Childhood obesity and adult morbidities1234

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The prevalence and severity of obesity have increased in recent years, likely the result of complex interactions between genes, dietary intake, physical activity, and the environment. The expression of genes favoring the storage of excess calories as fat, which have been selected for over many millennia and are relatively static, has become maladaptive in a rapidly changing environment that minimizes opportunities for energy expenditure and maximizes opportunities for energy intake. The consequences of childhood and adolescent obesity include earlier puberty and menarche in girls, type 2 diabetes and increased incidence of the metabolic syndrome in youth and adults, and obesity in adulthood. These changes are associated with cardiovascular disease as well as with several cancers in adults, likely through insulin resistance and production of inflammatory cytokines. Although concerns have arisen regarding environmental exposures, there have been no formal expert recommendations. Currently, the most important factors underlying the obesity epidemic are the current opportunities for energy intake coupled with limited energy expenditure.

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1

From the University of Cincinnati College of Medicine, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH (FMB), and the Department of Nutrition, Loma Linda University School of Public Health, Loma Linda, CA (MW).

2

Presented at the symposium “National Conference on Childhood Obesity,” held in Washington, DC, 18–19 June 2009.

3

Supported by NIH grant no. U01-ES12770.

4

Address correspondence to F Biro, Division of Adolescent Medicine (ML-4000), Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039. E-mail: [email protected].