Skip to main content

Advertisement

Log in

Treatment of child obesity

  • Clinical Article
  • Published:
Annals of Diagnostic Paediatric Pathology

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Aimez P (1976) Modification of pathogenic dietary behavior. Group technics. Ann Nutr Aliment 30:289–99

    CAS  PubMed  Google Scholar 

  2. Arner P (1995) The beta 3-adrenergic receptor — a cause and cure of obesity? (editorial comment). N Engl J Med 333:382–283

    CAS  PubMed  Google Scholar 

  3. Astrup A, Berum L, Toubro S (1995) Pharmacological and clinical studies of ephedrine and other thermogenic agonists. Obesity Res 3 [Suppl. 4]: 537S–540S

    CAS  Google Scholar 

  4. 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

    CAS  PubMed  Google Scholar 

  5. Atkinson RL, Bland RC, Loper JF, Schumacher D, Lutes RA (1995) Combined drug treatment of obesity. Obesity Res 3 [Suppl 4]:497S–500S

    CAS  Google Scholar 

  6. 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

    CAS  Google Scholar 

  7. 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

    CAS  Google Scholar 

  8. 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

    Google Scholar 

  9. 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

    Google Scholar 

  10. Blundell JE, Lawton CL, Halford JCG (1995) Serotonin, eating behaviour and fat intake. Obesity Res 3 [Suppl 4]:471S–476S

    CAS  Google Scholar 

  11. 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

    Google Scholar 

  12. Bouchard C (1995) Genetics and the metabolic syndrome. Int J Obesity 19 [Suppl 1]:S52–S59

    Google Scholar 

  13. Börjesson M (1962) Overweight in children. Acta Paediatr 51 [Suppl]

  14. Bray G (1995) Pharmacologic treatment of obesity: symposium overview. Obesity Res 3 [Suppl 4]:415S–417S

    Google Scholar 

  15. Bray G (1995) Evaluation of drugs for treating obesity. Obesity Res 3 [Suppl 4]:425S–434S

    CAS  Google Scholar 

  16. 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

    CAS  PubMed  Google Scholar 

  17. Brownell KD, Wadden TA (1991) The heterogeneity of obesity. Behav Ther 22:153–177

    Google Scholar 

  18. 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

    CAS  PubMed  Google Scholar 

  19. Bruch H (1964) Psychological aspects of overeating and obesity. Psychosomatics 5:269–274

    CAS  PubMed  Google Scholar 

  20. Bruch H (1970) Eating disorders in adolescence. Proc Annu Meet Am Psychopathol Assoc 59:181–202

    CAS  PubMed  Google Scholar 

  21. 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

    CAS  PubMed  Google Scholar 

  22. 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

    CAS  PubMed  Google Scholar 

  23. Cole TJ, Freeman JV, Preece MA (1995) Body mass index reference curves for the UK. Arch Dis Child 73: 25–29

    CAS  PubMed Central  PubMed  Google Scholar 

  24. 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

    CAS  PubMed  Google Scholar 

  25. Dare C (1992) Change the family, change the child? Arch Dis Child 67:643–648

    CAS  PubMed Central  PubMed  Google Scholar 

  26. 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

    CAS  PubMed  Google Scholar 

  27. DeLucia JL, Kalodner CR (1990) An individualized cognitive intervention: does it increase the efficacy of behavioral interventions for obesity? Addict Behav 15:473–479

    CAS  PubMed  Google Scholar 

  28. Dietz W (1991) Physical activity and childhood obesity. Nutrition 7:295–296

    CAS  PubMed  Google Scholar 

  29. Drent ML, Veen EA van der (1995) First clinical studies with orlistat: a short review. Obesity Res 3 [Suppl 4]: 623S–625S

    CAS  Google Scholar 

  30. 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

    CAS  PubMed  Google Scholar 

  31. 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

    CAS  PubMed  Google Scholar 

  32. 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

    Google Scholar 

  33. 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

    CAS  PubMed  Google Scholar 

  34. 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

    CAS  PubMed  Google Scholar 

  35. 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

    CAS  PubMed  Google Scholar 

  36. 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

    CAS  PubMed  Google Scholar 

  37. 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

    CAS  Google Scholar 

  38. Erlanson-Albertsson C (1994) Enterostatin — a peptide regulation fat intake. Scand J Nutr 38:11–14

    Google Scholar 

  39. Flodmark CE (1993) Obesity and hyperlipoproteinaemia in children. Thesis, Lund

  40. 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

    CAS  PubMed  Google Scholar 

  41. 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

    CAS  PubMed  Google Scholar 

  42. 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

    CAS  PubMed Central  PubMed  Google Scholar 

  43. 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

    CAS  PubMed  Google Scholar 

  44. 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

    CAS  Google Scholar 

  45. 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

    CAS  PubMed Central  PubMed  Google Scholar 

  46. Ganley RM (1986) Epistemology, family patterns, and psychosomatics: The case of obesity. Fam Process 25: 437–451

    CAS  PubMed  Google Scholar 

  47. 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

    CAS  Google Scholar 

  48. Gortmaker SL, Dietz WH, Sobol AM, Wehler CA (1987) Increasing pediatric obesity in the United States. Am J Dis Child. 141:535–540

    CAS  PubMed  Google Scholar 

  49. 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

    CAS  PubMed  Google Scholar 

  50. 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

    CAS  PubMed  Google Scholar 

  51. Greenberg DA (1993) Linkage analysis of ‘necessary’ disease loci versus ‘susceptibility’ loci. Am J Hum Genet 52:135–143

    CAS  PubMed Central  PubMed  Google Scholar 

  52. Greenswag LR (1987) Adults with Prader-Willi syndrome: a survey of 232 cases. Dev Med Child Neurol 29: 145–152

    CAS  PubMed  Google Scholar 

  53. Gurman A, Kniskern D (1981) Family therapy outcome research: knowns and unknowns. In: Handbook of family therapy. Branner/Mazel, New York, pp 742–751

    Google Scholar 

  54. Gustafsson PA (1987) Family interaction and family therapy in childhood psychosomatic disease. Thesis, Linköping

  55. Guy-Grand G (1995) Clinical studies with dexfenfrulamine: from past to future. Obesity Res 3 [Suppl 4]:491S–496S

    CAS  Google Scholar 

  56. 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

    CAS  PubMed  Google Scholar 

  57. Hansson K (1989) Family diagnosis (in Swedish). Thesis, Lund

  58. 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

    CAS  PubMed Central  PubMed  Google Scholar 

  59. Hazelrigg M, Cooper H, Bourdin C (1987) Evaluating the effectiveness of family therapy: an integrative review and analysis. Psychol Bull 101:428–442

    CAS  PubMed  Google Scholar 

  60. 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

    CAS  PubMed  Google Scholar 

  61. 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

    CAS  Google Scholar 

  62. 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

    CAS  Google Scholar 

  63. 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

    CAS  PubMed  Google Scholar 

  64. 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

    CAS  PubMed  Google Scholar 

  65. Kaslow FW (1974) The family as background to obesity. (The international book of family therapy) Bruner, New York

    Google Scholar 

  66. 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

    Google Scholar 

  67. 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

    Google Scholar 

  68. Kral JG (1992) Surgical treatment of obesity. In: Björntorp P, Brodoff BN (eds) Obesity. Lippincott, Philadelphia

    Google Scholar 

  69. Lask B (1987) Family therapy. BMJ 294:203–204

    CAS  PubMed Central  PubMed  Google Scholar 

  70. Leibel R, Rosenbaum M, Hirsch J (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332:621–628

    CAS  PubMed  Google Scholar 

  71. 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

    Google Scholar 

  72. Lissau I, Sorensen T (1994) Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet 343:324–327

    CAS  PubMed  Google Scholar 

  73. 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

    CAS  Google Scholar 

  74. 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

    CAS  PubMed  Google Scholar 

  75. 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

    CAS  Google Scholar 

  76. Mellbin T, Vuille JC (1989) Rapidly developing overweight in school children as an indicator of psychosocial stress. Acta Paediatr Scand 78:568–575

    CAS  PubMed  Google Scholar 

  77. 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

    CAS  PubMed  Google Scholar 

  78. 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

    CAS  PubMed  Google Scholar 

  79. Minuchin S, Fishman C (1981) Family therapy techniques, 1st edn. Harvard University Press, Cambridge, Mass

    Google Scholar 

  80. 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

    CAS  PubMed  Google Scholar 

  81. Minuchin S, Rosman B, Baker L (1978) Psychosomatic families, 1st edn. Harvard University Press, Cambridge, Mass

    Google Scholar 

  82. 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

    Google Scholar 

  83. 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

    CAS  Google Scholar 

  84. Mossberg HO (1989) 40-year follow-up of overweight children. Lancet II:491–493

    Google Scholar 

  85. 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

    CAS  PubMed  Google Scholar 

  86. 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

    CAS  PubMed  Google Scholar 

  87. Näslund I (1996) Obese on the operating table. Lakartidningen 93:485–488

    PubMed  Google Scholar 

  88. Orhagen T (1992) Working with families in schizophrenic disorders: the practice of psycho-educational intervention. Thesis, Linköping

  89. 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

    CAS  PubMed  Google Scholar 

  90. Porter K (1980) Combined individual and group psychotherapy: a review of the literature 1965–1978. Int J Group Psychother 30:107–114

    CAS  PubMed  Google Scholar 

  91. 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

    CAS  PubMed  Google Scholar 

  92. 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

    PubMed  Google Scholar 

  93. Rumpel C, Harris TB (1994) The influence of weight on adolescent self-esteem. J Psychosom Res 38:547–56

    CAS  PubMed  Google Scholar 

  94. Ryan DH, Kaiser P, Bray GA (1995) Sibutramine: a novel new agent for obesity treatment. Obesity Res 3 [Suppl 4]:553S–559S

    CAS  Google Scholar 

  95. Safer DJ (1991) Diet, behavior modification, and exercise: a review of obesity treatments from a long-term perspective. South Med J 84:1470–1474

    CAS  PubMed  Google Scholar 

  96. 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

    CAS  PubMed  Google Scholar 

  97. Segal K, Dietz W (1991) Physiologic responses to playing a video game. Am J Dis Child 145:1034–1036

    CAS  PubMed  Google Scholar 

  98. Sørensen TI (1988) Obesity in the Scandinavian countries: prevalence and developmental trends. Acta Med Scand Suppl 723:11–16

    PubMed  Google Scholar 

  99. Sørensen TIA (1992) Genetic aspects of obesity. Int J Obesity 16 [Suppl 2]: S27–29

    Google Scholar 

  100. Stuart RB (1967) Behavioral control of overeating. Behav Res Ther 5:357–365

    Google Scholar 

  101. 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

    CAS  PubMed  Google Scholar 

  102. 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

    CAS  Google Scholar 

  103. Wadden TA, Stunkard AJ, Brownell KD (1983) Very low calorie diets: their efficacy, safety and future. Ann Intern Med 99:675–684

    CAS  PubMed  Google Scholar 

  104. 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

    Google Scholar 

  105. 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

    CAS  PubMed  Google Scholar 

  106. 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

    CAS  PubMed  Google Scholar 

  107. 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

    CAS  PubMed  Google Scholar 

  108. 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

    CAS  PubMed  Google Scholar 

  109. Wilson GT (1994) Behavioral treatment of childhood obesity: theoretical and practical implications (editorial comment). Health Psychol 13:371–372

    CAS  PubMed  Google Scholar 

  110. 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

    CAS  PubMed  Google Scholar 

  111. Zakus G, Chin ML, Keown M, Hebert F, Held M (1979) A group behavior modification approach to adolescent obesity. Adolescence 14:481–490

    CAS  PubMed  Google Scholar 

  112. 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

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Flodmark, CE. Treatment of child obesity. Ann Diagn Paed Pathol 2, 37–47 (1998). https://doi.org/10.1007/s100570050007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s100570050007

Keywords

Navigation