Causes of Obesity
Only a small percentage of childhood obesity is
associated with a hormonal or genetic defect, with the
remainder being environmental in nature due to lifestyle
and dietary factors. Although rarely encountered, hypo-
thyroidism is the most common endogenous abnormal-
ity in obese children and seldom causes massive weight
gain.
Of the diagnosed cases of childhood obesity,
roughly 90% of the cases are considered environmen-
tal in nature and about 10% are endogenous in nature.Goals of therapy
The Division of Pediatric Gastroenterology and
Nutrition, New England Medical Center, Boston,
Massachusetts as well as many child organizations
agree that the primary goal of a weight loss program
for children to manage uncomplicated obesity is
healthy eating and activity, not achievement of ideal
body weight. Any program designed for the overweight
or obese child should emphasize behavior modification
skills necessary to change behavior and to maintain
those changes.
For children with a secondary complication of
obesity, improvement or resolution of the complication
is an important medical goal. Abnormal blood pressure
or lipid profile may improve with weight control, and
will reinforce to the child and their parents/caregivers
that weight control leads to improvement in health
even if the child does not approach ideal body weight.Weight goals
In review of much research, expert advice is that
most children who are overweight should not be placed
onaweightlossdietsolelyintendedtoloseweight.
Instead they should be encouraged to maintain current
weight, and gradually ‘‘grow into’’ their weight, as they
get taller. Furthermore, children should never be put
on a weight-loss diet without medical advice as this can
affect their growth as well as mental and physical
health. In view of current research, prolonged weight
maintenance, done through a gradual growth in height
results in a decline in BMI and is a satisfactory goal for
many overweight and obese children. The experience of
clinical trials suggests that a child can achieve this goal
through modest changes in diet and activity level.
For most children, prolonged weight mainte-
nance is an appropriate goal in the absence of any
secondary complication of obesity, such as mild
hypertension or dyslipidemia. However, children
with secondary complications of obesity may benefitfrom weight loss if their BMI is at the 95th percentile
or higher. For children older than 7 years, prolonged
weight maintenance is an appropriate goal if their
BMI is between the 85th and 95th percentile and if
they have no secondary complications of obesity.
However, weight loss for children in this age group
with a BMI between the 85th and 95th percentile who
have a nonacute secondary complication of obesity
and for children in this age group with a BMI at the
95th percentile or above is recommended by some
organizations.
When weight loss goals are set by a medical pro-
fessional, they should be obtainable and should allow
for normal growth. Goals should initially be small;
one-quarter of a pound to two pounds per week. An
appropriate weight goal for all obese children is a
BMI below the 85th percentile, although such a goal
should be secondary to the primary goal of weight
maintenance via healthy eating and increases in
activity.
Components of a Successful Weight Loss Plan
Many studies have demonstrated a familial correlation
of risk factors for obesity. For this reason, it is impor-
tant to involve the entire family when treating obesity
in children. It has been demonstrated that the long-
term effectiveness of a weight control program is sig-
nificantly improved when the intervention is directed at
the parents as well as the child. Below describes bene-
ficial components that should be incorporated into a
weight maintenance or weight loss effort for over-
weight or obese children.
Attainable and safe weight-loss; a rate of 1 to 4 lb per
month.
Dietary management goals should be provided; spec-
ify total number of calories allotted per day, broken
down into percentage of calories from fat, protein
and carbohydrates.
Physical activity recommended should match the
child’s fitness and mobility level, with an ultimate
goal of 20 to 30 minutes per day of structured
movement.
Behavior modification techniques should be incor-
porated; self-monitoring tools, nutritional educa-
tion, identification and modification of stimulus
controls, family role modeling, positive reinforce-
ments and non-food rewards.
Encourages and supports family involvement; family
involved in individual or class session, encouraged to
attain healthier eating patterns and lead an active
lifestyle.Children’s diets