Preface

Although the overall health status of the pediatric population in the United States has improved, the last quarter century has witnessed a dramatic rise in the prevalence of childhood obesity and its associated comorbid conditions. Specifically, the medical community is witnessing a steady and alarming rise in the prevalence of chronic diseases among obese children, including diabetes, hypertension, obstructive sleep apnea, hyperlipidemia, and cardiovascular disease.

This issue of Seminars in Pediatric Surgery is dedicated to the conference “Chronic Diseases in Childhood Obesity: Risks and Benefits of Early Intervention,” which was cosponsored by Nationwide Children's Hospital and the Ohio State University, College of Medicine, April 2–3, 2009. This 2-day symposium was organized to discuss the advent of commonly encountered chronic diseases among the overweight pediatric population while considering the application of various therapeutic options currently available to the health care community to address this important issue.

Conference speakers were selected to submit manuscripts for this issue based on their ability to illuminate specific areas of developing clinical information on childhood obesity and its comorbidities. Each article reviews the collective body of evidenced-based information regarding specific categories of obesity-related comorbid disease while focusing on the perceived health benefits of arresting, and potentially reversing, disease states using available pharmaceutical, medical, and/or surgical modalities. Dr. Dara Schuster discusses the changes in physiology that occur with increasing fat mass, and Dr. Stephen Daniels explores the metabolic syndrome in obese children. The identification and control of obesity-related liver disease in children is presented by Dr. Jeffery Schwimmer.

Several conference speakers address practical issues of how to identify risk among obese children. Dr. Sandra Hassink, a member of the American Academy of Pediatrics Expert Panel on Obesity, discusses the Expert Committee's recommendations for the evaluation and treatment of childhood obesity. Dr. Melinda Sothern highlights the promises and limits of lifestyle changes involving diet, exercise, and behavior modification.

Dr. John Dixon, the conference moderator, investigates the role of medical versus surgical intervention for metabolic complications of obesity, and Dr. Donna Caniano presents her expert insight into the complex ethical issues involved with performing bariatric surgery on morbidly obese children. Finally, Drs. Browne and Inge examine the applicability of current surgical options, as well as possible future technologies, for the treatment of childhood obesity.

This issue strives to help pediatric surgeons understand the complex metabolic changes that occur in childhood obesity. We must comprehend the potential and limitations of lifestyle changes and medical therapies currently available. Adult surgical therapies and all future technologies must be thoroughly examined to determine their applicability to the treatment of childhood obesity.