Addressing obesity for the benefit of the next generation

Research has shown that any combination of dietary/exercise or lifestyle interventions have a small but significant effect on BMI.²³ Once a diagnosis of overweight or obesity has been made, you should provide counseling to parents and caregivers apart from adolescents themselves.²³

Diet
Ensure that you address both the quantity and quality of food:^7,24

We recommend that clinicians prescribe and support healthy eating habits in accordance with the following guidelines of the American Academy of Pediatrics and the US Department of Agriculture:⁷

• decreased consumption of fast foods
• decreased consumption of added table sugar and elimination of sugar-sweetened beverages
• decreased consumption of high-fat, high sodium, or processed foods
• consumption of whole fruit rather than fruit juices
• portion control education
• reduced saturated dietary fat intake for children and adolescents
• timely, regular meals, and avoiding constant “grazing” during the day
• recognizing eating cues in the child’s or adolescent’s environment, such as boredom, stress, loneliness, or screen time
• encouraging single portion packaging and improved food labeling for easier use by consumers⁷

Physical Activity
It is recommended that a child/adolescent should take 60 minutes of physical activity per day, 20 minutes of which should be moderate to vigorous and should include activities enjoyed by the child/adolescent to improve adherence.⁷

Sleep
Healthy sleep patterns in children can decrease the likelihood of developing obesity due to changes in calorie intake and metabolism related to disordered sleep.⁷ Talk to parents and caregivers about quantity of sleep required and good bedtime routines.⁷

Treatment should be started and monitored in a specialist paediatric setting by experienced multidisciplinary teams.^{7, 25}

Anti-obesity medications may play a role in weight management for children and adolescents with obesity and may be considered an important component of a multimodal approach to managing obesity.²⁵

Bariatric surgery can be considered as a treatment option for adolescents with severe obesity, those with a BMI 140% of 95th percentile for age and sex or BMI 120% of 95th percentile with at least one significant obesity-related complication.⁷

Surgeons should have specific experience with adolescents, and have a dedicated and experienced multidisciplinary team to provide support before and after the surgical procedure.⁷ Bariatric surgery requires long-term follow-up of the metabolic and psychosocial needs of the patient and family.⁷ There may be a role for pharmacotherapy post bariatric surgery and medication review.²⁵