Sample Solution

Medication should be discontinued and the child should be re-evaluated if he/she does not have a 0.4% BMI/BMI z-score reduction after taking full dose of anti-obesity medication for 12 weeks.
BARIATRIC SURGERY
Pre-requisites (Endocrine Society recommendations):
1) Adolescent Tanner 4-5, and final/near final adult height.
2) BMI 40kg/m2 or BMI >35kg/m2 and significant extreme comorbidities.
3) Extreme obesity and co-morbidities persist despite lifestyle modification, with or without trial of pharmacotherapy.
4) Psychological evaluation confirms stability & competence of the family
5) Patient demonstrates ability to adhere to the principles of healthy dietary and activity habits.
6) Access to experienced surgeon in medical center.

Contraindications of bariatric surgery: preadolescents, pregnant/ breastfeeding, unresolved eating disorder, untreated psychiatric disorder, or Prader-Willi syndrome.

PREVENTION

Lifestyle behaviors to prevent obesity, rather than intervention to lose weight should be aimed in all children. Efforts must begin early in life, because childhood obesity usually persists into adulthood. Exclusive breastfeeding should be encouraged till 6months of age and maintenance of breastfeeding after introduction of solid food till 12 months of age. Children should limit consumption of sugar-sweetened beverages and fast foods, limit screen time, and consume well balanced diet. Consumption of whole fruits should be encouraged rather than fruit juices. Children and adolescents should engage in at least 20 minutes, ideally 60 minutes, of vigorous physical activity at least 5 days per week to improve metabolic health and reduce the chances of developing obesity. Participation of the parents to help the child develo