The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention. The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.

Context Obesity is associated with hypothyroidism and goiter. Objective The aim of the study was to verify whether thyroid structure and function would improve, after weight loss. Design and patients We evaluated 96 overweight/obese children, who showed an altered parenchymal pattern at thyroid ultrasound without circulating anti-thyroid antibodies. At phase 1, BMI standard deviation score (SDS), body composition, fT4, TSH, high sensitivity C Reactive Protein (CRP_hs), white blood cells (WBC), metabolic profile and a thyroid ultrasound were assessed. Thyroid volume was expressed as SDS on the basis of the references values for age, while alterations in echogenicity and homogeneity were graded from 0 to 5 (thyroid score). The same parameters were reexamined after a weight loss program (phase 2). Results After a mean period of treatment of 0.8 ± 0.3 yrs, there was a significant decrease of BMI SDS, % Fat mass, CRPhs, TSH and thyroid volume SDS (all p<.0001), while fT4 remained unchanged. The thyroid score significantly improved (Z = -9,088; p<0.0001), namely it decreased in 82 individuals, tied in 12 and worsened only in 2 subjects; the score completely normalized in 48 (50%) individuals. BMI SDS reduction was a unique predictor of the decrease of TSH, thyroid volume and structure, whereas CRP_hs reduction was an independent predictor only for the TSH change. Moreover, CRP_hs variations mediated the association between BMI SDS and TSH. Conclusion The alterations of thyroid function and structure in obese children are reversible after weight loss.

Childhood obesity is a growing global health concern, with established links to physical activity, nutrition, and, increasingly, to prenatal and perinatal factors. Emerging evidence highlights the significant role of maternal conditions such as obesity, comorbidities, nutrition, and environmental exposures in predisposing offspring to long-term metabolic and cardiovascular diseases. The “Developmental Origins of Health and Disease” (DOHaD) paradigm provides a framework for understanding how early life environmental exposures, particularly during the periconceptional, fetal, and neonatal periods, can program future health outcomes through epigenetic mechanisms. Epigenetic modifications alter gene expression without changing the DNA sequence and are increasingly recognized as key mediators in the development of obesity. This narrative review summarizes current findings on the early determinants of childhood obesity, emphasizing the molecular and epigenetic pathways involved. A comprehensive literature search was conducted across multiple databases and international sources, focusing on recent studies from the past decade. Both human and animal research were included to provide a broad perspective. This review aims to consolidate recent insights into early life influences on obesity, underscoring the need for preventive strategies starting as early as the preconception period.

Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative review of the literature and a summary of the main observations, conclusions, and perspectives raised in the literature and the study projects of the Working Group of Childhood Obesity (WGChO) of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED) on MetS in childhood obesity. Although there is an agreement on the distinctive features of MetS, no international diagnostic criteria in a pediatric population exist. Moreover, to date, the prevalence of MetS in childhood is not certain and thus the true value of diagnosis of MetS in youth as well as its clinical implications, is unclear. The aim of this narrative review is to summarize the pathogenesis and current role of MetS in children and adolescents with particular reference to applicability in clinical practice in childhood obesity.