Intensive therapy for severe paediatric morbid obesity

Morbid obesity in children and adolescents can cause life-threatening medical complications such as obstructive sleep apnoea, intracranial pressure and debilitating joint disease that require an aggressive, invasive approach. Studies have shown that a weight reduction of 5-10% can reduce or eliminate the need for invasive procedures in comparable adult populations. The aim of this paper is to describe an inpatient, multidisciplinary programme designed to reduce or eliminate the need for invasive medical procedures in a morbidly obese paediatric population. The programme incorporates the six elements recommended by the Expert Committee on Obesity Evaluation (Barlow & Dietz, 1998): (1) Close monitoring of the medical condition. (2) Moderate caloric restriction to induce a modest (5-10%) weight reduction. (3) Intensive family intervention. (4) Individual behavioural and cognitive therapy. (5) Physical activity education. (6) Gradual community involvement and long-term maintenance. Three patients with different life-threatening medical complications of morbid obesity are described, and the rationale of the programme and its potential role as an alternative or adjunct to invasive medical intervention in severe paediatric morbid obesity are discussed.