The office diagnosis and treatment of pediatric and adolescent obesity

Obesity is a common problem among U.S. children and adolescents, and the office-based pediatrician is often approached by patients and their parents seeking advice about weight loss. After a history, physical examination, and selected laboratory studies are performed, the pediatrician will usually find that the obesity is due to excessive caloric intake with inadequate caloric expenditure. Although treatment for obesity is a long-term, difficult process, the interested pediatrician can offer patients the tools for successful weight loss. The goal of treatment of mild obesity in children and growing adolescents should be to decrease the rate of weight gain, while moderately obese children can lose weight slowly without compromising linear growth. This treatment should be individualized, planned in conjunction with the patient and his family, based on previous eating habits. Simple guidelines to reduce fat intake will result in a significant reduction in caloric intake in most American diets, so modifying the patient's nutritional pattern to contain less fat is an important first step in treatment. In addition to dietary changes, other lifestyle changes, including the reduction of television viewing and the establishment of a pattern of regular aerobic exercise, will increase the likelihood of success in maintained weight normalization.