Faculty

Louise Baur

VIEW CV

Child & adolescent obesity and insulin resistance in Asia Pacific: health service implications

Child and adolescent obesity is a major health issue within the Asia Pacific region. By 2030 there will be 254 million children aged 5-19 years living with obesity (1). Of the “top 42” countries in terms of absolute numbers of affected children, 35 are low and middle income countries and 10 are in Asia. In terms of childhood obesity prevalence, then the “top ten” countries (>30%) are Pacific Island nations. The high prevalence of type 2 diabetes in adults in many Asian and Pacific countries is strongly linked to the rising prevalence of obesity. This is very likely the case for adolescents as well.

Given the high prevalence of paediatric obesity, then multi-point and multi-sectoral prevention strategies are needed. However, effective treatment services are also required.

There is strong evidence that treatment of paediatric obesity leads to some improvements in BMI as well as obesity-related complications. However, resourcing constraints prevent such interventions from being accessible and deliverable, at scale, in most health systems. A 2019/2019 survey of health professionals and other interest groups in 68 countries identified challenges for health systems in providing obesity treatment for both adults and children (2): a) while many countries have professional guidelines for obesity treatment, there is a lack of adequate services, especially in lower income countries, and in rural areas of most countries; b) there are very few clinical care pathways from primary care to secondary services; c) secondary level care services are absent or limited in some regions; d) there is a lack of training in obesity management for health care professionals; e) patients experience high costs; f) waiting lists for bariatric surgery are very long; and g) weight-based stigma is very common
within health care services. In addition, there have been concerns that self-initiated dieting may
inadvertently trigger an eating disorder, although the evidence for professionally run weight
management services is reassuring (3).

Following are some personal recommendations for health service delivery within such an environment: a) provide various types of short, accessible training on the recognition and management of paediatric obesity for primary and secondary level care paediatric health care professionals; b) harmonise basic treatment and health promotion messaging around healthy eating and activity across the health system; c) disseminate, and train all paediatric staff in the use of, BMI for age charts; d) tackle weight-based stigma throughout the health system; e) provide a range of accessible behavioural change treatment programs, with clear referral pathways related to age and severity; f) integrate obesity treatment into the management of type 2 diabetes. Specifically for adolescents with moderate to severe obesity,
consider a) pathways for accessible and affordable bariatric surgery; b) the use of more intensive dietary interventions (eg VLEDs); and c) use of appropriate drug therapies when available for this age group e.g. GLP1 receptor agonists.

References:
1. https://www.worldobesity.org/membersarea/global-atlas-on-childhood-obesity
2. Jackson-Leach R, Powis J, Baur LA, et al. Clinical care for obesity: a preliminary survey of 68
countries. Clinical Obesity 2020; 10:e12357.
3. Jebeile H. Lister NB, Baur LA, Garnett SP, Paxton SJ. Eating disorder risk in adolescents with
obesity. Obesity Rev 2021; 22:e13173

Return to Faculty List