Ideally, the goal of fat reduction in obesity should be to restore normal body composition and retain it for the rest of life. However, evidence suggests that morbidity and mortality are reduced with even small reductions in excess fat. Thus, loss of some excess fat and the pursuit of healthy eating and activity may be beneficial even if normal fatness is not restored. Parents and children need realistic guidance on achievable goals and on the time required to achieve them. Fat reduction programs should be sustainable, able to maintain normal linear growth, and follow overall healthy lifestyle practices.
For young children, it may not be necessary to lose weight since the normal rates of weight and height gain mean that keeping weight stationary while linear growth occurs allows children to grow 'into their weight.' However, most children presenting for help with obesity are so overweight that it would require years of static weights for current weights to decrease to normal for their heights. Gradual weight reduction should aim for weight losses of approximately 500-1000g/month. Dramatic weight losses suggest excessive energy deficit with perhaps reduced lean tissue deposition, shorter adult height, and potentially reduced peak bone mass. The fattest children are unlikely to ever achieve normal BMI for age and normal fatness, but they need to be encouraged that significant fat reduction will improve their self-image, ability to exercise, and reduce late complications of obesity.
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