Obesity is a complex, heritable trait influenced by the interplay of genetics, epigenetics, metagenomics and the environment. With the increasing access to high precision diagnostic tools for genetic investigations, numerous genes influencing the phenotype have been identified, especially in early onset severe obesity. This review summarizes the current knowledge on the known genetic causes of obesity and the available therapeutic options. Furthermore, we discuss the role and potential mechanism of epigenetic changes that may be involved as mediators of the environmental influences and that may provide future opportunities for intervention.
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
There is no diet that is recommended for all individuals. Some special diets (eg, gluten-free for celiac disease) are necessary for health and quality of life. Other diets may be recommended for a short period of time to aid in symptom relief but may not be recommended for the long- term (eg, LFD). Popular diets continue to come and go with varying levels of success. When considering adolescents, continued growth and development are most important, and restrictive diets can lead to nutrient inadequacies and poor growth. Before making any recommendation, it is important to consider the goal of the diet and the cost versus benefits associated with following the diet. Adherence is always a challenge, regardless of the type of diet implemented. If a special diet is not warranted for the health, safety, and desired quality of life of the individual, it should not be implemented.
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
Obesity in adolescents presents many challenges for the patient, family, and physician. The myriad problems involving the GI tract will be managed more effectively when the treating physician has an understanding of the presentations, pathophysiology, appropriate laboratory evaluation, and approaches to treatment for these complications. In addition to being familiar with the pharmacotherapeutic options available, having an approach to behavioral change, such as MI, can be an extremely useful tool.
Esophagitis is the end result of a variety of insults to epithelial homeostasis. Eosinophilic esophagitis is a manifestation of non-IgE-mediated food allergy that most commonly affects the esophagus of males who have other atopic phenomena. Reflux esophagitis reflects repeated exposure to acidic gastric contents because of failure of the normal protections afforded by the LES. Because certain histologic features can be present in either condition, endoscopic biopsy alone does not distinguish them. Their symptoms overlap, but the treatment options are very different, such that making a formal diagnosis by following consensus guidelines is essential. A treatment protocol designed to manage the inflammation by controlling the provocative factors (acid for GERD and food antigens for EoE) or suppressing the inflammation (ie, topical steroids for EoE) should result in normalization of the mucosa and resolution of symptoms. Eosinophilic esophagitis is a chronic condition that rarely remits spontaneously, so any therapeutic modality will need to be continued indefinitely.
The existing guidelines on screening and treatment are confusing because different guidelines target different populations. The IOM and AAP guidelines target generally healthy populations, whereas the Endocrine Society and other subspecialty guidelines target individuals with specific medical conditions associated with increased bone fragility. These distinctions have not always been well articulated. For healthy adolescents, the AAP does not recommend universal screening or screening of obese or dark-skinned individuals. Increased dietary intake of vitamin D is recommended, and vitamin D supplementation can be considered if the RDA cannot be met. For adolescents with chronic medical illnesses associated with increased fracture risk, screening for vitamin D deficiency should be performed by obtaining a serum 25-OHD level. Those found to be deficient (25-OHD level < 20 ng/mL) should be treated with doses of vitamin D2 or vitamin D3 higher than the daily requirement (as discussed in the section on vitamin D and chronic disease), followed by a maintenance dose. A repeat 25-OHD level should be obtained after the therapeutic course is completed. Some experts advocate for achievement of 25-OHD levels greater than 30 ng/mL in conditions associated with increased bone fragility, and several pediatric subspecialty organizations have made recommendations specific to the diseases they treat. In such instances, the recommendations of the pediatric subspecialty organizations should take precedence over the AAP recommendations for adolescents with chronic illnesses associated with increased bone fragility because the AAP recommendations were primarily targeted at a healthy population.
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
It is now recognized that the prevalence of atopic disorders including (EoE) and immune based conditions such as celiac disease and inflammatory bowel disease are on the rise. This changing epidemiology coupled with advancements in the diagnosis of these conditions have led to greater numbers of adolescents needing treatment.Topics include:Swallowing disorders and eosinophilic esophagitisCeliac and gluten-related disordersFunctional GI disordersAdvances in inflammatory bowel diseaseAdvances in hepatologyObesityFad diets, FODMAPSVitamin D and bone healthGut microbiome and probioticsGI issues in adolescents with eating disordersHealth maintenance in adolescents with chronic GI disordersTransition of care
Adolescent Medicine: State of the Art Reviews (AM:STARs) is the official publication of the American Academy of Pediatrics Section on Adolescent Health. AM:STARs is a series of clinical reviews that detail advances in the diagnosis and management of a wide range of health problems affecting adolescents.Edited by the AAP Section on Adolescent Health, AM:STARs helps you stay up-to-date in key areas of current adolescent clinical practice. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else.Articles in this issue:The role of the health care professional in curbing youth violenceAssessing and treating youth violence in the primary care settingViolence and mental health: trauma-informed practice and wellness approach to violence victimizationAdolescent relationship abuse prevention and interventionSocial media, cyberbullying, and adolescent healthMedia use and violence perpetrationSubstance abuse and violencePromoting resilience for youth who are violence involvedFirearm risk: assessment and intervention in the health care settingBuilding an evidence-based multi-tiered system of support for violence prevention in the health care settingTreating youth violence in the hospital and emergency department settings
Adolescent Medicine: State of the Art Reviews (AM:STARs) is the official publication of the American Academy of Pediatrics Section on Adolescent Health. AM:STARs is a series of clinical reviews that detail advances in the diagnosis and management of a wide range of health problems affecting adolescents.Edited by the AAP Section on Adolescent Health, AM:STARs helps you stay up-to-date in key areas of current adolescent clinical practice. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else.Articles in this issue:The role of the health care professional in curbing youth violenceAssessing and treating youth violence in the primary care settingViolence and mental health: trauma-informed practice and wellness approach to violence victimizationAdolescent relationship abuse prevention and interventionSocial media, cyberbullying, and adolescent healthMedia use and violence perpetrationSubstance abuse and violencePromoting resilience for youth who are violence involvedFirearm risk: assessment and intervention in the health care settingBuilding an evidence-based multi-tiered system of support for violence prevention in the health care settingTreating youth violence in the hospital and emergency department settings
Adolescent Medicine: State of the Art Reviews (AM:STARs) is the official publication of the American Academy of Pediatrics Section on Adolescent Health. AM:STARs is a series of clinical reviews that detail advances in the diagnosis and management of a wide range of health problems affecting adolescents.Edited by the AAP Section on Adolescent Health, AM:STARs helps you stay up-to-date in key areas of current adolescent clinical practice. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else.Articles in this issue:The role of the health care professional in curbing youth violenceAssessing and treating youth violence in the primary care settingViolence and mental health: trauma-informed practice and wellness approach to violence victimizationAdolescent relationship abuse prevention and interventionSocial media, cyberbullying, and adolescent healthMedia use and violence perpetrationSubstance abuse and violencePromoting resilience for youth who are violence involvedFirearm risk: assessment and intervention in the health care settingBuilding an evidence-based multi-tiered system of support for violence prevention in the health care settingTreating youth violence in the hospital and emergency department settings
Adolescent Medicine: State of the Art Reviews (AM:STARs) is the official publication of the American Academy of Pediatrics Section on Adolescent Health. AM:STARs is a series of clinical reviews that detail advances in the diagnosis and management of a wide range of health problems affecting adolescents.Edited by the AAP Section on Adolescent Health, AM:STARs helps you stay up-to-date in key areas of current adolescent clinical practice. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else.Articles in this issue:The role of the health care professional in curbing youth violenceAssessing and treating youth violence in the primary care settingViolence and mental health: trauma-informed practice and wellness approach to violence victimizationAdolescent relationship abuse prevention and interventionSocial media, cyberbullying, and adolescent healthMedia use and violence perpetrationSubstance abuse and violencePromoting resilience for youth who are violence involvedFirearm risk: assessment and intervention in the health care settingBuilding an evidence-based multi-tiered system of support for violence prevention in the health care settingTreating youth violence in the hospital and emergency department settings
Adolescent Medicine: State of the Art Reviews (AM:STARs) is the official publication of the American Academy of Pediatrics Section on Adolescent Health. AM:STARs is a series of clinical reviews that detail advances in the diagnosis and management of a wide range of health problems affecting adolescents.Edited by the AAP Section on Adolescent Health, AM:STARs helps you stay up-to-date in key areas of current adolescent clinical practice. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else.Articles in this issue:The role of the health care professional in curbing youth violenceAssessing and treating youth violence in the primary care settingViolence and mental health: trauma-informed practice and wellness approach to violence victimizationAdolescent relationship abuse prevention and interventionSocial media, cyberbullying, and adolescent healthMedia use and violence perpetrationSubstance abuse and violencePromoting resilience for youth who are violence involvedFirearm risk: assessment and intervention in the health care settingBuilding an evidence-based multi-tiered system of support for violence prevention in the health care settingTreating youth violence in the hospital and emergency department settings
Adolescent Medicine: State of the Art Reviews (AM:STARs) is the official publication of the American Academy of Pediatrics Section on Adolescent Health. AM:STARs is a series of clinical reviews that detail advances in the diagnosis and management of a wide range of health problems affecting adolescents.Edited by the AAP Section on Adolescent Health, AM:STARs helps you stay up-to-date in key areas of current adolescent clinical practice. This widely respected resource continues to deliver practice-focused, useful information you won't see anywhere else.Articles in this issue:The role of the health care professional in curbing youth violenceAssessing and treating youth violence in the primary care settingViolence and mental health: trauma-informed practice and wellness approach to violence victimizationAdolescent relationship abuse prevention and interventionSocial media, cyberbullying, and adolescent healthMedia use and violence perpetrationSubstance abuse and violencePromoting resilience for youth who are violence involvedFirearm risk: assessment and intervention in the health care settingBuilding an evidence-based multi-tiered system of support for violence prevention in the health care settingTreating youth violence in the hospital and emergency department settings
