Childhood Obesity

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REVIEW

Health consequences of obesity
J J Reilly, E Methven, Z C McDowell, B Hacking, D Alexander, L Stewart, C J H Kelnar .............................................................................................................................

Arch Dis Child 2003;88:748–752

The recent epidemic of childhood obesity1 has raised concern because of the possible clinical and public health consequences.2 3 However, there remains a widespread perception among health professionals that childhood obesity is a largely cosmetic problem, with minor clinical effects. No systematic review has yet focused on the diverse array of possible consequences of childhood obesity, though older non-systematic reviews are available.4 5 In addition, no review to date has considered the vast body of evidence on the health impact of childhood obesity which has been published recently. The aim of the present review was therefore to provide a critically appraised, evidence based, summary of the consequences of childhood obesity in the short term (for the child) and longer term (in adulthood). ..........................................................................

were rated for methodological quality by at least two independent reviewers using published criteria6–8: all or most methodological criteria met, low risk of bias; some criteria not fulfilled or study inadequately described, low risk of bias; few or no criteria fulfilled, high risk of bias. Conclusions of this review are based solely on evidence with low risk of bias, and references are cited for such evidence. The rationale for this approach is that recommendations based on evidence should be explicitly linked to the strength of the underlying evidence, and, where possible, based on high quality evidence.7 8 The nature of the question being addressed meant that most of the evidence considered was level 2 and 3. Reference details for studies which were excluded, and those which were appraised but rated as being of poor methodological quality, have not been cited here but are available from the corresponding author on request. Inclusion and exclusion criteria Studies were excluded from the appraisal if they did not define obesity in their subjects. This was relatively common in older literature. A number of other, largely older, studies did not describe how obesity was defined, or relied on subjective assessment for the definition, or subject self selection. The best available simple obesity definitions are based on body mass index (BMI) centile,6 and the present evidence appraisal is based largely on studies where obesity was defined in this way. In some of the studies we appraised, the Rohrer Index (weight/height3) was used to define obesity. We excluded case studies and reviews of case studies. We considered evidence from studies of subjects aged 1–18 years. The evidence fell logically into two major categories: co-morbidities of childhood obesity in childhood (psychological; cardiovascular risk factors; other medical consequences); and consequences for the adult who was obese as a child or adolescent (socioeconomic effects; persistence of obesity; cardiovascular risk factors; adult morbidity and premature mortality).

METHODS
Literature searching We searched for papers using Medline, Embase, Cinahl, Healthstar, the Cochrane Library, and the internet from January 1981 to the end of December 2001. 6 7 Literature searching was carried out by a specialist librarian. The search was supplemented by manual searching of reference lists from each relevant paper identified, as well as contents pages of 29 relevant specialist journals from January 1997 to December 2001. Further details of the search strategies used are available from the corresponding author. Papers which were identified were assessed for relevance to the question being addressed by a multidisciplinary group. Evidence appraisal The...
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