Drug treatment has been assessed in obese children, with several studies on the weight-loss drugs orlistat and sibutramine.  Both drugs have a number of side effects.  When used with lifestyle interventions, both drugs show slight improvement versus lifestyle alone.  The authors say: Although evidence exists for slight effectiveness of orlistat and sibutramine when combined with lifestyle intervention, treatment with these drugs is associated with more adverse effects than is lifestyle intervention alone.

The authors suggest a very conservative approach to drug therapy, arguing it should only be used for children in the highest 5 per cent of BMI who have substantial complications of obesity and have failed on lifestyle interventions.

They say: The risks of bariatric surgery are substantial, and long-term safety and effectiveness in children remain largely unknown.  Therefore, surgery should be reserved for only the most severely obese (BMI ?‰?50 kg/m , or ?‰?40 kg/m with important co-morbidities), and even then, considered with extreme caution.

The authors conclude that no evidence-based, clinically meaningful definition of childhood obesity has been established.  Calorie intake and activity recommendations need to be reassessed and better quantified at a population level because of the modern sedentary lifestyles of children.  For individual treatment, the currently recommended calorie prescriptions might be too conservative in view of evolving insight into the energy gap ™.

They say: Despite remaining challenges, glimmers of hope can be seen.  Recent statistics suggest that prevalence of childhood obesity might be stabilising in developed countries. All past efforts made towards prevention and treatment of obesity, though not of notable individual effect in trials, might still have contributed collectively to this trend.

The increased attention that has been directed to obesity by the media might have helped to raise public awareness of energy balance.  Expansion of food-product availability and more informative food labelling by the private sector might have helped the consumer to make better choices. 

We cannot wait to delineate the complex causal web of the obesity epidemic.  Unravelling of even one thread might allow an important degree of prevention.  Efforts to prevent obesity should continue at all levels, with the goal of an outcome that is greater than the sum of its parts.  These efforts should be made in tandem with an increased commitment to more robust research.  We expect that the next 10 years will be a time of new discoveries and collective societal actions that will help to eliminate this scourge of the new millennium.

Efforts to prevent obesity should continue at all levels, with the goal of an outcome that is greater than the sum of its parts. These efforts should be made in tandem with an increased commitment to more robust research. We expect that the next 10 years will be a time of new discoveries and collective societal actions that will help to eliminate this scourge of the new millennium.

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