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Childhood Obesity and Insulin Resistance: How Should It Be Managed?

  • Pediatric Congenital Heart Disease (G Singh, Section Editor)
  • Published:
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Opinion statement

Concomitant with the rise in global pediatric obesity in the past decades, there has been a significant increase in the number of children and adolescents with clinical signs of insulin resistance. Given insulin resistance is the important link between obesity and the associated metabolic abnormalities and cardiovascular risk, clinicians should be aware of high risk groups and treatment options. As there is no universally accepted biochemical definition of insulin resistance in children and adolescents, identification and diagnosis of insulin resistance usually relies on clinical features such as acanthosis nigricans, polycystic ovary syndrome, hypertension, dyslipidemia, and nonalcoholic fatty liver disease. Treatment for reducing insulin resistance and other obesity-associated comorbidities should focus on changes in health behaviors to achieve effective weight management. Lifestyle interventions incorporating dietary change, increased physical activity, and decreased sedentary behaviors, with the involvement of family and adoption of a developmentally appropriate approach, should be used as the first line treatment. Current evidence suggests that the primary objective of dietary interventions should be to reduce total energy intake and a combination of aerobic and resistance training should be encouraged. Metformin can be used in conjunction with a lifestyle intervention program in obese adolescents with clinical insulin resistance to achieve weight loss and to improve insulin sensitivity. Ongoing evaluation and research are required to explore optimal protocol and long-term effectiveness of lifestyle interventions, as well as to determine whether the improvements in insulin sensitivity induced by lifestyle interventions and weight loss will lead to a clinical benefit including reduced cardiovascular morbidity and mortality.

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All authors declare no potential conflicts of interest.

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Authors and Affiliations

  1. Discipline of Pediatrics and Child’s Health, The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Mandy Ho PhD, APD, RN, Sarah P. Garnett PhD, APD & Louise A. Baur PhD, FRACP

  2. Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead, NSW, Australia

    Mandy Ho PhD, APD, RN & Sarah P. Garnett PhD, APD

  3. Kids Research Institute, The Children’s Hospital at Westmead, Westmead, NSW, Australia

    Sarah P. Garnett PhD, APD & Louise A. Baur PhD, FRACP

Authors
  1. Mandy Ho PhD, APD, RN
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  2. Sarah P. Garnett PhD, APD
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  3. Louise A. Baur PhD, FRACP
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Corresponding author

Correspondence to Mandy Ho PhD, APD, RN.

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This article is part of the Topical Collection on Pediatric Congenital Heart Disease

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Ho, M., Garnett, S.P. & Baur, L.A. Childhood Obesity and Insulin Resistance: How Should It Be Managed?. Curr Treat Options Cardio Med 16, 351 (2014). https://doi.org/10.1007/s11936-014-0351-0

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  • DOI: https://doi.org/10.1007/s11936-014-0351-0

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