Treatment of Pediatric Obesity

TLDR

Pediatric obesity interventions ideally produce positive physiologic and psychological outcomes. This review seeks to guide long‑term weight maintenance in children by modifying eating and exercise habits and identifying effective intervention characteristics. The authors synthesize randomized controlled trials of dietary, activity, and behavior‑change strategies, applying behavioral choice theory, response‑extinction principles, and individualized, science‑based approaches. Treatments can lower blood pressure, lipids, and insulin resistance, but may also increase the risk of disordered eating.

Abstract

The primary goal of childhood obesity interventions is regulation of body weight and fat with adequate nutrition for growth and development. Ideally, these interventions are associated with positive changes in the physiologic and psychological sequelae of obesity. To contribute to long-term weight maintenance, interventions should modify eating and exercise behaviors such that new, healthier behaviors develop and replace unhealthy behaviors, thereby allowing healthier behaviors to persist throughout development and into adulthood. This overview of pediatric obesity treatment, using predominantly randomized, controlled studies, highlights important contributions and developments in primarily dietary, activity, and behavior change interventions, and identifies characteristics of successful treatment and maintenance interventions. Potential positive (eg, reduction in blood pressure, serum lipids, and insulin resistance) and negative (eg, development of disordered eating patterns) side effects of treatment also are described. Recommendations for improving implementation of childhood obesity treatments, including application of behavioral choice theory, improving knowledge of response extinction and recovery in regards to behavior relapse, individualization of treatment, and integration of basic science with clinical outcome research, are discussed.