THERAPEUTIC STRATEGIES IN CHILDHOOD OBESITY

Childhood obesity leads to approximately 30% of adult obesity. However, the natural history of childhood obesity that persists into adulthood suggests that the obese child who becomes an obese adult will have more severe adult obesity than adults whose obesity began in adulthood. Therefore, to the extent that the severity of obesity predicts morbidity, persistence of childhood obesity may be expected to account for a disproportionate share of the adult sequelae of obesity. Fifty-year follow-up studies of a cohort with adolescent obesity have demonstrated that the mortality and morbidity of cardiovascular disease was significantly increased compared with a cohort that was lean throughout adolescence. Furthermore, the effect of adolescent obesity on adult morbidity and mortality appeared independent of the effects of adolescent obesity on adult weight status. Because truncal fat is deposited during adolescence, adolescent onset obesity may entrain both adult obesity and the effects of adolescent onset obesity on mortality and morbidity. These observations suggest that successful treatment of childhood and adolescent obesity is an effective approach to the prevention of severe adult disease. Recently, follow-up of children treated with diet, exercise and behaviour modification showed significantly lower weights 10 years later than children treated in other ways (p < 0.01). These and other family-based treatments appear to be the most appropriate approaches to the treatment of childhood obesity. However, the prevalence of childhood and adolescent obesity suggests that even the most successful treatment may be of limited benefit if it relies on the traditional medical model (doctor/patient interaction). Therefore, alternatives to the conventional approach to therapy must be considered. These include approaches that focus on groups, schools, or the broader population. The preliminary results from several of these interventions are promising.