Treatment of obesity. What is practical?

At present no firm conclusions can be drawn on the potential efficacy and benefits of therapeutic interventions in obese children and adolescents because there is a lack of studies with high methodological quality that have evaluated therapeutic approaches. However, there is international expert consensus in the field that short-term, rapid weight loss is of little benefit. Rather, one should aim for a lasting stabilization of body weight with a reduction of obesity-associated risks. Elements of therapeutic intervention that appear useful are the reduction of sedentary behavior and promotion of regular physical activity, limitation of fat intake and of the consumption of carbonated soft drinks. No long-term benefits of a low-carbohydrate diet or of diets with low glycemic index have been documented in children. Inpatient therapy should be used only in highly selected patients, if after discharge continued intensive treatment on an outpatient basis is assured. Structured outpatient therapeutic programs in specialized treatment centers appear potentially useful, but are expensive and need to be further developed and evaluated. Simple and cheap behavioral programs appear useful as a first-line therapeutic option for broad application.