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The rehabilitation of children and adolescents with severe or medically complicated obesity: an ISPED expert opinion document

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Abstract

Severe/medically complicated obesity in childhood, and particularly in adolescence, is a real disability that requires an intensive and continuous approach which should follow the procedures and schedule of rehabilitation medicine. Given the lack of a specific document focusing on children and adolescents, the Childhood Obesity Study Group set out to explore the available evidence for the treatment of severe or medically complicated obesity and to set standards tailored to the specific context of the Italian Health Service. Through a series of meetings and electronic communications, the writing committee (selected from members of the Study Group) selected the key issues, explored the literature and produced a draft document which was submitted to the other experts until the final synthesis was approved by the group. In brief, the following issues were involved: (1) definition and epidemiology; (2) identification of common goals designed to regain functional competence and limit the progression of metabolic and psychological complications; (3) a multi-professional team approach; (4) the care setting. This paper is an expert opinion document on the rehabilitation of severe and medically complicated obesity in children and adolescents produced by experts belonging to the Childhood Obesity Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED).

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References

  1. Barlow SE, Expert Committee (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120(Suppl 4):S164–S192

    Article  Google Scholar 

  2. Flegal KM, Wei R, Ogden CL, Freedman DS, Johnson CL, Curtin LR (2009) Characterizing extreme values of body mass index for age by using the 2000 centers for disease control and prevention growth charts. Am J Clin Nutr 90:1314–1320. doi:10.3945/ajcn.2009.28335

    Article  CAS  PubMed  Google Scholar 

  3. Ogden CL, Carroll MD, Kit BK, Flegal KM (2014) Prevalence of childhood and adult obesity in the united states, 2011–2012. JAMA 311:806–814. doi:10.1186/s12889-015-1549-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Valerio G, Maffeis C, Balsamo A, Del Giudice EM, Brufani C, Grugni G, Licenziati, Brambilla P, Manco M, on the behalf of the Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology (2013) Severe obesity and cardiometabolic risk in children: comparison from two international classification systems. PLoS One 8:e83793. doi:10.1371/journal.pone.0083793

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 246:1–190

    Google Scholar 

  6. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull WHO 85:660–667. doi:10.2471/BLT.07.043497

    Article  PubMed  Google Scholar 

  7. Cacciari E, Milani S, Balsamo A, Spada E, Bona G, Cavallo L, Cerutti F, Gargantini L, Greggio N, Tonini G, Cicognani A (2006) Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest 29:581–593

    Article  CAS  Google Scholar 

  8. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH (2007) Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 150:12–17. doi:10.1016/j.jpeds.2006.08.042

    Article  PubMed  Google Scholar 

  9. Mazzarella G, Binkin N, Perra A; National Coordination Group OKkio Alla Salute (2008) Obesità severa del bambino e fattori correlati. http://www.epicentro.iss.it/ben/2008/dicembre/1.asp. Accessed 23 June 2016

  10. Bosello O, Donataccio MP, Cuzzolaro M (2016) Obesity or obesities? Controversies on the association between body mass index and premature mortality. Eat Weight Disord 21(2):165–174. doi:10.1007/s40519-016-0278-4

    Article  PubMed  Google Scholar 

  11. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2 Suppl 4th Report):555–576

    Article  Google Scholar 

  12. Puhl RM, Heuer CA (2009) The stigma of obesity: a review and update. Obesity 17:941–964. doi:10.1038/oby.2008.636

    Article  Google Scholar 

  13. Bacchini D, Licenziati MR, Garrasi A, Corciulo N, Driul D, Tanas R, Fiumani MP, Di Pietro M, Pesce S, Crinò A, Maltoni G, Iughetti L, Sartorio A, Deiana M, Lombardi F (2015) Valerio G (2015) Bullying and victimization among overweight and obese paediatric outpatients: an Italian Multicentric Study. PLoS One 10(11):e0142715. doi:10.1371/journal.pone.0142715

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tsiros MD, Coates AM, Howe PR, Grimshaw PN, Buckley JD (2011) Obesity: the new childhood disability? Obes Rev 12:26–36. doi:10.1111/j.1467-789X.2009.00706.x

    Article  CAS  PubMed  Google Scholar 

  15. Braet C, Van Winckel M (2000) Long-term follow-up of a cognitive behavioral treatment program for obese children. Behav Ther 31:55–74

    Article  Google Scholar 

  16. Danielsson P, Kowalski J, Ekblom Ö, Marcus C (2012) Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med 166:1103–1108. doi:10.1001/2013.jamapediatrics.319

    Article  PubMed  Google Scholar 

  17. Linee-guida del Ministro della sanità per le attività di riabilitazione (1998). Gazzetta Ufficiale 30 maggio 1998, n. 124

  18. Togashi K, Masuda H, Rankinen T, Tanaka S, Bouchard C, Kamiya H (2002) A 12-year follow-up study of treated obese children in Japan. Int J Obes Relat Metab Disord 26:770–777

    Article  CAS  Google Scholar 

  19. Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM (2007) Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 120(Suppl 4):S254–S288

    Article  Google Scholar 

  20. Valerio G, Licenziati MR, Tanas R, Morino G, Ambruzzi MA, Balsamo A, Brambilla P, Calcaterra V, Crinò A, Franzese A, Giordano U, Grugni G, Iaccarino Idelson P, Iughetti L, Maffeis C, Manco M, Miraglia del Giudice E, Mozzillo E, Bernasconi S, Gruppo di Studio Obesità Infantile della Società Italiana di Endocrinologia e Diabetologia Pediatrica (2012) Il percorso terapeutico del bambino e dell’adolescente con obesità grave. Minerva Pediatr 64:413–431

    CAS  PubMed  Google Scholar 

  21. Ho M, Garnett SP, Baur LA, Burrows T, Stewart L, Neve M, Collins C (2013) Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr 167:759–768. doi:10.1001/jamapediatrics.2013.1453

    Article  PubMed  Google Scholar 

  22. World Health Organization (1998) Therapeutic patient education: continuing education programs for healthcare providers in the field of prevention of chronic diseases. WHO Regional Office for Europe, Copenaghen

  23. Donini LM, Cuzzolaro M, Spera G, Badiali M, Basso N, Bollea MR, Bosello O, Brunani A, Busetto L, Cairella G, Cannella C, Capodaglio P, Carbonelli MG, Castellaneta E, Castra R, Clini E, Contaldo F, Dalla Ragione L, Dalle Grave R, D’Andrea F, Del Balzo V, De Cristofaro P, Di Flaviano E, Fassino S, Ferro AM, Forestieri P, Franzoni E, Gentile MG, Giustini A, Jacoangeli F, Lubrano C, Lucchin L, Manara F, Marangi G, Marcelli M, Marchesini G, Marri G, Marrocco W, Melchionda N, Mezzani B, Migliaccio P, Muratori F, Nizzoli U, Ostuzzi R, Panzolato G, Pasanisi F, Persichetti P, Petroni ML, Pontieri V, Prosperi E, Renna C, Rovera G, Santini F, Saraceni V, Savina C, Scuderi N, Silecchia G, Strollo F, Todisco P, Tubili C, Ugolini G, Zamboni M (2010) Obesity and eating disorders. Indications for the different levels of care. An Italian expert consensus document. Eat Weight Disord 15:1–31. http://www.sio-obesita.org/documenti/sio_303.pdf

  24. S.I.O - A.D.I. (2013) Standard Italiani per la cura dell'obesità (2012-2013).http://sio-obesita.org/Standard.pdf. Accessed 23 June 2016

  25. Ministero della Salute Piano d’indirizzo per la Riabilitazione Gruppo di Lavoro sulla Riabilitazione http://www.salute.gov.it/imgs/C_17_primopianoNuovo_291_documenti_item

  26. Puhl RM, Peterson JL, Luedicke J (2013) Weight-based victimization: a comprehensive assessment of weight-loss treatment-seeking youth. Pediatrics 131:e1–e9. doi:10.1542/peds.2012-1106

    Article  PubMed  Google Scholar 

  27. Whitlock EA, O’Connor EP, Williams SB, Beil TL, Lutz KW (2008) Effectiveness of weight management programs in children and adolescents. Evid Rep Technol Assess (Full Rep) 170:1–308

    Google Scholar 

  28. Epstein LH, Valoski A, Wing RR, McCurley J (1994) Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol 13:373–383

    Article  CAS  Google Scholar 

  29. Warschburger P, Fromme C, Petermann F, Wojtalla N, Oepen J (2001) Conceptualisation and evaluation of a cognitive-behavioural training programme for children and adolescents with obesity. Int J Obes Relat Metab Disord 25(suppl 1):S93–S95

    Article  Google Scholar 

  30. Lagger G, Pataky Z, Golay A (2010) Efficacy of therapeutic patient education in chronic diseases and obesity. Patient Educ Couns 79:283–286. doi:10.1016/j.pec.2010.03.015

    Article  PubMed  Google Scholar 

  31. Tanas R, Marcolongo R, Pedretti S, Gilli G (2007) A family-based education program for obesity: a three-year study. BMC Pediatr 7:33

    Article  Google Scholar 

  32. Committee on Hospital Care and Institute for Patient- and Family-centered Care (2012) Patient- and family-centered care and the pediatrician’s role. Pediatrics 129:394–404. doi:10.1542/peds.2011-3084

    Article  Google Scholar 

  33. Ludwig DS (2012) Weight loss strategies for adolescents: a 14-year-old struggling to lose weight. JAMA 307:498–508. doi:10.1001/jama.2011.2011

    Article  PubMed  Google Scholar 

  34. Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L, Academy Positions Committee (2013) Position of the academy of nutrition and dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet 113:1375–1394. doi:10.1016/j.jand.2013.08.004

    Article  PubMed  Google Scholar 

  35. Sung-Chan P, Sung YW, Zhao X, Brownson RC (2013) Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obes Rev 14:265–278. doi:10.1111/obr.12000

    Article  CAS  PubMed  Google Scholar 

  36. Capodaglio P, Lafortuna C, Petroni ML, Salvadori A, Gondoni L, Castelnuovo G, Brunani A (2013) Rationale for hospital-based rehabilitation in obesity with comorbidities. Eur J Phys Rehabil Med 49:399–417

    CAS  PubMed  Google Scholar 

  37. Freemark M (2007) Pharmacotherapy of childhood obesity: an evidence-based conceptual approach. Diabetes Care 30:395–402. doi:10.2337/dc06-1569

    Article  CAS  PubMed  Google Scholar 

  38. Petkar R, Wright N (2013) Pharmacological management of obese child. Arch Dis Child Educ Pract Ed 98:108–112. doi:10.1136/archdischild-2011-301127

    Article  PubMed  Google Scholar 

  39. Dan D, Harnanan D, Seetahal S, Naraynsingh V, Teelucksingh S (2010) Bariatric surgery in the management of childhood obesity: should there be an age limit? Obes Surg 20:114–117. doi:10.1007/s11695-009-9996-2

    Article  PubMed  Google Scholar 

  40. Pratt JS, Lenders CM, Dionne EA, Hoppin AG, Hsu GL, Inge TH et al (2009) Best practice updates for pediatric/adolescent weight loss surgery. Obesity 17:901–910. doi:10.1038/oby.2008.577

    Article  PubMed  Google Scholar 

  41. Treadwell JR, Sun F, Schoelles K (2008) Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg 248:763–776. doi:10.1097/SLA.0b013e31818702f4

    Article  PubMed  Google Scholar 

  42. Heber D, Greenway FL, Kaplan L, Livingston E, Salvador J, Still C (2010) Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 95:4823–4843. doi:10.1210/jc.2009-2128

    Article  CAS  PubMed  Google Scholar 

  43. Barnett SJ (2013) Bariatric surgical management of adolescents with morbid obesity. Curr Opin Pediatr 25:515–520. doi:10.1097/MOP.0b013e328362cd96

    Article  PubMed  Google Scholar 

  44. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, Nadolsky K, Pessah-Pollack R, Plodkowski R; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines (2016) American Association of Clinical Endocrinologists and American College Of Endocrinology Clinical practice guidelines for comprehensive medical care of patients with obesity—executive summary. Endocr Pract. doi:10.4158/EP161365.GL

    Article  PubMed  Google Scholar 

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Acknowledgements

The following members of Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED) approved the content of the document on rehabilitation of children and adolescents with severe or medically complicated obesity, contributing to the discussion through a series of meetings and electronic communications. They are considered coauthors: Amalia Ambruzzi (Roma); Antonio Balsamo (Bologna); Simonetta Bellone (Novara); Sergio Bernasconi (Parma); Vanessa Bianchi (Pisa); Adriana Bobbio (Aosta); Patrizia Bruzzi (Modena); Carmen Buongiovanni (Napoli); Annalisa Calcagno (Genova); Valeria Calcaterra (Pavia); Teresa Canali (Roma); Franco Cerutti (Torino); Nicola Corciulo (Gallipoli, Lecce); Fortunato Cotugno (Salerno); Giuliano Cuccarolo (Venezia); Osvaldo D’Amico (Salerno); Procolo Di Bonito (Pozzuoli, Napoli); Stefania Di Candia (Milano); Violetta Di Pietrantonio (Palermo); Mario Di Pietro (Atri, Teramo); Grazia Filannino (Ostuni, Brindisi); Danilo Fintini (Roma); Claudia Forziato (Pozzuoli, Napoli); Roberto Franceschi (Trento); Adriana Franzese (Napoli); Daniela Galeazzi (Narni, Terni); Luigi Gargantini (Treviglio, Bergamo); Lia Franca Giusti (Lucca); Antonella Gualtieri (Avezzano, L’Aquila); Dario Iafusco (Napoli); Maria Laura Iezzi (L’Aquila); Lorenzo Iughetti (Modena); Riccardo Lera (Alessandria); Raffaele Limauro (Napoli); Francesca Lombardi (Bologna); Sonia Lucchesi (Livorno); Annamaria Macchiaroli (Campobasso); Giulio Maltoni (Bologna); Melania Manco (Roma); Miraglia Del Giudice Emanuele (Napoli); Elisabetta Modestini (Atri, Teramo); Anita Morandi (Verona); Enza Mozzillo (Napoli); Laura Nanni (Pistoia); Alessandra Nicolosi (Catania); Maria Chiara Pellegrin (Trieste); Sonia Peruzzi (Lecce); Paola Peverelli (Belluno); Salvatore Purromuto (Comiso, Ragusa); Letizia Ragusa (Troina, Enna); Teresa Rosato (Pescara); Caterina Salvo (Palermo); Chiara Sartori (Parma); Maura Sticco (Caserta); Maria Elisabeth Street (Parma); Giuliana Trifirò (Rho, Milano); Patrizia Vianelli (Jesi, Ancona); Pietro Yiannakou (Albano Laziale, Roma).

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Authors and Affiliations

  1. Division of Auxology, Italian Auxological Institute, Verbania, Italy

    Graziano Grugni

  2. Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy

    Maria Rosaria Licenziati

  3. Department of Movement Sciences and Wellness, Parthenope University, Naples, Italy

    Giuliana Valerio

  4. Autoimmune Endocrine Diseases Unit Bambino Gesù Hospital, Research Hospital Palidoro, Rome, Italy

    Antonino Crinò

  5. Pediatric Diabetes and Metabolic Disorders Unit, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy

    Claudio Maffeis

  6. Pediatric Unit, Azienda Ospedaliera Universitaria, Ferrara, Italy

    Rita Tanas

  7. Nutrition Education Unit, Bambino Gesù Hospital, San Paolo Hospital, Rome, Italy

    Giuseppe Stefano Morino

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  1. Graziano Grugni
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  2. Maria Rosaria Licenziati
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  3. Giuliana Valerio
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  5. Claudio Maffeis
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  7. Giuseppe Stefano Morino
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Childhood Obesity Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED)

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Correspondence to Maria Rosaria Licenziati.

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Membership of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED) is provided in the Acknowledgments.

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Grugni, G., Licenziati, M.R., Valerio, G. et al. The rehabilitation of children and adolescents with severe or medically complicated obesity: an ISPED expert opinion document. Eat Weight Disord 22, 3–12 (2017). https://doi.org/10.1007/s40519-016-0305-5

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