Treatment of childhood obesity

To provide an overview of treatments for childhood obesity, highlighting recent advances and recommendations.

The three main treatment modalities are lifestyle interventions, medications, and bariatric surgery. Recent data support the short-term effectiveness of lifestyle interventions, and show that continued behavioral intervention increases the likelihood of a sustained effect for up to 2 years. New studies and regulatory decisions on medications for obesity (including orlistat, sibutramine, and metformin) are discussed. Emerging data suggest substantial weight loss after bariatric surgery in morbidly obese adolescents but also indicate adverse effects. An expert panel recently provided guidelines that alter definitions of obesity and offer a framework for obesity management. These guidelines are compared with others, and integrated recommendations presented.

While primary prevention of childhood obesity is important, broadly effective methods to do so are not yet available. Given the large population of obese children and the risks they face, an emphasis on treatment is also critical. We suggest a staged approach, emphasizing early intervention and lifestyle changes. We also suggest limiting bariatric surgery to selected adolescents in Institutional Review Board-approved research studies. Health-policy interventions can facilitate both prevention and treatment of childhood obesity.