Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Obesity · Children · Adolescents · Assessment ·

Management

Key Messages

• The BMI [weight (kg)/height (m)^2 ] should be plotted
  routinely on a BMI-for-age chart


• The principles of obesity management include:
  management of comorbidities; family involvement;
  a developmentally appropriate approach; the use
  of a range of behavior change techniques; long-
  term dietary change; increased physical activity,
  and decreased sedentary behaviors


• Orlistat may be useful as an adjunct to lifestyle
  change for more severely obese adolescents, and
  metformin for adolescents with clinical insulin re-
  sistance


• Bariatric surgery should be considered with severe-
  ly obese adolescents


• Coordinated models of care for health service deliv-
  ery are needed for the management of pediatric
  obesity © 2015 S. Karger AG, Basel

Introduction

Child and adolescent obesity is a prevalent prob-
lem in most westernized and rapidly westernizing
countries and is associated with both immediate
and longer-term complications. Effective treat-
ment of those affected by obesity is vital.

Clinical Assessment

Clinical history should aid in assessing current

and potential future comorbidities as well as

modifiable lifestyle practices ( table 1 ) [1–4]. The

BMI [weight (kg)/height (m)^2 ], a clinically useful

measure of body fatness in those aged >2 years,

should be plotted on nationally recommended

BMI-for-age charts [5] , e.g. the WHO Child

Growth Standards. However, the cutoff points

used to define overweight and obesity are some-

what arbitrary and may vary between countries.

For example, in the UK the cutoff points for over-

weight and obesity are the 91st and 98th percen-

tiles, respectively, compared with the 85th and

95th in the USA. Hence, local recommendations

should be checked. A waist circumference-to-

height ratio of >0.5 is associated with increased

cardiometabolic risk in school-aged children [6].

Waist circumference-for-age charts are available

for some countries.

Physic a l ex a m i nat ion is u sed to a ssess obesit y-

associated comorbidities as well as signs of un-

derlying genetic or endocrine disorders ( table 2 ).

The level of investigation is dependent on the pa-

tient’s severity of obesity and age, the clinical

findings and associated familial risk factors.

Baseline investigations may include fasting lipid

screening, glucose, liver function tests and, pos-

sibly, insulin [1– 4]. Second-line investigations

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

3.5 Management of Child and Adolescent Obesity

Louise A. Baur

3