Childhood obesity is a growing problem that often leads to adult obesity, which increases the risk of developing chronic diseases, including diabetes, metabolic syndrome, cancer, cardiovascular disease, mood disorders, sleeping disorders, nonalcoholic fatty liver disease, and musculoskeletal problems. It is important to find ways to manage childhood obesity to set the stage for a healthier life.

Studies have found a potential link between obesity and dysbiosis in the gut microbiome. Alterations to the balance of commensal bacteria may impact energy metabolism and thereby body composition through several mechanisms.

• Short chain fatty acid production, which manages key gut-derived hormones and satiety, and provides support for a healthy inflammatory response

• Bile acid metabolism regulation to aid in energy and glucose homeostasis

• Metabolic endotoxemia, which causes low-grade chronic inflammation — a factor associated with obesity and metabolic dysfunction

Those who have body mass indexes (BMIs) in the obese category typically have lower bacterial diversity and a higher Firmicutes-to-Bacteroides ratio. Improving this ratio and other potential dysbiosis may aid in weight management, as demonstrated by a meta-analysis on adult subjects. This analysis found a statistically significant reduction in body weight after taking prebiotics, probiotics, and synbiotics.

It is known that the makeup of bacteria in the gut influences body composition in adults. Studies of infants and children also demonstrate an association, although there are some differences when compared to adults. One study on children with obesity found a lower relative abundance of Bifidobacterium, Lactobacillus, and Oscillospira, and a higher relative abundance of Akkermansia bacteria compared to the normal weight group. Unlike the adult studies, they had a lower Firmicutes-to-Bacteroidetes ratio.

Changes to the microbiome may happen throughout life, but the development of a healthy microbiome in childhood is important for overall health, and it may also help manage childhood obesity. One study found that providing probiotics to pregnant women in their final month before delivery and 6 months postnatally led to less weight gain for their children during key development ages that correlate with obesity risks later in life. Conversely, antibiotic treatments in early childhood may negatively alter the microbiome, which is correlated with higher BMIs in children.

The type of probiotics taken may make a difference. A meta-analysis found that while probiotics aided weight loss in adults, it had the opposite effect in children and infants, who mainly took Lactobacillus supplements. However, a recent study points to the benefits of Bifidobacterium strains.

The cross-over, double-blind study compared weight loss in children and adolescents on a calorie-restriction diet with another group on the same diet who were also taking probiotics for 8 weeks. There was a total of 100 participants (ages 6 to 18 years) who were randomly separated into a placebo group and a control group taking a Bifidobacterium blend with the strains breve BR03 and breve B632. The probiotics group experienced a greater reduction in their BMI, insulin resistance parameters, and waist circumference.

The complexities of the gut microbiome and its relationship to body composition continue to be explored. The current research demonstrates the importance of developing a balanced microbiome early in life. Although probiotics are not the only factor, they may be an important part of a comprehensive treatment protocol for a healthier future by supporting normal body composition in children and adolescents with obesity.

By Kendra Whitmire, MS, CNS