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Management of childhood obesity in the primary care setting

Author
Joseph A Skelton, MD, MS
Section Editors
Martin I Lorin, MD
Kathleen J Motil, MD, PhD
Melvin B Heyman, MD, MPH
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

A variety of mechanisms participate in weight regulation and the development of obesity in children, including genetics, developmental influences ("metabolic programming", or epigenetics), and environmental factors. The relative importance of each of these mechanisms is the subject of ongoing research and probably varies considerably between individuals and populations. (See "Definition; epidemiology; and etiology of obesity in children and adolescents", section on 'Etiology' and "Obesity in adults: Etiology and natural history".)

Among these potential mechanisms, only environmental factors are potentially modifiable during infancy and childhood. Therefore, prevention and treatment of overweight and obesity in children in the primary care setting focuses on modifying behaviors that lead to excessive energy intake and insufficient energy expenditure. Experts who focus on cardiovascular health (rather than obesity per se) recommend very similar health behaviors, with a slightly different perspective. (See "Pediatric prevention of adult cardiovascular disease: Promoting a healthy lifestyle and identifying at-risk children".)

This topic review will address interventions to prevent and treat childhood obesity in the primary care setting. The definitions, epidemiology, and comorbidities of childhood obesity are discussed in separate topic reviews. Surgical treatment of severe obesity in adolescents also is discussed separately. (See "Definition; epidemiology; and etiology of obesity in children and adolescents" and "Comorbidities and complications of obesity in children and adolescents" and "Surgical management of severe obesity in adolescents".)

GUIDING PRINCIPLES

Few long-term randomized trials are available to determine which techniques to prevent or treat obesity are effective. Moreover, several of the techniques that have been addressed in clinical trials may not be practical for use in a clinical setting. Nonetheless, a number of approaches are recommended by expert consensus, based on clinical experience, inferences drawn from observing obesity-associated behaviors, and short-term evidence-based trials [1-9].

Recommendations for primary care providers center on:

                                 

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Literature review current through: Nov 2016. | This topic last updated: Thu Nov 10 00:00:00 GMT+00:00 2016.
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