Pediatric Nutrition in Practice

164 Baur^

may include liver ultrasound, an oral glucose tol-
erance test, more detailed endocrine assessment
and polysomnography.

T r e a t m e n t S t r a t e g i e s

Systematic reviews of pediatric obesity treatment
show that lifestyle interventions can lead to im-
provements in weight and cardiometabolic out-
comes [7, 8]. While there is no evidence to sup-
port one specific treatment program over anoth-
er, meta-analyses show that family-targeted
behavioral lifestyle interventions can lead to a

mean BMI reduction of 1.25 to 1.30 when com-

pared with no treatment or usual care [8]. The

longer the duration of treatment, the greater the

weight loss observed [8]. Lifestyle interventions

also lead to improvements in low-density lipo-

protein cholesterol, triglycerides, fasting insulin

and blood pressure up to 1 year from baseline [8].

Some of the challenges of treatment are that

‘real-world’ obesity clinics are often more poorly

resourced than in clinical trials, and clinic pa-

tients may be more socially disadvantaged, or

have a broader range of comorbidities, than those

who take part in trials, making treatment adher-

ence more difficult.

Ta b l e 1. Elements of history-taking in obese children and adolescents

General history Prenatal and birth – history of gestational diabetes and birth weight

Infant feeding – duration of breastfeeding

Current medications – glucocorticoids, some antiepileptics and

antipsychotics

Weight history Onset of obesity and duration of parental and child concerns about

their weight

Previous weight management interventions

Previous and current dieting behaviors

Complications

history

Psychological – bullying, poor self-esteem, depression

Sleep – snoring, symptoms suggestive of sleep apnea

Exercise tolerance

Specific symptoms related to gastroesophageal reflux, gallstones,

benign intracranial hypertension, orthopedic complications,

enuresis, constipation

Menstrual history (girls)

Family history Ethnicity

Family members with a history of: obesity, type 2 diabetes,

gestational diabetes, cardiovascular disease, dyslipidemia,

obstructive sleep apnea, polycystic ovary syndrome, bariatric

surgery, eating disorders

Lifestyle history Diet and eating behaviors – breakfast consumption, snacking,

fast-food intake, beverage consumption, family routines around

food, binge eating, sneaking food

Sedentary behavior – daily screen time; numbers of televisions,

gaming consoles, computers and smart phones in the bedroom

and home; pattern of screen time

Physical activity – after school and weekend recreation, sports

participation, transport to and from school, family activities

Sleep – duration and routines

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