Obesity in childhood and adolescence. Special problems in diagnosis and treatment

Obesity is an emotional, physical, and social problem in search of a definition as well as an explanation for its pathogenesis and an efficacious approach to therapy. The complexities of the problem and the limitations of our knowledge are compounded by the anabolic aspects of growth and the sex-specific differences in fat deposition and energy requirements of children and adolescents. The clinician has a delicately balanced responsibility to moderate weight gain while avoiding dietary regimens that will induce catabolism. Further, the clinician must provide empathetic counseling and support, modify behavior, and encourage physical activity. All this must be undertaken with the knowledge that the objective may be unobtainable and, on those occasions when it is achieved, the recidivism rate will be high. Despite these difficulties, it is critical that the child and the family be provided with a realistic and practical regimen that has the potential to help while doing no harm.