Obesity treatment programs for children and adolescents rarely have weight loss as a goal. Rather, the aim is to slow or halt weight gain so the child will grow into his or her body weight over a period of months to years. Dietz (1983) estimates that for every 20 percent excess of ideal body weight, the child will need one and one-half years of weight maintenance to attain ideal body weight.

Early and appropriate intervention is particularly valuable. There is considerable evidence that childhood eating and exercise habits are more easily modified than adult habits (Wolf, Cohen, Rosenfeld, 1985). Three forms of intervention include:

1. Physical Activity

Adopting a formal exercise program, or simply becoming more active, is valuable to burn fat, increase energy expenditure, and maintain lost weight. Most studies of children have not shown exercise to be a successful strategy for weight loss unless coupled with another intervention, such as nutrition education or behavior modification (Wolf et al., 1985). However, exercise has additional health benefits. Even when children's body weight and fatness did not change following 50 minutes of aerobic exercise three times per week, blood lipid profiles and blood pressure did improve (Becque, Katch, Rocchini, Marks, & Moorehead, 1988).

2. Diet Management

Fasting or extreme caloric restriction is not advisable for children. Not only is this approach psychologically stressful, but it may adversely affect growth and the child's perception of "normal" eating. Balanced diets with moderate caloric restriction, especially reduced dietary fat, have been used successfully in.treating obesity (Dietz, 1983). Nutrition education may be necessary. Diet management coupled with exercise is an effective treatment for childhood obesity (Wolf et al., 1985).

3. Behavior Modification

Many behavioral strategies used with adults have been successfully applied to children and adolescents: self-monitoring and recording food intake and physical activity, slowing the rate of eating, limiting the time and place of eating, and using rewards and incentives for desirable behaviors. Particularly effective are behaviorally based treatments that include parents (Epstein et al., 1987). Graves, Meyers, and Clark (1988) used problem-solving exercises in a parent-child behavioral program and found children in the problem-solving group, but not those in the behavioral treatment-only group, significantly reduced percent overweight and maintained reduced weight for six months. Problem-solving training involved identifying possible weight-control problems and, as a group, discussing solutions.

Self-monitoring

-- accomplished by food and activity diaries, which help the child become moreaware of his or her eating and exercise patterns.

Nutrition Education

- aimed at both the child and the family. It should include the components of a healthy diet and an understanding of food labels and the importance of dietary fiber. The patient should be taught that 3,500 calories equals one pound, that there are nine calories per gram of fat and only four calories per gram of carbohydrate or protein. Furthermore, 25 percent of the energy from carbohydrates will be used in its conversion and storage as fat in the body.

Surgery and medications

If your child has been struggling with his or her weight for a long time, you might think that surgery or medications can help. But these treatments aren't often used for children.

Weight-loss surgery

Because of the risks involved and possible long-term complications, weight-loss (bariatric) surgery is rarely considered for obese adolescents. The effects of surgery on adolescents' growing minds and bodies are largely unknown. However, if your child's severe weight poses greater health threats than the potential risks of surgery, your doctor may consider weight-loss surgery as an option.

Even so, surgery isn't the easy answer for weight loss. It doesn't guarantee that your child loses all of his or her excess weight or that your child keeps it off long term. It also doesn't replace the need for following a healthy diet and regular physical activity program.

Medications

Two prescription weight-loss drugs are available for adolescents: sibutramine (Meridia) and orlistat (Xenical). Sibutramine, which is approved for adolescents older than 16, alters the brain's chemistry to make the body feel fuller more quickly. Orlistat, which is approved for adolescents older than 12, prevents the absorption of fat in the intestines.

Though available, these drugs are rarely prescribed to adolescents. The risks of taking the medications long term are still unknown, and their effect on weight loss and weight maintenance for adolescents is still questioned. And, once again, weight-loss drugs don't replace the need to adopt a healthy diet and exercise regimen.