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Treatment Approaches in Severely Obese Children

Bariatric surgery is not the only effective treatment regimen in severely obese children…. 

Approximately 4-6% of all youth in the United States are severely obese, having BMI greater than 120% of the 95th percentile or an absolute BMI greater than 35kg/m2. Lifestyle modifications have modest improvement in BMI incorporating information, diet, physical activity, and a variety of behavior therapy strategies. Parent involvement is a crucial component of pediatric weight management, and the most successful weight management programs are family based.

Bariatric surgery has been effective for weight loss and improving cardiovascular and metabolic risk factors, but many youths do not qualify for surgery or there is no coverage from insurance companies.

Data suggests that the numbers of obese children are on the rise and prevention is the ultimate goal and ideal outcome. For younger children who are not suitable candidates for medication or surgery, home-based therapy or short term residential programs for families should be explored. The origin of obesity and identification of genetic and environmental factors associated with severe obesity may be used to design an optimal treatment approach. A chronic care model with ongoing care and monitoring will likely be needed. Treatment will need to be broad based and not target only adiposity, but also risk factors.

Practice Pearls:
  • Severe obesity in children is on the rise.
  • The most effective weight management programs are family based.
  • Treatment programs need to target risk factors as well as the origin of obesity.

Circulation: Journal of the American Heart Association, September 2013