William H. DietzTim J. Cole and Marie Francoise Rolland-CacheraMichele Guillaume and Inge LissauMartin WabitschMarie Francoise Rolland-Cachera and France BellisleYves Schutz and Claudio MaffeisAndrew J. Hill and Inge LissauKarl F.M. Zwiauer and Margherita Caroli and Ewa Malecka-Tendera and Elizabeth M.E. PoskittMarie-Laure Frelut and Carl-Erik FlodmarkGiuseppe Chiumello and Elizabeth M.E. PoskittEwa Malecka-Tendera and Denes MolnarDavid S. Freedman and Sathanur R. Srinivasan and Gerald S. BerensonInge Lissau and Walter Burniat and Elizabeth M.E. Poskitt and Tim J. ColeElizabeth M.E. PoskittMargherita Caroli and Walter BurniatJana Parizkova and Claudio Maffeis and Elizabeth M.E. PoskittCarl-Erik Flodmark and Inge LissauDenes Molnar and Ewa Malecka-TenderaAlessandro SalvatoniBeatrice Bauer and Claudio MaffeisMarie-Laure FrelutW. Philip T. James

List of contributors	p. xi
Foreword	p. xv
Preface	p. xix
Part I Causes	p. 1
1 Measurement and definition	p. 3
1.1 Introduction	p. 3
1.2 Natural history of adiposity	p. 4
1.3 Measurement of body fat	p. 4
1.4 Adiposity as proxy for later adiposity, morbidity and mortality	p. 14
1.5 Definition of childhood obesity	p. 15
1.6 Conclusions	p. 22
1.7 References	p. 22
2 Epidemiology	p. 28
2.1 Introduction	p. 28
2.2 Epidemiology and methods	p. 28
2.3 The scale of the problem	p. 34
2.4 Conclusions	p. 44
2.5 References	p. 45
3 Molecular and biological factors with emphasis on adipose tissue development	p. 50
3.1 Introduction	p. 50
3.2 Regulation of body weight	p. 51
3.3 Single gene defects	p. 52
3.4 Regulation of body energy stores at adipose tissue level	p. 55
3.5 Changes of body fat stores during development	p. 55
3.6 Changes at cellular level related to changes in body fat	p. 57
3.7 Lipid storage in adipose tissue (lipogenesis)	p. 58
3.8 Lipid mobilization (lipolysis)	p. 59
3.9 Preadipocytes in human adipose tissue	p. 60
3.10 Proliferation and differentiation of preadipocytes	p. 60
3.11 Adipogenic activity of human serum	p. 60
3.12 Hormonal and nutritional factors regulating adipose differentiation	p. 62
3.13 Human adipocytes are secretory cells	p. 65
3.14 Conclusions	p. 66
3.15 References	p. 66
4 Nutrition	p. 69
4.1 Introduction	p. 69
4.2 Secular trends of nutrition and obesity	p. 69
4.3 Relationship between nutrition and adiposity	p. 74
4.4 Qualitative assessment of intake behaviour	p. 79
4.5 Lifestyle	p. 83
4.6 Conclusions	p. 85
4.7 References	p. 86
5 Physical Activity	p. 93
5.1 Introduction	p. 93
5.2 Energy expenditure assessment	p. 93
5.3 Energy intake vs. energy expenditure	p. 94
5.4 Components of total energy expenditure	p. 95
5.5 Excess energy intake vs. low energy expenditure	p. 98
5.6 Aerobic capacity (VO [subscript 2 max]) in obesity	p. 101
5.7 Substrate oxidation and substrate balance	p. 102
5.8 Conclusions	p. 104
5.9 References	p. 105
6 Psychosocial factors	p. 109
6.1 Children's social background	p. 109
6.2 Attitudes to obesity	p. 111
6.3 Children's self-worth	p. 115
6.4 Parents and peers	p. 118
6.5 Conclusions	p. 122
6.6 References	p. 123
Part II Consequences	p. 129
7 Clinical features, adverse effects and outcome	p. 131
7.1 Clinical findings and immediate adverse effects	p. 131
7.2 Intermediate medical consequences	p. 142
7.3 Long-term consequences	p. 145
7.4 References	p. 147
8 The obese adolescent	p. 154
8.1 Biophysical factors	p. 154
8.2 Psychological aspects	p. 160
8.3 References	p. 166
9 Prader-Willi and other syndromes	p. 171
9.1 Introduction	p. 171
9.2 Endocrine problems	p. 171
9.3 Prader-Willi syndrome (PWS)	p. 174
9.4 Other obesity syndromes	p. 180
9.5 References	p. 184
10 Hormonal and metabolic changes	p. 189
10.1 Pituitary-adrenal axis	p. 190
10.2 Pituitary-gonadal axis	p. 192
10.3 Pituitary-thyroid axis	p. 194
10.4 Growth hormone and insulin-like growth factors	p. 195
10.5 Hyperinsulinaemia and insulin resistance	p. 198
10.6 Leptin	p. 203
10.7 References	p. 209
11 Risk of cardiovascular complications	p. 221
11.1 Introduction	p. 221
11.2 Secular trends	p. 223
11.3 Associations with risk factors	p. 224
11.4 Body fat patterning	p. 230
11.5 Longitudinal analyses	p. 234
11.6 Conclusions	p. 235
11.7 References	p. 235
Part III Prevention and management	p. 241
12 Prevention	p. 243
12.1 Prevention before management	p. 243
12.2 Why prevention?	p. 243
12.3 Prevention strategy	p. 245
12.4 Responsibilities for prevention	p. 248
12.5 Reduce sedentary activity	p. 252
12.6 Reduce poor dietary habits	p. 257
12.7 Prevention programmes	p. 263
12.8 Monitoring and evaluation	p. 264
12.9 Conclusions	p. 264
12.10 References	p. 265
13 Home-based management	p. 270
13.1 Introduction	p. 270
13.2 Principles of modifying lifestyles to encourage slimming in obese children	p. 273
13.3 What can be recommended?	p. 275
13.4 Eating and diet	p. 277
13.5 Conclusions	p. 280
13.6 References	p. 280
14 Dietary management	p. 282
14.1 Introduction	p. 282
14.2 History of dietary therapy	p. 282
14.3 Aims of dietary treatment	p. 283
14.4 Types of diet	p. 284
14.5 Consequences of dieting	p. 290
14.6 Guidelines for weight goals and dietetic treatments	p. 299
14.7 Conclusions	p. 301
14.8 References	p. 302
15 Management through activity	p. 307
15.1 Introduction	p. 307
15.2 Aims of the programmes	p. 308
15.3 Efficacy of exercise in lowering fat mass	p. 310
15.4 General principles	p. 313
15.5 Physical activity and exercise programmes	p. 314
15.6 How to improve compliance	p. 320
15.7 The role of the family	p. 321
15.8 Conclusions	p. 322
15.9 References	p. 323
16 Psychotherapy	p. 327
16.1 Obesity - a disease put into perspective	p. 327
16.2 The treatment of obesity	p. 328
16.3 Conclusions	p. 340
16.4 References	p. 341
17 Drug therapy	p. 345
17.1 Appetite suppressants	p. 345
17.2 Thermogenic agents	p. 348
17.3 Digestive inhibitors	p. 349
17.4 Hormone analogues and antagonists	p. 350
17.5 References	p. 352
18 Surgical treatment	p. 355
18.1 Introduction	p. 355
18.2 Surgical techniques and their complications	p. 355
18.3 Bariatric surgery in adolescence	p. 357
18.4 Conclusions	p. 358
18.5 References	p. 358
19 Interdisciplinary outpatient management	p. 361
19.1 Goal and general philosophy	p. 361
19.2 Multifaceted treatment programmes	p. 364
19.3 Organizing team work	p. 370
19.4 Acknowledgements	p. 374
19.5 References	p. 374
20 Interdisciplinary residential management	p. 377
20.1 Historical background and implementation	p. 377
20.2 A comprehensive approach	p. 378
20.3 Results and outcome	p. 385
20.4 Conclusions	p. 386
20.5 References	p. 386
21 The future	p. 389
21.1 Introduction	p. 389
21.2 Assessment of childhood obesity	p. 389
21.3 Ethnic differences in children's anthropometry	p. 391
21.4 The Thrifty Genotype	p. 393
21.5 The prevalence of childhood obesity	p. 394
21.6 Weaning practices and early eating habits	p. 395
21.7 The 'obesogenic' environment	p. 396
21.8 Can policy initiatives work?	p. 397
21.9 Devising and implementing new policies	p. 399
21.10 References	p. 401
Index	p. 403