There is a clear association between obesity and low self-esteem in adolescents. This relation brings other concerns that include the psychological or emotional harm a weight loss program may infer on a child. Eating disorders may arise, although a supportive, nonjudgmental approach to therapy and attention to the child’s emotional state minimize this risk. A child or parent’s preoccupation with the child’s weight may damage the child’s self-esteem. If weight, diet, and activity become areas of conflict, the relationship between the parent and child may deteriorate.

For most children, prolonged weight maintenance is an appropriate goal in the absence of any secondary complication of obesity, such as mild hypertension or dyslipidemia. However, children with secondary complications of obesity may benefit from weight loss if their BMI is at the 95th percentile or higher. For children older than 7 years, prolonged weight maintenance is an appropriate goal if their BMI is between the 85th and 95th percentile and if they have no secondary complications of obesity. However, weight loss for children in this age group with a BMI between the 85th and 95th percentile who have a nonacute secondary complication of obesity and for children in this age group with a BMI at the 95th percentile or above is recommended by some organizations.

When weight loss goals are set by a medical professional, they should be obtainable and should allow for normal growth. Goals should initially be small; one-quarter of a pound to two pounds per week. An appropriate weight goal for all obese children is a BMI below the 85th percentile, although such a goal should be secondary to the primary goal of weight maintenance via healthy eating and increases in activity.

Components of a Successful Weight Loss Plan Many studies have demonstrated a familial correlation of risk factors for obesity. For this reason, it is important to involve the entire family when treating obesity in children. It has been demonstrated that the long-term effectiveness of a weight control program is significantly improved when the intervention is directed at the parents as well as the child. Below describes beneficial components that should be incorporated into a weight maintenance or weight loss effort for overweight or obese children.

Of the diagnosed cases of childhood obesity, roughly 90% of the cases are considered environmental in nature and about 10% are endogenous in nature.

Orthopedic complications include slipped capital femoral epiphysis that occurs during the adolescent growth spurt and is most frequent in obese children. The slippage causes a limp and/or hip, thigh and knee pain in children and can result in considerable disability.

Blount’s disease (tibia vara) is a growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg. The cause is unknown but is associated with obesity. It is thought to be related to weight-related effects on the growth plate. The inner part of the tibia, just below the knee, fails to develop normally, causing angulation of the bone.

Overweight children with hypertension may experience blurred margins of the optic disks that may indicate pseudotumor cerebri, this creates severe headaches and may lead to loss of visual fields or visual acuity.

Research shows that 25 out of 100 overweight, inactive children tested positive for sleep-disordered breathing. The long-term consequences of sleep-disordered breathing on children are unknown. As in adults, obstructive sleep apnea can cause a lot of complications, including poor growth, headaches, high blood pressure and other heart and lung problems and they are also potentially fatal disorders.

Abdominal pain or tenderness may reflect gall bladder disease, for which obesity is a risk factor in adults, although the risk in obese children may be much lower. Children who are overweight have a higher risk for developing gallbladder disease and gallstones because they may produce more cholesterol, a risk factor for gallstones. Or due to being overweight, they may have an enlarged gallbladder, which may not work properly.

Endocrinologic disorders related to obesity include noninsulin-dependent diabetes mellitus (NIDDM), an increasingly common condition in children that once used to be extremely rare. The link between obesity and insulin resistance is well documented and which is a major contributor to cardiovascular disease.

Hypertension (high blood pressure), and dyslipi-demias (high blood lipids), conditions that add to the long-term cardiovascular risks conferred by obesity are common in obese children.

Childhood obesity also threatens the psychosocial development of children. In a society that places such a high premium on thinness, obese children often become targets of early and systematic discrimination that can seriously hinder healthy development of body image and self-esteem, thus leading to depression and possibly suicide.

In all of these examples, it is recommended that the primary clinician should consult a pediatric obesity specialist about an appropriate weight-loss or weight maintenance program.