Evaluation and Treatment of Pediatric Obesity

Abstract

Obesity is one of the most significant health problems facing children and adolescents. The definition of overweight in children is a body mass index between the 85th and less than 95th percentile, whereas obesity is greater than or equal to the 95th percentile for age and sex. There are multiple comorbidities associated with obesity, including dyslipidemia, hypertension, type 2 diabetes, sleep apnea, and nonalcoholic fatty liver disease, as well as psychosocial issues. Contributors to obesity are multifactorial, including genetic and environmental factors. Environmental factors associated with obesity include increased availability of inexpensive fast food, sugar-sweetened beverages, and high-fat and -sugar convenience foods; decreased exercise; and increased screen time. Treatment begins with behavioral interventions focusing on dietary modifications and increasing physical activity. Although medications to treat obesity are an area of increased interest, options in the pediatric population are limited. Currently, orlistat is the only FDA-approved option. For the treatment of severe obesity, bariatric surgery should be considered, based on age, weight, and associated comorbidities. Weight loss associated with surgery is robust and long-lasting and results in improvement in/resolution of multiple comorbidities. However, benefits should also be weighed against the long-term risks of vitamin deficiency. This review contains 73 references, 3 figures, and 3 tables. Key words: bariatric surgery, metabolic syndrome, obesity treatment, pediatric obesity, weight loss surgery