brougham M, Montgomery C, Richardson F, Gibson BE 2001 Effect of glucocorticoid therapy on energy intake in children treated for acute lymphoblastic leukemia. J Clin Endocrinol Metab 86: 3742–3745
Reilly JJ, Ventham JC, Ralston JM, Donaldson M, Gibson BE 1998 Reduced energy expenditure in pre-obese children treated for acute lymphoblastic leukemia. Pediatr Res 44: 557–562
Warner JT, Bell W, Webb DK, Gregory JW 1998 Daily energy expenditure and physical activity in survivors of childhood malignancy. Pediatr Res 43: 607–613
Butte NF, Ellis KJ 2003 Comment on “Obesity and the environment: where do we go from here?”. Science 301: 598
Reilly JJ 2005 Prevalence and causes of childhood obesity. CAB reviews: perspectives in Agriculture, Veterinary Science, Nutrition and Natural Resources. 1: 13
Wang YC, Gortmaker SL, Sobol AM, Kuntz KM 2006 Estimating the energy gap amongst US children: a counterfactual approach. Pediatrics 118: e1721–e1733
Ventham JC, Reilly JJ 1999 Childhood leukaemia: a model of pre-obesity. Proc Nutr Soc 58: 277–281
Wells JC 1998 Is obesity really due to high energy intake or low energy expenditure?. Int J Obes Relat Metab Disord 22: 1139–1140
Parsons TJ, Power C, Logan S, Summerbell CD 1999 Childhood predictors of adult obesity: systematic review. Int J Obes Relat Metab Disord 23: S1–S107
Whitaker RC 2003 Obesity prevention in primary care: four behaviors to target. Arch Pediatr Adolesc Med 157: 725–727
Reilly JJ 2005 Physical activity and obesity in childhood and adolescence. Lancet 366: 268–269
Wareham NJ, Van Sluis EM, Ekelund U 2005 Physical activity and obesity prevention: a review of the current evidence. Proc Nutr Soc 64: 229–247
Must A, Tybor DJ 2005 Physical activity and sedentary behavior: a review of longitudinal studies of weight and adiposity in youth. Int J Obes (Lond) 29: S84–S96
Ness AR, Leary SD, Rogers IS, Wells JC, Mattocks C, Reilly JJ, Davey-Smith G, Riddoch C 2007 Associations between objectively measured physical activity and lean and fat mass in a contemporary cohort of children. PLoS Med 4: e97
Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, Steer C, Sherriff A, Avon Longitudinal Study of Parents and Children Study Team 2005 Early life risk factors for childhood obesity: cohort study. BMJ 330: 1357
Reilly JJ, Coyle J, Kelly LA, Burke GB, Grant S, Paton JY 2003 An objective method for measurement of sedentary behavior in 3-4 year olds. Obes Res 11: 1155–1158
Levine JA 2004 Non-exercise activity thermogenesis. Nutr Rev 62: s82–s97
Corder K, Brage S, Wareham NT, Ekelund U 2005 Comparison of physical activity energy expenditure from combined and separate heart rate and movement models in children. Med Sci Sports Exerc 37: 1761–1767
Crouter SE, Clowers KG, Bassett DR 2006 A novel method for using accelerometer data to predict energy expenditure. J Appl Physiol 100: 1324–1331
Livingstone MB, Rennie KL 2005 Bio-behavioural determinants of energy intake and childhood obesity. In: Cameron N, Norgan NG, Ellison GT (eds) Childhood Obesity: Contemporary Issues. CRC Press, New York, pp 101–118
Wells JC 2000 A Hattori chart analysis of BMI in infants and children. Int J Obes Relat Metab Disord 24: 325–329
Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfield SB 1998 Body mass index as a measure of adiposity among children and adolescents: a validation study. J Pediatr 132: 204–210
Yarnell JW, McCrum EE, Skidmore P, Shields MD, McMahon J, Evans AE 2001 Prevalence and awareness of excess weight in 13-14 year olds in Northern Ireland using recent international guidelines. Acta Paediatr 90: 1435–1439
Grummer-Strawn LM, Mei Z 2004 Does breast-feeding protect against pediatric overweight?. Pediatrics 113: e81–e86
Wells JC, Fewtrell MS 2006 Measuring body composition. Arch Dis Child 91: 612–617
Reilly JJ 1998 Assessment of body composition in infants and children. Nutrition 14: 821–825
Stevens J, Suchindran C, Ring K, Guggett CP, Jobe JB, Story M, Thompson J, Going SB, Caballero B 2004 Physical activity as a predictor of body composition in American Indian children. Obes Res 12: 1974–1980
Wells JC, Cole TJ, ALSPAC study team 2002 Adjustment of fat-mass and fat-free mass for height in children aged 8 years. Int J Obes Relat Metab Disord 26: 947–952
Rogers IS, Ness AR, Steer CD, Wells JC, Emmett PM, Reilly JR, Tobias J, Smith GD 2006 Associations of size at birth and dual-energy X-ray absorptiometry measures of lean and fat mass at 9 to 10 y of age. Am J Clin Nutr 84: 739–747
Leary SD, Smith GD, Rogers IS, Reilly JJ, Wells JC, Ness AR 2006 Smoking during pregnancy and offspring fat and lean mass in childhood. Obesity (Silver Spring) 14: 2284–2293
Williams JE, Wells JC, Wilson CM, Haroun D, Lucas A, Fetwrell MS 2006 Evaluation of lunar prodigy DEXA for assessing body composition in healthy persons and patients by comparison with the criterion 4-component model. Am J Clin Nutr 83: 1047–1054
Wong WW, Hergenroeder AC, Stuff JE, Butte NF, Smith EO, Ellis KJ 2002 Evaluating body fat in girls and female adolescents: advantages and disadvantages of DEXA. Am J Clin Nutr 76: 384–389
Gordon-Larsen P, Adair LS, Nelson M, Popkin BM 2004 Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health. Am J Clin Nutr 89: 569–575
Lin BH, Huang CL, French SA 2004 Factors associated with women's and children's body mass indices by income status. Int J Obes Relat Metab Disord 28: 536–542
Bogen DL, Hanusa BH, Whitaker RC 2004 The effect of breast-feeding with and without formula use on the risk of obesity at 4 years of age. Obes Res 12: 1527–1535
Davey-Smith G, Ebrahim S 2005 What can Mendelian randomisation tell us about modifiable behavioural and environmental exposures. BMJ 330: 1076–1079
Kirkwood BR, Sterne JA 2003 Essential Medical Statistics. Blackwell Publishing, New York, 77–96
Whitaker RC 2002 Understanding the complex journey to obesity in early adulthood. Arch Intern Med 136: 923–925
Muthen B 2004 Latent variable analysis: growth mixture modelling and related techniques for longitudinal data. In: Kaplan D (ed) Handbook of Quantitative Methodology for the Social Sciences. Sage Publications, Newbury Park, CA, pp 345–368
Windle M, Grunbaum J, Elliott M, Tortolero SR, Berry S, Gililand J, Kanouse DE, Parcel GS, Wallander J, Kelder S, Collins J, Kolbe L, Schuster M 2004 Healthy passages: a multilevel, multimethod, longitudinal study of adolescent health. Am J Prev Med 27: 164–172
Mustillo S, Worthman C, Erklani A, Keeler G, Angold A, Costello EJ 2003 Obesity and psychiatric disorder: developmental trajectories. Pediatrics 111: 851–859
Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Laird N 1999 Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 153: 409–418
Robinson TN 1999 Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA 282: 1561–1567
Owen CG, Martin RM, Whincup PH, Davey-Smith G, Gillman MW, Cook DG 2005 The effect of breast-feeding on mean body mass index throughout life. Am J Clin Nutr 82: 1298–1307
Harder T, Bergman R, Lallischrigg G, Plagerman A 2005 Duration of breast-feeding and risk of overweight: a meta-analysis. Am J Epidemiol 162: 397–403
Arenz S, Ruckerl R, Koletzko B, Von Kries R 2004 Breast-feeding and childhood obesity - a systematic review. Int J Obes Relat Metab Disord 28: 1247–1256
Sterne JA, Egger M, Davey-Smith G 2001 Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 323: 101–105
Baird J, Fisher D, Lucus P, Kleinjen J, Roberts H, Law C 2005 Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 331: 929
Vanitallie TB 2006 Sleep and energy balance. Metabolism 55: S30–S35
Taheri S 2006 The link between short sleep duration and obesity. Arch Dis Child 91: 881–884
Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J 2001 Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ 323: 1029–1032
Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T, Norman J, Story M, Stone EJ, Stephenson L, Stevens J 2003 Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian school children. Am J Clin Nutr 78: 1030–1038
Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH, Lo Conte R, Paton JY, Grant S 2006 Physical activity for obesity prevention in pre-school children: cluster randomised controlled trial. BMJ 333: 1041
Robinson TN, Sirard JR 2005 Preventing childhood obesity: a solution oriented research paradigm. Am J Prev Med 2: 104–201
Kramer MS, Guo T, Platt RW, Vanilovich I, Sevkovskaya Z, Dzikovich I, Michaelsen KF, Dewey K, Promotion of Breastfeeding Intervention Trials Study Group 2004 Feeding effects on growth during infancy. J Pediatr 145: 600–605
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Reilly, J., Ness, A. & Sherriff, A. Epidemiologic and Physiologic Approaches to Understanding the Etiology of Pediatric Obesity: Finding the Needle in the Haystack. Pediatr Res 61, 646–652 (2007). https://doi.org/10.1203/pdr.0b013e3180536667
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DOI: https://doi.org/10.1203/pdr.0b013e3180536667
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