Pediatric Nutrition in Practice

166 Baur^

influences in order to aid weight control, with ex-
amples including not eating in front of the televi-
sion, or using smaller plates and bowls within the
home. A third commonly used technique, self-
monitoring, involves the recording of a specific
behavior or outcome, such as the use of a food di-
ary, daily pedometer measurement of physical ac-
tivity, or weekly weighing.

Dietary Change and Eating Behaviors
Treatment programs incorporating a dietary
component can be effective in achieving relative
weight loss in children and adolescents, although
no one dietary prescription appears superior to
another [8]. However, dietary interventions are
usually part of a broader lifestyle change pro-
gram, and are rarely evaluated on their own. The
two most commonly reported diets are: (a) the
modified stop/traffic light approach, where foods
are color-coded on the basis of nutritional value
and energy content to indicate those to be eaten
freely (green) or more cautiously (amber, red),
and (b) a calorie restriction/hypocaloric diet ap-
proach. Both diets can lead to sustained weight
loss across different settings and age groups [8].
The role of dietary macronutrient modification in
the management of obese children and adoles-
cents remains unclear.
In general, dietary interventions should follow
national nutritional guidelines and have an em-
phasis on the following [1–3] :

• Regular meals


• Eating together as a family


• Choosing nutrient-rich foods which are lower
  in energy and glycemic index


• Increased vegetable and fruit intake


• Healthier snack food options


• Decreased portion sizes


• Drinking water as the main beverage


• Reduction in sugary drink intake


• Involvement of the entire family in making
  sustainable dietary changes
  In advising patients and families on dietary chang-
  es, is there a risk of an eating disorder developing?

While most people with obesity do not have a

binge eating disorder, the latter is more common

in people with severe obesity. Further, overweight

adolescents are more likely to binge-eat, and child-

hood obesity is a risk factor for later bulimia. How-

ever, professionally run pediatric obesity programs

do not increase the risk of disordered eating and

may improve psychological wellbeing [10].

Physical Activity and Sedentary Behaviors

In clinical practice, increased physical activity

may best result from a change in incidental, or un-

planned, activity, such as by walking or cycling

for transport, undertaking household chores and

playing. Organized exercise programs have a role,

with children and adolescents being encouraged

to choose activities that they enjoy and which are

sustainable. Limiting television and other small-

screen recreation to less than 2 h per day is par-

ticularly strategic, but may be challenging [11].

Parental involvement is vital and may include

monitoring and limiting television use, role-mod-

eling of healthy behaviors, and providing access to

recreation areas or recreational equipment.

Long-Term Weight Maintenance

In those who undergo an initial weight manage-

ment intervention, a period of further therapeutic

contact appears to slow weight regain [12]. At

present, there is limited evidence to guide the na-

ture and type of long-term weight maintenance

interventions.

Nonconventional Therapies

There is relatively limited evidence to guide the

use of less orthodox treatment approaches such as

very-low-energy diets, pharmacological therapy

or bariatric surgery in treating severe pediatric

obesity. Such therapies should occur on the back-

ground of a behavioral weight management pro-

gram and be restricted to specialist centers with

expertise in managing severe obesity.

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