Childhood obesity: early detection and management

Abstract

Obesity is a chronic, complex, and relapsing disease associated with genetic, physiological, socioeconomic, and environmental factors, representing a major global public health challenge¹. In Argentina, 13.6% of children under 5 years of age and 41.1% of children and adolescents aged 5–17 years have excess weight².

Pediatric obesity is associated with an increased risk of obesity in adulthood and exposes children and adolescents to serious short and long term adverse health outcomes, including cardiovascular disease and diabetes¹.

Body mass index (BMI) correlates well with the degree of adiposity and, at the population level, with the risk of comorbidities and mortality. Despite its limitations, BMI remains the recommended tool for screening and diagnosing overweight and obesity. It should be complemented by other anthropometric measurements, such as waist circumference. Personal and family medical history, physical examination findings, and appropriate laboratory investigations should also be considered^1,2.

Children and adolescents with overweight or obesity should undergo a comprehensive evaluation, including medical history, physical examination, psychological assessment, screening for eating disorders, and evaluation of the social determinants of health. The presence of obesity-related comorbidities should also be assessed. Laboratory testing should be guided by the patient's age, clinical presentation, and medical history¹.

The prevention, diagnosis, and treatment of obesity without comorbidities should be managed by pediatricians in the primary care setting. Children and adolescents who do not respond adequately to initial treatment or who present with obesity-related comorbidities should be referred to a pediatric nutrition specialist and a multidisciplinary team².

Treatment should be comprehensive and include multicomponent behavioral and psychological interventions encompassing nutrition, physical activity, and psychological support. Care should adopt a patient- and family-centered approach, recognizing obesity as a chronic disease while avoiding weight stigma. Pediatric obesity specialists should consider weight loss pharmacotherapy as an adjunct to lifestyle interventions after carefully evaluating its indications, risks, and potential benefits^1,3.

Further evidence is needed regarding optimal weight-loss targets and the long-term risks and benefits of available interventions⁴.

Addressing the primary prevention of childhood obesity remains a fundamental public health priority³.