[Obesity is rarely curable: individual concepts and therapy programs for children and adolescents]

Obesity in children has an increased risk to persist in adulthood. In most cases, obesity starts to develop in children at school age. Lower social economic status and migration background are severe risk factors for obesity. Additionally, genetic predisposition for the development of obesity plays an especially important role in children and adolescents. However, the individual cause for obesity is heterogeneous and complex. This is the reason why only a systematic analysis of individually existing problems is necessary for a differentiated and realistic planning of the treatment. Long-lasting therapy concepts need to be based on current available evidence.The treatment of childhood obesity should rely on multiprofessional lifestyle programs. An exception might be rare monogenic or syndromic forms of obesity, because defects within the central regulatory pathways of body weight regulation could be present. In general, a key component of the treatment strategy should include an improvement of nutrition, physical exercise and self-esteem combined with a reduction of stress. Moreover, the inclusion of parents into the treatment strategy has shown to be beneficial and necessary. Long-term follow-up studies on the development of associated comorbidities are rare. Unfortunately, patient groups at risk are currently not necessarily reached with available treatment programs.A multiprofessional analysis of individual problems and differentiated treatment planning with a participative approach (acknowledging the cultural background and involving members of the family) should lead to long-lasting improvement of the therapeutic outcome. The individual main treatment aim should also include - apart from the reduction of body weight - the improvement of associated comorbidities and quality of life, especially by avoiding any stigmatization. A health-promoting environment is desirable for this salutogenetic approach.