According to the World Health Organization, schoolaged
children and youth (aged 5–19 years) whose
weight is greater than the 85 th centile are overweight,
and those whose weight is above the 97 th centile
are obese; younger children (aged 2–5 years) must be over
the 97th centile to be considered overweight and more than
the 99.9th centile to be considered obese.1 A recent Canadian
Health Measures Survey (2009–2011) reported obesity
prevalence among 5- to 17-year-olds at 11.7%, with an additional
19.8% classified as overweight.2 In the United States,
obesity prevalence among 2- to 19-year-olds (2009–2010)
was reported at 16.9%, with another 14.9% considered overweight.
3 Obesity that begins in childhood usually persists into
adulthood4 and is associated with adverse outcomes including
metabolic, cardiovascular, musculoskeletal, neurologic, gastrointestinal,
respiratory and psychosocial disturbances.5–10
The predicted increase in childhood obesity has intensified
the urgency of improving treatment approaches for the
pediatric population.
Treatment of childhood and adolescent obesity is an
active area of research, and a number of systematic reviews
have been published recently.11–17 Comprehensive behavioural
interventions including changes in diet, physical activity
and lifestyles involving individual patients or families are commonly used and generally considered primary modes of
treatment.18–21 Recent research has focused on establishing
the efficacy
of combining pharmacological agents such as
orlistat with conventional behavioural interventions, especially
in adolescents with severe obesity, but these drugs are
associated with potential adverse events.22–24 We aimed to
provide an updated synthesis of the evidence on benefits and
harms of overweight and obesity treatment interventions for
children and adolescents feasible for use in or referral from
primary care, and we examined the features of efficacious
interventions.