Pediatric Nutrition in Practice

Management of Child and Adolescent Obesity 167

3

Existing recommendations on management of
pediatric obesity suggest that drug therapy (large-
ly orlistat, a gastrointestinal and pancreatic lipase
inhibitor) can be used in the treatment of severely
obese adolescents, in the context of a tertiary care
protocol provided by a multidisciplinary care
team and incorporating continued diet and activ-
ity counseling [1– 4]. For obese, insulin-resistant
adolescents there may be a role for the use of met-
formin, an insulin-sensitizing agent [13].
The few consensus guidelines for bariatric sur-
gery in adolescents have highlighted its use in se-
verely obese adolescents, with consideration of the
adolescent’s decisional capacity and attainment of
physical maturity, as well as the presence of a sup-
portive family environment [1, 3, 4, 14, 15]. The
need for management in centers with multidisci-
plinary weight management teams, for the surgery
to be performed in tertiary institutions experi-
enced in bariatric surgery and for long-term mul-
tidisciplinary follow-up has been emphasized.

Health Service Delivery Issues

Given the high prevalence and chronicity of pedi-

atric obesity, there is a need for coordinated mod-

els of care for health service delivery. One poten-

tial approach, the chronic disease care model, is

based upon a tiered level of service delivery relat-

ing to disease severity [16]. Thus, while most peo-

ple affected by the problem of obesity can be man-

aged via self-care or family-based care, with sup-

port from primary care or community-based

health service providers, there is a need for treat-

ment by multidisciplinary care teams, and possi-

bly tertiary care clinics, for those who are more

severely affected. Individual clinicians should be

aware of the presence of other services within

their geographic region, and the capacity of these

to take referrals or to comanage patients.

target. Arch Pediatr Adolesc Med 2003;

157: 725–727.

12 Wilfley DE, Stein RI, Saelens BE, et al:

Efficacy of maintenance treatment ap-

proaches for childhood overweight: a

randomized controlled trial. JAMA

2007; 298: 1661–1673.

13 Quinn SM, Baur LA, Garnett SP, Cowell

CT: Treatment of clinical insulin resis-

tance in children: a systematic review.

Obes Rev 2010; 11: 722–730.

14 Baur LA, Fitzgerald DA: Recommenda-

tions for bariatric surgery in adolescents

in Australia and New Zealand. J Paediatr

Child Health 2010; 46: 704–707.

15 Inge TH, Krebs NF, Garcia VF, et al:

Bariatric surgery for severely overweight

adolescents: concerns and recommen-

dations. Pediatrics 2004; 114: 217–223.

16 Department of Health: Supporting peo-

ple with long term health conditions.

2007. http://www.dh.gov.uk/en/Publica-
      tionsandstatistics/Publications/Publica-
      tionsPolicyAndGuidance/Browsable/
      DH_4100317.

References

1 Barlow SE; Expert Committee: Expert
committee recommendations regarding
the prevention, assessment, and treat-
ment of child and adolescent overweight
and obesity: summary report. Pediatrics
2007; 120(suppl 4):S164–S192.
2 National Health and Medical Research
Council: Clinical practice guidelines for
the management of overweight and obe-
sity in adults, adolescents and children
in Australia. 2013. http://www.nhmrc.
gov.au/guidelines/publications/n57.
3 Scottish Intercollegiate Guidelines Net-
work: Management of obesity: a nation-
al clinical guideline. 2010. http://www.
sign.ac.uk/pdf/sign115.pdf/.
4 National Institute for Health and Clini-
cal Excellence: Obesity: guidance on the
prevention, identification, assessment
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http://guidance.nice.org.uk/CG43/
NICEGuidance/pdf/English.
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6 Garnett SP, Baur LA, Cowell CT: Waist-

to-height ratio: a simple option for de-

termining excess central adiposity in

young people. Int J Obes (Lond) 2008;

32: 1028–1030.

7 Oude Luttikhuis H, Baur L, Jansen H, et

al: Interventions for treating obesity in

children. Cochrane Database Syst Rev

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8 Ho M, Garnett SP, Baur LA, et al: Effec-

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9 Golan M, Crow S: Targeting parents

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11 Whitaker RC: Obesity prevention in pe-

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Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 163–167
DOI: 10.1159/000360331