Obesity in children. Part 2: Prevention and managementBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1848 (Published 22 October 2008) Cite this as: BMJ 2008;337:a1848
- Ruth R Kipping, research fellow1,
- Russell Jago, senior lecturer2,
- Debbie A Lawlor, professor of epidemiology13
- 1Department of Social Medicine, University of Bristol, Bristol BS8 2PS
- 2Department of Exercise, Nutrition and Health Sciences, University of Bristol, Bristol BS8 ITP
- 3MRC Centre for Causal Analysis in Translational Epidemiology, University of Bristol, Bristol BS8 2BN
- Correspondence to: R Kipping
Few obesity prevention interventions have been shown to be effective in children
Comprehensive strategies that tackle diet and physical activity as well as providing psychosocial support and environmental change may help prevent obesity
Community based interventions aimed at changing activity levels, dietary knowledge, and eating behaviour may be useful but need evaluation for effectiveness and cost effectiveness
Specialist treatment may include treatment with sibutramine or orlistat in children over 12, although long term studies are needed
Surgery is recommended only in adolescents with extreme obesity, in limited circumstances, but the benefits need to be balanced against the possible side effects
In the first part of this article we described how obesity in children is measured, its prevalence, whether children should be screened, and the risk factors for and consequences of obesity.1 In this part we review the current evidence on the prevention and management of childhood obesity.
Sources and selection criteria
This review draws on the Foresight report, guidance from the National Institute for Health and Clinical Excellence and the Australian National Health Medical Research Council, and Cochrane review.
In April 2008 we searched the Cochrane Library database of reviews and the Centre for Reviews and Dissemination databases using the search term “obesity”. We also conducted a Medline search ((Child$ or paediatric or pediatric or adolescent) and (Obes$ or overweight)) limited to 1 January 2005 to 6 May 2008 and “review articles”; this identified 1105 articles. We read the abstracts of these articles and retrieved relevant papers. We also used articles from our own bibliographies collected over the past 10 years.
The evidence to support the measurement, prevention, and management of obesity in children is still relatively weak, with few randomised controlled trials or systematic reviews. The strength of evidence is developing and the updated Cochrane review that will be published in 2009 …