Comment: The global epidemic of childhood obesity: is there a role for the paediatrician?

Is there a role for the paediatrician in the global epidemic of childhood obesity? The answer should be obvious. When parents and the society are concerned about child health, they still turn to health professionals caring for children and adolescents, such as paediatricians, family practitioners , general practitioners or nurses. The report of the International Obesity TaskForce to the World Health Organization in this issue of Obesity Reviews (1) estimates that about 10% of young people aged 5–17 years are overweight , among which 2–3% are obese, corresponding for the year 2000 to 155 million overweight children including 30–45 million obese children worldwide. This report also describes how the burden of paediatric obesity is unequally distributed between regions of the world, and even between populations within countries. While paediatric obesity is still a relatively marginal problem in Sub-Saharan Africa and in large parts of the Asia-Pacific region, it is rapidly becoming the most frequent chronic paediatric condition in many countries of the Americas, Europe and the Near/ Middle East. Therefore, at least in these regions, the primary health care providers for children can no longer ignore such a frequent problem. Most paediatricians actually are very concerned about obesity in their young patients, and feel that they have to do something about it, anything! But most also feel unprepared, ill-equipped, and frankly ineffective to address the problem (2). One of the reasons for the paediatrician's awkwardness with the obesity epidemic is that the approach of obese children and adolescents has almost only focused on weight loss. Pediatricians often do not have the training and the skills for weight management using behaviour modification (2), and such programmes are difficult to implement in the office setting under the classic acute paediatric care model. Most approaches involve a team, including a dietitian, a psychologist, or/and a physical activity specialist, resources that are usually not available in the paediatric office or even in referral centres. Therefore primary care providers are faced with pressing requests to which they are unable to respond alone. Even if they could, in many countries where medicine is not socialized, these efforts are not financially compensated (3), discouraging involvement outside the traditional boundaries of the paediatric practice. Clearly, considering the size of the obesity epidemic, not all obese children will be able to be treated by a specialized team, and creative solutions need to be generated for weight management in the …