Description of Treatment:
Obesity in children and adolescents is a serious and growing public health problem in the United States. The estimated prevalence of obesity in 6 – 19 year olds is 16.5% (Hedley et al., 2004). Obesity is associated with a number of comorbidities in children and adolescents such as type II diabetes, hypertension, hyperlipidemia, coronary artery disease (especially in adult life), obstructive sleep apnea, orthopedic problems, asthma, depression, and pseudotumor cerebri (intracranial hypertension). Treatments for pediatric obesity include dietary modifications, increases in physical activity, behavioral interventions, pharmacotherapy, and bariatric surgery.

Committee Conclusions:

1. Safe treatments for pediatric obesity include exercise and behavioral interventions.
   
2. Any caloric restriction in prepubertal children and very low calorie diets (such as protein sparing modified fasts) for children and adolescents require medical supervision.
   
3. Integration of dietary, exercise, and behavioral treatments for obesity into a multidisciplinary program with appropriately trained personnel appears to be more effective than any of the treatments alone, noting a long-term decrease in excess weight by 10% to 15% in controlled trials. However, small sample sizes and the intensity of the intervention in the studies make generalizing the results to populations in the clinical (non-investigational) setting difficult (Conclusion Grade II).
   
4. There are no long-term results to demonstrate that pharmacological agents for weight loss are safe and efficacious in children and adolescents.
   
5. In contrast to adults, there are no controlled or long-term studies in children or adolescents to show lasting efficacy of bariatric surgery. In the short-term, bariatric surgery appears to lead to significant weight loss with resolution of comorbidities. Based on small case series, bariatric surgical complications in adolescents (age 11 years or greater) are no higher than in adults, although the impact of bariatric surgery on growth, development, metabolic homeostasis, and nutritional balance is unknown. There are no data on bariatric surgery in prepubertal children (age less than 11 years) to permit conclusions regarding safety and efficacy in this population.