Early management of childhood obesity is key to prevent complications such as cardiovascular disease, type 2 diabetes, steatohepatitis and sleep apneoa. Strategies range from environmental changes to lifestyle modification to pharmacotherapy to bariatric surgery.

Environmental strategies include changes to food marketing and labelling, improved education, accessible leisure facilities and the increasing use of fitness wearables and applications. Campaigns such as ‘5-a-day’ for fruit and vegetable intake have done a lot with simple memorable messages to improve awareness.

Lifestyle interventions are the mainstay of paediatric obesity management with an emphasis on simple messages, avoiding added sugars, daily exercise goals, limiting screen time and promoting good sleep hygiene. A whole-family approach is preferred with positive messages about promoting good health and fitness.

Pharmacotherapy of childhood obesity is limited by the lack of medications licensed for use in children, but can be considered for those who are gaining weight despite lifestyle intervention. Licensed medications include Orlistat and GLP-1 analogues for paediatric obesity, Setmelanotide for POMC, proprotein convertase subtilisin/kexin type 1 and LEPR deficiency, and Metreleptin for congenital Leptin deficiency. Other agents are under review but lack sufficient data for paediatric licensing.

Bariatric surgery should be considered in post pubertal children who have obesity with comorbidities, or those with obesity despite lifestyle modifications, but requires an experienced bariatric multi-disciplinary team approach. Ongoing studies have shown that weight loss post bariatric surgery is maintained at 5 year follow up.