The treatment of childhood obesity may include pharmacological and nonpharmacological measures, and some cases in adolescents may even require surgery.Chief among the nonpharmacological measures are changes in diet and lifestyle habits, with an increase in hours spent in physical activity and a decrease in the time spent in sedentary activities. present the results of a systematic literature review that included a total of 48 studies in the paediatric age group with the purpose of evaluating the efficacy of different clinical interventions in childhood obesity.
The very nature of the child as a growing being whose body composition changes as years go by precludes the determination of a single value for each age-and-sex range.
It is on this point that disagreements arise as to which is the appropriate standard for comparison.
This is why, for all its drawbacks, the body mass index (BMI) has been adopted as the preferred method to define overweight and obesity.
Whereas BMI values of 25 and 30 are unanimously accepted as the cut-off points for overweight and obesity in adults, the situation is quite different in paediatrics.
Thus, prevention may be a more effective approach to the problem.
Starting with the research of Osmond and Barker, the scientific community has produced a growing body of evidence on the existence of “foetal programming” by which certain physiological events that take place in the early stages of life between conception and age 2 years (the so-called first thousand days of life) produce permanent changes in metabolism that somehow promote the subsequent development of various cardiovascular risk factors and diseases.Studies have been published that demonstrate the efficacy of these interventions when they are implemented in primary care settings and applying the principles of motivational interviewing.Motivational interviewing is a patient-centred communication style used extensively in behaviour modification.Obesity corresponds to excess body fat, so its correct diagnosis requires some marker or anthropometric measure that can be used to assess body fat accurately and be available to all paediatricians in everyday practise.It is possible to measure total fat mass directly with great accuracy, but the methods employed for this purpose are only within reach of a few research facilities.This approach is based on empathy, avoids “labelling” and assigning blame to the patient, and works on accepting ambivalent feelings, identifying resistance to change, and ultimately generating self-motivating affirmations that can foster positive change.Difficulties in adhering to treatment and in the long-term maintenance of results have been widely reported in relation to the management of obese paediatric patients.An adequate control of diet that guarantees optimal weight gain during pregnancy, maintenance of exclusive breastfeeding until age 6 months, the gradual introduction of solid foods in a balanced diet without excessive consumption of animal protein and with adequate intake of fruits, vegetables, and whole grains and few simple carbohydrates, the structured monitoring of weight and height gain in children in primary care, and educating parents in how to promote healthy lifestyle habits in children, emphasising active over sedentary leisure activities, are some of the elements that research has shown ought to be implemented in strategies for the prevention of childhood obesity.A Cochrane review on interventions for preventing obesity in children identified the following strategies as having beneficial effects: a school curriculum that includes healthy eating, physical activity and body image; increased sessions for physical activity and the development of fundamental movement skills throughout the school week; improvements in nutritional quality of the food supply in schools; environments and cultural practices that support children eating healthier foods and being active throughout each day; support for teachers and other staff to implement health promotion strategies and activities; parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities.Childhood obesity is unquestionably one of the major health problems confronting the developed world, and it has been termed a global XXI century epidemic by the World Health Organisation.While the aetiology of this disease is multifactorial and includes genetic and environmental causes, we can broadly state that the excess fat that defines it fundamentally arises from an imbalance in energy intake and expenditure.