Livsstilsbehandling för nyttigare matvanor och mer fysisk aktivitet kan hjälpa barn med kraftig övervikt, obesitas. Men sådan behandling har även effekt på längre sikt. Risken för allvarliga hälsoproblem och för tidig död minskar i vuxen ålder.
En studie från Karolinska institutet visar att barn och ungdomar som svarar bra på behandling mot obesitas, det vill säga kraftig övervikt, löper lägre risk att utveckla sjukdomar som typ 2-diabetes, högt blodtryck och höga blodfetter som unga vuxna.
Vården som undersöktes i studien handlar om så kallad livsstilsbehandling. Det innebär att barn med obesitas och deras familjer får stöd och motivation att främja hälsosam kost, fysisk aktivitet och sömn.
– Resultatet är mycket glädjande. Det har länge debatterats om behandling av obesitas i barndomen har hälsoeffekt på sikt eftersom viktnedgångar är svåra att bibehålla, säger Emilia Hagman, docent vid Karolinska institutet.
Risken att dö minskar
Studien visar också att barn med obesitas som får livsstilsbehandling, och lyckas minska i vikt, också löper en minskad risk att dö i förtid.
En tidigare studie från samma forskargrupp har visat att barn med obesitas har markant högre risk att dö som unga vuxna. De dog i högre uträckning av både självmord och sjukdomar, där ungefär en fjärdedel var relaterade till obesitas.
– Det här understryker hur viktigt det är att barn med obesitas får behandling tidigt. Vi vet att tidig behandling ger bättre förutsättningar för att lyckas och därmed också bättre hälsa på sikt, säger Emilia Hagman.
Depression och ångest påverkas inte
Risken för att drabbas av depression och ångest i ung vuxen ålder påverkas dock inte av behandlingsresultatet i barndomen.
– Det funnits en tro på att bara man går ner i vikt kommer även symptom på depression och ångest att minska. Nu kan vi visa att det inte stämmer. Obesitas och depression är två sjukdomar som ofta förekommer tillsammans, men måste behandlas parallellt, säger Emilia Hagman.
6700 studiedeltagare
I studien ingick över 6 700 personer som fått behandling för obesitas under barndomen. De identifierades via kvalitetsregistret BORIS och har följts upp som unga vuxna i patientregistret, läkemedelsregistret och dödsorsaksregistret.
En kontrollgrupp ur befolkningen har använts som jämförelse och matchats i ålder, kön och bostadsort.
Användandet av GLP1-analoger*, ett läkemedel som blivit populärt mot övervikt på senare år, förekommer inte i studien eftersom de inte var godkända när deltagarna fick behandling för obesitas. Det är fortfarande inte särskilt vanligt att ge den här typen av läkemedel till barn, enligt Emilia Hagman.
– Jag är positivt inställd till läkemedelsbehandling, eftersom det dämpar hungerkänslor vilket vissa kämpar mycket med, men livsstilsbehandling är fortfarande grunden i all behandling av barnobesitas.
* Läkemedel med så kallade GLP1-analoger, som sänker blodsockret, är främst avsedda för patienter med diabetes. Men eftersom preparaten, till exempel Ozempic, även visat sig vara effektiva för att minska fetma används de nu av miljontals människor världen över.
Vetenskaplig studie:
Effect of Pediatric Obesity Treatment on Long-Term Health, Jama Pediatrics.
Läs studien i sin helhet, pdf, free
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2829443
Original Investigation
January 21, 2025
Effect of Pediatric Obesity Treatment on Long-Term Health
Resthie R. Putri, PhD1; Pernilla Danielsson, PhD1; Nils Ekström, PhD2; et al Åsa Ericsson, PhLic2; Louise Lindberg, PhD1; Claude Marcus, PhD1; Emilia Hagman, PhD1
JAMA Pediatr. Published online January 21, 2025. doi:10.1001/jamapediatrics.2024.5552
Key Points
Question To what extent is pediatric obesity treatment effectiveness associated with morbidity and mortality in young adulthood?
Findings This cohort study demonstrated that good response to pediatric obesity treatment was associated with reduced long-term morbidity, such as type 2 diabetes, dyslipidemia, and hypertension. Additionally, a link between pediatric obesity treatment effectiveness and lower incidences of mortality in young adulthood was observed; however, effective pediatric obesity treatment was not associated with adult depression or anxiety, highlighting their distinct nature despite frequent coexistence.
Meaning In this study, beneficial treatment response in pediatric obesity treatment had enduring positive effects in young adulthood.
Abstract
IMPORTANCE
Data regarding the long-term impact of treating childhood obesity on the risk of obesity-related events, including premature mortality, are limited.
OBJECTIVE
To evaluate the long-term effect of different responses to pediatric obesity treatment on critical health outcomes in young adulthood.
Design, Setting, and Participants
The study included a dynamic prospective cohort of children and adolescents with obesity within The Swedish Childhood Obesity Treatment Register (BORIS) and general population comparators, linked with national registers. Baseline data were collected between 1996 and 2019. Formal analyses for this study was conducted in 2023. Outcomes were assessed from individuals aged 18 to 30 years (2005 to 2020). Participants included children and adolescents aged 6 to 17 years receiving at least 1 year of obesity treatment. General population comparators were matched on a ratio of 1:5 on sex, year of birth, and geographical area.
EXPOSURE
Pediatric obesity treatment response was based on changes in body mass index standard deviation score and categorized as poor, intermediate, and good response and obesity remission.
MAIN OUTCOMES
Obesity-related events included type 2 diabetes (T2D), dyslipidemia, hypertension, depression or anxiety, and weight-loss bariatric surgery. Additionally, mortality was assessed.
RESULTS
Of 6713 individuals (3777 male [56%] and 2936 female [44%]), the median age at obesity treatment initiation was 12.1 (quartile 1; quartile 3: 10.1; 14.3) years and treatment duration was 3.0 (1.8; 4.9) years. For T2D, hypertension, dyslipidemia, weight-loss bariatric surgery, and depression or anxiety outcomes, unadjusted incidence rates tended to decrease with better treatment response and the lowest estimate was observed among general population comparators. Compared with poor response, obesity remission or a good response in obesity treatment was associated with reduced risk of mortality (adjusted hazard ratio [HR], 0.12; 95% CI, 0.03-0.46). Good response was also associated with lower risk of TD2 (HR, 0.42; 95% CI, 0.23-0.77), dyslipidemia (HR, 0.31; 95% CI, 0.13-0.75), and bariatric surgery (HR, 0.42; 95% CI, 0.30-0.58). Obesity remission showed similar reduced risk, but also a reduced risk of hypertension (HR, 0.40; 95% CI, 0.24-0.65). Treatment response was not associated with depression or anxiety.
CONCLUSIONS AND RELEVANCE
In this study, beneficial pediatric obesity treatment response yielded enduring health benefits, markedly lowering future morbidity and mortality risks in young adulthood.
From the article
Introduction
Childhood obesity has reached epidemic proportions in both developed and developing countries.1 By 2035, the global prevalence of obesity in individuals aged 5 to 19 years is estimated to be 18% among girls and 20% among boys.2 Childhood obesity is associated with hypertension, steatotic liver disease, insulin resistance,3–6 and psychosocial issues, such as anxiety, depression, and stigma.7,8 Additionally, children and adolescents with obesity are at a greater risk of ill health in adulthood compared with those of a healthy weight.9–12
Beneficial response to behavioral lifestyle obesity treatments in children and adolescents improves short- and long-term health.12 In adolescents, both bariatric surgery and pharmacotherapy have been shown to reduce the degree of obesity when lifestyle intervention alone proves insufficient.13–15 However, the extent of weight loss necessary to mitigate, or even eliminate, long-term obesity-related outcomes remains to be determined.
Evidence-based treatment options for childhood obesity have been available in Sweden for more than 15 years, with the main option being behavioral lifestyle modification.16 Multiple studies3–5,7,11,16–18 have used the Swedish Childhood Obesity Treatment Register (BORIS)16 to assess the link between obesity and related complications in children. BORIS is the world’s second largest prospective register of children and adolescents receiving treatment for obesity. The aim of this study was to assess the impact of pediatric obesity treatment response on obesity-related outcomes and mortality in young adulthood.
Discussion
This nationwide prospective cohort study demonstrated the association between beneficial pediatric obesity treatment response and a reduced risk of obesity-related events in young adulthood, except for depression or anxiety. Particularly, a marked decrease in the risk of T2D, dyslipidemia, and premature mortality was observed, with greater risk reduction seen in groups with better response in pediatric obesity treatment. However, only complete remission of childhood obesity was associated with a discernible long-term reduction in the risk of hypertension.
The bidirectional link between obesity and depression or anxiety has been established in both adults and children.7,29 In a study of 81 adolescents, weight loss after bariatric surgery did not alleviate mental health conditions.30 Nevertheless, the effect of pediatric obesity treatment effectiveness on adult risk of depression or anxiety in large cohorts has not previously been evaluated. The current study demonstrates that obesity treatment effectiveness is not associated with depression or anxiety in adulthood; this suggests that although these conditions coexist, there is a need for independent treatment of each condition.7,29,31
A previous study11 has shown that pediatric obesity more than doubles the risk of suicide and increases the risk of death from endogenous causes, such as acquired disorders, by over 4-fold. The results of the current study expand on these findings, demonstrating a significant risk reduction of premature mortality in early adulthood by preventing poor treatment response in childhood. The mortality rates in individuals with obesity remission, a good treatment response, and an intermediate treatment response were similar to those of the general population between ages 18 to 30 years. This highlights the potential of normalizing the risk of premature mortality through effective pediatric obesity treatment.
Early manifestations of altered glucose metabolism, dyslipidemia, and elevated blood pressure are prevalent in children and adolescents with obesity.18 This study highlights the importance of effective pediatric obesity treatment in mitigating the risk of T2D, hypertension, and dyslipidemia in young adulthood. Notably, even a moderate response to treatment substantially decreased the risk of developing T2D in young adulthood, whereas significant reductions in the risk of hypertension and dyslipidemia were primarily observed in those experiencing complete obesity remission or a good treatment response. Consequently, to ensure a long-term reduction in the risk of obesity-related cardiometabolic morbidities, pediatric obesity treatment should be rigorously aimed at obtaining obesity remission.
This study also evaluated the risk reduction of undergoing bariatric surgery, a marker of a persistent high degree of obesity or obesity with complications. As expected, the highest incidence was observed for the group with poor treatment response in childhood.17 The greatest risk reduction was observed in the obesity remission group. Meanwhile, the magnitude of reduction in the group with good and intermediate treatment responses was similar. Despite the marked risk reduction, it is critical to acknowledge that the necessity for bariatric surgery persisted to some extent across all treatment response groups. This underscores the complexity of obesity as a disease, which proves challenging to manage through lifestyle modifications alone.
The weight trajectory following the treatment period in this study remains unknown. However, it is widely recognized that weight regain is common in the years following substantial weight loss.32,33 Despite this, we observed that beneficial response to pediatric obesity treatment significantly reduces long-term morbidity and mortality. This highlights the critical importance of obtaining substantial reduction in degree of obesity during childhood for optimal future health, independent of potential weight regain in young adulthood.
Given the real-world setting of the present study, it is crucial to recognize that the response to treatment cannot be attributed solely to the patient and their family. Various factors could contribute to the lack of beneficial reduction in degree of obesity, including the possibility that the treatment provided by the medical unit was not adequately tailored to the patient’s specific needs.
Conclusions
This nationwide study provides compelling evidence that beneficial response to pediatric obesity treatment in a real-world setting can lower risk of cardiometabolic morbidities in young adulthood. The greatest risk reductions were demonstrated in those who experienced obesity remission during childhood. However, effective obesity treatment does not mitigate the long-term risk of depression or anxiety. For the first time, to our knowledge, this study presents a link between pediatric obesity treatment effectiveness and reduced mortality in young adulthood.
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