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2015 ; 54
(10
): 929-40
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Evaluation and Treatment of Severe Obesity in Childhood
#MMPMID25567296
Wickham EP 3rd
; DeBoer MD
Clin Pediatr (Phila)
2015[Sep]; 54
(10
): 929-40
PMID25567296
show ga
Pediatric obesity is highly prevalent in developed countries globally (and
worsening in developing countries) and threatens to shorten the lifespan of the
current generation. At highest risk for weight-related comorbidities including
Type 2 diabetes mellitus, non-alcoholic fatty liver disease and dyslipidemia is a
sub-set of children with severe obesity, often defined as a body mass index (BMI)
percentile ?99(th) percentile for age and sex. The pathophysiology of severe
obesity in childhood is complex, resulting from the dynamic interplay of a myriad
of individual and societal factors including genetic predisposition and health
behaviors contributing to energy imbalance. Approximately 4?6% of children have
severe obesity, representing a common scenario encountered by providers, and
intervention is critical to halt ongoing weight gain and, when possible, reverse
the trend. Clinical approaches promoting behavioral weight loss may result in
modest, albeit clinically significant, reductions in BMI; however, such changes
are often difficult to maintain long-term. Data regarding the impact of targeted
pharmacotherapy including agents such as orlistat are limited in the pediatric
population and again only suggest modest results. However, increasing evidence
suggest that surgical treatment, as an adjunct to ongoing lifestyle changes, may
be a promising option in carefully-screened adolescents with severe obesity and
weight-related comorbidities who are motivated to adhere to the long-term
treatment needs.