published in Huisarts Nu mei 2008; 37(4):189-202
· Obesity is defined as an excess of fat mass (adiposity) with deleterious consequences for physical and mental health (evidence level 2). Obesity is described as an energy imbalance: dietary habits, sedentary lifestyle and lack of physical exercise (evidence level 2).
· The easiest way of measuring relative obesity in children is by calculating the Body Mass Index or BMI (evidence level 2): BMI = weight (kg) / height (m) 2. BMI values are recorded on obesity growth curves, based on age and gender (see appendix 1, pp. 197 and 198) (evidence level 2).
· The main risk factors for obesity in children are (evidence level 2): obesity in parents, birth weight, premature adiposity rebound or a rapid upward shift in BMI on obesity curves, social/cultural and environmental factors and the familial and psychological context.
· Breast-feeding as a protective factor against obesity in children is currently the subject of debate.
· Complications of childhood obesity are mainly (evidence level 2): arterial hypertension, poor lipid profile, abnormal glucose metabolism with hyperinsulinism and/or insulin resistance and the risk of diabetes type 2, orthopaedic complications, sleep apnoea and psychological distress. Childhood obesity is an important predictive factor for obesity and associated morbidity/mortality in adult years.
· Evaluating obesity: case history, clinical examination, BMI calculation and plotting BMI on obesity curves, in order to determine the level of obesity, its impact and progression.
· Requests for additional investigations and specialist referral: only in suspected cases of (evidence level 2):
o obesity of endocrine origin (delayed growth rate);
o obesity syndrome (dysmorphic features, psychomotor retardation, mental retardation and somatic abnormalities);
o complicated obesity (respiratory, orthopaedic, cardiovascular, metabolic or psychological symptoms).
· A standard biological blood test (thyroid, lipids, glycaemia) can be requested to detect any possible complications and, above all, to give parents peace of mind (evidence level 3).
· Depending on their availability, how much time they can dedicate to managing the problem and their competence in the dietary field, GPs may also refer the child to a paediatric specialist or a dietician (evidence level 3).
· Therapeutic objectives (evidence level 2): stabilise the child’s weight and change the family’s behaviour and lifestyle habits.
· Treatment includes a combination of interventions (evidence level 3) aimed at behavioural change (behavioural therapy aimed at the family and/or child):
o changing dietary behaviour (dietary education, change in eating habits) (evidence level 2);
o combating sedentary behaviour (evidence level 2);
o encouraging general daily physical activity (evidence level 2).
· Parental involvement (evidence level 2) and environmental engagement must be sought.
Follow-up by the treating doctor is a key strategic element (evidence level 3): support, family encouragement, reassessment of objectives; education; evaluating the response to weight management measures.
· Change in dietary habits, sedentary lifestyle and physical inactivity (evidence level 2).
· Pedagogical intervention in the child’s scholastic and family environment (evidence level 1).
· As tackling childhood obesity is difficult once established, preventive measures should be given priority, as well as measures for early detection of the problem.