The Proceedings of the Nutrition Societ, August 2008 has a very informative series of papers on Behavioural nutrition and energy balance in the young.
Obesity is increasing, 17 % of US children and adolescents exceed the 95th percentile for BMI(1), and other developed countries are facing similar problems.
Childhood obesity has multiple causes, most of them capable of explaining only one part of the problem. Population-wide sedentary lifestyles and availability of energy-dense food is an important factor, but substantial individual differences in body weight exist suggest individual responses to the ‘obesogenic’ environment.
One mechanism for this variation is the early expression of appetitive traits, including low responsiveness to internal satiety signals, high responsiveness to external food cues, high subjective reward experienced when eating liked foods and preferences for energy-dense foods.
Case-control studies support the existence of such among obese children compared with normal-weight children. The origins of appetitive traits are as yet uncharted, but will include both genetic and environmental influences. Parental feeding style may affect the development of appetite.
Carnell and Wardle 2008 Appetitive traits and child obesity: measurements, origins and implications for intervention. Proc. Nutrition Society vol 67 , pp 343-355
Obesity in children is difficult to treat, but it seems to be easier to treat than adult obesity. The first step in treatment is to identify effective advice relating to nutrition and physical activity. In most treatment studies the macronutrient composition of the diet is not of major importance for treatment outcome. In relation to physical activity fat-utilisation strategies have been described.
The second step includes appropriate approaches to lifestyle change. Family therapy may be an effective approach in preventing severe obesity from developing during puberty. The family, not the therapist, assumes responsibility for the changes achieved.
Flodmark and Ohlsson 2008 Childhood obesity : from nutrition to behaviour. Proc. Nutrition Society vol 67 , pp 356-362

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