EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents

Abstract

Introduction: This position statement on medical nutrition therapy (MNT) in the management of overweight or obesity in children and adolescents was prepared by an expert committee convened by the European Association for the Study of Obesity (EASO) and developed in collaboration with the European Federation of the Associations of Dietitians (EFAD). Methods: It is based on the best evidence available from systematic reviews of randomised controlled trials on child and adolescent overweight and obesity treatment and other relevant peer-reviewed literature. Results: Multi-component behavioural interventions are generally considered to be the gold standard treatment for children and adolescents living with obesity. The evidence presented in this position statement confirms that dietary interventions can effectively improve adiposity-related outcomes. Dietary strategies should focus on the reduction of total energy intake through promotion of food-based guidelines that target modification of usual eating patterns and behaviours. These should target increasing intakes of nutrient-rich foods with a lower energy density, specifically vegetables and fruits, and a reduction in intakes of energy dense nutrient-poor foods and beverages. In addition, higher intensity, longer duration treatments, delivered by interventionists with specialised dietetic-related skills and co- designed with families are associated with greater treatment effects. Discussion: Such interventions should be resourced adequately so that they can be implemented in a range of settings and in different formats, including digital or online delivery, to enhance accessibility.

Correlation between Obesity and Socioeconomic and Psychological Characteristics of Students Attending Different Rural School Types

“…Various components are important for the treatment of obesity in children and adolescents. In addition to diet and exercise, education and behavioral changes are particularly important [ 17 , 18 , 19 ]. There are numerous studies showing that physical activity has a potential benefit, especially for adolescents with overweight [ 20 , 21 , 22 ].…”

ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults—an approach for cardiologists

“…The evaluation of a patient with obesity must include the search for causes or favouring conditions [ 77 ]. A multidisciplinary team should perform the complex diagnostic assessment [ 81 – 85 ].…”

“…At least 4.0 million deaths are thought to be attributable to obesity each year worldwide [ 25 ]. Obesity is a medical problem [ 81 ]. It is not simply a phenotype but itself a disease in its own right [ 86 , 87 ], intricately linked with many other diseases and risk factor [ 25 ].…”

The ‘Behavioral Balance Model’: A new perspective on the aetiology and therapy of obesity

“…stimulus control and stress reduction strategies, generally aim to strengthen the top-down control of eating behaviour and physical activity. 46 While such therapeutic interventions provide important support for treatment-seeking individuals with obesity by supporting cognitive restraint and reducing emotional eating, alone they rarely can achieve a sufficient long-term weight reduction. [47][48][49] Similarly, acceptance and commitment therapy has been found to be very helpful in reducing emotional distress caused by obesity, but is unlikely to bring to and maintain body weight at a lower level.…”

“…Given that dietary restraint is a prerequisite for weight loss, classic behavioural approaches such as dietary counselling or cognitive‐behavioural therapies, including, e.g. stimulus control and stress reduction strategies, generally aim to strengthen the top‐down control of eating behaviour and physical activity 46 . While such therapeutic interventions provide important support for treatment‐seeking individuals with obesity by supporting cognitive restraint and reducing emotional eating, alone they rarely can achieve a sufficient long‐term weight reduction 47–49 .…”