Disease management programs targeting obesity in children - Setting the scene for wellness in the future

An epidemic of childhood obesity has been recognized over the past few decades and obesity is now the most common health problem among children in the developed world. Pediatric obesity rates have also increased in developing countries in recent years. There is a widespread perception among health professionals, patients, and families that childhood obesity is mainly a cosmetic problem, with relatively minor health risks. However, there is a large body of consistent and high-quality evidence showing that childhood obesity has significant health risks in both the short term (for the obese child) and in the long term (for the adult who was obese as a child). These include cardiovascular risk factors, fatty liver, psychological ill health, asthma, type 2 diabetes mellitus, inflammation, and orthopedic problems in childhood; and the persistence of obesity, cardiovascular risk factors, premature mortality, and adverse social and economic outcomes in adulthood. Systematic reviews have consistently concluded that high-quality evidence on the management of pediatric obesity is limited. Despite weaknesses in the evidence base, useful guidance on promising strategies to treat pediatric obesity are widely available. Key components of a successful weight management program include an increase in physical activity, dietary modification, targeting reduction in sedentary behaviors, involving parents in treatment, and employing behavioral techniques. These approaches produce modest improvements in weight-related outcomes (10-20% decrease in percentage overweight or 1-3 unit kg/m<sup>2</sup> change in body mass index [BMI]), and can increase physical fitness, enhance psychosocial functioning, and improve cardiovascular and metabolic health. Although treatment programs for obese children appear to be successful, it it widely recognized that broader preventive interventions targeting the school setting, the community, the physical environment, and society are needed to prevent and reduce obesity in children and young people