Obesity Prevention and Treatment

Ellen S. Rome, MD, MPH* 1. *Associate Professor of Pediatrics, Cleveland Clinic Lerner College of Medicine at Case; Head, Section of Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, OH. After completing this article, readers should be able to: 1. Provide current definitions of pediatric obesity. 2. Identify strategies for recognition and management of the overweight and obese child and adolescent in the office setting. 3. Discuss community solutions for pediatric obesity, including those strategies targeting schools, the built environment, local food availability, and the home. 4. Describe the role of legislation in pediatric obesity, similar to legislative changes affecting other pediatric issues, such as tobacco control. Pediatric obesity has been viewed as a growing epidemic of the past few decades that requires intervention, similar to tobacco use and its accrued medical risks that has prompted multifaceted preventive efforts. Affecting as many as 34% of American children, (1) obesity can be viewed as a top public health threat due to its associated morbidity and mortality. (2) The medical consequences of obesity accounted for 40% of the health-care budget by 2006, with an expected $147 billion in health-care spending alone in 2008. (3) In 2006, obese adults had estimated medical costs $1,429 higher than those for persons of normal weight. (3) For children coming to a pediatric integrated health-care delivery system, expenses were $179 per year higher in obese children versus children who had normal body mass index (BMI). (4) Using the Medical Expenditure Panel Survey data from 2002 to 2005 for children ages 6 to 19 years, the total additional health expenditure in prescription drugs, outpatient appointments, and emergency department visits for children who had elevated BMIs was estimated to be $14.1 billion annually. (5) Pediatric obesity affects all organ systems, (6) with its medical sequelae paralleling the increasing prevalence in younger children. Type 2 diabetes …