Abstract
Prevention of obesity should have the highest priority and be started as early in life as possible in high-risk families. This review covers the most promising areas of today’s research aimed at finding better ways of treating obesity in the future and an overview of the treatment choices available at present. The cause of obesity is genetic in approximately 40–50% of adults and probably a larger proportion of children. This means that it is possible to remain overweight without a higher calorie intake than that of individuals of normal weight who lack the genetic susceptibility to obesity. Treatment is recommended from 10 years of age with a slightly hypocaloric diet (1500 kcal) and a reduced fat content (30 energy-percent). Exercise is often provided naturally by the child before this age. It is helpful to try to replace aspects of our sedentary life-style, including televiewing, with moderate physical activities, such as walking. Family therapy has been effective in introducing these changes in life-style. Other strategies, such as behavioral therapy, have also been tried, individually, in groups, or at school. Cognitive therapy has no advantage over behavioral therapy in childhood obesity. No reports on psychodynamic therapy have been published. Surgery is used only in the case of rare inborn metabolic diseases. Thus, further development of obesity therapy is needed, although the treatment of children seems to give better results than treating adults.
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References
Aimez P (1976) Modification of pathogenic dietary behavior. Group technics. Ann Nutr Aliment 30:289–99
Arner P (1995) The beta 3-adrenergic receptor — a cause and cure of obesity? (editorial comment). N Engl J Med 333:382–283
Astrup A, Berum L, Toubro S (1995) Pharmacological and clinical studies of ephedrine and other thermogenic agonists. Obesity Res 3 [Suppl. 4]: 537S–540S
Atkinson RL, Fuchs A, Pastors JG, Saunders JT (1992) Combination of very low calorie diet and behavior modification in the treatment of obesity. Am J Clin Nutr 56:199S–202S
Atkinson RL, Bland RC, Loper JF, Schumacher D, Lutes RA (1995) Combined drug treatment of obesity. Obesity Res 3 [Suppl 4]:497S–500S
Barkeling B, Ekman S, Rössner S (1992) Eating behaviour in obese and normal weight 11-year-old children. Int J Obesity Relat Metab Disord 16: 355–360
Barkeling B, Rössner S, Sjoberg A (1995) Methodological studies on single meal food intake characteristics in normal weight and obese men and women. Int J Obesity Relat Metab Disord 19:284–290
Björvell H, Rössner S (1992) A ten-year follow-up of weight change in severely obese subjects treated in a combined behavioural modification programme. Int J Obesity Relat Metab Disord 16:623–625
Blundell JE (1996) Food intake and body weight regulation. In: Bouchard C, Bray GA (eds) Regulation of body weight. Biological and behavioral mechanisms. Wiley, Chichester, pp 111–133
Blundell JE, Lawton CL, Halford JCG (1995) Serotonin, eating behaviour and fat intake. Obesity Res 3 [Suppl 4]:471S–476S
Bouchard C (1994) Recent advances in the molecular and genetic basis of human obesity. In: Dischuneit H, Gries FA, Hauner H, Schusdziarra V, Wechsler JG (eds) Proceedings of the 5th European Congress on Obesity. Libbey, London
Bouchard C (1995) Genetics and the metabolic syndrome. Int J Obesity 19 [Suppl 1]:S52–S59
Börjesson M (1962) Overweight in children. Acta Paediatr 51 [Suppl]
Bray G (1995) Pharmacologic treatment of obesity: symposium overview. Obesity Res 3 [Suppl 4]:415S–417S
Bray G (1995) Evaluation of drugs for treating obesity. Obesity Res 3 [Suppl 4]:425S–434S
Brownell KD, Kaye FS (1982) A school-based behavior modification, nutrition education, and physical activity program for obese children. Am J Clin Nutr 35:277–283
Brownell KD, Wadden TA (1991) The heterogeneity of obesity. Behav Ther 22:153–177
Brownell KD, Kelman JH, Stunkard AJ (1983) Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 71:515–523
Bruch H (1964) Psychological aspects of overeating and obesity. Psychosomatics 5:269–274
Bruch H (1970) Eating disorders in adolescence. Proc Annu Meet Am Psychopathol Assoc 59:181–202
Campfield LA, Smith FJ, Guisez Y, Devos R, Burn P (1995) Recombinant mouse OB protein: evidence for a peripheral signal linking adiposity and central neural networks (see comments). Science 269:546–549
Clement K, Vaisse C, Manning B, Basdevant A, Guy-Grand B, Ruiz J, Silver K, Shuldiner A, Froguel P, Strosberg AD (1995). Genetic variation in the b3-adrenergic receptor and an increased capacity to gain weight in patients with morbid obesity. N Engl J Med 333:352–354
Cole TJ, Freeman JV, Preece MA (1995) Body mass index reference curves for the UK. Arch Dis Child 73: 25–29
Considine R, Sinha M, Heiman M, Kriaciunas A, Stephens T, Nyce M, Ohannesian J, Marco C, McKee L, Bauer T, Caro J (1996) Serum immunoreactive-leptin concentrations in normal weight and obese humans. N Engl J Med 334:292–295
Dare C (1992) Change the family, change the child? Arch Dis Child 67:643–648
Davis K, Christoffel KK (1994) Obesity in pre-school and school-age children. Treatment early and often may be best. Arch Pediatr Adolesc Med 148:1257–1261
DeLucia JL, Kalodner CR (1990) An individualized cognitive intervention: does it increase the efficacy of behavioral interventions for obesity? Addict Behav 15:473–479
Dietz W (1991) Physical activity and childhood obesity. Nutrition 7:295–296
Drent ML, Veen EA van der (1995) First clinical studies with orlistat: a short review. Obesity Res 3 [Suppl 4]: 623S–625S
Duffy G, Spence SH (1993) The effectiveness of cognitive self-management as an adjunct to a behavioural intervention for childhood obesity: a research note. J Child Psychol Psychiatry 34:1043–1050
Echwald SM, Sorensen TD, Sorensen TI, Tybjaerg Hansen A, Andersen T, Chung WK, Leibel RL, Pedersen O (1997) Amino acid variants in the human leptin receptor: lack of association to juvenile onset obesity. Biochem Biophys Res Commun 233: 248–252
Epstein LH (1993) New developments in childhood obesity. In: Stunkard AJ, Wadden TA (eds) Obesity. Theory and therapy, 2nd edn. Raven Press, New York, pp 301–312
Epstein LH, Wing RR, Steranchak L, Dickson B, Michelson J (1980) Comparison of family based behavior modification and nutrition education for childhood obesity. J Pediatr Psychol 5:25–36
Epstein LH, Valoski A, Wing RR, McCurley J (1990) Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 264: 2519–2523
Epstein LH, Valoski A, McCurley J (1993) Effect of weight loss by obese children on long-term growth. Am J Dis Child 147:1076–1080
Epstein LH, Valoski AM, Vara LS, McCurley J, Wisniewski L, Kalarchian MA, Klein KR, Shrager LR (1995) Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol 14:109–115
Epstein LH, Valoski AM, Kalarchian MA, McCurley J (1995) Do children lose and maintain weight easier than adults: a comparison of child and parent weight changes from six months to ten years. Obesity Res 3:411–417
Erlanson-Albertsson C (1994) Enterostatin — a peptide regulation fat intake. Scand J Nutr 38:11–14
Flodmark CE (1993) Obesity and hyperlipoproteinaemia in children. Thesis, Lund
Flodmark CE, Ohlsson T, Ryden O, Sveger T (1993) Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy. Pediatrics 91:880–884
Francke S, Clement K, Dina C, Inoue H, Behn P, Vatin V, Basdevant A, Guy Grand B, Permutt MA, Froguel P, Hager J (1997) Genetic studies of the leptin receptor gene in morbidly obese French Caucasian families. Hum Genet 100:491–496
Freeman JV, Cole TJ, Chinn S, Jones PR, White EM, Preece MA (1995) Cross-sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 73:17–24
Fujisawa T, Ikegami H, Yamato E, Takekawa K, Nakagawa Y, Hamada Y, Oga T, Ueda H, Shintani M, Fukuda M, Ogihara T (1996) Association of Trp64Arg mutation of the beta3-adrenergic-receptor with NIDDM and body weight gain. Diabetologia 39:349–352
Fumeron F, Durack Bown I, Betoulle D, Cassard Doulcier AM, Tuzet S, Bouillaud F, Melchior JC, Ricquier D, Apfelbaum M (1996) Polymorphisms of uncoupling protein (UCP) and beta 3 adrenoreceptor genes in obese people submitted to a low calorie diet. Int J Obesity Relat Metab Disord 20: 1051–1054
Gagnon J, Mauriege P, Roy S, Sjostrom D, Chagnon YC, Dionne FT, Oppert JM, Perusse L, Sjostrom L, Bouchard C (1996) The Trp64Arg mutation of the beta3 adrenergic receptor gene has no effect on obesity phenotypes in the Quebec Family Study and Swedish Obese Subjects cohorts. J Clin Invest 98:2086–2093
Ganley RM (1986) Epistemology, family patterns, and psychosomatics: The case of obesity. Fam Process 25: 437–451
Goldstein DJ, Rampey AH, Roback PJ, Wilson MG, Hamilton SH, Sayler ME, Tollefson GD (1995) Efficacy and safety of long-term fluoxetine treatment of obesity — maximizing success. Obesity Res 3 [Suppl 4]: 481S–490S
Gortmaker SL, Dietz WH, Sobol AM, Wehler CA (1987) Increasing pediatric obesity in the United States. Am J Dis Child. 141:535–540
Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH (1993) Social and economic consequences of overweight in adolescence and young adulthood (see comments). N Engl J Med 329:1008–1012
Gotoda T, Manning BS, Goldstone AP, Imrie H, Evans AL, Strosberg AD, McKeigue PM, Scott J, Aitman TJ (1997) Leptin receptor gene variation and obesity: lack of association in a white British male population. Hum Mol Genet 6:869–876
Greenberg DA (1993) Linkage analysis of ‘necessary’ disease loci versus ‘susceptibility’ loci. Am J Hum Genet 52:135–143
Greenswag LR (1987) Adults with Prader-Willi syndrome: a survey of 232 cases. Dev Med Child Neurol 29: 145–152
Gurman A, Kniskern D (1981) Family therapy outcome research: knowns and unknowns. In: Handbook of family therapy. Branner/Mazel, New York, pp 742–751
Gustafsson PA (1987) Family interaction and family therapy in childhood psychosomatic disease. Thesis, Linköping
Guy-Grand G (1995) Clinical studies with dexfenfrulamine: from past to future. Obesity Res 3 [Suppl 4]:491S–496S
Halaas JL, Gajiwala KS, Maffei M, Cohen SL, Chait BT, Rabinowitz D, Lallone RL, Burley SK, Friedman JM (1995) Weight-reducing effects of the plasma protein encoded by the obese gene (see comments). Science 269: 543–546
Hansson K (1989) Family diagnosis (in Swedish). Thesis, Lund
Hasstedt SJ, Hoffman M, Leppert MF, Elbein SC (1997) Recessive inheritance of obesity in familial noninsulin-dependent diabetes mellitus, and lack of linkage to nine candidate genes. Am J Hum Genet 61:668–677
Hazelrigg M, Cooper H, Bourdin C (1987) Evaluating the effectiveness of family therapy: an integrative review and analysis. Psychol Bull 101:428–442
Higashi K, Ishikawa T, Ito T, Yonemura A, Shige H, Nakamura H (1997) Association of a genetic variation in the beta 3-adrenergic receptor gene with coronary heart disease among Japanese. Biochem Biophys Res Commun 232:728–730
Hinney A, Lentes KU, Rosenkranz K, Barth N, Roth H, Ziegler A, Hennighausen K, Coners H, Wurmser H, Jacob K, Romer G, Winnikes U, Mayer H, Herzog W, Lehmkuhl G, Poustka F, Schmidt MH, Blum WF, Pirke KM, Schafer H, Grzeschik KH, Remschmidt H, Hebebrand J (1997) Beta 3-adrenergic-receptor allele distributions in children, adolescents and young adults with obesity, underweight or anorexia nervosa. Int J Obesity Relat Metab Disord 21:224–230
Horton T, Geissler C (1996) Postprandial thermogenesis with ephedrine, caffein and aspirin in lean, predisposed obese and obese women. Int J Obesity 20:91–97
Jeyasingam CL, Bryson JM, Caterson ID, Yue DK, Donnelly R (1997) Expression of the beta 3-adrenoceptor gene polymorphism (Trp64Arg) in obese diabetic and non-diabetic subjects. Clin Exp Pharmacol Physiol 24: 733–735
Kalodner CR, DeLucia JL (1991) The individual and combined effects of cognitive therapy and nutrition education as additions to a behavior modification program for weight loss. Addict Behav 16:255–263
Kaslow FW (1974) The family as background to obesity. (The international book of family therapy) Bruner, New York
Kendall P, Lochman J (1994) Cognitive-behavioural therapies. In: Rutter M, Taylor E, Hersov L (eds) Child and adolescent psychiatry. Blackwell, London, pp 844–857
Kim Motoyama H, Yasuda K, Yamaguchi T, Yamada N, Katakura T, Shuldiner AR, Akanuma Y, Ohashi Y, Yazaki Y, Kadowaki T (1997) A mutation of the beta 3-adrenergic receptor is associated with visceral obesity but decreased serum triglyceride. Diabetologia 40:469–472
Kral JG (1992) Surgical treatment of obesity. In: Björntorp P, Brodoff BN (eds) Obesity. Lippincott, Philadelphia
Lask B (1987) Family therapy. BMJ 294:203–204
Leibel R, Rosenbaum M, Hirsch J (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332:621–628
Lissau L, Sorensen T (1992) Prospective study of the influence of social factors in childhood on risk of overweight in young adulthood. Int J Obesity Relat Metab Disord 16:169–175
Lissau I, Sorensen T (1994) Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet 343:324–327
Lissau I, Breum L, Sorensen T (1993) Maternal attitude to sweet eating habits and risk of overweight in offspring: a ten-year prospective population study. Int J Obesity Relat Metab Disord 17:125–129
Long CG, Simpson CM, Allott EA (1983). Psychological and dietetic counselling combined in the treatment of obesity: a comparative study in a hospital outpatient clinic. Hum Nutr Appl Nutr 37:94–102
Maffeis C, Schutz Y, Piccoli R, Gonfiantini E, Pinelli L (1993) Prevalence of obesity in children in north-east Italy. Int J Obesity Relat Metab Disord 17:287–294
Mellbin T, Vuille JC (1989) Rapidly developing overweight in school children as an indicator of psychosocial stress. Acta Paediatr Scand 78:568–575
Mellbin T, Vuille JC (1989) Further evidence of an association between psychosocial problems and increase in relative weight between 7 and 10 years of age. Acta Paediatr Scand 78:576–580
Menghetti E, Marulli P, Montaleone M, Liberti A, Cellitti R, Di F, G, Lipenda J (1995) Dietetic counselling of obese school children. Study in an elementary school. Pediatr Med Chir 17:349–351
Minuchin S, Fishman C (1981) Family therapy techniques, 1st edn. Harvard University Press, Cambridge, Mass
Minuchin S, Baker L, Rosman BL, Liedman R, Milman L, Todd TC (1975) A conceptual model of psychosomatic illness in children: family organisation and family therapy. Arch Gen Psychiatry 32:1031–1038
Minuchin S, Rosman B, Baker L (1978) Psychosomatic families, 1st edn. Harvard University Press, Cambridge, Mass
Miura J, Arai K, Tsukahara S, Ohno M, Ikeda Y (1989) The long-term effectiveness of combined therapy by behavior modification and very low calorie diet: 2 years follow-up. Int J Obesity 2:73–77
Moriarty M, Wing RR, Kuller LH, Ferrell RE (1997) Trp64Arg substitution in the beta 3-adrenergic receptor does not relate to body weight in healthy, premenopausal women. Int J Obesity Relat Metab Disord 21:826–829
Mossberg HO (1989) 40-year follow-up of overweight children. Lancet II:491–493
Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH (1992) Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 327:1350–1355
Nagase T, Aoki A, Yamamoto M, Yasuda H, Kado S, Nishikawa M, Kugai N, Akatsu T, Nagata N (1997) Lack of association between the Trp64 Arg mutation in the beta 3-adrenergic receptor gene and obesity in Japanese men: a longitudinal analysis. J Clin Endocrinol Metab 82: 1284–1287
Näslund I (1996) Obese on the operating table. Lakartidningen 93:485–488
Orhagen T (1992) Working with families in schizophrenic disorders: the practice of psycho-educational intervention. Thesis, Linköping
Pelleymounter MA, Cullen MJ, Baker MB, Hecht R, Winters D, Boone, T, Collins F (1995) Effects of the obese gene product on body weight regulation in ob/ob mice (see comments). Science 269:540–543
Porter K (1980) Combined individual and group psychotherapy: a review of the literature 1965–1978. Int J Group Psychother 30:107–114
Roberts SB, Savage J, Coward WA, Chew B, Lucas A (1988) Energy expenditure and intake in infants born to lean and overweight mothers. N Engl J Med 318:461–466
Rössner S, Barkeling B, Erlanson Albertsson C, Larsson P, Wahlin, Boll E (1995) Intravenous enterostatin does not affect single meal food intake in man. Appetite 24:37–42
Rumpel C, Harris TB (1994) The influence of weight on adolescent self-esteem. J Psychosom Res 38:547–56
Ryan DH, Kaiser P, Bray GA (1995) Sibutramine: a novel new agent for obesity treatment. Obesity Res 3 [Suppl 4]:553S–559S
Safer DJ (1991) Diet, behavior modification, and exercise: a review of obesity treatments from a long-term perspective. South Med J 84:1470–1474
Sakane N, Yoshida T, Umekawa T, Kondo M, Sakai Y, Takahashi T (1997) Beta 3-adrenergic-receptor polymorphism: a genetic marker for visceral fat obesity and the insulin resistance syndrome. Diabetologia 40: 200–204
Segal K, Dietz W (1991) Physiologic responses to playing a video game. Am J Dis Child 145:1034–1036
Sørensen TI (1988) Obesity in the Scandinavian countries: prevalence and developmental trends. Acta Med Scand Suppl 723:11–16
Sørensen TIA (1992) Genetic aspects of obesity. Int J Obesity 16 [Suppl 2]: S27–29
Stuart RB (1967) Behavioral control of overeating. Behav Res Ther 5:357–365
Thompson DB, Ravussin E, Bennett PH, Bogardus C (1997) Structure and sequence variation at the human leptin receptor gene in lean and obese Pima Indians. Hum Mol Genet 6:675–679
Vogler GP, Sørensen TI, Stunkard AJ, Srinivasan MR, Rao DC (1995) Influences of genes and shared family environment on adult body mass index assessed in an adoption study by a comprehensive path model. Int J Obesity Relat Metab Disord 19:40–45
Wadden TA, Stunkard AJ, Brownell KD (1983) Very low calorie diets: their efficacy, safety and future. Ann Intern Med 99:675–684
Wadden TA, Sternberg JA, Letizia KA, Stunkard AJ, Foster GD (1989) Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obesity Relat Metab Disord 2:39–46
Wadden TA, Foster GD, Letizia KA (1994) One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. J Consult Clin Psychol 62:165–171
Walston J, Silver K, Bogardus C, Knowler WC, Celi FS, Austin S, Manning B, Strosberg AD, Stern MP, Raben N (1995) Time of onset of non-insulin-dependent diabetes mellitus and genetic variation in the beta3-adrenergic-receptor gene (see comments). N Engl J Med 333:343–347
Ward D, Bar-Or E (1986) Role of the physician and physical education teacher in the treatment of obesity at school. Pediatrician 13:44–51
Widen E, Lehto M, Kanninen T, Walston J, Shuldiner A, Groop L (1995) Association of a polymorphism in the b3-adrenergic receptor gene with features of the insulin resistance syndrome in Finns. N Engl J Med 333:348–351
Wilson GT (1994) Behavioral treatment of childhood obesity: theoretical and practical implications (editorial comment). Health Psychol 13:371–372
Yuan X, Yamada K, Koyama K, Ichikawa F, Ishiyama S, Koyanagi A, Koyama W, Nonaka K (1997) Beta 3-adrenergic receptor gene polymorphism is not a major genetic determinant of obesity and diabetes in Japanese general population. Diabetes Res Clin Pract 37:1–7
Zakus G, Chin ML, Keown M, Hebert F, Held M (1979) A group behavior modification approach to adolescent obesity. Adolescence 14:481–490
Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman JM. (1994) Positional cloning of the mouse obese gene and its human homologue. Nature 372:425–432
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Flodmark, CE. Treatment of child obesity. Ann Diagn Paed Pathol 2, 37–47 (1998). https://doi.org/10.1007/s100570050007
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DOI: https://doi.org/10.1007/s100570050007