Nathalie Farpour-Lambert’s research while affiliated with University of Geneva and other places

The continued high prevalence of childhood and adolescent obesity emphasizes the need for both clinical and community‐based approaches to prevention and treatment. This chapter highlights evidence‐based and emerging treatment for child obesity, based on a new understanding of obesity as a biological condition rather than a personal lifestyle decision, and includes treatment descriptions for comprehensive, intensive lifestyle supports, dietary interventions, pharmacotherapy, and weight loss surgery. Nutrition and activity counseling in primary care is necessary but not sufficient to achieve a reduction in adiposity among children and adolescents. Comprehensive, multidisciplinary obesity treatment is the foundational approach to achieve body mass reduction or the attenuation of excessive weight gain in children. Successful body mass index (BMI) reduction is more common in adolescents, and the magnitude of BMI reduction is similar to behavioral interventions. Successful modification of diets, physical activity, and sedentary behaviors will require public health approaches that complement clinical interventions.

Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics — from epidemiology, awareness, care and treatment to public health policies and leadership — that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.

Effective interventions for the prevention and treatment of child and adolescent obesity play an important role in reducing the global health and economic burden of non-communicable diseases. Although multi-component interventions targeting various health behaviors are deemed promising, evidence for their effectiveness is still limited. Self-regulation seems to be a relevant working mechanism in this regard. Therefore, we propose a playful, smartphone-based self-regulation training that also utilizes the health benefits of a slow-paced breathing exercise. The mobile app uses the microphone of the smartphone to detect breathing sounds (e.g. inhalation, exhalation) and translates these sounds into a visual biofeedback on the smartphone screen. The design and evaluation of a very first prototype is described in this interdisciplinary work of obesity experts, clinical psychologists, young patients, and computer scientists. The apps' breathing detection module uses a random forest tree for quasi real-time classification of the incoming audio samples and biofeedback generation. A study with 11 obese children and adolescents was conducted to assess the prototype. Results indicate overall positive evaluations and suggestions for improvement. Implications and limitations are discussed, and an outlook on future work is provided.

Background: Less than 2% of overweight children and adolescents in Switzerland can participate in multi-component behaviour changing interventions (BCI), due to costs and lack of time. Stress often hinders positive health outcomes in youth with obesity. Digital health interventions, with fewer on-site visits, promise health care access in remote regions; however, evidence for their effectiveness is scarce. Methods: This randomized controlled not blinded trial (1:1) was conducted in a specialized childhood obesity center in Switzerland. Forty-one youth aged 10-18 years old with body mass index (BMI) >P.90 with risk factors or co-morbidities or BMI>P.97 were recruited. During 5.5 months, the PathMate2 group (PM) received daily conversational agent counselling via mobile app, combined with standardized counselling (4 on-site visits). Controls (CON) participated in a BCI (7 on-site visits). We compared the outcomes of both groups after 5.5 (T1) and 12 (T2) months. Primary outcome was reduction in BMI-SDS (BMI standard deviation score). Secondary outcomes were changes in body composition and further physical parameters. Additionally, we hypothesized that less stressed children would lose more weight. Thus, children performed biofeedback relaxation exercises while cortisol and other stress parameters were evaluated. Results: After randomization and dropouts before intervention start (n=10), the median BMI-SDS of all patients (18 PM, 13 CON) at T0 was 2.61 (range 1.7 to 3.5). BMI-SDS decreased significantly at T1 in CON (median change -0.35, -1.6 to 0.1, p=0.002) compared to PM ( 0.08, -0.4 to 0.3, p=0.15), but not at T2. Muscle mass, strength and agility improved significantly in both groups at T2; only PM reduced significantly their body fat at T1 and T2. Average daily PM app usage rate was 71.5%. Cortisol serum levels reduced significantly after biofeedback but with no association between stress parameters and BMI-SDS. No side effects were observed. Conclusions: Equally to BCI, PathMate2 intervention resulted in significant and lasting improvements of physical capacities and body composition, but not in sustained BMI-SDS decrease. This youth-appealing mobile health intervention provides an interesting approach for youth with obesity who have limited access to health care. Biofeedback reduces acute stress and could be an innovative adjunct to usual care.

The World Health Organization declared COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, a pandemic on March 12, 2020. COVID-19 is causing massive health problems and economic suffering around the world. The European Association for the Study of Obesity (EASO) promptly recognised the impact that the outbreak could have on people with obesity. On one side, emerging data suggest that obesity represents a risk factor for a more serious and complicated course of COVID-19 in adults. On the other side, the health emergency caused by the outbreak diverts attention from the prevention and care of non-communicable chronic diseases to communicable diseases. This might be particularly true for obesity, a chronic and relapsing disease frequently neglected and linked to significant bias and stigmatization. The Obesity Management Task Force (OMTF) of EASO contributes in this paper to highlighting the key aspects of these two sides of the coin and suggests some specific actions.

Physical activity is an important determinant of physical and mental health during adolescence. However, the pubertal period is marked by substantial physical, psychological and social changes, and is considered as a critical window in competitive sports. Adolescent athletes have increased risks of musculoskeletal injuries, as well as psychological and eating disorders. The later may result in abnormal pubertal development and amenorrhea, impaired bone mineral acquisition, osteoporosis and stress fractures in females. A comprehensive pre-participation medical evaluation should include the sport, medical and family history, as well as an assessment of nutritional and weight status, sleep duration and quality, school performance and encountered difficulties. Youth strength training can have potential benefits including sport performance, injury prevention and rehabilitation. Education and communication between adolescents, parents, sports and health care professionals are essential to prevent and manage injuries and diseases, and enhance sports performance in adolescent athletes. The training workload and competition frequency should be regularly adapted to the physical and psychological state of adolescent athletes. Balancing the risks and benefits of youth sport participation should gain greater emphasis in decision-making and policy discussions, with effects in terms of informed participation, coach and health care professionals training, and access to quality care.