Pediatric Nutrition in Practice

Management of Child and Adolescent Obesity 165

3

However, the broad principles of management
are well recognized [1– 4 , 7, 8] : management of
obesity-associated comorbidities; family involve-
ment; a developmentally appropriate approach;
long-term behavior modification; dietary change;
increased physical activity; decreased sedentary
behaviors; a plan for longer-term weight mainte-
nance strategies; and consideration of the use of
pharmacotherapy and other nonconventional
therapies.

Elements of Treatment

Family Focus
Many clinical trials show that family-based inter-
ventions can lead to long-term relative weight
loss, i.e. from 2 to 10 years. Parental involvement
when managing obese preadolescent children ap-
pears vital, although there are more limited data
on management of adolescents.

A Developmentally Appropriate Approach

For preadolescent children, weight outcomes

may be improved with a parent-focused interven-

tion, without direct engagement of the child [9].

There are more limited data on the treatment of

adolescent obesity than on younger children, and

especially on interventions that would be sustain-

able in most health care settings. Generally, pro-

vision of at least some separate therapist session

time with the adolescent seems appropriate.

Behavior Modification

Weight outcomes are improved with the use of a

broader range of behavior change techniques [1–

4]. One such technique, goal-setting, can include

performance goals (such as changing eating or ac-

tivity behaviors) or outcome goals (such as spe-

cific weight loss). Examples of the former include

not buying cookies, or reducing television time to

3 h per day. Another technique, stimulus control,

refers to modifying or restricting environmental

Ta b l e 2. Physical examination of obese children or adolescents and important physical findings [9, 11]

Organ system Physical findings

Skin/subcutaneous
tissues

Acanthosis nigricans, skin tags, hirsutism, acne, striae, pseudogynecomastia (males),

intertrigo, xanthelasmas (hypercholesterolemia)

Neurological Papilledema and/or reduced venous pulsations on funduscopy (pseudotumor cerebri)

Head and neck Tonsillar size, obstructed breathing

Cardiovascular Hypertension, heart rate (cardiorespiratory fitness)

Respiratory Exercise intolerance, wheeze (asthma)

Gastrointestinal Hepatomegaly and hepatic tenderness (nonalcoholic fatty liver disease), abdominal
tenderness (secondary to gallstones or gastroesophageal reflux)

Musculoskeletal Pes planus, groin pain, and painful or waddling gait (slipped capital femoral epiphysis),
tibia vara (Blount disease), lower-limb arthralgia and restriction of joint movement

Endocrine Goiter, extensive striae, hypertension, dorsocervical fat pad, pubertal staging, reduced
growth velocity

Psychosocial Flat affect and low mood, poor self-esteem, social isolation

Other – evidence of
a possible underlying
genetic syndrome

Short stature, disproportion, dysmorphism, developmental delay

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