Management of Obesity in Children
GARY S. GOLDFIELD
LEONARD H. EPSTEIN
The prevalence of childhood obesity has doubled in the past 20 years and approximately one-fourth of children ages 6–11 and adolescents ages 12–18 are obese, making childhood obesity one of the most serious pediatric health problems in the Unites States (see Chapters 77 and 85). Several reasons underlie the need to treat pediatric obesity. First, obesity tracks throughout development such that obese children are more likely than lean children to become obese adults. Second, pediatric and adolescent obesity are related to subsequent morbidity and mortality more than 50 years later, even controlling for adult weight. Third, pediatric obesity is associated with adverse medical conditions such as cardiovascular risk factors, asthma, and orthopedic problems, as well as deleterious psychosocial consequences, including teasing, body dissatisfaction, and poor self-esteem.
There are also behavioral, biological, and financial reasons to treat pediatric obesity. It may be easier to mobilize family support for children than for adults. Children also have not had the unhealthy eating and activity patterns as long as adults; thus, their habits may be more amenable to change. Treatment of pediatric obesity can take advantage of growth and increases in lean body mass. Instead of shrinking adipose cells, treatment at an early age prevents the development of excess adipose cells. Finally, the economic costs of obesity and related comorbidities have been estimated to be over $70 billion, or 7% of national health care expenditures (see Chapter 82). Given the limited effectiveness of treatment for obese adults, early intervention that prevents obese children from becoming obese adults may not only improve health and prevent disease, but it may also be especially cost-effective (see Chapter 112).
The goal of any weight loss therapy is to achieve negative energy balance in which energy expenditure exceeds energy intake. Negative energy balance can be achieved much more