Management of Cardiovascular Metabolic Risks in Obese Children and Adolescents in China: Based on the 2024 Italian Society of Pediatric Endocrinology and Diabetes Position Paper on Cardiovascular Metabolic Risks in Obese Children and Adolescents

ZHANG Ying¹, TANG Yijun², LIU Lidi³*, JIANG Lihua¹, JIA Yu¹, YANG Rong¹, YANG Ziyu¹, LIAO Xiaoyang¹

¹ General Practice Ward/International Medical Center Ward, Teaching & Research Section, General Practice Research Institute, and General Practice Medical Center, West China Hospital of Sichuan University, Chengdu 610041, China
² Department of General Practice, Guixi Community Health Service Center in Chengdu High Tech Zone, Chengdu 610094, China
³ Day Surgery Center, General Practice Medical Center, West China Hospital of Sichuan University, Chengdu 610041, China

Corresponding author: LIU Lidi, Attending physician; E-mail: 1661824860@qq.com
ZHANG Ying and TANG Yijun are co-first authors

Abstract: Childhood and adolescent obesity is a critical global public health challenge, posing immediate health risks and increasing the risk of cardiometabolic diseases in adulthood. In 2024, the Italian Society for Pediatric Endocrinology and Diabetology issued a position paper on Cardiometabolic Risk in Children and Adolescents with Obesity, offering significant guidance for the evaluation and management of cardiometabolic risk in obese children and adolescents based on the latest evidence. This article aims to interpret the core content of this document to provide references and recommendations for cardiometabolic risk management of obesity in Chinese children and adolescents.

Keywords: Pediatric obesity; Adolescent obesity; Cardiometabolic risk; Comorbidity of obesity; Management

Funding: Sichuan Provincial Science and Technology Department Project (2023YFS0027); Sichuan Provincial Health Commission Science and Technology Project (Chuan Gan Yan 2023-101)

Citation: ZHANG Y, TANG Y J, LIU L D, et al. Management of cardiovascular metabolic risks in obese children and adolescents in China: based on the 2024 Italian Society of Pediatric Endocrinology and Diabetes position paper on Cardiovascular Metabolic Risks in Obese Children and Adolescents[J]. Chinese General Practice, 2025. DOI: 10.12114/j.issn.1007-9572.2025.0118. [Epub ahead of print].

1 Diagnosis of Obesity and CMR

Obesity is a condition of excessive adipose tissue closely associated with increased prevalence of cardiometabolic risk factors (CMRFs). Since direct measurement of body fat is rarely feasible in clinical practice, the weight-for-length ratio (for children <2 years) or BMI (for those ≥2 years) serves as the most commonly used tool for diagnosing and classifying overweight or obesity, rather than body fat percentage itself. As BMI is strictly dependent on sex and age, various BMI metrics can be utilized, including BMI Z-score, BMI percentile, percentage of the 95th percentile, or percentage of the median BMI. All these metrics correlate significantly with obesity, visceral adiposity, and CMRFs in children and adolescents, with the latter two showing the strongest association with obesity [5]. Stratification of weight categories based on age- and sex-specific BMI percentiles demonstrates that more severe obesity is associated with higher prevalence of cardiometabolic risks. Evidence indicates that central obesity in childhood increases at a faster rate than BMI [6], necessitating comprehensive assessment of obesity using additional tools.

While waist circumference can serve as a proxy for abdominal fat content, its application is limited by the lack of established cutoff points and reference values for children and adolescents. In contrast, the waist-to-height ratio (hereinafter referred to as "WHtR") exhibits minimal age variation and allows for cross-age stratification using a single threshold, making it a convenient tool for screening abdominal obesity and cardiometabolic risk in children. The position paper recommends using WHtR ≥0.60 in obese children and adolescents to predict CMR [4]. Another study determined and validated optimal WHtR cutoff values based on cross-sectional survey data from children and adolescents across 10 countries (including China), revealing that the optimal WHtR cutoff is approximately 0.50 for Europe and the United States, while lower values around 0.46 were identified for Asia, Africa, and South America [7]. China's "Dietary Guidelines for Obese Children and Adolescents" defines central obesity using age- and sex-specific criteria: WHtR >0.48 for boys aged 6–17 years and girls aged 6–9 years, and WHtR >0.46 for girls aged 10–17 years [8]. The position paper emphasizes that BMI is crucial for screening overweight, obesity, and severe obesity in children over 5 years of age, as well as for stratifying CMR. WHtR can provide additional support when CMR is suspected. For obese adolescents, combining BMI with WHtR can monitor changes in overall and abdominal obesity during weight management programs. The position paper outlines diagnostic criteria for obesity and cardiometabolic risk factors, presented in Table 1 [TABLE:1].

2 Early Screening and Intervention for CMRFs

Through comprehensive assessment of children and adolescents, early identification of obesity-related CMRFs is essential. These include hypertension, dyslipidemia, prediabetes/T2DM, metabolic dysfunction-associated steatotic liver disease (MASLD), polycystic ovary syndrome (PCOS), obstructive sleep apnea (OSA), declining renal function, and physical inactivity. In 2024, experts from the Italian Society of Pediatric Endocrinology and Diabetes' "Childhood Obesity Study Group" published a position paper titled "Cardiometabolic Risk in Children and Adolescents with Obesity" [4] (hereinafter referred to as the "Position Paper"), aimed at evaluating CMRFs in obese children and adolescents. However, China currently lacks corresponding guidelines or consensus systematically addressing cardiometabolic risk (CMR) in obese children and adolescents. Therefore, this study aims to interpret the core elements of this Position Paper and, in conjunction with relevant Chinese guidelines, provide references and recommendations for clinical practice in managing CMR in obese Chinese children and adolescents. Early screening, diagnosis, and intervention recommendations are summarized in Table 2 [TABLE:2].

2.1 Hypertension

Hypertension is common in overweight/obese children, with prevalence rates of 5.0% in overweight and 15.3% in obese children, compared to 1.9% in normal-weight children [10]. Blood pressure screening is recommended for all overweight/obese children and adolescents starting at age 2 years, with repeated measurements at each clinic visit. While multiple guidelines suggest confirming hypertension at three different time points, the Position Paper considers this approach may lead to attrition risk and instead recommends following the European Society of Cardiology consensus [11]: a second blood pressure measurement should be performed within 2–3 weeks of initial detection to confirm hypertension. Ambulatory blood pressure monitoring has limited clinical application due to the lack of pediatric standards. The Position Paper recommends diagnosing hypertension in overweight/obese children and adolescents according to the European Society of Cardiology consensus [11], using blood pressure percentiles defined by sex, age, and height: elevated blood pressure (90th–<95th percentile), Stage 1 hypertension (≥95th percentile), and Stage 2 hypertension (≥95th percentile + 12 mmHg) (Table 2). Confirmation requires two measurements (within 2–3 weeks). Following initial diagnosis, echocardiography should be performed to assess left ventricular hypertrophy as a marker of target organ damage, which informs decisions regarding pharmacotherapy and subsequent monitoring strategies.

The optimal treatment approach for elevated blood pressure or hypertension in obese children and adolescents corresponds to multidisciplinary obesity management. Lifestyle intervention forms the foundation, including low-calorie diets, reduced sodium intake, limited screen time, and increased moderate-to-vigorous physical activity. If hypertension persists after 6 months, medications approved for pediatric use may be initiated in cases of cardiac/renal injury or failed non-pharmacological therapy. Stage 2 hypertension warrants immediate treatment initiation or specialist referral. Antihypertensive medications suitable for children include angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers [11-12]. Diuretics or beta-blockers are not recommended except in specific circumstances.

2.2 Dyslipidemia

The association between childhood obesity and dyslipidemia can persist into adulthood and predict fatal and non-fatal cardiovascular events in later life. Research has demonstrated a strong link between visceral and ectopic fat accumulation and the development of atherogenic dyslipidemia [4]. The optimal age to initiate dyslipidemia screening remains controversial. The Position Paper recommends screening obese children starting at age 6 years, which may be advanced to age 2 years in the presence of family history of cardiovascular disease or high-risk conditions [13-14]. Dyslipidemia includes elevated serum triglycerides and low-density lipoprotein cholesterol, along with reduced high-density lipoprotein cholesterol levels. Diagnostic criteria from the Position Paper are presented in Table 1, which align with Chinese reference standards for dyslipidemia in children and adolescents [15]. Notably, triglyceride cutoff values vary by age (with 10 years as the cutoff point) and differ from adult thresholds (1.7 mmol/L).

Obesity-related dyslipidemia is typically managed through dietary and lifestyle interventions, such as controlling total fat intake to 30% of total energy, with saturated fat at 8%–10%, unsaturated fat at 20%, cholesterol <300 mg/day, avoidance of trans fats, and increased dietary fiber. If dyslipidemia persists, further restrictions are recommended: total fat 25%–30%, saturated fat ≤7%, and cholesterol <200 mg/day [4]. Chinese dyslipidemia management guidelines emphasize that dietary interventions must ensure adequate nutritional intake to avoid compromising growth and development in children and adolescents, while recommending at least 1 hour of moderate-to-high intensity physical activity daily and limiting sedentary time to 2 hours per day [15]. For overweight/obese children with familial hypercholesterolemia (characterized by markedly elevated low-density lipoprotein cholesterol), pharmacological therapy may be required in addition to dietary and lifestyle interventions.

2.3 Prediabetes/T2DM

Obese children and adolescents face a 13-fold higher risk of developing diabetes (1.3% prevalence) and nearly threefold higher risk of prediabetes (17.0% prevalence) compared to their normal-weight peers, with risks positively correlated with BMI [16]. The Position Paper recommends that obese children begin receiving fasting glucose testing and glycosylated hemoglobin (HbA1c) assessment at age 6 years [13]. For overweight/obese children aged ≥10 years or who have entered puberty with additional risk factors (first- or second-degree relatives with T2DM, maternal history of diabetes or gestational diabetes, high-risk ethnicity, or signs/conditions associated with insulin resistance such as acanthosis nigricans, hypertension, dyslipidemia, PCOS, or small-for-gestational-age status), oral glucose tolerance test (OGTT) and HbA1c testing should be performed (Table 2).

Lifestyle intervention forms the cornerstone of prediabetes/T2DM management. For adolescents with prediabetes, all guidelines recommend healthy lifestyle modifications, including individualized dietary plans appropriate for age and BMI, replacement of juices and sugary drinks with water, and regular physical activity (1 hour of moderate/vigorous exercise daily and ≥3 sessions of bone and muscle strengthening per week) [4]. For T2DM, pharmacological therapy should be combined with lifestyle interventions based on the severity of metabolic impairment [17]. The target HbA1c should be <7%. Metformin monotherapy can be titrated up to 2 g/day (if HbA1c <8.5%) or combined with subcutaneous basal insulin at 0.25–0.5 U·kg⁻¹·d⁻¹ (if HbA1c >8.5%). Intravenous insulin therapy should be initiated first if ketoacidosis or hyperosmolar state is present [17]. Approximately 90% of patients on metformin + insulin can discontinue insulin within 2–6 weeks. If HbA1c remains uncontrolled, a glucagon-like peptide-1 agonist approved for pediatric use may be added to metformin [17]. Patients with HbA1c >9% require subcutaneous insulin in addition to maximal-dose metformin and glucagon-like peptide-1 agonist/other agents, possibly including prandial insulin [17]. Patients using insulin or sulfonylureas require close glucose monitoring [13]. HbA1c should be checked every 3 months, with retinopathy and proteinuria screening at diagnosis and annually [17].

2.4 Metabolic Syndrome

Metabolic syndrome represents a cluster of multiple CMRFs, particularly visceral obesity, hypertension, dyslipidemia, and altered glucose metabolism, which increase the risk of cardiovascular disease and T2DM in adulthood. However, due to the lack of consensus on definition and diagnostic criteria for metabolic syndrome in children [18], its clinical applicability is poor, making it difficult to accurately determine its clinical significance [19] and impact on clinical practice for overweight/obese children and adolescents. Therefore, the Position Paper recommends abandoning the diagnosis of metabolic syndrome and focusing on established risk factors instead. Additionally, children's CMRFs should be reassessed at the end of puberty to confirm persistence of risk, with intensified treatment if risks remain. Greater awareness is needed regarding obesity-related comorbidities not included in the metabolic syndrome definition, such as fatty liver disease, PCOS, or OSA, which may augment cardiovascular disease risk in overweight/obese children and adolescents.

2.5 Fatty Liver Disease

Excessive fat accumulation in the liver is a common feature of childhood obesity, previously termed non-alcoholic fatty liver disease and now preferentially called metabolic dysfunction-associated steatotic liver disease (MASLD), which has become a major chronic liver disease in pediatrics. Children with MASLD carry a long-term cardiometabolic burden with increased morbidity and mortality in young adulthood [20]. The Position Paper recommends that overweight/obese children or adolescents from age 6 years should be considered at risk for MASLD if they have elevated serum alanine aminotransferase or other CMRFs, and should undergo abdominal ultrasound with monitoring every 12 months for hepatic steatosis to assess progression to fibrosis.

Lifestyle interventions (such as dietary modification, avoidance of sugar-sweetened beverages, moderate-to-high intensity physical activity, and limiting screen time to <2 hours daily) remain the mainstay of treatment. Domestic research has confirmed that weight loss interventions significantly improve glucose and lipid metabolism and liver function in obese children and adolescents with non-alcoholic fatty liver disease, with the degree of liver enzyme improvement increasing alongside weight loss percentage [21]. Evidence for dietary supplements (vitamin E, omega-3 fatty acids, etc.), prebiotics, and insulin sensitizers remains inconsistent. Currently, no medications are approved, though several promising agents are emerging to reduce steatosis and fibrosis.

2.6 PCOS

Whether PCOS constitutes a risk factor for cardiovascular disease in adolescence remains unclear, with limited and inconsistent research findings. A systematic review of 23 studies showed that women with PCOS have increased risks of T2DM, hypertension, dyslipidemia, and cerebrovascular disease, suggesting elevated cardiometabolic risk [20], yet the same review found no increased risk of coronary heart disease events [20]. In contrast, a retrospective study demonstrated increased risks of myocardial infarction, angina, and revascularization in young women with PCOS, with weight gain and prior T2DM identified as modifiable risk factors [22].

Hormonal evaluation should be performed in obese adolescents with persistent irregular menstrual cycles and clinical or biochemical signs of hyperandrogenism. The Position Paper emphasizes lifestyle intervention as the fundamental approach to improving metabolic and cardiovascular risk while simultaneously alleviating PCOS clinical manifestations. Additionally, pharmacological therapy is required to correct hyperandrogenism and menstrual irregularities [23]. Combined oral contraceptives remain the standard treatment for hyperandrogenism. Moderate-to-severe hirsutism requires treatment with combined oral contraceptives or anti-androgen agents (such as spironolactone or finasteride) for at least 6–9 months [23]. Although metformin represents off-label use, it may be considered in combination with combined oral contraceptives when treatment goals are not achieved [23].

2.7 OSA

OSA is characterized by complete or partial upper airway obstruction during sleep, leading to sleep disruption, intermittent hypoxemia, and heightened inflammation. The prevalence of OSA in obese children and adolescents (13%–59%) is significantly higher than in healthy peers (1%–4%) [24]. Although an independent association exists between OSA and cardiometabolic risk in adults [4], evidence in children remains insufficient [25]. Clinical suspicion of OSA is based on symptoms including snoring, daytime sleepiness, headaches, attention deficits, and hyperactivity. For obese children exhibiting these features, screening with the Pediatric Sleep Questionnaire is recommended [4], with a score ≥0.33 indicating OSA. Confirmation requires polysomnography, with an apnea-hypopnea index (AHI) >1 event/hour diagnosing OSA, 5–10 events/hour indicating moderate OSA, and >10 events/hour suggesting severe OSA [4].

First-line treatment for OSA is adenotonsillectomy, which is recommended for adolescents with AHI >5 events/hour. However, residual OSA occurs frequently in obese patients after adenotonsillectomy, potentially requiring non-invasive ventilation [4]. Additionally, multidisciplinary weight loss interventions should be implemented, and bariatric surgery may be considered for severely obese adolescents with OSA (AHI >5 events/hour). For severe OSA in children and adolescents at high anesthetic risk, meticulous perioperative evaluation and management are required. Reassessment of OSA should be conducted using the Pediatric Sleep Questionnaire, with nocturnal polysomnography repeated every 6 months if residual OSA is suspected [4].

2.8 Physical Inactivity

The World Health Organization recommends that children and adolescents engage in at least 1 hour of moderate-to-vigorous physical activity daily, with sedentary time limited to less than 2 hours per day [26]. Low physical activity levels and prolonged sedentary behavior are associated with poor dietary habits, contributing to the development and persistence of obesity. Physical inactivity negatively impacts cardiorespiratory and musculoskeletal health, exerting detrimental effects on obesity, lipid profiles, and cardiometabolic health [27-28].

Exercise interventions should be tailored to address obesity-related physiological and psychological limitations, thereby enhancing physical self-esteem, exercise enjoyment, and long-term adherence. Aerobic exercise or combined aerobic and resistance training appears most effective for reducing body fat, controlling obesity, and managing related cardiometabolic complications [29]. The Position Paper recommends exercising 3 times per week, progressively achieving a target of 60 minutes per session. Walking, remote physical activity, and exergaming are considered adjunctive tools against inactivity [30]. Chinese physical activity guidelines for children and adolescents recommend that overweight/obese youth adopt combined aerobic and resistance exercise, high-intensity interval training, and other modalities for weight reduction, with moderate-intensity aerobic exercise potentially more beneficial for weight loss [31]. These guidelines also emphasize that severely obese children and adolescents should undergo expert evaluation before exercising, with gradual load progression and attention to preventing joint injuries [31].

2.9 Cardiac Issues

Left ventricular hypertrophy represents the most common phenotype of cardiac structural and functional abnormalities in overweight/obese adolescents, with a prevalence of 36.3%–46.6% among overweight/obese Italian youth [32]. The Position Paper advocates that diagnosis of left ventricular hypertrophy in overweight/obese adolescents should be based on pediatric left ventricular mass index reference values [33] rather than adult cutoff standards. Echocardiographic screening should be performed when the following comorbidities are present: hypertension, chronic renal failure, dyslipidemia, T2DM, and MASLD. Identifying left ventricular hypertrophy is a crucial step in assessing cardiovascular risk. Strategies to reduce progression of cardiac damage, particularly left ventricular hypertrophy or dysfunction, include lifestyle modifications such as reducing sugar, salt, and lipid intake while increasing physical activity to decrease hemodynamic overload [4].

2.10 Vascular Issues

Research indicates that atherosclerosis can manifest early changes during childhood [34]. Evidence suggests that obese children may initially exhibit signs of endothelial dysfunction even without comorbidities, such as impaired flow-mediated vasodilation [35] and increased carotid-radial pulse wave velocity [36], followed by morphological changes like increased carotid intima-media thickness (cIMT). Increased arterial stiffness may serve as an early marker of heightened cardiovascular risk, with carotid-radial pulse wave velocity representing the gold standard for assessment. Although flow-mediated dilation measurement is an important pathophysiological factor related to altered vascular reactivity, it is less commonly used in clinical practice, whereas cIMT ultrasound measurement is more feasible.

cIMT has been established as an independent predictor of cardiovascular events in adults, but its predictive value in adolescents has not been confirmed in longitudinal studies of cardiovascular outcomes. It is currently used only as a non-invasive measure of preclinical atherosclerosis in pediatric research and is not recommended for routine diagnosis in overweight/obese adolescents. Multi-strategy weight loss interventions in adults may improve early vascular functional and structural abnormalities [37]. In children, Mediterranean diet and physical activity have been shown to normalize cIMT in obese children [38], and exercise training can improve endothelial function and reduce arterial stiffness in overweight/obese adolescents, particularly when BMI <30 kg/m² [39]. Aerobic exercise appears most effective for improving arterial stiffness [39].

2.11 Renal Issues

Obesity-related kidney disease can manifest in childhood and, as a modifiable risk factor, accelerates renal function deterioration and increases mortality risk in children with end-stage kidney disease [40-41]. Renal disease screening involves measuring microalbuminuria and serum creatinine—the former being a well-established assessment method and the latter an economical, widely adopted clinical indicator of renal function. Given the adverse effects of obesity on renal function and its prognostic implications, the Position Paper recommends that all overweight/obese children aged ≥6 years undergo microalbuminuria and serum creatinine testing at initial evaluation. If results are abnormal, renal function should be monitored every 6 months; if accompanied by other comorbidities such as hypertension, prediabetes/T2DM, or PCOS, monitoring should occur every 3–6 months.

Since obesity is a modifiable risk factor for kidney disease, weight loss strategies (including dietary modification, salt reduction, and increased physical activity) constitute first-line therapy [40-42]. Simultaneously, blood pressure must be strictly controlled below the 90th percentile for age, sex, and height. Currently, evidence for pharmacological interventions in obese children with kidney disease remains limited and inconclusive [4,40,43]. Beyond conventional renoprotective medications (such as ACEI/ARB), glucagon-like peptide-1 receptor agonists show promise for renal protection through metabolic and anti-inflammatory effects, though data remain variable [4,40,43]. Furthermore, bariatric surgery has demonstrated positive effects on kidney disease in severely obese adolescents [43], but its application is limited and long-term outcomes remain lacking [4].

3 Summary and Implications

Obesity represents a major risk factor for cardiovascular disease in children and adolescents through both direct and indirect mechanisms, necessitating effective monitoring and intervention strategies to reduce cardiovascular morbidity and premature mortality in this population. The Position Paper provides an important reference framework for developing relevant guidelines in China, particularly regarding screening for CMRFs, comorbidity management, and follow-up monitoring in obese children and adolescents. Management of CMRFs in obese children and adolescents requires comprehensive measures to reduce cardiometabolic disturbances, including early screening for obesity-related comorbidities, multidisciplinary treatment, and long-term monitoring. Weight loss therapy can simultaneously reduce cardiovascular risk. Comprehensive weight management should integrate lifestyle interventions (behavioral modification, diet, exercise), pharmacotherapy, and metabolic/bariatric surgery [44].

Lifestyle intervention constitutes the primary therapeutic approach. It is recommended to adopt a low-calorie diet while ensuring adequate nutritional intake for normal growth and development, reducing consumption of high-sodium, high-fat processed foods, decreasing saturated fatty acid intake, avoiding sugar-sweetened beverages and trans fatty acids, increasing dietary fiber, and cultivating healthy eating habits (such as regular meal timing and avoiding screen use during meals) [4,44]. Physical activity should be progressively increased to at least 60 minutes of moderate-to-high intensity exercise daily (combining aerobic and resistance training), gradually achieving a target of ≥3 sessions per week, while limiting screen time/sedentary time to ≤2 hours daily [4,44].

Regarding pharmacotherapy, weight loss medications should not be used in overweight children and adolescents and should be strictly limited in obese youth, considered only when intensive lifestyle interventions fail to achieve effective weight loss or comorbidity improvement [45]. If BMI Z-score does not decrease by >4% after 12 weeks of medication, weight loss drugs should be discontinued and the patient's condition re-evaluated [44]. Currently, no weight loss medications are approved for use in children or adolescents in China [45].

Metabolic/bariatric surgery for children or adolescents should strictly follow surgical indications, with individualized assessment of surgical necessity, timing, and procedure type [45]. According to the "Chinese Guidelines for Surgical Treatment of Obesity in Children and Adolescents (2019 Edition)" [46], the main surgical procedures for pediatric obesity are sleeve gastrectomy and Roux-en-Y gastric bypass, both performed using minimally invasive techniques. The entire perioperative course should be managed by a multidisciplinary team including experienced bariatric surgeons, pediatricians, nutritionists, and psychologists to ensure surgical safety and postoperative recovery. Although surgery effectively controls obesity, long-term risks exist, such as potential deficiencies in iron, vitamin B12, and vitamin D, as well as complications like postprandial hypoglycemia and growth retardation. Furthermore, poor adherence in children and adolescents makes long-term nutritional supplementation challenging [46], necessitating extended follow-up, nutritional management, and mental health monitoring to prevent depression, anxiety, and self-esteem issues, thereby improving long-term outcomes and quality of life.

Employing a multidisciplinary collaborative model, the involvement of pediatricians, endocrinologists, nutritionists, exercise specialists, family physicians, psychologists, surgeons, and other team members is encouraged to develop individualized intervention plans, provide continuous psychological support and behavioral modification, and ensure compliance. Additionally, traditional Chinese medicine, acupuncture, and massage therapy may be integrated based on syndrome differentiation.

Management of obesity-related CMRFs should implement specialized strategies targeting specific comorbidities, combining pharmacotherapy when necessary on the basis of lifestyle intervention while considering benefits for other obesity-related comorbidities. Throughout this process, regular monitoring of comorbidities is essential to evaluate treatment efficacy and optimize management protocols promptly, thereby reducing future cardiovascular risk. With the widespread application of artificial intelligence technology, guideline-based risk prediction, decision support, real-time monitoring, and dynamic feedback systems have become feasible. Machine learning can analyze electronic health records to achieve precise stratification of cardiometabolic risk and automatic identification of high-risk patients, generating personalized intervention plans and tracking dietary behaviors, physical activity, and weight changes through digital tools (e.g., apps). Smart wearable devices (e.g., fitness trackers) can monitor blood pressure, heart rate, and activity levels in real time, enabling dynamic adjustment of intervention intensity and content based on live data. This approach enhances management precision and effectiveness while providing psychological support to children and adolescents through emotional interaction features, thereby improving treatment adherence.

Furthermore, management should shift upstream, prioritizing prevention over treatment. Multidisciplinary teams should actively participate in screening and managing childhood obesity and related risk factors, promoting healthy dietary and behavioral habits. A closed-loop management system encompassing "school-family-hospital-community" should be established under government leadership, strengthening school and family involvement, promoting campus health promotion programs, and conducting family-based education on healthy eating and exercise knowledge [44].

Author Contributions: ZHANG Ying and TANG Yijun were responsible for conceptualization, manuscript drafting, and revision, with overall responsibility for the article; JIANG Lihua, JIA Yu, YANG Rong, YANG Ziyu, and LIAO Xiaoyang provided guidance and revision; LIU Lidi conducted feasibility analysis, participated in manuscript revision, supervised the project, and was responsible for quality control and proofreading.

Conflict of Interest: The authors declare no conflict of interest.

ORCID:
ZHANG Ying https://orcid.org/0009-0006-1766-4956
TANG Yijun https://orcid.org/0009-0006-0473-3051
LIU Lidi https://orcid.org/0009-0009-8608-181X

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Received: 2025-05-14; Revised: 2025-08-03
Edited by: KANG Yanhui