Prevention and Treatment of Obesity, Metabolic Syndrome, and Type 2 Diabetes in Children and Adolescents

Abstract

Are health care providers adequately trained and motivated to fight the obesity epidemic? Many pediatricians view obesity treatment in a negative way,1 and this attitude may impair their ability to evaluate and treat children who are trending upward on, as well as closing in on the upper percentiles of, the BMI chart. Many health care providers believe that most people who lose weight will experience rebound.2 This negative perspective generates an atmosphere of futility rather than the promotion of self-efficacy so needed by both health care providers and patients. Equally disturbing is a recent report by the U.S. Preventive Services Task Force, which concluded that there is insufficient evidence to recommend for or against primary care providers screening for overweight in children and adolescents to prevent obesity.3 After reading this report, providers may be left with the impression that there is nothing they can do, or they may face a dilemma as to whether to intervene with a child who appears to be gaining excessive weight as evidenced by an upward trend of the child's BMI or relative BMI. This is reminiscent of the time before completion of the Diabetes Control and Complications Trial,4 when the medical profession was ambivalent about the direct relationship of poor glycemic control (as opposed to inherent aspects of the disease itself) and the complications of diabetes. Because of a lack of definitive information, neither patients nor health care providers felt the burden of responsibility for poor treatment outcomes. Subsequently, neither providers nor patients were motivated to tighten glycemic control. A similar view of obesity may already be the standard of …