Childhood obesity management may influence cardiovascular risk trajectory in adulthood

The optimization of screening programs and risk management strategies for obesity-related cardiovascular risk in childhood could potentially change cardiovascular disease-related trajectories later in adulthood, according to a newly published scientific statement.¹

Produced by the Task Force for Childhood Health of the European Association of Preventive Cardiology (EAPC) and the European Childhood Obesity Group (ECOG), the document is a review of childhood obesity, including current concepts in primary prevention, risk management strategies through lifestyle interventions, and the potential for cardiovascular risk reversal in childhood.

“The global rise in childhood obesity, to a large extent driven by more physical inactivity, has been linked with an increased prevalence of high blood pressure, blood lipids, and blood glucose in childhood,” said Professor Henner Hanssen of the University of Basel.² “This combination of factors is in turn linked with damage to the arteries and heart, which can be reversed with exercise in children, but much less so in adults.”

From 1980 to 2013, the worldwide prevalence of childhood obesity increased by nearly two-fold. Analyses show children with obesity are 5 times more likely to suffer from obesity as adults compared with those without childhood obesity. Together, these data highlight the need to effectively optimize cardiovascular risk management in childhood to combat the hazards and burdens of cardiovascular disease in later life.

Typically, obesity-related cardiovascular risk is linked to a complex relationship between genetic factors and the environment, with both maternal and paternal health and lifestyle behaviors serving as contributing factors. Socioeconomic status has been linked to unhealthy food habits, sedentary behaviors, and low physical activity; implementation of a healthy lifestyle, however, could be challenged by a reactive temper in children with overweight and obesity.

The writing group identified unhealthy food marketing in the media as an important determinant of unhealthy diets and obesity among children and adolescents. Data show children are exposed to the promotion and marketing of products, including fast food and sugar-sweetened beverages, approximately 200 times per week on social media. However, although the marketing of unhealthy foods increased a child’s immediate food intake, the equivalent marketing of healthy foods had no subsequent effect.

According to clinical guidelines, lifestyle interventions should be the initial step for the management of obesity and cardiovascular risk factors in children. Recommended targets for physician activity in youth are ≥60 minutes per day of moderate to vigorous aerobic physical activity, as well as muscle strengthening and activities that increase bone strain ≥3 times per week. Diet guidelines suggest children should lower fat and sugar intake; instead, children should focus on eating 3 meals per day, avoiding eating between meals, and increasing uptake of unprocessed fruit, vegetables, and fiber-rich cereal.

Body mass index (BMI) is still widely used in large-scale cohort studies. However, changes in body size and weight, age-related variations in blood pressure and lipids, as well as differences in sex and race, have suggested cardiovascular risk factors are continuous variables and not strict cutoffs. As a result, the investigative team suggests screening programs should focus on cardiovascular risk beyond BMI to avoid stigmatization of these children.

The report identified the need to increase awareness among both the clinical community and the public on the complex nature of the underlying causes of childhood obesity and its associated cardiovascular risk. Particularly, investigators noted a lack of consistent governmental support in school-based settings for both health promotion and intervention, including the availability of high-quality school meals and exercise education curricula.

Local and national discrepancies in government support in limiting the production and marketing of unhealthy foods were also noted, suggesting the need to provide greater access to lower-cost, healthy foods in these neighborhoods. Hanssen and colleagues noted policymakers and involved stakeholders should work to address these societal limitations and adopt appropriate tools to measure success.

“Prevention of CVD needs to start early,” Hanssen said.² “Rather than wait and see whether or not today’s obese children become tomorrow’s heart attacks and strokes, an action plan is needed now to put a halt to future health problems. We already know that obesity is harming children’s health. What more proof do we need?”

References:

1. Hanssen H, Moholdt T, Bahls M, et al. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood-onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group [published online ahead of print, 2023 Jul 25]. Eur J Prev Cardiol. 2023. doi:10.1093/eurjpc/zwad152

2. Escardio. How to stop obese children having heart disease in adulthood. EurekAlert! July 25, 2023. Accessed July 26, 2023. https://www.eurekalert.org/news-releases/996498.

This article was initially published by our sister publication, HCP Live®.