Childhood obesity in the United States continues to alarm experts, affecting one in three children in 2010, according to KidsHealth.org. Obese children may develop serious health complications, including type 2 diabetes, hypertension and elevated cholesterol. Effective weight management incorporates behavior, family involvement and possible medical intervention to combat the risks associated with childhood obesity.
Obesity
Health care professionals typically use body mass index, or BMI, to rank levels of obesity in children and adolescents. To arrive at BMI, physicians divide an individual's body weight in kilos by his height in meters squared. Although BMI is not a perfect indicator of body fat, KidsHealth notes that a BMI at or above the 95th percentile may indicate obesity and the need for a weight management program, as directed by your physician.
Behavioral Intervention
Weight management programs focused on behavioral interventions include counseling and education regarding balanced nutrition and may include education regarding physical activity. A 2008 study prepared by Dr, Evelyn P. Whitlock et al. for the U.S. Department of Health and Human Services evaluated behavioral programs conducted over the internet or organized by schools and medically managed weight loss clinics for children and adolescents. The average weight loss was three to 23 pounds. Loosely structured programs conducted over the internet or school-based settings had the lowest effect on BMI. Any program that combined nutritional counseling and physical exercise showed better success than those that focused only on diet or activity.
Medication Plus Behavior
According to the 2008 Health and Human Services study, programs that included behavioral intervention and sibutramine, an appetite suppressant, or orlistat, a fat absorption blocker, for six to 12 months showed mixed results but an overall reduction in BMI as compared to behavioral intervention alone. Sibutramine showed the most reduction in BMI, an average of 1.6 to 2.7 kg/m2. Orlistat, on average, reduced BMI by 0.5 to 0.85 kg/m2. Side effects of these medications ranged from mild increase in heart rate and blood pressure with sibutramine to abdominal pain and fecal incontinence with orlistat.
Surgical Intervention
Doctors might recommend surgical intervention for weight management in morbidly obese adolescents who have diabetes, hypertension or other serious health issues or for those at risk of developing these conditions due to their weight. The 2008 Health and Human Services study noted that adolescents undergoing laparoscopic adjustable gastric banding showed reduction in BMI of 5.0 to 8.1 kg/m2 after six months and 9.4 to 10.2 kg/m2 after nine months. The bypass procedures showed 15 to 20 kg/m2 reduction in BMI after one year. Before surgical intervention is undertaken, participants undergo several months of counseling regarding behavioral intervention and psychological assessments. Surgical complications ranged from a repeat surgery to reposition banding in 10 to 15 percent of patients undergoing laparoscopic procedures to severe complications in 5 percent of those undergoing gastric bypass. No deaths were reported in the study.
Group Effort
Comprehensive programs, like the one offered at Lucile Packard Children's Hospital in California, incorporate teams of professionals to help children or adolescents and their families get involved in healthy weight practices. Their program includes evaluation by physicians, psychologists and nutritionists to define and explain the factors leading to a patient's obesity. They design a multifaceted approach for participants that include individual and group behavioral intervention involving the entire family. Physicians may refer participants for surgical intervention or utilize medication as necessary. The program reports a more than 80 percent success rate since 1999.
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