Obesity is now a worldwide epidemic. In recent years, different phenotypes of obesity, ranging from metabolically healthy normal weight to metabolically unhealthy obese, were described. Although there is no standardized definition for these phenotypes or for metabolic health, the influence of lifestyle and early-life factors is undisputed. In this context, the ratio of muscle-to-fat tissue seems to play a crucial role. Both adipose tissue and skeletal muscle are highly heterogeneous endocrine organs secreting several hormones, with myokines and adipokines being involved in local autocrine/paracrine interactions and crosstalk with other tissues. Some of these endocrine factors are secreted by both tissues and are, therefore, termed adipo-myokines. High (cardiorespiratory) fitness as a surrogate parameter for an active lifestyle is epidemiologically linked to “better” metabolic health, even in the obese; this may be partly due to the role of adipo-myokines and the crosstalk between adipose and muscle tissue. Therefore, it is essential to consider (cardiovascular) fitness in the definition of metabolically healthy obese/metabolic health and to perform longitudinal studies in this regard. A better understanding of both the (early-life) lifestyle factors and the underlying mechanisms that mediate different phenotypes is necessary for the tailored prevention and personalized treatment of obesity.

A healthy lifestyle that includes physical activity has numerous positive effects on the mother and child during and after pregnancy. In this context physical activity plays a central role due to its influence on body composition. While visceral fatty tissue has a pro-inflammatory effect via so-called adipokines, myokines seem to have a more anti-inflammatory effect and thus prevent numerous diseases such as gestational hypertension or gestational diabetes. However, many women show a decreased level of physical activity during pregnancy when compared to pre-gestation levels. The reasons underlying this change are manifold and include concern about the effects of physical exertion on the unborn child. Gynaecologists and midwives are also often uncertain about what specific advice to give regarding physical activity. The present review describes, besides the underlying mechanisms, current physical activity recommendations and corresponding evidence with a focus on weight development in terms of obesity, gestational diabetes and foetal outcome.

Exercise during pregnancy has beneficial effects on maternal and offspring’s health in humans and mice. The underlying mechanisms remain unclear. This comparative study aimed to determine the long-term effects of an exercise program on metabolism, weight gain, body composition and changes in hormones [insulin, leptin, brain-derived neurotrophic factor (BDNF)]. Pregnant women (n=34) and mouse dams (n=44) were subjected to an exercise program compared with matched controls (period I). Follow-up in the offspring was performed over 6 months in humans, corresponding to postnatal day (P) 21 in mice (period II). Half of the mouse offspring was challenged with a high-fat diet (HFD) for 6 weeks between P70 and P112 (period III). In period I, exercise during pregnancy led to 6% lower fat content, 40% lower leptin levels and an increase of 50% BDNF levels in humans compared with controls, which was not observed in mice. After period II in humans and mice, offspring body weight did not differ from that of the controls. Further differences were observed in period III. Offspring of exercising mouse dams had significantly lower fat mass and leptin levels compared with controls. In addition, at P112, BDNF levels in offspring were significantly higher from exercising mothers while this effect was completely blunted by HFD feeding. In this study, we found comparable effects on maternal and offspring’s weight gain in humans and mice but different effects in insulin, leptin and BDNF. The long-term potential protective effects of exercise on biomarkers should be examined in human studies.

During the COVID-19 pandemic, physical inactivity and being overweight increased in children, especially those from lower socioeconomic backgrounds. Additionally, a decrease in motor performance has been increasingly reported; however, there is a lack of meaningful data on the relationship between these findings and socioeconomic status. Therefore, we examined the BMI, BMI z score, the prevalence of overweight/obesity, and motor performance (based on lateral jumping, the standing long jump, and the 6-min run) among three cohorts from timelines before (2016) and during the pandemic (2020, 2021), using a cohort sequential design. Our analysis revealed that all parameters examined showed a significant negative trend over time. For children with a low social burden, the trend was statistically detectable only for lateral jumping and the 6-min run. For children with a high social burden, the prevalence of overweight/obesity increased from 4.2% to 5.4% between 2016 and 2021. The prevalence of being underweight also increased from 3.4% to 4.3% during this time. Motor performance decreased from 11.3% to 12.3%, except in the standing long jump. Children with a high social burden showed significantly lower results (7.4% to 9.6%). Thus, our data confirm an increase in both measurements of overweight/obesity and underweight, as well as a decrease in motor performance under the pandemic conditions, especially in children from socioeconomically deprived backgrounds. These findings affirm the urgent need for action regarding health promotion measures, especially for children with high social burdens.

Sarcopenic obesity is increasingly found in youth, but its health consequences remain unclear. Therefore, we studied the prevalence of sarcopenia and its association with cardiometabolic risk factors as well as muscular and cardiorespiratory fitness using data from the German Children’s Health InterventionaL Trial (CHILT III) programme. In addition to anthropometric data and blood pressure, muscle and fat mass were determined with bioelectrical impedance analysis. Sarcopenia was classified via muscle-to-fat ratio. A fasting blood sample was taken, muscular fitness was determined using the standing long jump, and cardiorespiratory fitness was determined using bicycle ergometry. Of the 119 obese participants included in the analysis (47.1% female, mean age 12.2 years), 83 (69.7%) had sarcopenia. Affected individuals had higher gamma-glutamyl transferase, higher glutamate pyruvate transaminase, higher high-sensitivity C-reactive protein, higher diastolic blood pressure, and lower muscular and cardiorespiratory fitness (each p < 0.05) compared to participants who were ‘only’ obese. No differences were found in other parameters. In our study, sarcopenic obesity was associated with various disorders in children and adolescents. However, the clinical value must be tested with larger samples and reference populations to develop a unique definition and appropriate methods in terms of identification but also related preventive or therapeutic approaches.

Körperliche Aktivität während und nach der Schwangerschaft hat zahlreiche positive Effekte auf Mutter und Kind. Empfehlungen für Deutschland liegen bislang nicht vor. Zu diesem Zweck erfolgte eine systematische Literaturrecherche in der Datenbank Medline nach vorhandenen Empfehlungen für Bewegung während und nach der Schwangerschaft über den Zeitraum Januar 2010 bis September 2015. Die systematische Literaturrecherche ergab 29 Artikel. Empfehlungen aus dem Kontext spezifischer Erkrankungen (Gestationsdiabetes, Präeklampsie, Adipositas, Hypertension, PCO, Inkontinenz) sowie Interventionsprogramme wurden ausgeschlossen, sodass aus diesen Artikeln nur 2 Artikel extrahiert wurden, die sich tatsächlich mit Empfehlungen befassten. 2 weitere Artikel wurden integriert, die eine Zusammenfassung sämtlicher international vorliegender Bewegungsempfehlungen zu Schwangerschaft und postpartaler Phase darstellen. Um von den positiven Effekten der Bewegung auf Mutter und Kind zu profitieren, sollten Schwangere ohne relevante Kontraindikationen motiviert werden, weiterhin oder neu (angemessen) körperlich aktiv zu bleiben oder aktiv zu werden. Schwangere ohne gesundheitliche Einschränkungen und Mütter postpartum sollen sich mindestens 150 min pro Woche (analog 20–30 min an möglichst vielen Tagen in der Woche) in moderat bis intensiver aerober Intensität bewegen. Regular physical activity during and after pregnancy has beneficial effects for mother and child. German recommendations for physical activity during pregnancy are still missing. We searched PubMed (MedLine) for guidelines published between January 2010 and September 2015 on physical activity during and after pregnancy. A systematic literature research identified 29 articles. Recommendations in the context of specific diseases (gestational diabetes, preeclampsia, obesity, hypertension, PCO, incontinence) or intervention programs were excluded. Only 2 articles met the criteria. 2 separate articles summarizing all international recommendations for physical activity during and after pregnancy were included. In order for mother and child to benefit from physical activity, pregnant women without contraindications should be encouraged to participate in regular physical activity or to remain active. Healthy pregnant and postpartum women should exercise for at least 150 min per week (analogically 20–30 min per day on most or all days of the week) in moderate to vigorous aerobic intensity.