Defining metabolically healthy obesity in children: a scoping review.

We conducted a scoping review to identify definitions of metabolically healthy obesity (MHO), describe gaps in the literature, and establish a universal definition of MHO in children. We searched electronic databases from January 1980 to June 2017 and grey literature. Experimental, quasi-experimental, or observational studies were eligible for inclusion if they (i) included a definition of MHO that identified risk factors, cut-off values, and the number of criteria used to define MHO, and (ii) classified 2-18 year olds as overweight or obese. Two reviewers independently screened 1,711 papers for relevance and quality; we extracted data from 39 individual reports that met inclusion criteria. Most (31/39; 79%) definitions of MHO included an absence of cardiometabolic risk factors. Heterogeneity across MHO definitions, obesity criteria, and sample sizes/characteristics resulted in variable prevalence estimates (3-80%). Finally, we convened an international panel of 46 experts to complete a 4-round Delphi process to generate a consensus-based definition of MHO. Based on consensus (≥ 80% agreement), our definition of MHO included: high density lipoprotein-cholesterol > 40 mg/dl (or > 1.03 mmol/l), triglycerides ≤ 150 mg/dl (or ≤ 1.7 mmol/l), systolic and diastolic blood pressure ≤ 90th percentile, and a measure of glycemia. This definition of MHO holds potential universal value to enable comparisons between studies and inform clinical decision-making for children with obesity.

Family-health professional relations in pediatric weight management: an integrative review.

In this integrative review, we examined contemporary literature in pediatric weight management to identify characteristics that contribute to the relationship between families and health professionals and describe how these qualities can inform healthcare practices for obese children and families receiving weight management care. We searched literature published from 1980 to 2010 in three electronic databases (MEDLINE, PsycINFO and CINAHL). Twenty-four articles identified family-health professional relationships were influenced by the following: health professionals' weight-related discussions and approaches to care; and parents' preferences regarding weight-related terminology and expectations of healthcare delivery. There was considerable methodological heterogeneity in the types of reports (i.e. qualitative studies, review articles, commentaries) included in this review. Overall, the findings have implications for establishing a positive clinical relationship between families and health professionals, which include being sensitive when discussing weight-related issues, using euphemisms when talking about obesity, demonstrating a non-judgmental and supportive attitude and including the family (children and parents) in healthcare interactions. Experimental research, clinical interventions and longitudinal studies are needed to build on the current evidence to determine how best to establish a collaborative partnership between families and health professionals and whether such a partnership improves treatment adherence, reduces intervention attrition and enhances pediatric weight management success.