Obesity in paediatrics has become one of the most serious public health concerns worldwide. Paediatric obesity leads to increased adult obesity and is associated with several comorbidities, both physical and psychological. Within gastroenterology, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of paediatric liver disease and the most common cause of liver transplantation in young adults. Treatment for NAFLD largely focuses on treatment of obesity with weight loss strategies. Unfortunately, the traditional method of weight loss using multicomponent lifestyle modification (dietary changes, increased exercise and behavioural modification) has often led to disappointing results. In adult patients with obesity, treatment strategies have evolved to include bariatric surgery and, more recently, bariatric endoscopy. In paediatrics, the obesity and NAFLD epidemics will likely require this variety of treatment to address children in a personalized manner. Here, we present a review of paediatric obesity, paediatric NAFLD and the various treatment strategies to date. We focus on non-pharmacologic and emerging therapies, including bariatric surgery and bariatric endoscopy-based treatments. With such a large population of children and adolescents with obesity, further development of these treatments, including paediatric-focused clinical trials, is essential for these emerging modalities.

中文翻译：

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儿童肥胖和非酒精性脂肪肝的回顾——关注新兴的非药物治疗策略

儿科肥胖已成为全球最严重的公共卫生问题之一。儿童肥胖会导致成人肥胖增加，并与多种身体和心理合并症相关。在胃肠病学领域，非酒精性脂肪肝病 (NAFLD) 现在是儿童肝病的最常见原因，也是年轻人肝移植的最常见原因。NAFLD 的治疗主要集中在通过减肥策略治疗肥胖。不幸的是，使用多方面的生活方式改变（饮食改变、增加运动和行为改变）的传统减肥方法常常导致令人失望的结果。对于成年肥胖患者，治疗策略已经发展到包括减肥手术和最近的减肥内窥镜检查。在儿科领域，肥胖症和非酒精性脂肪性肝病（NAFLD）的流行可能需要采取多种治疗方法，以个性化的方式针对儿童进行治疗。在这里，我们对儿童肥胖、儿童 NAFLD 以及迄今为止的各种治疗策略进行了回顾。我们专注于非药物和新兴疗法，包括减肥手术和基于减肥内窥镜的治疗。由于肥胖儿童和青少年人数如此之多，进一步开发这些治疗方法，包括以儿科为重点的临床试验，对于这些新兴的治疗方式至关重要。