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Feature Article

The management of obesity in childhood and adolescence

Susie Burrell, Shirley Alexander, Louise A Baur

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Abstract

Obesity in children and adolescents can have a major impact on their lives. It affects their self-esteem and can lead to bullying and health problems such as premature heart disease. Diet, exercise and behavioural changes are the keys to managing the condition.

Key Points

  • Obesity is a chronic disorder of energy imbalance. Management should focus on both sides of the energy equation: energy in and energy out.
  • Body mass index (BMI) should be calculated and plotted on a BMI-for-age chart, with waist circumference also measured and recorded.
  • A developmentally sensitive approach should be used. With children, focus on parents as the agents of change; with adolescents, provide the opportunity for the adolescent and parents to attend sessions separately.
  • Long-term behavioural change is required, involving an increase in incidental physical activity, a reduction in sedentary behaviour (including television viewing and use of other forms of passive electronic entertainment) and a sustainable change to a lower energy intake.
  • In prepubertal children, weight maintenance or reduction in the rate of weight gain are appropriate goals of therapy: after puberty, weight loss is generally appropriate.
  • Vulnerable eating patterns include skipping breakfast; excessive consumption of soft drinks, cordials and fruit juices; large portion sizes and frequent snacking.

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