Evidence based management of childhood obesity

Abstract

This is the second in a series of five articles The parents of a 10 year old boy who is very overweight bring him to consult you. He is an only child. His mother is of normal weight but his father is a large man and is overweight. His father's two brothers are obese. His parents report that the boy's behaviour is deteriorating and that he is becoming isolated from his peers. His mother has tried various dieting strategies but these have not halted his increasing gain in weight. His parents are concerned that he will “end up like his two uncles.” The boy says he is unhappy about his size because he gets teased and has trouble making friends. His mother asks whether his health is at risk and how he can be helped. #### Summary points Young obese children should maintain weight or gain weight slowly rather than lose weight Inculcating healthy eating habits is better than restricting diet Sustainable lifestyle activities should be encouraged Psychosocial problems are important consequences of overweight or obesity Behavioural treatments should be individually designed All treatments must be acceptable to the family In 1998 the World Health Organization designated obesity as a global epidemic.1 The epidemic, which includes adults and children, is a result of societal and environmental factors that promote weight gain, factors that health professionals cannot expect to change. Results of obesity treatment programmes at obesity clinics have been disappointing, although children do better than adults. Prevention is therefore essential to reduce the health burden of obesity on society. It is vital to treat and prevent obesity in childhood, as lifestyle behaviours that contribute to and sustain obesity in adults are less well established in children and may be more amenable to change. The evidence suggests that the family provides a suitable …