The treatment of obesity in children and adolescents

Abstract

The main reason why the rising prevalence of childhood obesity is an important public health issue is that obese children are likely to become obese adults at high risk of developing diabetes and cardiovascular disease and it is feared that the future cost of healthcare for obesity-related illnesses will be beyond the nation’s resources.1,2 From the perspective of the individual obese child and his or her family, however, more immediate consequences of obesity, such as having low self-esteem, being bullied, teased or socially marginalised, being unable to participate in physical activities and sport or to wear fashionable clothes, tend to be of greater importance. There is evidence that many parents of overweight or obese children are unaware of their child’s weight status although the reasons for this have not been thoroughly explored.3 Raising awareness of the significance of childhood obesity, as the Lets Move! campaign started by Michelle Obama has done in the U.S.,4,5 is important as unless parents are motivated to change their families’ habits to improve their children’s weight there is little point in offering intervention. There is a general consensus among obesity experts that tackling the obesity problem requires a whole of society approach to prevention, and that this involves tackling complex social and economic issues in areas including food production, manufacturing and retailing, trade, urban planning, transport, healthcare, education and culture6 through the coordinated efforts of public sectors and private industries.7,8 Nevertheless, those who work in healthcare want to be able to help individual obese children and their families in the here and now. This in-depth topic aims to provide information on evidence-based interventions for the treatment of established overweight and obesity in children and adolescents. It is organised into five sections as follows: • Identifying and engaging children (and their parents) who are candidates for weight management interventions • Insights from a 2009 Cochrane review of obesity interventions in children and adolescents • Insights from other reviews of obesity interventions in children and adolescents • New Zealand interventions • Primary care interventions, including recent RCTs addressing obesity in primary care There are a number of evidence-based guidelines for the management of overweight and obesity in children and young people, including those published by the NZ Ministry of Health (2009),9 the U.K. National Institute for Health and Care Excellence (2013),10 the Scottish Intercollegiate Guidelines Network (2010),11 and the Australian National Health and Medical Research Council (2013).12 Readers wanting more detailed information than is provided here might like to refer to these guidelines.