Disease Management Programs Targeting Obesity in Children: Setting the Scene for Wellness in the Future

Abstract

An epidemic of childhood obesity has occurred over the past few decades and obesity is now the most common health problem among children in the developed world. Developing countries have also experienced rising pediatric obesity rates in recent years. There is a widespread perception among health professionals, patients and families that childhood obesity is mainly a cosmetic problem, with relatively minor health risks. However, there is a large body of consistent and high quality evidence showing that childhood obesity has significant health risks in the short-term (for the obese child) and in the long-term (for the adult who was obese as a child). These include cardiovascular risk factors, fatty liver, psychological ill health, asthma, type 2 diabetes, inflammation and orthopedic problems (in childhood); obesity persistence, cardiovascular risk factors, premature mortality, adverse social and economic outcomes (in adulthood). Systematic reviews have consistently concluded that high quality evidence on management of pediatric obesity is limited. Despite weaknesses in the evidence base, useful guidance on promising strategies to treat pediatric obesity are widely available. Key components of a successful weight management program include an increase in physical activity, dietary modification, targeting reduction in sedentary behaviors, involving parents in treatment and employing behavioral techniques. These approaches produce modest improvements in weight-related outcomes (10 to 20% decrease in percent overweight or 1 to 3 unit change in BMI) and can increase physical fitness, enhance psychosocial functioning and improve cardiovascular and metabolic health.