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International audience; Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. PEM increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Paediatric Society recommends weighing and measuring any child when hospitalized or seen as outpatients. Body mass index (BMI) must be calculated and analyzed according to references anytime growth kinetics cannot be analyzed. Any child with a BMI below the third centile or -2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an aetiology, and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing a nutritional strategy along with the global care plan. A target weight needs to be determined as well as the quantitative, qualitative and modality of nutritional care. This plan must be evaluated afterwards in order to adapt nutritional therapy. (C) 2013 Published by Elsevier Masson SAS.

La progression de l’obésité en France se confirme à travers une série d’étudesépidémiologiques concordantes chez l’enfant comme chez l’adulte. Desmesures préventives s’imposent. Le système de soins doit répondre à cenouvel enjeu.Aujourd’hui, la question n’est plus celle du bien-fondé de programmes desanté publique pour lutter contre l’obésité mais celle de leur conception, deleur application, de leur pérennité et de leur évaluation.La recherche d’une cohérence entre les programmes de santé publique et lespolitiques publiques, en particulier dans le domaine de l’agro-alimentaire, del’aménagement urbain et de la communication nutritionnelle est essentielle.(...)

Research demonstrated that the eating behaviour of obese individuals consists of a wide variety of patterns like eating caloric rich food to compensate for negative feelings, vomiting after overeating, eating at night, restrained eating, meal skipping (1). It may be difficult to grasp and treat these eating behaviours specifically when they are related to psychological factors. Early assessment and treating of these problems in children is important as they can easily reach more serious levels for which more intensive and expensive interventions are required (2) and they can hinder weight loss. Therefore, the following chapter aims to summarize psychological antecedents observed in paediatric obesity. The literature indentified several psychological models that can guide a thorough psychological assessment. There is no ‘leading’ theory and clinicians will test different hypotheses when an obese child applies for help. Restraint attitudes, emotional factors, learning mechanisms, personality and family variables will always be explored to help tailoring the treatment program to the individual needs of the child. Therefore it is recommended to construct a psychological profile of every obese child seeking treatment. The models, the psychological factors and the specific measures to be used in an assessment will be presented. Finally, issues related to screening in a paediatric setting are discussed.

Editeur commercial : ECOG’s eBook on Child and Adolescent Obesity; Central and autonomic nervous systems are involved in the regulation of whole body energy by regulating its different components: intake, expenditure and storage. The different functions (metabolic, secretory, plasticity) of adipose tissues are indeed deeply controlled by the autonomic nervous system. In most mammals, two types of adipose tissue, white and brown, are present. Both are able to store energy in the form of triacylglycerols and to hydrolyze them into free fatty acids and glycerol. Whereas white adipose tissue (WAT) provide lipids as substrates for other tissues, brown adipose tissue (BAT) uses fatty acids for heat production. Over a period of time, white fat mass reflects the balance between energy expenditure and energy intake. Remarkably body fat mass remains relatively constant in adult suggesting that food intake and energy expenditure are linked. This has been supported by numerous studies that demonstrated the inter-dependency of these parameters and thus a feedback loop between the brain and adipose tissues with the involvement of the autonomic nervous system on one side and that of sensory fibers and metabolites or hormonal signals on the other.

Eating behavior is a complex, essentially learned activity critical for development and survival. It can be broken down into several components: when, how, what and how much to eat.1,2 We will mainly describe in this chapter the important periods and factors associated with the development of “what” to eat, or in other words, food preferences and choice. Other aspects relevant to the early development of eating behavior have been previously reviewed.2,3 Although it has previously been shown that food and flavor preference may be influenced by flavor exposure during the prenatal period4-6, we will focus in this chapter on the acquisition of food preferences consecutive to direct exposure of the infant to foods. Detailed descriptions of prenatal influences may be found elsewhere.7,8 Food habits form early during childhood and are likely to track over childhood until the beginning of adulthood.9,10 Understanding the determining factors of the acceptance of the very first foods other than milk, is therefore of particular importance, since these foods will form the basis of the child’s future food repertoire. We will describe here how preferences are acquired during the first years of life, and how they can be modified in preschool children, until about the age of 5 years. We focused in particular on the acquisition of preference for fruits and vegetables, because these foods are generally not as consumed by children as it is recommended. The development of preference for other foods is described elsewhere.11-13

Until recently, obesity research has mainly focused on biological and behavioral factors. However, there is growing agreement among researchers that the social and physical environment may play an important role as well. Certain aspects of the environment may promote or discourage physical activity and therefore have an influence on children’s body weight. The purpose of this chapter is to give an overview of the current knowledge on the relation between the physical neighborhood environment and physical activity in children.