[Obesity in infancy: new precision treatment]. / Obésité infantile : nouveautés thérapeutiques ciblées.

Obesity is a chronical disease, which leads to multiple short- and long-term complications. 4% of Swiss children and adolescents are obese. A prompt diagnosis and multicomponent lifestyle intervention is mandatory to avoid persistence of the disease into adulthood. Growth and BMI charts are still the essential tools to diagnose and define the etiology of obesity. A precocious and severe obesity, accompanied by hyperphagia, will raise the suspicion of monogenic obesity. The precise molecular diagnosis enables in some patients the use of a specific treatment. Leptine in case of LEP gene defects, or setmelanotide when the affected gene is part of the MC4R signaling pathway (LEPR, POMC, PCSK1).

L'obésité est une maladie chronique, associée à de multiples complications à court et à long termes, présente chez 4 % des enfants et adolescents en Suisse. Un dépistage et une intervention multidisciplinaire précoces sont essentiels pour éviter la persistance de la maladie à l'âge adulte. Les courbes de croissance et de l'IMC sont les outils indispensables pour repérer la maladie et orienter l'étiologie. Ainsi, une obésité d'apparition précoce, de caractère sévère et accompagnée d'une hyperphagie oriente le clinicien vers le diagnostic d'obésité monogénique. Un diagnostic moléculaire précis permet de connaître le gène défectueux et offre, dans certains cas, un traitement ciblé très efficace pour le patient : la leptine en cas de mutation du gène LEP, ou le setmélanotide dans les défauts de la voie de signalisation du MC4R (LEPR, POMC, PCSK1).

High Prevalence of Hypovitaminosis D in Adolescents Attending a Reference Centre for the Treatment of Obesity in Switzerland.

Background: Hypovitaminosis D is common in populations with obesity. This study aimed at assessing (1) the prevalence of hypovitaminosis D and (2) the associations between vitamin D levels and cardiovascular risk factors in adolescents attending a reference centre for the treatment of obesity. Design: Cross-sectional pilot study conducted in the paediatric obesity unit of the Lausanne university hospital, Switzerland. Methods: Participants were considered eligible if they (1) were aged between 10 to 16.9 years and (2) consulted between 2017 and 2021. Participants were excluded if (1) they lacked vitamin D measurements or (2) the vitamin D measurement was performed one month after the base anthropometric assessment. Hypovitaminosis D was considered if the vitamin D level was <30 ng/mL (<75 nmol/L). Severe obesity was defined as a BMI z-score > 3 SD. Results: We included 52 adolescents (31% girls, mean age 13 ± 2 years, 33% with severe obesity). The prevalence of hypovitaminosis D was 87.5% in girls and 88.9% in boys. The vitamin D levels were inversely associated with BMI, Spearman r and 95% CI: −0.286 (−0.555; −0.017), p = 0.037; they were not associated with the BMI z-score: −0.052 (−0.327; 0.224), p = 0.713. The vitamin D levels were negatively associated with the parathormone levels (−0.353 (−0.667; −0.039), p = 0.028) and positively associated with the calcium levels (0.385 (0.061; 0.708), p = 0.020), while no association was found between vitamin D levels and blood pressure and lipid or glucose levels. Conclusion: almost 9 out of 10 adolescents with obesity in our cohort presented with hypovitaminosis D. Hypovitaminosis D does not seem to be associated with a higher cardiovascular risk profile in this group.

Consumption of Ultraprocessed Foods in a Sample of Adolescents With Obesity and Its Association With the Food Educational Style of Their Parent: Observational Study.

BACKGROUND: Both parental education and the food environment influence dietary intake and may therefore contribute to childhood obesity. OBJECTIVE: We aimed to assess the consumption of ultraprocessed foods (UPFs) in a convenience sample of adolescents with obesity and to determine its association with the food educational style of their parent. METHODS: This observational study included 24 participants, 12 adolescents (8 boys and 4 girls) aged from 12 to 14 years and their 12 parents, who were followed in a specialized pediatric obesity clinic in the French-speaking part of Switzerland. The adolescents were asked to take a photograph with a smartphone application of all meals and beverages consumed in their daily routine over 14 consecutive days. They evaluated their parent's food educational style using the Kids' Child Feeding Questionnaire. The parent who was present at the study visits also completed the Feeding Style Questionnaire. A dietitian analyzed the pictures to extract food group portions and to identify UPFs using the NOVA classification. A nonparametric statistical test was used to investigate associations between UPF intake and food educational style. RESULTS: Overall, the adolescents had unbalanced dietary habits compared to national recommendations. They consumed an insufficient quantity of vegetables, fruits, dairy products, and starchy foods and an excessive amount of meat portions and sugary and fatty products compared to the current Swiss recommendations. Their consumption of UPFs accounted for 20% of their food intake. All adolescents defined their parent as being restrictive in terms of diet, with a mean parental restriction score of 3.3±SD 0.4 (norm median=2.1). No parent reported a permissive food educational style. A higher intake of UPFs was associated with a lower parental restriction score (P=.04). CONCLUSIONS: Despite being followed in a specialized pediatric obesity clinic, this small group of adolescents had an unbalanced diet, which included 20% UPFs. The intake of UPFs was lower in participants whose parent was more restrictive, suggesting the importance of parents as role models and to provide adequate food at home. TRIAL REGISTRATION: ClinicalTrials.gov NCT03241121; https://clinicaltrials.gov/ct2/show/NCT03241121.

The Effects of Time-Restricted Eating versus Standard Dietary Advice on Weight, Metabolic Health and the Consumption of Processed Food: A Pragmatic Randomised Controlled Trial in Community-Based Adults.

Weight loss is key to controlling the increasing prevalence of metabolic syndrome (MS) and its components, i.e., central obesity, hypertension, prediabetes and dyslipidaemia. The goals of our study were two-fold. First, we characterised the relationships between eating duration, unprocessed and processed food consumption and metabolic health. During 4 weeks of observation, 213 adults used a smartphone application to record food and drink consumption, which was annotated for food processing levels following the NOVA classification. Low consumption of unprocessed food and low physical activity showed significant associations with multiple MS components. Second, in a pragmatic randomised controlled trial, we compared the metabolic benefits of 12 h time-restricted eating (TRE) to standard dietary advice (SDA) in 54 adults with an eating duration > 14 h and at least one MS component. After 6 months, those randomised to TRE lost 1.6% of initial body weight (SD 2.9, p = 0.01), compared to the absence of weight loss with SDA (-1.1%, SD 3.5, p = 0.19). There was no significant difference in weight loss between TRE and SDA (between-group difference -0.88%, 95% confidence interval -3.1 to 1.3, p = 0.43). Our results show the potential of smartphone records to predict metabolic health and highlight that further research is needed to improve individual responses to TRE such as a shorter eating window or its actual clock time.

[Challenges of the transition for obese teenager towards adult care]. / Défis de la transition de l'adolescent obèse aux soins adultes.

The prevalence of overweight and obesity among young patients increases with age, and affects one out of five at secondary school level. Ensuring continuous care of these young patients during their growth into adulthood is a true challenge, and requires a close collaboration of pediatric and adult care teams. Each step of this transition is precarious and needs specific attentions and competencies to be successful, as teenagers and young adults are simultaneously undergoing multiple changes and challenges. As each of these young patients present with their own individual development and life experiences, individualized care transitional care plans are necessary.

La prévalence des jeunes en surpoids ou obèses augmente avec l'âge, et atteint la proportion d'un écolier sur cinq au niveau secondaire. Assurer la continuité des soins de ces jeunes patients à l'âge adulte représente un véritable challenge et demande la collaboration étroite des équipes pédiatriques et adultes. Chaque étape de la transition de soins est délicate et nécessite des attentions et des compétences particulières. Les phases d'adolescence et d'adulte émergent sont caractérisées par de multiples changements rendant la transition d'autant plus difficile. Chaque jeune patient a un développement et un vécu qui lui sont propres, ce qui implique que la transition doit être individualisée et adaptée.

Impact of physical activity on energy balance, food intake and choice in normal weight and obese children in the setting of acute social stress: a randomized controlled trial.

BACKGROUND: Psychological stress negatively influences food intake and food choices, thereby contributing to the development of childhood obesity. Physical activity can also moderate eating behavior and influence calorie intake. However, it is unknown if acute physical activity influences food intake and overall energy balance after acute stress exposure in children. We therefore investigated the impact of acute physical activity on overall energy balance (food intake minus energy expenditure), food intake, and choice in the setting of acute social stress in normal weight (NW) and overweight/obese (OW/OB) children as well as the impact of psychological risk factors. METHOD: After receiving written consent from their parents, 26 NW (BMI < 90(th) percentile) and 24 7-to 11-year-old OW (n = 5)/OB (n = 19, BMI ≥ 90(th) percentile) children were randomly allocated using computer-generated numbers (1:1, after stratification for weight status) to acute moderate physical or to sedentary activity for 30 min. Afterwards, all children were exposed to an acute social stressor. Children and their parents completed self-report questionnaires. At the end of the stressor, children were allowed to eat freely from a range of 12 different foods (6 sweet/6 salty; each of low/high caloric density). Energy balance, food intake/choice and obesity-related psychological risk factors were assessed. RESULTS: Lower overall energy balance (p = 0.019) and a decreased choice of low density salty foods (p < 0.001) in NW children compared with OW/OB children was found after acute moderate physical activity but not sedentary activity. Independent of their allocation, OW/OB children ate more high density salty foods (104 kcal (34 to 173), p = 0.004) following stress. They scored higher on impulsive behavior (p = 0.005), restrained eating (p < 0.001) and parental corporal punishment (p = 0.03), but these psychological factors were not related to stress-induced food intake/choice. Positive parenting tended to be related to lower intake of sweet high density food (-132 kcal, -277 to 2, p = 0.054). CONCLUSIONS: In the setting of stress, acute moderate physical activity can address energy balance in children, a benefit which is especially pronounced in the OW/OB. Positive parenting may act as a protective factor preventing stress-induced eating of comfort food. TRIAL REGISTRATION: clinicaltrials.gov NCT01693926 The study was a pilot study of a project funded by the Swiss National Science Foundation (CRSII3_147673).