Working with children who are overweight is a challenge for the pediatrician. Obesity is a chronic disease that requires frequent office visits, reinforcement, and encouragement for the patient and family. Because of the poor success rate and prognosis, frustration is common.

The first step in treating children with obesity is to recognize the problem and take the time to address the problem with the patient and family. If the physician is not prepared to care for these individuals, referral to other physicians and helpers is recommended.

The incidence of childhood obesity is approximately 20% in the United States and about 30% of adults who are obese have a history of childhood obesity.

Most cases of obesity are identified by the appearance of the child. The Body Mass Index (BMI) has been used in adolescents and adults to define obesity. It is calculated by the formula of weight in kg./length in meters squared. Values over the 95% are considered to be indicative of with a strong liklihood that the child will have persistence of obesity into adulthood. These children should have a complete medical assessment to identify any underlying syndromes and secondary complications. 85%-95% range should be evaluated for complications of obesity.

Etiology of Obesity

1. Excessive intake of food will lead to increase in body stores of fat when intake of energy exceeds expenditure.
2. Medical Conditions associated with Obesity
1. Endocrinopathies
1. Hypothyroid- decrease linear growth
2. Cushing's syndrome- hirsutism, striae, truncal obesity
3. Hyperinsulinism
4. Hypothalamic conditions
2. Psychological
1. eating disorders
2. Depression
3. Syndromes
1. Prader Willi
2. Laurence Moon Biedl
3. Stein-Leventhal Syndrome
4. Turner's syndrome

1. Sleep apnea
2. Pichwickean Syndrome
3. Slipped Capital Femoral Epiphysis
4. Blounts disease
5. Cardiovascular problems
1. hypertension
2. dyslipedemias
6. Gall Bladder disease
7. Pseudotumor cerebri

1. Intervention should begin early. The risk of adult obesity increases with the child's age. Adolescent changes are quite difficult.
2. Overcome the child's feeling of embarassment and involve them in conversatins
3. Acknowledge that obesity is a chronic disease that requires treatment. Emphasize the medical complication and risks. 
4. Encouragement
5. Establish readiness and desire to institute change. If the family and child are not ready, stop.
6. Involve outside caregivers such as grandparents, babysitters, daycare facilities.
7. Obtain a complete diet history
1. attention to eating outside the house
2. Discuss quality and quantity of food intake
8. Exercise history
1. Television watching
2. be aware of the difficulties of some children playing outside
3. encourage sports, dancing, involvement in chores around the house, walking, using stairs
9. Emphasize that this is a long term plan and involves life style changes. Other family members may benefit from joining the "program"
10. Small changes at a time. Minor adjustments in food intake and exercise may have large benefit.
11. Monitor linear growth
12. Use outside help such as nutritionists, psychotherapists, exercise trainers, Weight Watcher type groups

1. In most instances, maintenance of weight will be adequate because as linear growth continues, the BMI will decrease
2. If there are medical complications, weight loss may be necessary
3. Follow-up frequently, every 2 weeks, to monitor progress, encourage, reinforce success, and insure linear growth.

1. Barlow, Sarah and Dietz, William. Obesity Evaluation and Treatment: Expert Committee Recommendations. Pediatrics September 1998
2. Klish WJ. Childhood Obesity. Pediatrics in Review. 1998; 19:312-315.
3. Committee on Nutrition. Prevention of Pedatric Overweight and Obesity Pediatrics August 2003
4. Collins J. et al. Screen for and treat overweight in 2 to 5 year olds? Yes! Cont Peds Oct 2004
5. Dietz W., Robinson T. Overweight Children and Adolescents.  NEJM May 19, 2005
6. Schneider M. and Brill S. Obesity in Children and Adolescents.  Pediatrics in Review. May 2005
7. Hoppin et al. A 15 year old with Severe Obesity. NEJM Oct 12, 2006
8. McCrindle B. et al. Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents: A Scientific Statement. Circulation Vol 115(14) April 10 2007
9. STRATEGIES FOR THE MANAGEMENT AND REDUCTION OF CHILDHOOD OBESITY*
   An Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity, made up of representatives from the AAP and 14 other health professional organizations, was convened by the American Medical Association (AMA) to develop strategies to help physicians more effectively work with families, school health professionals, public health organizations and community groups to reduce overweight and obesity and to eliminate racial and ethnic disparities in childhood obesity. The committee recently released 22 recommendations for health care professionals to apply in their practices. A complete list of the recommendations can be found at www.ama-assn.org/ama1/pub/upload/mm/433/ped_obesity_recs.pdf.