Childhood Obesity Treatment Options

Childhood obesity is on the rise in the United States. In fact, according to the Centers for Disease Control (CDC) in Atlanta, Georgia, "The number of children and adolescents with obesity has more than tripled since the 1970s." 

Treatment of childhood obesity depends on several factors, these include:

• The child’s age
• Co-occurring medical conditions (such as high cholesterol, high blood pressure, diabetes, or other obesity-related conditions)

Treatment for childhood obesity may involve:

• Changes in the child’s diet and eating habits
• An increase in the child’s physical activity level
• Weight loss surgery or medication (only under specific circumstances)
• Behavioral counseling

A primary tool for assessing obesity in children (as well as in adolescents and adults) is called the body mass index or BMI. The BMI measures fat content based on a ratio of the child’s height and weight. For children, the pediatrician (or another healthcare provider) measures the BMI and calculates where it falls on the "BMI-for-age and growth chart," says Mayo Clinic.

Using a growth chart, the child’s percentile is calculated by comparing the measurements with other children of the same age and sex. For example, if a child is in the 85th percentile, it indicates that compared with other children (the same age and sex) 85% have a lower BMI (or weight).

The CDC determines which percentiles equate to being overweight or obese, as follows:

Note: The BMI isn’t always a highly accurate measurement of body fat content because it doesn’t take into account factors such as body frame and variable growth patterns in children. The pediatrician or other healthcare providers will consider the child’s growth and development, and other factors, such as obesity in the family, activity level, eating habits and other health conditions—like diabetes or high cholesterol levels—before making a final determination.

A 2010 study, published by the journal Obesity reported that the "gold standard of obesity treatment for children," has historically been comprised of a program aimed at involving both the parents and children, focusing on:

• Nutrition, addressing dietary intake
• Education involving nutrition, changes in eating habits, and activity level
• Behavioral reinforcement of both the child and the parent

Treatment involving each of these factors has been linked with the most successful outcomes for childhood obesity.  

The study authors wanted to find out if both the children and the parents needed to be involved in treatment, so they examined the results when just the parents participated, without the children.

The results showed that parent-only (PO) treatment programs were equivalent to those that involved both the parent and the child in addressing the primary treatment modalities (nutrition, education, and behavioral re-enforcement). 

The study authors wrote, "Overall, this project suggests that a PO [parent-only] treatment could provide similar results to PC [parent and child treatment] in child weight loss and other relevant outcomes, and potentially could be more cost-effective and easier to disseminate."

A 2015 study discovered significant changes in BMI after intensive treatment for childhood obesity involving a multi-disciplinary approach, including:

• Dietary education
• Physical activity education
• Coaching in a group setting on behavioral management and physical activity
• Therapy sessions with a psychologist
• Weekly in-home coaching sessions, to identify play areas for children and help remove low-nutrient foods from the home environment
• Group physical activity sessions led by a physiotherapist (a specialist in physical activity)

For some children, medication may be prescribed as part of a weight loss program. Medication is only prescribed under specific situations, such as for children who have obesity and diabetes or other obesity-related conditions.

Weight loss surgery is only an option for adolescents, not for small children. Of course, just like any other type of surgery, weight loss surgery can pose a risk. But for adolescents who are unable to lose weight and lower their BMI with diet and lifestyle changes, surgery may pose a lower risk than obesity does when it comes to long-term health.

The adolescent's healthcare professional will decide if weight loss surgery is an option. Other professionals, such as a dietician or a pediatric endocrinologist (specializing in diseases like diabetes) may be consulted.

Surgery will not replace the need for diet and exercise, it is simply an adjunct treatment that may help an adolescent begin the weight loss process. A healthy diet and regular exercise program will be required in the long-term.

When a child (or adolescent) is diagnosed with obesity, the healthcare provider will recommend a diet, along with goals for increased activity and healthy weight loss.

There are some general guidelines that most professionals recommend:

• Parents—not the children— must take charge of the food that is purchased and cooked as well as when it will be eaten.
• A healthy diet consists of ample fresh fruits, vegetables, lean meat, healthy fats (such as avocadoes and olive oil) as well as whole grains.
• Saturated fats, trans-fats, sugary baked goods, and high caloric/high sugar drinks (this includes fruit juice), processed foods, and fried foods should be eliminated from the diet.
• Healthy snacks should consist of foods such as fresh fruits, nuts, and high-fiber whole foods (such as popcorn).
• Parents should cook at home as much as possible and avoid eating out, particularly at fast-food restaurants.
• Parents and children should have family meals together with ample time to converse.
• Parents should not allow eating in front of the television or while viewing any type of electronic device (such as smartphones or tablets). According to Mayo Clinic, eating while playing video games, or in front of a computer or television, can result in eating too fast and overeating. 
• Parents should control portion sizes, avoiding the mistake that many parents make by forcing the child to finish all the food on the plate.
• When eating out, parents should keep in mind that restaurant portions are usually way too large. Try splitting the meal, boxing up half to take home later for another meal.
• Parents should limit the time the child engages in inactive leisure activity such as video games and television.
• Parents should encourage at least an hour each day of rigorous outdoor play and all types of physical activity (such as bike riding) in the form of play. 

The need for weight control in early childhood is vital for kids who are overweight or obese. In fact, a 2015 study found that weight status in early childhood is a strong indicator for weight problems, associated with other conditions (such as diabetes, high cholesterol levels, high blood pressure and more) later in life. 

The evidence suggested in many studies has shown that an intensive multi-disciplinary intervention/treatment program is a must in order to attain long-term, positive results for children who are diagnosed with obesity.