Although we have managed to slightly reduce the prevalence of obesity in our children, there is a significant number of children that have severe obesity or associated comorbidities.
The management of these patients requires a more aggressive and multidisciplinary approach.
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.
Numerous authors have highlighted that there is an obesogenic environment in our society characterised by the availability of foods rich in calories, refined sugars, saturated fats and salt at all times of day, and the emergence of sedentary leisure habits, with several hours a day spent in the use of televisions, console videogames, smart phones, etc., and a considerable decline in the hours children engage in physical activity, be it play or sports.
Although the concept of obesity is well understood by all, its appropriate diagnosis continues to be a subject of debate.Its purpose is to establish a common ground for patient and clinician, who then form a dynamic team in which the patient is the most important member.In the specific case of childhood obesity, motivational interviewing must necessarily involve the family.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.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.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.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.