Surgical and pharmacological treatment of childhood obesity.

The increase in obesity prevalence has been slowing down in numerous countries recently. WHO Europe has organized surveillance of childhood obesity (Childhood Obesity Surveillance Initiative, COSI) since 2008, which observed the prevalence of overweight and obesity of 6-9-year-old children is followed during this study and proved this result. The study Children's Health 2016 showed that after a period of the global increase of obesity until 2011, there was in the Czech Republic a period of certain stabilization, in which there weren´t major changes in weight. Unfortunately, the covid pandemic changed this trend and the current data from 2021 showed in the Czech Republic a serious increase in childhood obesity. For these children will be necessary to use a new type of treatment of obesity as a surgical and pharmacological specific treatment.

Change in the prevalence of overweight/obesity in Czech seven-year-old children between 2008 and 2019.

World Health Organization (WHO) Europe organizes Childhood Obesity Surveillance Initiative (COSI), in which the Czech Republic participates since the beginning. The aim of this project is to monitor the prevalence of overweight and obesity of 7-year-old children in the Czech Republic. Data were obtained from 2349 children examined by 72 pediatricians across the Czech Republic. Anthropometric parameters were measured and subjects filled questionnaire. The prevalence of obesity and overweight did not change significantly between 2008 and 2019. Although in the fifth round in 2019, the prevalence of obesity increased and the prevalence of overweight slightly decreased in both sexes. In 2019 6.09 % of boys and 7.12 % of girl had overweight. The prevalence of obesity in the fifth round was 9.26 % in boys and 8.64 % in girls (assessed according to the Czech reference values). Already in the first round we noticed a relatively high prevalence of severe obesity (3.21 % for boys and 0.8 % for girls), which did not differ significantly between rounds. Even if the prevalence of overweight has not significantly increased until 2019, preventive and treatment programs are very important, because it is an important part of the prevention and early detection of obesity in children.

Influence of COVID-19-Related Restrictions on the Prevalence of Overweight and Obese Czech Children.

Apart from influencing the health of the worldwide population, the COVID-19 pandemic changed the day-to-day life of all, including children. A sedentary lifestyle along with the transformation of eating and sleep habits took place in the child population. These changes created a highly obesogenic environment. Our aim was to evaluate the current weight in the child population and identify the real effects of the pandemic. Height and weight data were collected by pediatricians from the pre-COVID-19 and post-COVID-19 periods from 3517 children (1759 boys and 1758 girls) aged 4.71 to 17.33 years. We found a significant rise in the z-score BMI between pediatric visits in the years 2019 and 2021 in both sexes aged 7, 9, 11, and 13 years. Especially alarming were the percentages of (severely) obese boys at the ages of 9 and 11 years, which exceed even the percentages of overweight boys. With the use of statistical modeling, we registered the most dramatic increment at around 12 years of age in both sexes. Based on our research in the Czech Republic, we can confirm the predictions that were given at the beginning of the pandemic that COVID-19-related restrictions worsened the already present problem of obesity and excess weight in children.

Obesity in childhood and adolescence and what we can do with an obese child in a pediatric health care.

Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and it is steadily affecting health care of many countries. Increase in obesity prevalence has been slowing down in numerous countries recently. WHO Europe has organized surveillance of childhood obesity (Childhood Obesity Surveillance Initiative, COSI) since 2008. Prevalence of overweight and obesity of children from ages 6 to 9 is followed during this study. The seven-year-old children are examined in the Czech Republic, where overweight and obesity prevalence of whom is stable. In 2016 overweight was found in 7,6 % of boys and in 6,5 % of girls, obesity in 8,8 % of boys and 6,5 % of girls. However, the study "Children's Health 2016" shows that after the period of global increase of obesity until 2011, there is a period of a certain stabilization, in which there are no major changes of weight. The incidence of overweight and obesity in preschool children remains favorable in the long period. The most problematic is the incidence of obesity of school children, especially boys. To improve the care of obese children in the Czech Republic, general practitioners for children and adolescents (PLDD) were involved in the health care, the educational program for PLDD was created and implemented in 2015-2017, and in 2020 the Ministry of Health approved examination, which will enable PLDD not only to look for overweight and obese children, but also to treat them effectively. The general recommendations are supplemented by practical knowledge and recommendations of doctors treating obese children.

Effect of the DASH-diet and salt Kardisal® on blood pressure in adolescents with prehypertension (Cooperative multicentre interventional study).

BACKGROUND: In a cooperative multi-center interventional study of 60 probands with prehypertension and normal BMIs were followed for 3 months. DESIGN: The intervention included the DASH diet for 3 months in 30 probands plus sodium limited intake using the low sodium salt Kardisal® (60% NaCl, 40% KCl) (group A) and the DASH diet for 3 months in 30 probands without Kardisal® (group B). RESULTS: In group A (n=26 probands evaluated) the systolic blood pressure (median) decreased significantly from 138 to 129 mmHg (p<0.001), while the diastolic blood pressure had a statistically non-significant decrease. In group B (n=25 probands evaluated) the SBP decreased significantly from 135 to 132 mmHg (p<0.001), and the DBP decreased significantly from 85 to 69 mmHg (p<0.001). CONCLUSION: Despite a relatively short period on the DASH diet, the intervention produced a significant decrease in the blood pressure of prehypertensive adolescents. The additional use of a low sodium salt for home cooking was not found to have any advantages over the DASH diet alone.

Growth of Czech breastfed infants in comparison with the World Health Organization standards.

Growth references are important for paediatric health monitoring. It is critical to understand differences in growth interpretation and potential consequences when using available growth references. This study compares the growth of Czech breastfed children with the current WHO growth standards 2006 and the Czech references 1991, 2001. A total of 960 infant/parent pairs in the Czech Republic were recruited through paediatric practices. Anthropometric data were collected during infants' first 12 months of life and parent questionnaires were gathered during a preventive visit at 18 months. Czech breastfed infants were longer with a greater head circumference at all percentiles compared to the WHO standards and were similar to the national references. The percentile weight-for-age and weight-for-length values of infants (: 6 months) were lower, and higher (6-12 months) compared to the WHO standards. The infant growth in the sample differed from both the WHO standards as well as the national references. Our findings indicate that the growth of Czech breastfed children differs from the current national references. These discrepancies were smaller compared to the WHO standards. The results of the study were used for new growth assessment guidelines to optimize feeding recommendations for Czech infants. The adoption of the WHO standards in the Czech Republic is not recommended.

[Overweight, obesity and underweight prevalence in 7-year-old children in the Czech Republic since 1951]. / Prevalence nadváhy, obezitya podváhy u sedmiletých detí v Ceské republice od roku 1951*

BACKGROUND: Childhood overweight prevalence increases worldwide. The aim of the study was to clarify the change in underweight, overweight and obesity in seven year old Czech children since 1951. METHODS: Data on underweight, overweight and obesity prevalence were obtained using repeated cross-sectional surveys. In 1951-2001 six Czech National Anthropological Surveys were conducted. In years 2008 and 2010 the data were collected as a part of the WHO Europe initiated Childhood Obesity Surveillance Initiative (COSI). The data were evaluated according to WHO references (2007), in 2010 results were assessed also according to the Czech reference standards (1991). RESULTS: From 1951, overweight and obesity prevalence increased in both genders up to 2001. In 2008, a modest decrease in obesity and stable overweight prevalence in girls and in boys a slight increase in obesity and decrease in overweight were found. In 2010, a modest increase in obesity prevalence in girls achieving the levels assessed in 2001 and stable level of overweight were found; in boys the levels remained as in 2008. BMI z score increased significantly between 1951 and 2001. CONCLUSION: These results suggest stabilisation of obesity and overweight prevalence in the Czech Republic in 7 years old children during the last 10 years. Underweight prevalence has remained low.

[Relation between dietary and physical activity patterns and obesity in seven year old children--current situation--WHO study]. / Soucasný stav stravování a pohybové aktivity ve vztahu k obezite u sedmiletých detí--studie WHO.

BACKGROUND: Childhood obesity is a global health problem. For monitoring of trends in obesity prevalence and comparison between countries standardized methods are necessary. WHO/Europe launched the "Childhood Obesity Surveillance Initiative" project in 2006 aiming to monitor childhood obesity and associated factors in European countries. This paper provides an overview of the situation in the Czech Republic with focus on diet and physical activity. METHODS AND RESULTS: The cohort included 1704 seven-year olds who were examined by paediatricians in 2008 (essential anthropometric measurements). Questionnaires on children's eating habits, physical activity, family, and school environment were filled in. Statistical methods employed. Multivariate regression with reduction of dimensionality (bi-directional orthogonal projection to the latent structure), one-way ANOVA. Low-fat milk intake frequency was positively correlated with BMI (p = 0.0001), while full-fat milk intake was negatively correlated (p = 0.005). These results probably reflect the change in the diet due to increasing BMI. Number of preventive school programmes aimed on health promotion was negatively associated with BMI (p = 0.026). CONCLUSIONS: Surprisingly, low-fat milk consumption was associated with higher BMI in seven years old children, while full-fat milk consumption was associated with lower BMI. School preventive programmes positively affect children's weight.