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Exogenous obesity in children: Overweight and Obesity in Children and Adolescents

In: Nelson Textbook of Pediatrics.

Lucas Cox
Tuesday, January 14, 2020
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  • Therefore, clinical judgment should be used Indeed, the Institute of Medicine Report recommends that clinicians, regardless of specialty, serve as role models and provide leadership in their communities for obesity prevention efforts

  • Medication might be prescribed for some children and adolescents as part of an overall weight-loss plan.

  • Limitations due to adiposity are rare in this age group. The Pediatric Obesity Algorithm 4 is an evidence based roadmap for the diagnosis and management of children with obesity.

  • Older children and adolescents who have obesity or severe obesity might be encouraged to modify their eating habits to aim for weight loss of up to 2 pounds or about 1 kilogram a week.

  • Obes Rev. Among the risk factors, obesity plays a central role as obesity tracks more strongly than any other risk factor from childhood into adult life.

Exogenous Obesity

Pediatr Rev. Typically, the dyslipidemia of obesity is a high triglyceride level and low high density lipoprotein HDL level. Figure 2. Clin Pediatr. Kaplowitz P.

Int J Obes. If possible, a substitution for a less obesogenic medication may aid in controlling weight gain. Sonographic evaluation of visceral and subcutaneous fat in obese children. Adiposopathy is a term used to describe endocrine and immune responses to increased adipose tissue while fat mass disease describes the physical response to increased adipose tissue 13 Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study.

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If your child has complications from being obese, you might be referred to additional specialists to help manage these complications. More Information Cholesterol test. This content obesoty not have an Arabic version. Some of these tests require that your child not eat or drink anything before the test. Methods: A total of 63 pre-pubertal children with exogenous obesity whom 27 of them having metabolic syndrome attending Hacettepe University Ihsan Dogramaci Children's Hospital were included in this study. The control group consisted of 34 age- and sex-matched healthy children with no significant underlying medical conditions.

Finally, the clinician needs to assess sedentary time and non-academic screen time. Nonpitting edema may indicate hypothyroidism. Epigenetics and fetal children programming: Exogeenous call for integrated research on larger cohorts. Up to the age of 2 years, no screen time is recommended. Epigenetics Involves the mechanism through which in utero factors can produce heritable changes in adiposity, which has been suggested to be due to DNA methylation or histone modification of DNA in gene regulatory regions.

Background

Mayo Clinic does not endorse companies or products. Centers for Disease Control and Prevention. Success depends largely on your commitment to helping your child make these changes.

American Academy of Pediatrics. Age children onset is helpful in distinguishing overfeeding from genetic causes of overweight since syndromic obesity often has its onset before two years of age. If screening for vitamin D deficiency is undertaken, levels are measured as serum 25 hydroxyvitamin D. Approach to Physical Exam The physical exam is both important and challenging in children with obesity. Maloney AE.

Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. Parents are the ones who buy groceries, cook meals and decide where the food is eaten. This content does not have an English version. Children ages 6 to 11 whose weight falls into the obesity category might be encouraged to modify their eating habits for gradual weight loss of no more than 1 pound or about 0. Don't be afraid to bring up the topic of health and fitness. Conclusions: This study shows much higher BPA exposure among obese children with metabolic syndrome during the prepubertal period.

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This helps determine whether your child's weight is a health concern. Some of these tests require that your child not exogenous obesity in children or drink anything before the test. Abstract Objectives: Recent studies have shown a potential link between chronic exposure to Bisphenol A BPA and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. Overweight and obesity.

  • It plays an important role for bone health through the absorption of calcium from small intestine, and is available in diet and through synthesis from sunlight. NEJM —

  • Weight-loss surgery might be an option for adolescents with severe obesity, who have been unable to lose weight through lifestyle changes. Talk to your kids directly, openly, and without being critical or judgmental.

  • N Engl J Med.

  • Dietary risk factors for development of childhood obesity. Contemporary reviews in sleep medicine.

  • Bariatric surgery, while being done more frequently in adolescents, is still reserved for adolescents with severe obesity, and is best accomplished in a center with expertise. Is adiposopathy sic fat an endocrine disease?

Principi N, Esposita S. Effects of recombinant leptin therapy in a child with children leptin deficiency. This strategy is in congruence with the first law of thermodynamics. Clin Orthop Relat Res. Octreotide therapy of pediatric hypothalamic obesity: a double-blind, placebo-controlled trial. Children with special needs are at increased risk of developing obesity Pescovitz and Eugster.

This should start in the primary care setting. For infants up to the age of 2, BMI is not assessed. The hunger games: a systematic review of pediatric bariatric surgery. No use, distribution or reproduction is permitted which does not comply with these terms. Treatment includes lifestyle modification and dietary control with studies finding metformin therapy when indicated to be effective in combination with weight loss 50 In the age of the smart phone, children in this age group are rarely without their devices. This review intends to analyze the current medical literature pertaining to overweight and obesity in the pediatric age group and highlight the clinically pertinent practical points.

Publication types

The worldwide prevalence of childhood overweight and obesity increased from 4. Presentation is highly variable and the practitioner should take a careful family history and consider a referral to a geneticist. Earlier and more comprehensive management through resources such as the Pediatric Obesity Algorithm serve to help guide health care practitioners with an evidence based roadmap for the diagnosis and management of children with obesity, and provide families with the tools needed for a healthy future.

Int J Pediatr Obes. Metformin pathways: pharmacokinetics and pharmacodynamics. The metabolic panel provides a random glucose, serum alanine aminotransferase ALT and aspartate aminotransferase. Cummings DE, Overduin J. Insulin resistance is the common denominator for many of the metabolic and cardiovascular complications of obesity.

  • It is in the children with a deceleration in growth that testing for thyroid hormones is indicated. This manuscript is based on the initial version of the Pediatric Obesity Algorithm, sponsored by the Obesity Medical Association and launched in September 4.

  • And surgery doesn't replace the need for a healthy diet and regular physical activity. In addition to BMI and charting weight on the growth charts, the doctor evaluates:.

  • Keywords: children, obesity, algorithm, adolescents, comorbidities.

  • The control group consisted of 34 age- and sex-matched healthy children with no significant underlying medical conditions.

  • After puberty, adolescents become less active in general. An Integrative approach to obesity.

Type 2 diabetes: an epidemic disease in childhood. In either case, a family-based approach will help extend these concepts of prevention to the other family members. Pediatr Clin North Am. The growing prevalence of childhood obesity has also led to appearance of obesity-related comorbid disease entities at an early age.

Treatment for childhood obesity is based on your child's age and whether he or she has other medical conditions. Using the growth chart, your doctor determines your child's children, meaning how your child compares with other children of the same sex and age. Abstract Objectives: Recent studies have shown a potential link between chronic exposure to Bisphenol A BPA and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. Ask if your child needs to fast before a blood test and for how long. Your child's family doctor or pediatrician will probably make the initial diagnosis of childhood obesity.

INTRODUCTION

Don't be afraid to bring up the topic of health and fitness. When you make the appointment, ask if there's anything your child needs to do in advance, such as fast before having certain tests and for how long. This content does not have an English version.

Take advantage of every opportunity to build your child's self-esteem. Treatment for childhood obesity is based on your child's age and exogenous obesity in children he or she has other medical conditions. Objectives: Recent studies have shown a potential link between chronic exposure to Bisphenol A BPA and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. This content does not have an Arabic version. Using the growth chart, your doctor determines your child's percentile, meaning how your child compares with other children of the same sex and age. Even small changes can make a big difference in your child's health. Associated Procedures Bariatric surgery Cholesterol test.

Children This study shows much higher BPA exposure among obese children with metabolic syndrome during the prepubertal period. Definition, epidemiology and etiology of obesity in children and adolescents. As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI -for-age growth chart. A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. McGraw Hill; Advertising revenue supports our not-for-profit mission.

MeSH terms

Abnormalities in the leptin signaling pathway is an example 1 Country of Birth Children from low- and middle-income countries tend to be stunted and underweight but with sufficient nutrition gain healthy weight and with overnutrition are prone to obesity Measured heights and weights should be used for accuracy. Expert Committee Recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: a summary report. Ghrelin levels rise shortly before mealtimes.

Associated Procedures Bariatric surgery Cholesterol test. Kliegman RM, et al. It burns calories, strengthens bones and muscles, and helps children sleep well at night and stay alert during the day. Take advantage of every opportunity to build your child's self-esteem.

NAFLD has become the most common cause of chronic liver disease in children in the US, parallel to the increasing frequency of obesity 9 The prevalence of obesity-related comorbidities has been on the rise parallel to the increasing prevalence of pediatric obesity. Global prevalence and trends of overweight and obesity among preschool children. These comorbidities have been listed in Table 1. The growing prevalence of childhood obesity has also led to appearance of obesity-related comorbid disease entities at an early age. Risk factors for obesity in 7-year-old European children: the Auckland Birthweight Collaborative Study.

Abdominal ultrasonography may be indicated in children with findings consistent with gallstones childrne. In the meantime, rates of severe obesity continue to increase, especially in minority and low income children 3. Sleep Disorders in children with obesity can have varied presentations including apnea associated with snoring or disrupted sleeping, daytime sleepiness, hyperactivity, depression, audible pauses in breathing, new onset nocturnal enuresis, irritability, and learning difficulties.

Endoscopic procedures are also in clinical trials, but adults are the target group. In children and adolescents, the children state is generally caused by a lack of physical activity, unhealthy eating patterns resulting in excess energy intake, or a combination of the two resulting in energy excess. Acanthosis nigricans is an important cutaneous marker of insulin resistance that is more commonly being diagnosed in obese children and adolescents worldwide. They should not be consuming any sugar sweetened beverages, nor any fast food. Clinical tracking of severely obese children: a new growth chart. An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Because of improved assay standardization and validation against other diagnostic methods, HbA1c has recently gained more emphasis as a screening tool for diabetes mellitus.

A children increase in activity in those who are starting from relative inactivity is suggested. Indeed, the Institute of Medicine Report recommends that clinicians, regardless of specialty, serve as role models and provide leadership in their communities for obesity prevention efforts The prevalence of pseudotumor cerebri also increases fold with increasing BMI. It is caused by lack of expression of genes on chromosome 15q, which are imprinted such that they are only expressed on the paternally inherited copy of the chromosome Pediatricians, regardless of their subspecialty, should consider routinely discussing obesity prevention and recommendations with patients and families 9. Metformin is frequently used to offset weight gain secondary to psychiatric medication. Keywords: overweight, obesity, Pediatric, prevention, Diabetes, weight management, dyslipidemia, type 2 diabetes mellitus.

  • Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. Inadequate sleep contributes to hunger.

  • Hay WW, et al. Your child's family doctor or pediatrician will probably make the initial diagnosis of childhood obesity.

  • NAFLD represents the fatty infiltration of the liver in the absence of alcohol consumption.

  • This helps determine whether your child's weight is a health concern.

Sateia MJ. Obesity Comorbidities Comorbidity management complicates the treatment of children with obesity. Pediatrics Suppl. Inadequate sleep contributes to hunger. They should not be consuming any sugar sweetened beverages, nor any fast food.

Prader Willi syndrome: genetics, metabolomics, hormonal function, and new approaches to therapy. Ethnic and sex differences in body fat and visceral and subcutaneous adiposity in children and adolescents. Symptoms include habitual nightly snoring often with intermittent pauses, snorts, or gaspsdisturbed sleep and daytime neurobehavioral problems. Published online Jan Acta Obstet Gynecol Scand.

Terminology

Childhood exogenous obesity in children can adversely affect nearly every organ system and often has serious consequences, including hypertension, dyslipidemia, insulin resistance, prediabetes, type 2 diabetes mellitus T2DMfatty liver disease and psychosocial complications 124539 Adverse effects necessitate careful monitoring and may lead to discontinuation of medication. Biological plausibility linking sleep apnoea and metabolic dysfuntion.

  • Abstract Childhood obesity is a growing global health problem.

  • Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development.

  • It is of utmost importance to have a stepwise approach in goal setting.

Obesity and children with special healthcare needs: special considerations for a special population. N Engl J Med. Identifying and classifying these children exogneous early as possible is important, as is identifying comorbid conditions. Breast feeding is unlikely to be causally protective of childhood obesity. However, it was noted that the addition of exercise to dietary intervention led to greater improvements in HDL cholesterol, fasting glucose and fasting insulin levels Early life risk factors for obesity in childhood: cohort study. Rapid deterioration of insulin secretion in obese adolescents preceding the onset of type 2 diabetes.

  • Abstract Obesity among children, adolescents and adults has emerged as one of the most serious public health concerns in the 21st century. Metabolic correlates with obstructive sleep apnea in obese subjects.

  • Success depends largely on your commitment to helping your child make these changes. Klish WJ, et al.

  • Epigenetics is thought to play a large role in the precipitous rise in obesity over the past 30 years. The clinician must be cognizant of the fact that these diagnostic methods are suboptimal in sensitivity and specificity for NAFLD and other causes of liver disease must be ruled out.

  • Take advantage of every opportunity to build your child's self-esteem.

Childhood obesity: Evidence-based guidelines for clinical practice — Part one. Mayo Exogenous obesity in children does not endorse companies or products. If you have days or weeks before your child's scheduled appointment, keep a record of what your child eats and how active he or she is. In: Nelson Textbook of Pediatrics. If your child has complications from being obese, you might be referred to additional specialists to help manage these complications. And surgery doesn't replace the need for a healthy diet and regular physical activity.

Increased BMI in childhood and adolescence is children with early introduction of complementary foods. The diagnostic work up of a child with obesity is driven by a careful history of prenatal factors, family history, feeding history, sleep duration and issues, exercise, family and cultural expectations, screen time, location and timing of meals, bullying or social isolation, motivation and ability to make modifications of the family, and finally financial constraints. Congenital or acquired hypothalamic abnormalities have been associated with a severe form of obesity in children and adolescents 1 A review of nighttime eating disorders. An increasing amount of children with obesity presenting for treatment have BMIs well above the 95th percentile and the increased amount of children with severe obesity concerns most clinicians. The next step is education of the family to limit the intake of sugary beverages.

Childhood obesity causes and consequences. However, as with any type of surgery, there are potential risks and long-term complications. Childhood obesity: Evidence-based guidelines for clinical practice — Part two. Discuss the pros and cons with your child's doctor.

Clinical practice exogenosu for screening and management of high blood pressure in children and adolescents. Children and adolescents with a BMI over the 85th but less than the 95th percentile for age and gender are considered overweight and those with a BMI greater than the 95th percentile are considered obese. Lifestyle modification involving nutrition and physical activity i. Evaluation of adolescents with PCOS should exclude alternate androgen-excess disorders.

ALSO READ: Childhood Obesity In Us Facts

Ethnic Origin Some ethnic groups e. Integrative Medicine. Prescription medications: a modifiable contributor to obesity. Review of physiology, clinical manifestations, and management of hypothalamic obesity in humans. Med Clin North Am.

Talk to your kids directly, openly, and without being critical or judgmental. Davis RL, et al. Request an Appointment at Mayo Clinic. Medication might be prescribed for some children and adolescents as part of an overall weight-loss plan.

Lifestyle modification involving nutrition and physical activity i. Int J Obes Lond ; 33 Suppl 1 — Children with obesity in the 5—9 age group should be consuming 3 meals per day plus 1—2 nutritious snacks. Neurologic complications include idiopathic intracranial hypertension, a disorder which typically presents with headache and blurred vision and is diagnosed by presence of papilledema and elevated intracranial pressure in the absence of infectious, vascular, or structural causes.

Prevalence estimates of obesity are derived from surveys or population studies. Try out PMC Labs and tell us what you think. Genetics of obesity in humans. J Pediatr Endocrinol Metab. Int J Obes Lond ; 33 Suppl 1 — In the age of the smart phone, children in this age group are rarely without their devices.

Learn More. Available randomized control trial data on dietary intervention in youth are relatively sparse, children explainable by the high attrition rates and relatively short-term follow-up periods Acta Obstet Gynecol Scand. At present, there is a crucial need for pediatric obesity advocacy. Children who have comorbidities of obesity should be referred to appropriate subspecialty services. Obstructive sleep apnea is independently related to the development of hypertension, cardiovascular disease, behavioral disorders and poor school performance in children

Talk to your kids ib, openly, and without being critical or judgmental. A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. In certain circumstances, treatment might include medications or weight-loss surgery. Klish WJ, et al. Treatment for childhood obesity is based on your child's age and whether he or she has other medical conditions. Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.

Childhood obesity causes and consequences. Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. Ask if your child needs to fast before a blood test and for how long.

Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. Kliegman RM, et al. Treatment for childhood obesity is based on your child's age and whether he or she has other medical conditions. Management of childhood obesity in the primary care setting. Davis RL, et al. If your child has complications from being obese, you might be referred to additional specialists to help manage these complications.

It is recommended to consider certain screening tests for a general metabolic assessment in all patients and pursue a more in-depth evaluation if and when indicated by the case-specific characteristics of the child being evaluated. Orlistat appetite suppressor and sibutramine gastrointestinal lipase inhibitor are FDA-approved for treatment of pediatric obesity. Congenital or acquired hypothalamic abnormalities have been associated with a severe form of obesity in children and adolescents 1 Pediatrics :e—

Polfuss ML, et al. Results: Urinary BPA levels among obese children were significantly higher than those of the control group median: Davis RL, et al. Objectives: Recent studies have shown a potential link between chronic exposure to Bisphenol A BPA and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. When you make the appointment, ask if there's anything your child needs to do in advance, such as fast before having certain tests and for how long. Mayo Clinic does not endorse companies or products.

The extents of the long-term effect of metformin on body weight or its complications are unknown. J Pediatr Gastroenterol Nutr. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease.

  • The primary treatment for obesity associated hypertension is weight loss 34 — Global prevalence and trends of overweight and obesity among preschool children.

  • The American Academy of Pediatrics recommends that children older than 2 whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain. If your child has complications from being obese, you might be referred to additional specialists to help manage these complications.

  • Despite a continual rise in the rate of childhood obesity in the United States and other developed countries over the last 30 years, there is still no clear treatment strategy. Although there are several new medications on the market for adults, none have been FDA approved for children.

  • Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Mayo Clinic does not endorse companies or products.

  • Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.

Treatment usually includes changes in your child's eating habits and physical activity level. Abstract Objectives: Recent studies have shown a potential link between chronic obesitu children Bisphenol A BPA and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. Klish WJ, et al. Childhood obesity: Evidence-based guidelines for clinical practice — Part one. As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI -for-age growth chart. Treatment for childhood obesity is based on your child's age and whether he or she has other medical conditions.

J Clin Endocrinol Metab. Of the approved medications, orlistat can produce a small amount of children loss but is associated with oily stools, a side effect not tolerated by many children. Endothelial dysfunction represents the key early step in the development of atherosclerosis Nystagmus or visual complaints raise the possibility of a hypothalamic-pituitary lesion Pharmacotherapy for childhood obesity: present and future prospects. Nat Genet. Assessment of general appearance may help to distinguish the etiology of obesity.

This strategy allows the child to add inches in height but not pounds, exogenous obesity the BMI to drop over time into a healthier range. Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention, help classify the severity of a child's weight problem:. Children ages 6 to 11 whose weight falls into the obesity category might be encouraged to modify their eating habits for gradual weight loss of no more than 1 pound or about 0. This content does not have an Arabic version. As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI -for-age growth chart.

Human adenovirus is associated with increased children weight and paradoxical reduction of serum lipids. Evidence from a prospective birth cohort study. Food groups should include 3 servings of protein per day, 1—2 servings of dairy per day, and 4—5 servings of non-starchy vegetables per day. Children, like adults, suffer from the manifestations of obesity on most aspects of their physical and psychological health. Pediatric overweight: A review of the literature. Orthop Clin North Am. Cuda ude.

The Bogalusa Heart study is a landmark study which demonstrated that cardiovascular risk factors present in childhood are predictive of coronary artery disease in adulthood The Pediatric Obesity Algorithm was created by a collaboration of clinicians from the Obesity Medicine Association who reviewed and summarized the literature and is intended for use by health care providers in clinical practice, research, and education. It may neither be realistic nor feasible to establish a similar center in each institution as this is highly contingent upon staffing and funding. Measurement of the waist circumference, in conjunction with calculation of the BMI, may help to identify patients at risk for these comorbidities. In addition, it can cause cleft palate in the fetus, making it more complicated to use in an adolescent female. Obes Facts 10 — Therefore, clinical judgment should be used

Exogeenous review our privacy policy. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. Obesity Facts 9 — Intrauterine Exposures a Intrauterine exposure to gestational diabetes: In populations at high risk of obesity and diabetes e. Children with obesity commonly present wearing more clothing than called for by climatic conditions and may be wearing spandex or other restraining garments under their loose outerwear.

McGraw Hill; Journal of Pediatric Health Care. When you make the appointment, ask if there's anything your child needs to do in advance, such as fast before having certain tests and for how long. Diagnosis As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI -for-age growth chart. This helps determine whether your child's weight is a health concern.

Because BMI doesn't consider things such non exercise activity thermogenesis in obesity management journal being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. Management of childhood obesity in the primary care setting. More Information Cholesterol test. Overweight and obesity. Keywords: bisphenol A; metabolic syndrome; obesity; prepubertal period. Accessed Oct.

Ask if your child needs to fast before a blood test and for how long. Mayo Clinic Exogenkus Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Treatment usually includes changes in your child's eating habits and physical activity level. Show references Helping your child who is overweight.

Treatment usually includes changes in your child's eating habits and physical activity level. Make a list of:. Mayo Clinic does not endorse companies or products.

Normal childhood nutrition and its disorders. Treatment usually includes changes in your child's eating habits and physical activity level. Parents are the ones who buy groceries, cook meals and decide where the food is eaten. This strategy allows the child to add inches in height but not pounds, causing the BMI to drop over time into a healthier range.

There should be special considerations for at risk patient populations including children with obesity, malabsorptive syndromes, or on medications affecting vitamin D metabolism such as anticonvulsants, glucocorticoids, antifungals, and antiretrovirals. Int Eogenous Antimicrobial Agents 46 —7. The heritability of body weight is high and genetic variation plays a major role in determining the interindividual differences in susceptibility or resistance to the obesogenic environment The prevalence of asthma is also increased in obese children. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Evidence from a prospective birth cohort study.

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