Professor Maffeis is a Professor of Paediatrics at the University of Verona. In addition to directing the Pediatric Diabetes and Metabolic Disorders Unit at the Regional Center for Pediatric Diabetes at University Hospital, Dr Maffeis is President-elect of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED).
Thank you for agreeing to discuss the publication of this important Consensus Conference on Childhood and Adolescent Obesity in Italy, which was a major collaborative effort.
Which were the key organisations involved in developing the consensus policy?
The Consensus document is the result of the contribution of the members of different paediatric organisations in the country, who are directly involved in the prevention and treatment of childhood and adolescent obesity.
The Italian Society of Paediatric Endocrinology and Diabetology (ISPED) and the Italian Society of Paediatrics (ISP) led the consensus process, which involved several other Societies, which include:
- Cultural Association of Paediatricians;
- Italian Federation of Paediatricians;
- Italian Society of Adolescent Medicine;
- Italian Society of Dietetics and Clinical Nutrition;
- Italian Society of Gastroenterology, Epatology, and Nutrition;
- Italian Society of Obesity;
- Italian Society of Paediatric Nutrition;
- Italian Society of Preventive and Social Paediatrics;
- Italian Society of Primary Care.
In Italy, paediatricians perform most of the cultural and clinical work on paediatric obesity. Paediatricians working in the country offer primary care interventions primary and secondary prevention as well as obesity treatment). Paediatricians working in hospitals offer secondary and tertiary levels of care; most of them are paediatric endocrinologists and diabetologists. The high prevalence of obesity and overweight in Italy and the rising prevalence of metabolic and non-metabolic chronic diseases associated with obesity including among the very youngest, stimulated this group of clinicians to develop a consensus document on obesity, to provide a common basis for organising and harmonising interventions around both prevention and treatment, in all regions of the country.
When was the process initiated, who led the process and how long did it take to organise consensus around this prevention and treatment strategy?
The process was initiated in January 2016 and concluded during October 2017. Coordinators of the Consensus were Giuliana Valerio, Giuseppe Saggese, and myself. The work was organised around four main themes: diagnosis, co-morbidities, treatment, and prevention. The four working groups were coordinated by 10 paediatrician and other 47 contributed to writing the document; another 29 who are members of the obesity study group of ISPED, provided comments and suggestions, read and eventually the group approved the document. To all of the 88 colleagues we offer thanks for the incredibly generous and valuable help they provided to the process of developing the Consensus Statement.
Obesity rates are increasing in Italy as they are in the rest of Europe. This process seems to be a particularly important development, since it has been endorsed by the Italian Ministry of Health. Was the Ministry involved in the process?
The Ministry of Health was involved at the end of the working group process and gave the group sincere appreciation and of course the support of the endorsement. We hope that riding on the wave of this support, the various regions of the country will also endorse and support it, and make use of it when undertaking planning for paediatric obesity care organisations.
Publication of the consensus statement will be an important component of developing paediatric care and treatment in Italy for children with obesity and their families. Do you anticipate funding challenges or other policy challenges as you look toward policy implementation?
The ISPE has developed the diagnostic therapeutic assistance paths (DTAP) for childhood and adolescent obesity, which will be presented soon. This further document contains procedures for actualising obesity prevention and care undertaken by the Health Care System in the paediatric field across the country. Of course, the DTAP also need the endorsement of the Ministry of Health to increase the chance that the procedures will put in practice. In order to achieve these aims, a major effort was made around developing a common understanding (the Consensus) and a tool designed for translating concepts into practise (the DTAP). It is clear that the multifactorial etiology of obesity as well as the sociocultural components leading to its increase among the population need a more comprehensive approach than that presently offered by the Health Care System. We hope that these documents may contribute to increasing the efficacy of childhood and adolescent obesity treatment and prevention.
Two particular issue have been highlighted to date: early prevention and obesity co-morbidities. On the basis of emerging evidence of the significance of early life nutrition for metabolic programming, appropriate nutrition in the first years of life is essential for obesity prevention; this may be a feasible and effective strategy for primary prevention among some portion of the population.
Regarding obesity co-morbidities, we note that around at least two of these there is at present relatively low attention among the public and within the profession as well: impaired glucose tolerance and fatty liver.
In Italy, the prevalence of high glucose levels (impaired fasting glucose and impaired glucose tolerance) among children and adolescents with obesity is 5% whereas the prevalence of type 2 diabetes (T2D) is very low (much less than 1%). Of course, it is not possible, at the moment, to predict the percentage of children and adolescents with obesity and impaired glucose metabolism who will develop T2D. However, on the basis of what we see in the USA the prediction is that by 2050 the prevalence of T2D among children and adolescents will be more than 1:1.500. T2D is much more aggressive in the youngest, and diabetes complications start three times earlier; thus it is necessary to provide early diagnosis and treatment of glucose impairment among these young people with obesity, following them appropriately. Similarly, the prevalence of fatty liver is higher than 30% among children and adolescents with obesity, and in at least in some cases the pathologic process of liver damage may get worse, thus we recommend early diagnosis and treatment of this condition.
We are pleased to contribute to improving the health of children and young people across Italy.