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Obesity is a chronic disease, in which treatment outcomes are highly dependent on patient and family adherence to behavioural recommendations. The role of healthy eating, physical activity, medication adherence as well as adherence to pre- and post-bariatric surgery protocols are of utmost importance for long-term treatment outcomes. Even the best interventions are not likely to reach their maximum benefit without significant levels of adherence on the part of the individual and family. Traditionally, the annual meeting of the European Childhood Obesity Group (ECOG) includes an expert workshop addressing one specific topic within the field of childhood obesity. During the 30th annual meeting, hosted by the University of Pécs, Hungary, as a virtual meeting, “adherence to treatment recommendations in obesity as a chronic disease” was addressed. The discussions that developed during the workshop are summarized in the following article.

International audience; Reducing the burden of non-communicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color - A, B, C, D, E letters] front-of-pack labelling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in seven European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

Pregnant and lactating women are continuously and ubiquitously exposed to numerous environmental pollutants from various sources including air, food, water, and occupational and household environments. The available evidence shows that pollutants are present in human milk and one of the emerging questions is what happens when the nursing infant is involuntarily exposed to contaminants through breastfeeding.The available literature does not currently provide a conclusive evidence of any consistent or clinically relevant health consequences in infants exposed to environment chemicals through breast milk. The available data strongly suggest that the benefits of breastfeeding outweigh the potential harmful effects of pollutants contained in human milk. The committee of nutrition of the French Pediatric Society strongly supports breastfeeding but also calls for public health actions to reduce the overall contamination level in the environment, to continue promoting breastfeeding, and to support research in this area.

Introduction: While international prevention guidelines recently advocated, in addition to moderate and vigorous physical activity (MVPA) guidelines, for a minimization of sedentary (SED) time, recommendations remain to be developed for youths with obesity. Methods: A literature search was conducted in PubMed, the Cochrane Library, plus the reference lists of selected articles for relevant publications in English, including original papers, systematic reviews, and meta-analyses, with search terms “sedentary behaviors” or “sedentary time” or “screen time” AND “children” or “adolescents” AND “obesity” or “adiposity” or “cardiometabolic risk” or “cardiometabolic disease.” The results were summarized as a narrative review and presented to the scientific board of the European Childhood Obesity Group (ECOG), who then discussed their implication in clinical practice and proposed the position outlined in this paper. Results: SED and screen times are associated with adiposity and cardiometabolic risks, independently of youths’ physical activity (PA) level. Besides considering MVPA and SED times as separate variables, comprehensive studies have questioned the impact of different patterns of MVPA and SED levels. Although lower body adiposity and better cardiometabolic health are achieved among those with desirable movement behavior patterns (i.e., more MVPA/less SED or active/not SED), youths with intermediate patterns (i.e., high MVPA/high SED and low MVPA/low SED, or active/SED and inactive/not SED) have been found to be associated with intermediate risks. Conclusion: There is a need to decrease SED behaviors irrespective of MVPA and to consider PA-SED patterns in youth with obesity. The ECOG encourages anti-obesity strategies targeting both PA and SED behaviors to support the shift from long periods of SED time, especially screen time, to daily routines incorporating bouts of PA. Stepwise or sequential approaches to movement behavior counseling might start with targeting SED at first to decrease cardiometabolic risks when implementing MVPA is not yet possible.

BackgroundThe vast majority of the world population declares affiliation to a religion, predominantly Christianity and Islam. Many religions have special dietary rules, which may be more or less strictly adhered to.MethodsReligious food rules were collected from holy books and religious websites as well as their translation into dietary practices. The literature was searched for potential associations between these rules and potential nutritional consequences.ResultsJewish, Islamic and Indian religions support prolonged breastfeeding. Religious avoidance of alcohol is probably beneficial to health. When strictly applied, a few rules may lead to nutritional inadequacies, mainly in populations living in unfavourable socio-economic or environmental conditions. In Jewish and Muslim observants, animal slaughtering procedures may increase the risk of iron deficiency. Jews may be at risk of excess sodium intake related to home-prepared foods. A vegan diet, as observed by some believers, often by drifting from original precepts, or by some Hindus or Buddhists, may result in vitamin B12, calcium, iron, zinc, selenium and n-3 fatty acids deficiencies.ConclusionWhen implemented in accordance with the rules, most religious food precepts are not detrimental to health, as suggested by the fact that they have more or less been followed for millennia. Nevertheless, some practices may lead to nutritional inadequacies, such as iron, calcium, vitamin D and vitamin B12 deficiencies. Patients with low socio-economic status, children and women of childbearing age are of particular risk of such deficiencies. Being aware of them should help health professionals to take an individualized approach to decide whether to supplement or not.

Formulas adapted to infant feeding, although most of the time made from cow’s milk proteins, can be made from hydrolyzed rice protein but they must be classified as “formulas for specific medical needs”, according to European regulations. The nutritional quality of rice proteins is thus suitable to be used in infant formulas giving that it is supplemented by certain amino acids which can be lacking. Besides, hydrolysis is required to facilitate their water solubility and digestibility. Owing to a low allergenicity of rice and to the absence of the cross-allergy between milk proteins and rice proteins, these formulas are adapted to the diet of children with cow’s milk protein allergy (CMPA), which explains their growing use in some countries. However, CMPA, an expanding disorder, has consequences for growth, bone mineralization, and often has an association with allergy to other foods, including cow’s milk extensive hydrolysate, so that a surveillance of the adaption of hydrolyzed rice protein formulas (HRPF) to CMPA, the absence of unexpected side effects, and the appropriate response to its various health hazards seems mandatory. This paper analyses the health problem deriving from CMPA, the industrial development of hydrolyzed rice protein formulas, and the limited number of clinical studies, which confirms, at the moment, a good allergic tolerance and safety. The goal is to better advise heath care professionals on their use of HRPFs during CMPA.

International audience

International audience; Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.

National audience; ’ARFID (trouble d’alimentation sélective et/ou d’évitement) a été récemment ajouté au DSM V dans la classification des troubles du comportement alimentaire (TCA). L’ARFID se caractérise par un manque d’intérêt pour l’alimentation ou un évitement de certains aliments, en raison de leurs caractéristiques sensorielles se traduisant par un déficit d’apports nutritionnels. Ce comportement peut entraîner des carences nutritionnelles importantes et peut, dans les cas graves, générer une dépendance aux suppléments nutritionnels oraux et interférer avec le fonctionnement psychosocial. La prévalence de l’ARFID peut atteindre 3 % dans la population générale. L’ARFID est souvent associée à des symptômes gastro-intestinaux et apparaît principalement chez les enfants souffrant de troubles anxieux. Compte tenu de la forte prévalence de ce trouble alimentaire, une enquête nutritionnelle systématique rapide devrait être réalisée à chaque consultation pédiatrique. Le traitement doit être adapté à la gravité du problème nutritionnel et peut nécessiter une hospitalisation avec une prise en charge multidisciplinaire (pédiatre, nutritionniste, diététicien, psychologues et orthophonistes).

International audience; Avoidant/restrictive food intake disorder (ARFID) has recently been added to the DSM V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) as a new class of eating disorders (EDs). ARFID is characterized by a lack of interest in eating or avoiding specific types of foods because of their sensory characteristics. This avoidance results in decreased nutritional intake, eventually causing nutritional deficiencies. In severe cases, ARFID can lead to dependence on oral nutritional supplements, which interferes with psychosocial functioning. The prevalence of ARFID can be as high as 3% in the general population, and it is often associated with gastrointestinal symptoms and mainly appears in children with anxiety disorders. Given the high prevalence of ARFID, a rapid and systematic nutrition survey should be conducted during every pediatric consultation. Its treatment should also be adapted depending on the severity of the nutritional problem and may involve hospitalization with multidisciplinary care (pediatrician, nutritional therapist, dietitian, psychologists, and speech therapists).

The increasing prevalence of paediatric obesity and related metabolic complications has been mainly associated with lower aerobic fitness while less is known regarding potential musculoskeletal impairments. The purpose of the present systematic review was to report the evidence regarding muscular fitness in children and adolescents with obesity. A systematic article search was conducted between November 2014 and June 2015 using MEDLINE, EMBASE, CINAHL psycINFO, SPORTDiscus and SocINDEX. Articles published in English and reporting results on muscle strength and muscular fitness in children and adolescents aged 6 to 18 years were eligible. Of 548 identified titles, 36 studies were included for analyses. While laboratory-based studies described higher absolute muscular fitness in youth with obesity compared with their lean peers, these differences are negated when corrected for body weight and lean mass, then supporting field-based investigations. All interventional studies reviewed led to improved muscular fitness in youth with obesity. Children and adolescents with obesity display impaired muscular fitness compared to healthy-weight peers, which seems mainly due to factors such as excessive body weight and increased inertia of the body. Our analysis also points out the lack of information regarding the role of age, maturation or sex in the current literature and reveals that routinely used field tests analysing overall daily muscular fitness in children with obesity provide satisfactory results when compared to laboratory-based data.

Background: Health risks associated with the high consumption of sugar-sweetened beverages (SSBs) include overweight or obesity and their complications such as diabetes, as well as oral and dental decay, among others. Aim: The aim of the present statement is to inform health care professionals, parents, care-givers, teachers and school head teachers, stakeholders and governing bodies about the risks associated with drinking SSBs in infants, children and adolescents. Methods: We searched PubMed and the Cochrane databases for English language studies published from 2010 through October 1, 2018, for randomized clinical trials, meta-analyses, systematic reviews and observational studies (search terms are reported in eAppendix in the Supplement). We also manually searched the references of selected articles, reviews, meta-analyses and practice guidelines. Recommendations: Consumption of SSB by children and adolescents should be limited, and the consumption of water and other non-sweetened beverages should be promoted. Educational institutions such as nurseries, pre-schools and schools should offer unlimited access to drinking water, whereas the sale of SSBs should be banned.

Childhood Obesity : The Need to Translate Research into Daily Practice: Announcing the Annals of Nutrition and Metabolism as the Official Journal of the European Childhood Obesity Group

The prevalence of pediatric obesity continues to increase worldwide, bringing with it various metabolic, functional, social, and psychological complications.1 Both the prevention and treatment of childhood obesity must be based on multidisciplinary approaches combining nutrition, physical activity (PA), and psychological support.2 As an essential element of these multicomponent strategies, regular physical activity has been acknowledged as having beneficial effects on children's and adolescents’ body composition, physical fitness, and metabolic profile, as well as on their health-related quality of life, social and psychological health, and academic achievement.3, 4 Given that only a relatively small proportion of children and adolescents meet the public health recommendations for PA,5 and given that weight loss exercise-based interventions suffer from a high attrition rate, there is a clear need for appropriate PAs. Traditional sports, including football, handball, gymnastics, athletics, and martial arts, are usually defined as specific and structured activities organized through rules and specific regulations under the control and administration of sports associations and federations. As a part of the overall PA compendium, could these and other classical sporting activities provide a relevant alternative for the prevention and treatment of pediatric obesity? An entire session was dedicated to this question at the 28th European Childhood Obesity Group Congress (ECOG) held in Porto, Portugal, on 13–16 November 2018; the session brought together international experts in the field. This article summarizes the initial conclusions of this expert panel and details the main considerations when it comes to recommending traditional sports for the prevention and/or treatment of pediatric overweight and obesity.

International audience; CONTEXT: Infrequent mutations have been reported in the leptin receptor (LEPR) gene in humans with morbid obesity and endocrine disorders. However LEPR mutations are rarely examined in large populations from different ethnicities in a given country. OBJECTIVE: We estimated the prevalence of LEPR mutations in French patients with severe obesity and evaluated mutated patients' phenotype. DESIGN AND PATIENTS: We sequenced the LEPR gene in 535 morbidly obese French participants. We conducted clinical investigations to determine whether individuals with a novel shared mutation display particular characteristics relative to obesity history, body composition, hormonal functions, and the outcome of bariatric surgery. RESULTS: We identified 12 patients with a novel LEPR mutation (p.C604G, p.L786P, p.H800_N831del, p.Y422H, p.T711NfsX18, p.535-1G\textgreaterA, p.P166CfsX7). Six unrelated subjects were carriers of the p.P166CfsX7 mutation leading to deletion overlapping exons 6 to 8. All subjects originated from Reunion Island (France). Their clinical features (severe early-onset obesity, food impulsivity, and hypogonadotropic hypogonadism) did not differ from other new LEPR mutation carriers. Results concerning weight loss surgery were inconsistent in homozygous LEPR mutation carriers. Heterozygous LEPR mutation carriers exhibited variable severity of obesity and no endocrine abnormality. CONCLUSION: Among seven newly discovered LEPR mutations in this French obese population, we identified a LEPR frameshift mutation shared by six subjects from Reunion Island. This observation suggests a founder effect in this Indian Ocean island with high prevalence of obesity and supports a recommendation for systematic screening for this mutation in morbidly obese subjects in this population.

Objective: This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice. Methods: Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors' combined clinical experience, a three-staged approach to assessment was agreed by consensus. Results: Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three-staged approach to assessing eating behaviours in the absence of hunger is described. Conclusions: This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.

Resume La denutrition proteino-energetique est l’etat pathologique resultant d’une inadequation entre les besoins et les apports proteino-energetiques. Elle peut entrainer une augmentation de la morbidite voire de la mortalite d’une eventuelle pathologie sous-jacente. Le Comite de nutrition de la Societe francaise de pediatrie recommande de peser et de mesurer tout enfant quel que soit le contexte de visite ou d’hospitalisation. En l’absence d’information sur la cinetique de la croissance, l’indice de masse corporelle (IMC) doit etre calcule et interprete en fonction des courbes de reference figurant dans le carnet de sante. Pour tout IMC inferieur au troisieme percentile pour l’âge et le sexe, il est recommande d’examiner l’enfant a la recherche de signes cliniques de denutrition ou de signes orientant vers son origine et de noter dans le dossier l’evolution de la croissance staturo-ponderale (IMC et taille). Une strategie nutritionnelle integree a la prise en charge globale de l’enfant sera alors etablie. Elle suppose de definir le poids cible et d’adapter les apports proteino-energetiques en termes qualitatif, quantitatif, et de modalites d’administration (orale, enterale, parenterale). Dans tous les cas, cette attitude sera evaluee et adaptee selon l’effet obtenu.

Resume La denutrition proteino-energetique est l’etat pathologique resultant d’une inadequation entre les besoins et les apports proteino-energetiques. Elle est deletere par ses consequences fonctionnelles et structurelles (perte tissulaire) et peut entrainer une augmentation de la morbidite voire de la mortalite d’une eventuelle pathologie sous-jacente. Le Comite de nutrition de la Societe francaise de pediatrie (SFP) recommande de peser et de mesurer tout enfant quel que soit le contexte de visite ou d’hospitalisation. En l’absence d’information sur la cinetique de la croissance, l’indice de masse corporelle (IMC) doit etre calcule et interprete en fonction des courbes de reference figurant dans le carnet de sante. Pour tout IMC inferieur au 3 e percentile pour l’âge et le sexe, il est recommande : (1) d’examiner l’enfant a la recherche de signes cliniques de denutrition ou de signes orientant vers son origine ; (2) de tracer l’evolution de la croissance staturoponderale (IMC et taille). Toute denutrition, qu’elle soit identifiee en pediatrie communautaire ou en milieu hospitalier, necessite d’etablir une strategie nutritionnelle integree a la prise en charge globale de l’enfant. Elle suppose de definir le poids cible et d’adapter les apports proteino-energetiques en termes de niveaux, de composition et de modalites d’administration (orale, enterale, parenterale). Dans tous les cas, cette attitude sera evaluee et adaptee selon l’effet obtenu.

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or -2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care including its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy.

The goal of this study is to determine whether cardiovascular risk and the methylenetetrahydrofolate reductase 677 C-T polymorphism (MTHFR), an enzyme involved in folate metabolism and in epigenetics, are linked in morbidly obese non-diabetic adolescents. One-hundred and thirteen obese (BMI = 39.1 ± 6.4 kg/m(2)) adolescents aged 14.4 ± 1.5 years were investigated before entering a weight reduction program. Information on growth obtained from individual health records was available at birth (n = 107), 1 (n = 102), 2 (n = 106), 4 (n = 91) and 8 (n = 73) years of age. Fifty-nine subjects were heterozygote (CT, 52.2%) and 8 were homozygote for the mutation (TT, 7.0%). Birth weights were lower in TT (2.95 ± 0.48 kg, p = 0.004) than in CC (3.34 ± 0.43 kg) and CT (3.38 ± 0.50 kg) subjects, as well as birth lengths (CC: 0.50 ± 0.02 m, CT : 0.50 ± 0.02 m, TT: 0.47 ± 0.03 m, p = 0.01). These differences persisted until 1 year of age. Median and mean fasting glycaemia were similar. Insulin levels were higher in TT (median: 26.4 UI/mL) than in CC (median: 15.0 UI/mL) or CT (median: 16.0 UI/mL) (p = 0.017) subjects, as well as HOMA IR (p = 0.04). Body composition, blood pressure, plasma lipids, homocysteine and leptin concentrations were similar among the three genotypes in both boys and girls. The common 677 C-T mutation seems therefore to represent a link between altered early growth and enhanced degree of insulin resistance that occurs later in obese adolescents.

The pro-opiomelanocotin (POMC) plays a key role in body weight regulation, where its derived peptides mediate leptin action via the hypothalamic melanocortin 4 receptor (MC4R). The pathogenic effects of POMC mutations have been challenged in obesity. Our aim was to assess the relevance of POMC mutations in a cohort of French obese and nonobese children. Direct sequencing of the POMC gene was performed in 322 obese and 363 control unrelated children. Functional studies for the novel Phe144Leu mutation included the response to alpha-melanocyte stimulating hormone (alphaMSH) and a competitive binding assay. POMC mutations were identified in 3.72% of obese [95% confidence interval (CI): 1.66-5.80] and 2.20% of control (95% CI: 0.69-3.71) subjects. The novel mutation located in the alphaMSH region of the POMC gene (Phe144Leu) was found in one obese child and was transmitted by the obese father. Functional studies showed that MC4R activation in response to Leu144alphaMSH was almost completely abolished due to a dramatically altered binding of Leu144alphaMSH to MC4R. The frequency of POMC mutations is not significantly different between obese and control children in our cohort. The novel heterozygous mutation Phe144Leu leading to the absence of melanocortin signaling was associated with early-onset obesity suggesting its pathogenic role.

Resume La prevalence de l’obesite et du surpoids lors d’une enquete transversale a ete mesuree dans un echantillon de 251 enfants âges de 8 a 12 ans dans la population urbaine de l’est Algerien. Les references utilisees sont celles de l’IOTF. Les profils alimentaires et l’activite physique ont ete evalues au moyen de questionnaires adaptes aux enfants. La prevalence du surpoids et l’obesite est de 21,5 %. Le surpoids seul touche 15,9 % et l’obesite 5,6 % des enfants. Plusieurs caracteristiques differencient les enfants en surpoids et obeses des enfants normoponderaux: les obeses sont moins nombreux a prendre souvent un petit dejeuner et a consommer du lait et grignotent plus souvent des aliments riches en glucides et lipides. Les apports caloriques totaux des deux groupes sont semblables. Le pourcentage d′energie provenant des proteines mais pas leur quantite absolue est superieur chez les enfants en surpoids et obese et l’apport lipidique est superieur chez les garcons en surpoids. La majorite des enfants en surpoids ne pratique aucune activite sportive (78 %). Apres ajustement sur l′energie, les apports lipidiques sont correles a la duree du sport. La prise des repas ou le grignotage devant la television sont frequents. Cette premiere etude suggere que l’obesite infantile est devenu un probleme de sante publique en Algerie.

Introduction et but de l’etude Le recepteur de la leptine (LEPR) joue un role cle dans le controle de la prise alimentaire. Seules quelques mutations du gene LEPR ont ete identifiees chez des sujets ayant une obesite massive associee a des anomalies endocriniennes. Le but de notre travail etait de preciser la frequence des mutations de LEPR dans une large population francaise de patients obeses et de preciser le phenotype associe. Materiel et methodes Le sequencage direct du gene LEPR a ete realise chez 535 sujets obeses francais. En cas de mutation, le phenotype comprenait l’histoire ponderale, l’effet de la chirurgie bariatrique, un bilan metabolique, la composition corporelle, la depense energetique de repos et l’exploration des axes hypothalamo-hypophysaires. Resultats et analyse statistique Douze patients (âge au diagnostic 18 ans 6 mois [4–36 ans]) porteurs d’une nouvelle mutation du gene LEPR (p.C604G, p.L786P, p.H800_N831del, p.Y422H p.T711N, p.535-1G>A, p.P166CfsX7) ont ete identifies, soit 2,24 %. Six sujets non apparentes, mais tous originaires de La Reunion, etaient porteurs de la mutation p.P166CfsX7 entrainant une deletion des exons 6 a 8 (5 homozygotes et 1 heterozygote composite). Le phenotype des sujets homozygotes etait caracterise par une obesite severe a debut precoce (âge de debut 4 mois [1–6 m] ; Z-score de l’IMC + 6,6 DS [5–12,3]), une impulsivite alimentaire (73 % des cas) et des anomalies endocriniennes (hypogonadisme hypogonadotrope chez 6 adultes sur 9 [67 % des cas] ; deficit GH chez 4 sujets [36 %]). Le phenotype des sujets porteurs de la mutation p.P166CfsX7 n’etait pas significativement different. Les resultats de la chirurgie bariatrique chez les patients homozygotes etaient variables (n = 4). Les sujets heterozygotes presentaient une obesite de severite variable dans 80 % des cas avec absence d’anomalies endocriniennes. Conclusion Notre etude montre que les mutations du gene LEPR sont frequentes et le plus souvent associees a un phenotype specifique. En particulier, nous avons identifie une mutation partagee par 6 sujets non apparentes tous originaires de La Reunion suggerant un effet isolat de cette mutation. La prevalence de l’obesite etant particulierement elevee dans cette ile, le depistage systematique de la mutation p.P166CfsX7 pourrait etre discute chez les patients ayant une obesite morbide.

Objective The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating. Method Obese adolescents (n = 102) were assessed with the Binge Eating Scale (BES), the State–Trait Anxiety Inventory for Children (STAIC), the Beck Depression Inventory (BDI), Coopersmith's Self-Esteem Inventory (SEI), and the Body-Esteem subscale from the Piers–Harris Children's Self-Concept Scale (PHCSS). They were also evaluated with the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA). Two subgroups (i.e., binge eaters and non-binge eaters) were then established according to the BES score. Results Binge eating symptoms were frequent in this population and the binge eating dimension was related to high levels of anxiety and depression, as well as to low levels of self-esteem and body-esteem. The dimensions of anxiety and depression were associated specifically with binge eaters. Discussion As observed in the obese adult population, binge eating symptoms were found frequently in severely obese adolescents seeking treatment and were related strongly to studied parameters. Obese adolescents who binge eat are a subgroup with high psychopathologic distress. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 235–243, 2003.

L'obesite est par definition un exces de masse grasse. Peser lourd ne signifie donc pas etre obese. Toutefois, il faut reconnaitre que la majorite des exces de poids de l'enfant est due a une obesite que confirme le simple examen clinique. Ce phenomene va croissant dans les pays industrialises. Aux Etats-Unis, de 13 a 25 %, selon le critere utilise, des adolescents sont obeses. Ceci mene a un adulte sur trois obeses et a un « marche , toutes depenses confondues, lie a l'obesite, estime a 30 milliards de dollars par an… Cette situation a conduit a d'intenses recherches, notamment genetiques, pour tenter de comprendre le phenomene. Des avancees majeures ont eu lieu, sans pour l'instant avoir de consequences therapeutiques, consequences cependant escomptables dans les annees a venir. Les donnees actuelles permettent de concevoir l'obesite, y compris celle de l'enfant, comme l'intrication d'un terrain genetique favorable et d'un environnement qui permet la pleine expression de ce terrain. A l'echelle de la population, la part de l'heredite serait de 25 a 40%[10].

Background/Aims: To compare body fat (BF) measurements obtained with a new ultrasound method with those assessed by dual-energy X-ray absorptiometry (DEXA) in obese adolescents. Methods: In 94 adolescents (57 females and 37 males) aged 12–19 years and body mass index (BMI) exceeding 30 kg·m–2, the z-score BMI for age was 6.7 (adolescent girls) and 6.6 (adolescent boys) >97th percentile. BF was measured using DEXA and a method based on ultrasound measurements, body weight, height, abdominal circumference and mid-thigh circumference. Results: Obesity class I was noted in 39%, II in 28% and III in 33% of the patients. BF by ultrasound correlated closely with BF by DEXA, in both females (r = 0.958) and males (r = 0.981), with standard errors of the estimates (SEE) being 2.9 and 2.5 kg, respectively. The ultrasound method was more accurate than the skinfold technique (n = 24; SEE: 2.2 vs. 6.5 kg, respectively). In 13 adolescents who had marked weight loss after 6 months of treatment, the decrease in DEXA-measured BF correlated closely with the decrease in ultrasound-measured BF (r = 0.95). Conclusions: Our innovative portable ultrasound technique has advantages in terms of reliability, reproducibility, accuracy and costs for screening and monitoring obese adolescents. A patent application has been submitted. Our method should prove valuable for epidemiological studies.

The rapid rising prevalence of childhood obesity is related to increased risk of obesity-related diseases during adulthood. The aim of the present study was to review the data concerning the prevalence of metabolic syndrome (MS) in European children and adolescents (Part 1) and to determine and compare the prevalence of MS among overweight and obese children, and adolescents in five European countries using four MS definitions (Part 2). In total, 1 241 European obese children from five different countries (France: n =283, Greece: n =145, Italy: n =274, Poland: n =90, and Hungary: n =449) were studied for MS according to the definition of Ferranti et al., the World Health Organisation, the National Cholesterol Education Program and the International Diabetes Federation. We used age- and sex-specific cut-off values for the diagnosis of high blood pressure and increased waist circumference. The prevalence of MS was 35.7%, 31.4%, 20.3%, and 16.4%, respectively, according to the above-mentioned definitions. Only 6.3-8.8% of obese adolescents were free from any risk factors and the clustering of three risk factors or more was very high: 20.3-35.7% (depending on the type of definition). A total of 12.2% of children had MS and 55.8% were free from MS according to all four definitions.The prevalence of MS is high among European obese children whatever criteria are used. There is an urgent need to achieve consensus concerning the definition of MS in adolescents and children.

International audience; The relationship between taste acuity and food neophobia, food familiarity and liking has been studied in the context of a residential Weight Reduction Session (WRS, mean duration: 10 months) in 39 obese adolescents. Taste acuity was assessed using recognition thresholds for sucrose, citric acid, sodium chloride and 6-nprophylthiouracyl (PROP) and supra-threshold perceived intensities for sucrose, sodium chloride and PROP. Food neophobia was assessed by using the Food Neophobia Scale at the beginning and at the end of the WRS. At the same times, a Food Familiarity and Liking Questionnaire was used to assess changes in food familiarity and likes or dislikes for different food categories. Taste acuity appeared to mediate behavioural food-related changes during the WRS. High taste acuity was associated with limited reductions in food neophobia; less sensitive subjects showed greater increases in the acceptability of healthy foods, especially fruits and vegetables. Therefore, taste perception (and particularly PROP perception) appears to be a predictor of the magnitude of food-related behavioural change achieved during a Weight Reduction Session.

Aim. The present study assessed caries experience in an adolescent population being treated for severe obesity. The DMFT indices of a group of obese adolescents (n = 41) and a group of nonobese adolescents (n = 41) were compared. Design. The parameters examined in this transversal study were body mass index (BMI) and the number of decayed, missing, and filled teeth (DMFT). The obese and nonobese groups were matched by age, gender, and parental socio-occupational category. Differences between the two groups were assessed using nonparametric tests. Results. There was a significant association between BMI and DMFT indices (P = 0.01) in the severely obese group. The obese adolescents were more likely to have caries than the nonobese ones. Conclusions. The severely obese children (n = 16) had a high level of caries experience. Given the tremendous increase in the prevalence of obesity in children, dentists should promote a healthy diet not only to prevent dental decay but also to reduce the risk for obesity. Dentists should participate in multidisciplinary medical teams managing obese adolescents.

L’obesita in eta pediatrica costituisce un serio motivo di preoccupazione: si stima infatti che in Europa un bambino su dieci in alcuni paesi addirittura uno su tre sia obeso. Eppure, malgrado l’attuazione di numerose e promettenti strategie, in nessuno dei Paesi coinvolti nell’epidemia di obesita e stato possibile contrastare efficacemente tale incremento epidemiologico. Per questa ragione gli operatori sanitari e i pediatri saranno sempre piu frequentemente chiamati a rispondere alle preoccupazioni e alle domande di genitori o familiari.

OBJECTIVE The objective of this study was to investigate the consequences of low dietary folate intake and the impact of the 677 C-->T methylenetetrahydrofolate reductase (MTHFR) common mutation on liver function in obese adolescents. METHODS Fifty-seven obese girls (BMI = 36.1 +/- 6.0 kg/m) aged 14.1 +/- 1.5 years were included before starting a weight reduction program. Dietary intakes for folate were assessed by means of an adapted food frequency questionnaire (n = 50). Liver enzymes, plasma lipids, glucose metabolism parameters, ferritin, homocysteine and erythrocyte folate content were measured in plasma or blood obtained under fasting conditions. The MTHFR 677 C-->T polymorphism, which is associated with decreased enzyme activity, was determined using PCR. Body composition was assessed using dual x-ray absorptiometry. RESULTS Twenty-three subjects were heterozygote (CT) for the mutation and 5 were homozygote (TT). An increase in alanine amino transferase (ALT) and ALT/aspartate aminotransferase ratio was associated with the mutation (F = 4.46, P = 0.016 and F = 5.92, P = 0.0049, respectively). Alanine amino transferase was correlated negatively to folate intake (r = -0.32, P = 0.024) (n = 50) and positively to homocysteine concentrations (r = 0.30, P = 0.025). Body composition was similar among the 3 genotypic groups. Ferritin was also correlated to ALT concentrations of the entire group (P = 0.009). CONCLUSION Our data suggest that folate intake and the MTHFR polymorphism represent a part of the link between antioxidant status and liver disease in obese adolescent girls.

Previous studies in humans have shown that short to middle-term pre-exposure to multiple foods can reduce the negative response to novel foods (neophobia). In order to explore the effects of a long-term exposure to varied foods on food neophobia, we studied a population of obese adolescents observed in a longitudinal protocol in which the multiple food experiences are induced by a residential weight reduction program (WRP) that encourages the consumption of a wide variety of foods. Seventy-two massively obese adolescents (22 boys) filled the food neophobia scale (FNS, [Pliner, P., & Hobden, K. (1992). Development of a scale to measure the trait of food neophobia in humans. Appetite 19, 105-120]) and an ad hoc food familiarity and liking questionnaire at the beginning and at the end of the program (mean duration: 8.9 months). Their scores were compared to those of a control group of 51 adolescents (14 boys) tested within a similar period. FNS results show a decrease of food neophobia, without significant difference between the control group and the WRP subjects, although only WRP have encountered new foods experiences as attested by the familiarity and liking results. Methodological considerations, concerning the characteristics of the participants, the nature of the multiple food exposure and the food neophobia measurements, will be proposed to explain differences among studies.

Estimates of the prevalence of childhood overweight and obesity have been made in several European countries during the last decade. The methods used and the assessment criteria differ from survey to survey. The present paper reports the prevalence data from 21 surveys in Europe using a single, internationally accepted definition of overweight in childhood, allowing direct comparisons to be made. A tendency for a higher prevalence of overweight among children in western and especially southern Europe is shown and some possible reasons for this are discussed.

Biophysical factors Introduction Adolescence is a key period in life for major physiological and psychological change. Obesity, perhaps dating from infancy, may peak in severity at adolescence. It is thus highly desirable to intervene with vigorous preventive or curative actions early in life. However, adolescents' aspirations and their developing capacity to control their own lives can act as useful adjuncts to the management of obesity in those for whom earlier interventions have been unsuccessful. From the practical point of view, it is critically important that adolescents understand the biological processes affecting them. Stressing the advantages (e.g. growth spurt, increased fat-free mass (FFM) and, as a consequence, increased energy expenditure and requirements) as well as the disadvantages (e.g. increased fat mass in girls) of the pubertal changes in body composition can help adolescents feel more in control of weight management. The differences that develop between sexes should be discussed so that they are understood, accepted and not just seen as further disadvantages for subjects already suffering low self-esteem. Adolescents also want better understanding of their own behaviour. A recent study from the United States found 24% of a nationally representative sample of adolescents were overweight, but 45% of the girls and 20% of the boys had been dieting, and 13% and 7% of girls and boys, respectively, reported disordered eating. The risk of disordered eating increased during adolescence and correlated with depressive patterns of behaviour (Kaltzman et al., 2000).

Introduction et but de l’etude Le recepteur de la leptine (LEPR) joue un role cle dans le controle de la prise alimentaire. Seules quelques mutations du gene LEPR ont ete identifiees chez des sujets ayant une obesite massive associee a des anomalies endocriniennes. Le but de notre travail etait de preciser la frequence des mutations de LEPR dans une large population francaise de patients obeses et de preciser le phenotype associe. Materiel et methodes Le sequencage direct du gene LEPR a ete realise chez 535 obeses francais. En cas de mutation, le phenotype comprenait l’histoire ponderale, l’effet de la chirurgie bariatrique, un bilan metabolique, la composition corporelle, la depense energetique de repos et l’exploration des axes hypothalamo-hypophysaires. Resultats et Analyse statistique Douze patients (âge au diagnostic 18 ans 6 mois [4–36 ans]) porteurs d’une nouvelle mutation du gene LEPR (p. C604G, p. L786P, p. H800_N831del, p. Y422H p. T711N, p.535-1G>A, p. P166CfsX7) ont ete identifies, soit 2,24 % . Six sujets non apparentes, mais tous originaires de La Reunion, etaient porteurs de la mutation p. P166CfsX7 entrainant une deletion des exons 6 a 8 (5 homozygotes et 1 heterozygote composite). Le phenotype des sujets homozygotes etait caracterise par une obesite severe a debut precoce (âge de debut 4 mois [1–6 m] ; Z-score de l’IMC +6,6 SDs [5–12,3]), une impulsivite alimentaire (73 % des cas) et des anomalies endocriniennes (hypogonadisme hypogonadotrope chez 6 adultes sur 9 (67 % des cas) ; deficit GH chez 4 sujets (36 %)). Le phenotype des sujets porteurs de la mutation p. P166CfsX7 n’etait pas significativement different. Les resultats de la chirurgie bariatrique chez les patients homozygotes etaient variables (n =4). Le phenotype des sujets heterozygotes etait intermediaire (obesite dans 80 % des cas, absence d’anomalies endocriniennes). Conclusion Notre etude montre que les mutations du gene LEPR sont frequentes et le plus souvent associees a un phenotype specifique. En particulier, nous avons identifie une mutation partagee par 6 sujets non apparentes tous originaires de La Reunion suggerant un effet isolat de cette mutation. La prevalence de l’obesite etant particulierement elevee dans cette ile, le depistage systematique de la mutation p. P166CfsX7 pourrait etre discute chez les patients ayant une obesite morbide.

Nineteen overweight girls 14.54 +/- 0.38 years of age were studied. Results were compared with those obtained in eight age-matched (14.07 +/- 0.51 years) and sex-matched normal weight controls. Energy expenditure (EE) was determined using open-circuit indirect calorimetry at rest, both after a 12-h fast and after an oral sucrose load of 3 g/kg ideal body weight. Food-induced thermogenesis (FIT) was evaluated by computing the area under the curve of the EE response above resting energy expenditure (REE) during the first 3 h after the sucrose load, REE (kcal/day) was higher in the overweight patients (1,818 +/- 46 vs. 1,527 +/- 67; p = 0.002); REE standardized by fat-free mass (FFM) (kcal/kg FFM/day) was lower in obese children than in controls (35.2 +/- 1.0 vs. 44.9 +/- 1.9; p = 0.0001). A linear correlation between REE and FFM was evidenced in both controls and overweight subjects (r = 0.78 and 0.68, respectively; p = 0.05 and p < 0.001, respectively). Actual REE in the obese children was significantly lower than the value predicted by applying the regression equation of REE on FFM in controls to the actual FFM in obese children (paired t test; p = 0.003). FIT was identical in overweight and normal weight subjects, regardless of whether it was expressed in absolute value, as the percentage calorie intake, or standardized by FFM.(ABSTRACT TRUNCATED AT 250 WORDS)

La prévalence de l’obésité augmente dans tous les pays du monde et la Francen’échappe pas à ce phénomène épidémique. C’est un fait de société lié auxmodifications des modes de vie. Bien que définir l’obésité de l’enfant n’apparaissepas si simple, les tendances évolutives appréciées par des définitionsdiverses sont concordantes pour conclure que l’enfant est particulièrementaffecté par cette épidémie. En France, on peut estimer que la prévalence del’obésité des enfants de 5 à 12 ans est passée de 6 % dans les années quatrevingtsà 10-12 % une quinzaine d’années plus tard. L’augmentation du nombred’enfants touchés est très rapide, et pose en termes de santé publique, leproblème des complications susceptibles de compromettre leur santé à longterme.De nombreuses études ont tenté d’estimer la part des différents facteurs derisque de survenue de l’obésité, maintenant reconnue comme une maladie. Ledéveloppement de celle-ci est favorisé par des facteurs génétiques et d’environnement.Paradoxalement, les maladies des sociétés d’abondance que sontl’obésité et ses complications - diabète de type 2, hypertension artérielle etmaladies cardiovasculaires - touchent plus particulièrement les adultes ensituation socialement moins favorable. Cet effet semble moins net chez lesenfants.Les premiers progrès réalisés dans la compréhension de l’obésité sont dus auxavancées de la génétique et à l’élucidation de mécanismes moléculaires quirégulent l’appétit et le développement de la masse grasse. Quelle que soit lacomplexité de ces systèmes, le surpoids et l’obésité sont toujours le résultatd’une inadéquation entre apports et dépenses énergétiques. La tendance séculaireétant plutôt à une diminution du nombre de calories absorbées par jouren moyenne dans la population, l’augmentation de l’obésité serait probablementen rapport avec les changements du mode de vie liés à une sédentaritéaccrue. La valeur moyenne ne reflète cependant pas obligatoirement lesmodifications des apports caloriques dans certains sous-groupes de population.Quelques études d’observation ont montré une association entre le tempspassé devant la télévision et l’obésité chez l’enfant et l’adolescent. D’autresfacteurs, notamment nutritionnels, pourraient jouer un rôle dès la premièreenfance : les déterminants de l’obésité peuvent se mettre en place précocementet l’obésité n’apparaître que bien plus tard...

National audience; Nous présentons un ensemble de données sur les perceptions gustatives, vues à la fois d'un point de vue psychophysique et psychoculturel, permettant d'analyser leurs implications dans l'obésité et dans les programmes visant à la réduction de la masse corporelle.

Understanding the links between taste perception and obesity would help authorities cope with obesity, which diminishes the health of human populations. This has been highlighted by a study of the impact of programs intended to educate obese adolescents about healthy diets (Pasquet et al., 2007)1. We present and discuss the results of this study in this chapter. In order to analyze the relationships between taste perceptions and obesity, we will (I) present the main aspects of taste perception: psychophysical (mostly nerve impulses) and psychocultural dimensions, (II) specifically describe responses to sugars and fats, (III) explore the ethnic variability of taste responses, (IV) assess psychocultural dimensions of taste perception which would promote a loss of weight, and (V) show how psychophysical taste perceptions could interfere with the weight loss program throughout the psychocultural dimension.