Complementary and Integrative Approaches to Prevention and Treatment of Child and Adolescent Obesity

Childhood Obesity is a significant global challenge impacting children's health world-wide.2 Recent research focuses on emerging factors: inflammation, gut microbiome, and environmental influences. Significant alterations in the gut microbiome due to Ce-sarean Section delivery, exposure to antibiotics in the second or third trimester, and for-mula feeding were associated with higher offspring obesity risk.36 In children and adolescents, obesity is characterized by the activation of inflammatory markers and alteration of gut permeability.2 Emerging evidence indicates prebiotic food and probiot-ics may favorably alter the gut microbiome, reducing the risk of obesity. A large-scale randomized trial on brief motivational interviewing (MI) by pediatric practices demon-strated reductions in BMI.52 In addition, successful lifestyle modification is effective in reducing inflammation and BMI.2 According to a recent Cochrane review, the existing studies suggest that lifestyle interventions could benefit overweight and obese children specifically in overall school achievement, mathematics, memory, and specific thinking skills.50 Among 2-5-year-old obese children, multi-disciplinary, intensive approaches to treatment have the most evidence of efficacy.53 In preschool-age children, baseline ADHD symptoms predict poor responses to obesity treatment, but parenting-focused interventions reduce both BMI and externalizing behavioral problems.36 For children with elevated LDL-C levels, a diet-based intervention focusing on a low-fat diet has been shown effective in modestly reducing LDL-C levels while not negatively impacting the child's psychological well-being.52 Mindfulness research has some of the most promising results. Mindfulness programs are helpful for obese children and their families in regard to diet, exercise, eating behavior, insulin resistance in diabetic obese adoles-cent girls, and prevention of weight gain in children of parents participating in the mind-fulness programs. Probiotics have striking effects in obese children with NAFLD and insulin resistance and may be extremely effective in targeting harmful parameters asso-ciated with these diseases. Synbiotics have shown effectiveness as an adjunct to pro-grams involving diet and exercise in obese children. Finally, for teens, a combination of a short, once-weekly physical activity intervention and CBT skills was found effective in reducing both BMI and depressive symptoms. In summary, Intensive Lifestyle Interventions, MI-based nutritional coaching for fam-ilies, physical activity, Mindfulness, synbiotics, and Cognitive behavioral therapy are recommended to help reduce obesity in this age group. Probiotics in obese children with NAFLD and insulin resistance also should be recommended. Including parents is critical to long-lasting effects. In addition, it is becoming increasingly clear that pe-diatric obesity and youth mental health reciprocally impact each other, and for optimal results, interventions should account for this.