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Assessment and management of obesity in childhood and adolescence

Nature Reviews Gastroenterology & Hepatology volume 8, pages 635–645 (2011)Cite this article

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Abstract

The increased prevalence of obesity in childhood and adolescence highlights the need for effective treatment approaches. Initial assessments of these patients should include taking a careful history (investigating comorbidities, family history and potentially modifiable behaviors) and physical examination with BMI plotted on a BMI-for-age chart. The degree of investigation is dependent on the patient's age and severity of obesity, the findings on history and physical examination, and associated familial risk factors. There are several broad principles of conventional management: management of comorbidities; family involvement; taking 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 can be useful as an adjunct to lifestyle changes in severely obese adolescents and metformin can be used in older children and adolescents with clinical insulin resistance. Bariatric surgery should be considered in those who are severely obese, with recognition of the need for management in centers with multidisciplinary weight management teams and for surgery to be performed in tertiary institutions experienced in bariatric surgery. Finally, given the high prevalence and chronic nature of obesity, coordinated models of care for health-service delivery for the management of pediatric obesity are needed.

Key Points

  • BMI (weight/height2) should be plotted routinely on a BMI-for-age chart and provides a reasonable measure of body fatness in children and adolescents with obesity

  • Conventional management for childhood and adolescent obesity includes: management of comorbidities; family involvement; developmentally appropriate approaches; behavior change techniques; long-term dietary change; increased physical activity; and decreased sedentary behaviors

  • Pharmacotherapy for obesity is limited; orlistat can be used in conjunction with lifestyle changes in severely obese adolescents, while metformin can be used in older children and adolescents with clinical insulin resistance

  • Bariatric surgery should be considered in severely obese adolescents, preferably with management in centers with multidisciplinary weight management teams and surgery performed in tertiary institutions experienced in bariatric surgery

  • Coordinated models of care for health-service delivery for the management of pediatric obesity are needed

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Figure 1: BMI-for-age charts in boys and girls.
Figure 2: Chronic disease management pyramid for pediatric overweight and obesity.

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Acknowledgements

V. Shrewsbury was supported by an Australian National Health and Medical Research Council Postgraduate Research Scholarship.

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  1. Weight Management Services, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW, Australia

    Louise A. Baur & Briony Hazelton

  2. University of Sydney Clinical School, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW, Australia

    Vanessa A. Shrewsbury

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Baur, L., Hazelton, B. & Shrewsbury, V. Assessment and management of obesity in childhood and adolescence. Nat Rev Gastroenterol Hepatol 8, 635–645 (2011). https://doi.org/10.1038/nrgastro.2011.165

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