Although rare in the past, obesity is now among the most widespread medical problems affecting children and adolescents living in the developed countries. About 15% of adolescents (12-19 years of age) and children (6-11 years of age) are obese in the United States. Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems such as high cholesterol, high blood pressure, early heart disease, diabetes, bone problems and skin conditions such as heat rash, fungal infections, and acne. Children become overweight and obese for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as a hormonal problem. A child’s total diet and activity level play an important role in determining a child’s weight. As computers and video games become increasingly popular, the number of hours of inactivity may increase.
An early behavioral treatment may be one way to reduce treatment failures during adolescence. Behavioral treatment is successful when initiated early in life both for moderately and severely obese children. The behavioral treatment of obesity consists of a set of principles and techniques to help overweight individuals modify inappropriate eating and activity habits. This approach produces an average loss of around 8.5 kg (9% of initial weight) in approximately 20 weeks. The maintenance of weight loss is facilitated by the provision of long-term patient-provider contact as well as by the use of weight-loss medications. The most promising results are likely to be obtained when behavioral and pharmacologic approaches are combined. Also, treating obese individuals with respect and compassion is extremely important.
Adolescents with severe obesity show no effect at all of behavioral treatment, while those adolescents with moderate obesity show a response that is much less pronounced than for younger children with moderate obesity. For the severely obese adolescents, new treatment modalities such as gastric banding or gastric bypass need to be developed and tested. Laparoscopic Roux-en-Y gastric bypass involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions. In laparoscopic adjustable gastric banding, surgeons place a band-like device around the stomach, dividing the stomach into two smaller compartments.