Academic Edi o : Niko Kaci o i
Recei ed: 7 Feb ua y 2025
Re ised: 28 Feb ua y 2025
Accep ed: 5 Ma ch 2025
Published: 10 Ma ch 2025
Ci a ion: Filippi-A iaga, F.;
Geo goulis, M.; Ba h ellou, E.;
Kon ogianni, M.D.; Mogas, E.;
Gas elum, G.; Ciudin, A. Key Gaps in
he P e en ion and T ea men o
Obesi y in Child en and Adolescen s:
A C i ical App aisal o Clinical
Guidelines. Child en 2025,12, 347.
h ps://doi.o g/10.3390/
child en12030347
Copy igh : © 2025 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license
(h ps://c ea i ecommons.o g/
licenses/by/4.0/).
Re iew
Key Gaps in he P e en ion and T ea men o Obesi y in
Child en and Adolescen s: A C i ical App aisal o
Clinical Guidelines
F ancesca Filippi-A iaga 1, Michael Geo goulis 2, Ei ini Ba h ellou 2, Me opi D. Kon ogianni 2,
Edua d Mogas 3, G aciela Gas elum 1and And eea Ciudin 1,*
1Endoc inology and Nu i ion Depa men , Obesi y Uni , Vall Heb on Uni e si y Hospi al,
08035 Ba celona, Spain; ancesca. ilippi@ hi .o g (F.F.-A.); g aciela.gas elum@ hi .o g (G.G.)
2Depa men o Nu i ion and Die e ics, School o Heal h Sciences and Educa ion, Ha okopio Uni e si y o
A hens, 17671 A hens, G eece; [email p o ec ed] (M.G.); eba h [email p o ec ed] (E.B.); [email p o ec ed] (M.D.K.)
3Pedia ic Endoc inology Depa men , Vall Heb on Uni e si y Hospi al, 08035 Ba celona, Spain;
edua d.mogas@ allheb on.ca
*Co espondence: and eea.ciudin@ allheb on.ca
Abs ac : Backg ound: The wo ldwide inc ease in he p e alence o childhood obesi y
necessi a es e ec i e p e en ion and ea men s a egies. Clinical p ac ice guidelines
(CPGs) o e guidance, bu signi ican he e ogenei y o lack o p ac ical applica ion ex-
is s in hei ecommenda ions. The pu pose o he p esen s udy is o p o ide an expe ,
comp ehensi e, and compa a i e analysis o gaps in cu en CPGs o he p e en ion
and ea men o obesi y in child en and adolescen s. Resul s: A o al o 14 CPGs we e
iden i ied, ocusing on childhood obesi y p e en ion (n = 11), ea men (n = 9), o bo h
(n = 6). P e en ion CPGs gene ally ecommend body mass index (BMI) assessmen , bu
speci ic measu emen equency is o en absen . While some p o ide age-speci ic die a y
ecommenda ions, g aphical ools a e lacking. Recommenda ions o inc eased physical
ac i i y and educed sc een ime a e common, bu age-s a i ied guidance is de icien .
Fu he mo e, ecommenda ions ega ding men al heal h and sleep a e no ably absen .
T ea men CPGs u ilize BMI o obesi y diagnosis, bu inconsis encies in cu -o poin s pe -
sis . Como bidi y assessmen is gene ally ecommended, ye age-speci ic guidance emains
lacking. Die a y ecommenda ions a e p esen in mos CPGs, bu many lack de ailed speci-
ica ions (e.g., meal equency, po ion sizes, mac onu ien dis ibu ion, age-app op ia e
examples). Mos CPGs ad oca e o 60 min o daily physical ac i i y and limi sc een ime
o 2 h pe day. Recommenda ions conce ning sleep a e consis en ly absen . While pa en al
in ol emen is acknowledged, speci ic guidance o ac i e pa icipa ion in p e en ion
and ea men is de icien . Pha macological ea men op ions a e equen ly ou da ed,
and su gical in e en ion is ese ed o excep ional cases o se e e obesi y. Conclusions:
S anda dizing BMI cu -o poin s and de ining age g oups ac oss CPGs would imp o e
consis ency and compa abili y in he diagnosis, p e en ion, and ea men o childhood
obesi y. Tailo ing ecommenda ions o die , physical ac i i y, seden a y beha io , and
sleep o speci ic age g oups would ensu e de elopmen ally app op ia e in e en ions. A
s onge emphasis on ea ly p e en ion s a egies is needed o add ess he oo causes o
obesi y. Clea guidance o pa en s and amilies would acili a e hei ac i e engagemen in
p e en ion and ea men . Up- o-da e in o ma ion ega ding pha macological and su gical
ea men s is impe a i e.
Keywo ds: obesi y; child en; adolescen s; p e en ion; ea men ; clinical guidelines
Child en 2025,12, 347 h ps://doi.o g/10.3390/child en12030347
Child en 2025,12, 347 2 o 14
1. In oduc ion
The global p e alence o o e weigh and obesi y among child en and adolescen s
has exhibi ed a conce ning escala ion [
1
–
3
]. Pe inen da a om he Wo ld Heal h O ga-
niza ion (WHO) e eal ha he p e alence o o e weigh and obesi y among child en
and adolescen s has eached ala ming le els, wi h o e 390 million young people a ec ed
in 2022 [
4
]. This su ge in p e alence highligh s he u gen need o e ec i e p e en ion
and ea men s a egies o mi iga e he isk o de eloping associa ed complica ions and
como bidi ies, as well as managing exis ing condi ions. The e iology o childhood obesi y
is complex and mul i ac o ial, encompassing a ange o ac o s including gene ic p edis-
posi ion, nu i ional habi s, physical ac i i y le els, como bidi ies, sleep pa e ns, and
amilial and communi y en i onmen s [
3
,
5
,
6
]. This in ica e in e play o ac o s necessi a es
a comp ehensi e unde s anding by heal hca e p o essionals, amilies, and pa ien s alike.
To na iga e his complexi y, clinical p ac ice guidelines (CPGs) a e sough a e o in o m
bo h p e en a i e s a egies and ea men modali ies. Howe e , despi e he a ailabili y o
CPGs, conside able he e ogenei y can exis s in hei ecommenda ions, aising conce ns
abou hei p ac icali y and implemen a ion ac oss di e se heal hca e sys ems, p ima y
and specialized ca e se ings, and wi hin he amily dynamic [
7
]. This na a i e e iew
aims o p o ide an expe , comp ehensi e, and compa a i e analysis o gaps in cu en
CPGs o he p e en ion and ea men o obesi y in child en and adolescen s.
2. Ma e ials and Me hods
A comp ehensi e sea ch was execu ed in PubMed, Scopus, and Google Schola
da abases o iden i y CPGs o he p e en ion and/o ea men o obesi y in child en
and adolescen s aged 2 o 19 yea s. The sea ch pa ame e s encompassed all publica ions
indexed up o Janua y 2025, wi hou empo al es ic ions on p io s udies. Sea ch e ms
employed included “clinical guideline”, “socie y”, “obesi y”, “o e weigh ”, “child en”,
and “adolescen s”. To be included in his e iew, CPGs had o mee speci ic c i e ia: pub-
lica ion in English, o igin om Wes e n egions (Eu ope, he Uni ed S a es o Ame ica
(USA), Canada, o Oceania), and de elopmen o publica ion by a na ional o in e na ional
scien i ic socie y o o ganiza ion. This geog aphic ocus allows o a compa a i e analysis o
guidelines wi hin egions sha ing simila socioeconomic de elopmen and cul u al he i age
oo ed in Eu opean adi ions. CPGs ailing o mee hese c i e ia, including documen s
lacking clinical ecommenda ions and hose a ailable exclusi ely in languages o he han
English, we e excluded. Any ele an documen s iden i ied ou side he ini ial sea ch we e
added in a a ge ed manne . Two in es iga o s (F.-F.A. and A.C.) independen ly conduc ed
documen selec ion based on p ede ined inclusion and exclusion c i e ia. Documen s we e
ca ego ized as clinical guidelines o p e en ion o obesi y in child en and adolescen s,
ea men o obesi y in child en and adolescen s, o bo h. Disc epancies ega ding docu-
men inclusion we e esol ed h ough in-dep h con en e iew and consensus. No di ec
con ac was made wi h au ho s o o ganiza ions. Two in es iga o s (F.-F.A. and A.C.)
pe o med da a ex ac ion and syn hesis. The e we e 14 di e en CPGs included (Table 1).
The con en o he selec ed CPGs was analyzed sepa a ely o p e en ion and ea men
ecommenda ions. CPGs we e classi ied as ocusing on p e en ion, ea men , o bo h
aspec s. The in o ma ion ex ac ed included he assessmen o obesi y (weigh s a us, heal h
s a us), li es yle ecommenda ions (die , physical ac i i y, seden a y beha io , and sleep),
ea men (d ugs, su ge y), and he ole o pa en s/gua dians in he p e en ion/ ea men
o childhood obesi y (de ailed in o ma ion is p o ided in Supplemen a y Ma e ials).
Child en 2025,12, 347 3 o 14
3. Resul s
The CPGs p esen ed subs an ial he e ogenei y in hei ecommenda ions, wi h some
ocusing on p e en ion (n = 11) [
8
–
18
], o he s on ea men (n = 9) [
5
,
8
–
10
,
13
,
15
,
17
,
19
,
20
],
and mos add essing bo h aspec s (n = 6) [8,9,13,15,17,19].
3.1. Clinical Guidelines o he P e en ion o Obesi y in Child en and Adolescen s
Conce ning he e alua ion o weigh s a us, he majo i y o clinical p ac ice guidelines
(CPGs) o he p e en ion o obesi y in child en and adolescen s ad oca ed o he u iliza ion
o body mass index (BMI) measu emen ; howe e , a subs an ial p opo ion ailed o speci y
ecommenda ions ega ding he equency o assessmen [
8
,
9
,
11
,
14
,
17
,
18
]. Wi h espec o heal h
s a us e alua ion, mos CPGs o p e en ion did no include he assessmen o sc eening o
o ganic pa hologies (gene ic diso de s, endoc ine diso de s) ha could lead o he de elopmen
o obesi y [
8
,
11
–
13
,
16
,
18
]. Fu he mo e, obesi y in child en and adolescen s can be associa ed
wi h men al heal h diso de s; howe e , speci ic ecommenda ions o hei assessmen we e
no ably absen om p e en ion-o ien ed guidelines [8–18].
Wi hin he domain o li es yle modi ica ions, se e al clinical p ac ice guidelines (CPGs)
ad oca e o exclusi e b eas eeding o a leas he i s 6 mon hs o li e, as a p ophylac-
ic measu e agains subsequen obesi y de elopmen [
8
,
9
,
11
]. Fu he mo e, all CPGs
inco po a e gene al ecommenda ions pe aining o a a ied and heal hy die , and mos
o hem men ion he impo ance o schools in os e ing he adop ion o heal hy die a y
habi s. Howe e , a subse o CPGs a e mo e de ailed ega ding op imal die a y in ake
by p o iding speci ic po ion ecommenda ions ailo ed o di e en age g oups [
11
,
16
,
17
].
No ably, ce ain guidelines emphasize he impo ance o inco po a ing high- ibe oods,
such as ui s, ege ables, and whole g ains [
11
,
14
,
16
]. Fo example, he Regis e ed Nu ses
Associa ion o On a io (RNAO) guidelines p esen a able de ailing ha child en aged
4–8 should ha e i e se ings o ege ables and ui , ou se ings o g ain p oduc s, and
h ee se ings o milk and al e na i es daily. In con as , child en aged 9–13 should ha e
six se ings o ege ables and ui , six se ings o g ain p oduc s, and h ee se ings o
milk and al e na i es This age-speci ic b eakdown ensu es ha die a y ecommenda ions
a e commensu a e wi h he e ol ing nu i ional equi emen s o child en du ing g ow h
and de elopmen [
11
]. Addi ionally, he AND’s (Academy o Nu i ion and Die e ics)
guide unde sco es he c i ical ole o nu i ionis s in obesi y, ecognizing hei unique qual-
i ica ions o p o ide nu i ion counseling in pedia ic se ings [
18
]. Rega ding g aphical
ools and isual aids, mos CPGs ail o include diag ams o ables ha could exempli y
app op ia e se ings o di e en ood g oups and ansla e die a y ecommenda ions o
meaning ul counselling guidance [13,15–19].
Physical ac i i y is a de e minan ac o in pedia ic ca dio ascula , musculoskele al,
and men al heal h, as well as in physical, social, and cogni i e de elopmen [
21
]. Mos
CPGs o ien ed on p e en ion concu on he ecommenda ion o a minimum o 60 min
o s uc u ed physical ac i i y daily [
11
,
13
,
15
–
17
]. The majo i y o CPGs highligh he
impo ance o schools o p omo e physical educa ion and spo ing ac i i ies [
5
,
8
,
9
,
12
].
Howe e , mos o he CPGs lack clea ecommenda ions ega ding age-speci ic exe cise
du a ion and in ensi y. Addi ionally, hey ail o p o ide examples o de elopmen ally
app op ia e ac i i ies and spo s o di e en age g oups [
8
,
9
,
12
,
14
,
18
]. Mi iga ion o seden-
a y beha io is a c i ical p ophylac ic s a egy agains obesi y, and in e en ions aimed
a educing ec ea ional sc een media exposu e may esul in a subs an ial inc ease in
child en’s engagemen in physical ac i i y [
22
]. Mos o he e iewed CPGs ad oca e
o a es ic ion o sc een ime (e.g., ele ision iewing, ideo gaming) o a maximum o
2 h pe day o child en exceeding 2 yea s o age, wi h comple e abs inence ecommended
o younge child en [
8
,
11
,
15
,
16
]. Ne e heless, ce ain p e en i e CPG ecommenda-
Child en 2025,12, 347 4 o 14
ions lack su icien in o ma ion on sc een use and ime limi s [
5
,
12
–
14
]. Mo eo e , i is
unclea whe he hese ecommenda ions should be uni e sal o adjus ed o speci ic age
g oups. Mul iple c oss-sec ional in es iga ions ha e es ablished a co ela ion be ween
educed sleep du a ion and dis up ed sleep cycles wi h he de elopmen o obesi y in
child en [
23
–
26
]. In e es ingly, he e is lack o ecommenda ions on sleep habi s as his
domain is la gely omi ed om he majo i y o p e en ion CPGs [5,8,9,11–14,16–20].
3.2. Clinical Guidelines o he T ea men o Obesi y in Child en and Adolescen s
Nine o he guidelines iden i ied we e o ien ed on obesi y ea men [
2
–
5
,
8
,
10
,
12
–
14
].
All CPGs ad oca e o he assessmen o weigh s a us u ilizing BMI pe cen iles o he
diagnosis o o e weigh and obesi y. Fo child en
≥
2 yea s o age, mos CPGs ag ee on he
diagnosis o o e weigh i he BMI is
≥
85 h pe cen ile and <95 h pe cen ile o age and
sex, and o he diagnosis o obesi y i BMI is
≥
95 h pe cen ile o age and sex [
8
,
10
,
15
].
Howe e , ce ain CPGs employ al e na i e pe cen ile h esholds o diagnos ic classi i-
ca ion [
9
,
15
,
19
]. Fo ins ance, he Spanish Clinical P ac ice Guideline o he P e en ion
and T ea men o Childhood and Ju enile Obesi y designa es a BMI
≥
97 h pe cen ile o
age and sex as he diagnos ic c i e ion o obesi y [
9
]. Simila ly, he Sco ish In e colle-
gia e Guidelines Ne wo k ecommend ha o clinical use, obese child en a e hose wi h a
BMI
≥
98 h pe cen ile o he Uni ed Kingdom (UK) 1990 e e ence cha o age and sex
(see Supplemen a y Ma e ials) [19].
Mos o he ea men CPGs ad oca e o a comp ehensi e medical his o y and a
ho ough physical examina ion o exclude seconda y e iologies o obesi y in pedia ic
popula ions [
8
,
9
,
19
,
20
]. Fo he assessmen o heal h s a us, mos CPGs concu ha chil-
d en wi h obesi y should be e alua ed o como bidi ies [
10
,
15
,
17
,
19
,
20
]. This ypically
includes he measu emen o blood p essu e, blood glucose, and lipid p o ile [
10
,
15
,
17
,
20
].
Rega ding como bidi y assessmen , an op imal app oach would in ol e he delinea ion
o speci ic indica ions and diagnos ic s udies ailo ed o dis inc age g oups [
13
,
15
,
20
]. A
salien example o his age-s a i ied app oach is p o ided by he I alian guideline o Diag-
nosis, ea men , and p e en ion o pedia ic obesi y sugges s [15]. This CPG includes he
ollowing ecommenda ions: measu ing choles e ol, high-densi y lipop o ein choles e ol
(HDL), and iglyce ides in all child en and adolescen s wi h obesi y s a ing a he age o 6;
measu ing blood p essu e in all child en wi h o e weigh o obesi y s a ing a he age o 3;
measu ing as ing blood glucose in all child en and adolescen s wi h o e weigh o obesi y
s a ing a he age o 6, as he i s s ep o sc eening p ediabe es and ype 2 diabe es; and
assessing ansaminases and li e ul asound in all child en and adolescen s wi h obesi y
s a ing a he age o 6, among o he s [15].
When add essing men al heal h, CPGs acknowledge he impo ance o psychological
suppo o he ea men o o e weigh and obesi y in child en and adolescen s, and
hey ad oca e o e e al o specialis s in he p esence o suspec ed dep essi e and/o
anxious symp oms, dysmo phophobia ai s, suicidal isk, and ea ing diso de s [
8
,
13
,
15
,
19
].
Howe e , hey do no ecommend a psychological ou ine o ollow-up e alua ion.
Die a y ecommenda ions wi hin ea men -o ien ed CPGs equen ly encompass gene al
guidance p omo ing he consump ion o a balanced and a ied die , nega i e calo ic balance,
ea ing a egula imes, and inc easing he in ake o ui and ege ables [
8
,
9
,
13
,
15
,
20
]. Re-
ga ding meal pa e ns, some examples o speci ic ecommenda ions include a consis en meal
schedule wi h i e s uc u ed meals pe day a egula in e als, minimizing snacking and
a oiding skipping meals [
17
]. Rega ding die a y pa e ns, CPGs emphasize balanced nu i ion
by including p o ein, ca bohyd a es, and heal hy a s in e e y meal, in he consump ion o
ui s, ege ables, ibe - ich ce eals, and low- a dai y p oduc s, as well as he limi a ion o
high-ene gy and low-nu ien oods, such as swee ened d inks, as ood, suga y snacks, and
Child en 2025,12, 347 5 o 14
sauces [
9
,
13
,
20
]. Addi ional ecommenda ions include he p io i iza ion o wa e consump-
ion o e suga -swee ened be e ages, as well as he p omo ion o mind ul ea ing p ac ices,
such as ood label sc u iny, amily meal encou agemen , limi a ion o es au an dining, and
age-app op ia e po ion con ol [5,15,17].
In he ealm o physical ac i i y, mos ea men -o ien ed clinical p ac ice guidelines
(CPGs) align wi h hei p e en ion coun e pa s, ecommending a minimum o 60 min o
s uc u ed physical ac i i y pe day [
10
,
13
,
15
,
17
,
19
,
20
]. Conce ning seden a y beha io ,
mos CPGs o e gene al guidance on cu ailing ime spen in seden a y ac i i ies, such as
ele ision iewing, ideo game playing, and in e ne use [
8
,
9
,
15
,
19
]. T ea men CPGs also
concu wi h p e en ion CPGs in ad oca ing o he es ic ion o sc een ime o 1–2 h pe
day [
9
,
13
,
17
,
19
,
20
]. A consis en de iciency ac oss all ea men CPGs is he lack o speci ic
ecommenda ions pe aining o adequa e sleep du a ion and quali y [
5
,
8
–
10
,
13
,
15
,
17
,
19
,
20
].
Rega ding pha macological in e en ions, a subs an ial p opo ion o CPGs exhibi
ou da ed ecommenda ions, sugges ing medica ions such as sibu amine, li aglu ide, o
o lis a , wi hou p o iding age-s a i ied guidance [
9
,
17
,
19
]. Mos CPGs concu ha weigh -
loss pha maco he apy should be ese ed o adolescen s
≥
12 yea s o age wi h obesi y
(BMI
≥
95 h pe cen ile), in acco dance wi h medica ion indica ions, isk–bene i p o iles,
and as an adjunc o beha io al and li es yle in e en ions [
9
,
17
,
20
]. Some CPGs indica e
ha ba ia ic su ge y in adolescen s is ecommended only in ex eme cases o se e e obesi y
(BMI
≥
40 kg/m
2
) wi h signi ican como bidi ies o ex eme obesi y (BMI
≥
50 kg/m
2
)
when in ensi e li es yle in e en ions, wi h o wi hou d ug ea men , ha e ailed o
a leas six mon hs [
8
,
9
,
13
,
17
]. Eligibili y c i e ia ypically include a ainmen o Tanne
s age 4 o 5 pube al de elopmen and nea - inal o inal adul heigh . Fu he mo e, CPGs
emphasize ha ba ia ic su ge y should be pe o med exclusi ely in cen e s wi h mul i-
disciplina y eams expe ienced in adolescen ba ia ic su ge y [
9
,
13
,
15
,
17
]. The guidelines
emphasize ha su ge y ep esen s he las eso and should only be conside ed a e all
o he ea men op ions ha e been exhaus ed.
3.3. Pa en al Role
Resea ch has shown ha in ol ing pa en s o ca egi e s in he p e en ion and ea -
men o child en and adolescen s wi h obesi y leads o be e long- e m weigh managemen
compa ed o ocusing solely on he child wi hou pa en al in ol emen [
24
,
25
]. Mos CPGs
gene ally men ion o encou age beha io al in e en ions inco po a ing pa en al and/o
amilial in ol emen and acknowledge he pi o al ole o he amily in os e ing a li es yle
conduci e o obesi y p e en ion. Howe e , hey do no include speci ic ecommenda ions
(die , sleep, physical ac i i y, amily en i onmen ) ha pa en s should ollow o p e en o
ea obesi y om home [5,8,11–13,15,19].
Table 1. Compa ison o clinical p ac ice guidelines o he p e en ion and ea men o obesi y in
child en and adolescen s.
Guideline Assessmen Li es yle Changes T ea men Pa en al Role
CPGs Focused
on P e en ion
Weigh S a-
us/Diagnosis
Heal h s a us Men al
Heal h
Die Physical
Ac i i y
Seden a y Time
Sleep D ugs Su ge y
Canadian
clinical p ac ice
guidelines on
he
managemen
and p e en ion
o obesi y in
adul s and
child en
[summa y]
(2007) [8].
✔ ✔ X✔✔✔X - - ✔
Child en 2025,12, 347 6 o 14
Table 1. Con .
Guideline Assessmen Li es yle Changes T ea men Pa en al Role
CPGs Focused
on P e en ion
Weigh S a-
us/Diagnosis
Heal h s a us Men al
Heal h
Die Physical
Ac i i y
Seden a y Time
Sleep D ugs Su ge y
Spain. Clinical
P ac ice
Guideline o
he P e en ion
and T ea men
o Childhood
and Ju enile
Obesi y (2009)
[9].
✔ ✔ X✔✔✔X - - ✔
Sco ish
In e collegia e
Guidelines
Ne wo k:
Managemen o
Obesi y A
na ional clinical
guideline (2010)
[19].
✔ ✔ XXXXX - -✔
Canada.
P ima y
P e en ion o
Childhood
Obesi y (2nd
edi ion).
In e na ional
A ai s and Bes
P ac ice
Guidelines.
Regis e ed
Nu ses
Associa ion o
On a io (RNAO)
(2014) [11].
✔ ✔ X✔✔✔X - - ✔
England.
Na ional
Ins i u e o
Heal h and Ca e
Excellence
(NICE). Obesi y
p e en ion
clinical
guideline (2015)
[12].
XXX✔ ✔ X X - - ✔
Eu opean
Socie y o
Endoc inology
and he
Pedia ic
Endoc ine
Socie y (2017)
[13].
✔X X ✔✔✔✔ - - ✔
Uni ed S a es.
Sc eening o
Obesi y in
Child en and
Adolescen s: US
P e en i e
Se ices Task
Fo ce Recom-
menda ion
S a emen (2017)
[14].
✔ ✔ X✔✔✔✔ - - X
I aly. Diagnosis,
ea men and
p e en ion o
pedia ic
obesi y:
Consensus
posi ion
s a emen o he
I alian Socie y
o Pedia ic
Endoc inology
and
Diabe ology
and he I alian
Socie y o
Pedia ics (2018)
[15].
X✔X✔✔✔✔ - - X
Ge many.
Cu en
Guidelines o
Obesi y
P e en ion in
Childhood and
Adolescence
(2018) [16].
XXX✔✔✔X - - X
Child en 2025,12, 347 7 o 14
Table 1. Con .
Guideline Assessmen Li es yle Changes T ea men Pa en al Role
CPGs Focused
on P e en ion
Weigh S a-
us/Diagnosis
Heal h s a us Men al
Heal h
Die Physical
Ac i i y
Seden a y Time
Sleep D ugs Su ge y
Poland.
Childhood
Obesi y:
Posi ion
S a emen o he
Polish Socie y o
Pedia ics,
Polish Socie y
o Pedia ic
Obesi y, Polish
Socie y o
Pedia ic
Endoc inology
and Diabe es,
he College o
Family
Physicians in
Poland, and he
Polish
Associa ion o
S udy on
Obesi y (2022)
[17].
✔ ✔ X✔✔✔X - - ✔
Uni ed S a es.
P e en ion o
Pedia ic
O e weigh and
Obesi y:
Posi ion o he
Academy o
Nu i ion and
Die e ics Based
on an Umb ella
Re iew o
Sys ema ic
Re iews (2022)
[18].
✔X X ✔✔✔X - - ✔
CPGs Focused
on T ea men
Weigh s a-
us/diagnosis
Heal h S a us Men al
Heal h
Die Physical
Ac i i y
Seden a y Time
Sleep
Pha maco he apy
Su ge y Pa en al Role
Canadian
clinical p ac ice
guidelines on
he
managemen
and p e en ion
o obesi y in
adul s and
child en
[summa y]
(2007) [8].
✔✔✔✔✔✔X✔ ✔ X
Spain. Clinical
P ac ice
Guideline o
he P e en ion
and T ea men
o Childhood
and Ju enile
Obesi y (2009)
[9].
✔✔✔✔✔✔X✔ ✔ ✔
Sco ish
In e collegia e
Guidelines
Ne wo k:
Managemen o
Obesi y A
na ional clinical
guideline (2010)
[19].
✔✔✔✔✔✔X✔ ✔ ✔
Eu opean
Socie y o
Endoc inology
and he
Pedia ic
Endoc ine
Socie y (2017)
[8]
✔✔✔✔✔✔X✔ ✔ X
I aly. Diagnosis,
ea men and
p e en ion o
pedia ic
obesi y:
consensus
posi ion
s a emen o he
I alian Socie y
o Pedia ic
Endoc inology
and
Diabe ology
and he I alian
Socie y o
Pedia ics (2018)
[15].
✔✔✔✔✔✔X✔ ✔ ✔
Child en 2025,12, 347 8 o 14
Table 1. Con .
Guideline Assessmen Li es yle Changes T ea men Pa en al Role
CPGs Focused
on P e en ion
Weigh S a-
us/Diagnosis
Heal h s a us Men al
Heal h
Die Physical
Ac i i y
Seden a y Time
Sleep D ugs Su ge y
Poland.
Childhood
Obesi y:
Posi ion
S a emen o he
Polish Socie y o
Pedia ics,
Polish Socie y
o Pedia ic
Obesi y, Polish
Socie y o
Pedia ic
Endoc inology
and Diabe es,
he College o
Family
Physicians in
Poland, and he
Polish
Associa ion o
S udy on
Obesi y (2022)
[17].
✔✔✔✔✔✔X✔ ✔ ✔
Uni ed S a es.
T ea men o
Pedia ic
O e weigh and
Obesi y:
Posi ion o he
Academy o
Nu i ion and
Die e ics Based
on an Umb ella
Re iew o
Sys ema ic
Re iews (2022)
[5].
✔X✔ ✔ XXXXX✔
Ame ican
Academy o
Pedia ics.
Execu i e
Summa y:
Clinical P ac ice
Guideline o
he E alua ion
and T ea men
o Child en and
Adolescen s
wi h Obesi y
(2023) [20].
✔✔✔✔✔✔X✔ ✔ X
I aly. Ca -
diome abolic
isk in child en
and adolescen s
wi h obesi y: a
posi ion pape
o he I alian
Socie y o
Pedia ic
Endoc inology
and
Diabe ology
(2024) [10].
✔ ✔ X✔✔✔X X X X
Guidelines ha add essed speci ic o gene al aspec s (
✔
); guidelines ha did no add ess speci ic o gene al
aspec s (X). CPGs: clinical p ac ice guidelines.
4. Discussion
Obesi y in child en and adolescen s is a signi ican public heal h conce n wo ldwide.
To add ess his issue, CPGs o he p e en ion and ea men o obesi y in child en and
adolescen s ha e been de eloped. Howe e , hese CPGs a e e y he e ogenous be ween
Eu opean coun ies and wo ldwide and p esen se e al gaps and challenges. He e ogenic-
i y in CPGs o en leads o inconsis encies in ecommenda ions and con usion o heal hca e
p o ide s, pa ien s, and pa en s [
7
]. Based on he gaps and he e ogenei y iden i ied in he
p esen e iew, we ha e c ea ed a p oposal o ecommenda ions o co e gaps in u u e
CPGs o he p e en ion and ea men o obesi y in child en and adolescen s (see Table 2).
Child en 2025,12, 347 9 o 14
Table 2. Recommenda ions o co e gaps in u u e CPGs o he p e en ion and ea men o obesi y
in child en and adolescen s.
A eas Recommenda ions
Weigh s a us •C ea e uni e sal diagnos ic pa ame e s o obesi y in child en and adolescen s
•Same BMI pe cen iles
•Explo a ion o adipose- issue- ocused diagnos ics
Heal h s a us •S a i ica ion in age g oups
•Ins uc ions o e alua ion o como bidi ies
•Desc ip ion o complemen a y es s o pe o m
•Indica e equency o ollow-up
Men al heal h •Indica e who o sc een
•Indica e when o sc een
•Desc ibe wha es s o use (e.g., ques ionnai es)
•Indica e equency o ollow-up
Die •S a i ica ion in age g oups
•Desc ibe numbe o meals pe day
•Desc ibe po ion sizes
•Include mac onu ien pe cen ages
•Desc ibe ypes o oods o a oid
•P o ide g aphic examples
•Indica e equency o ollow-up
Physical ac i i y •S a i ica ion in age g oups
•Indica e ype o physical ac i i y
•Indica e du a ion o physical ac i i y
•Indica e in ensi y o physical ac i i y
•Di e en ia e be ween p e en ion and ea men ecommenda ions i possible
•P o ide examples o ou ine
Seden a y ime •S a i ica ion in age g oups
•Indica e du a ion o sc een ime
•Recommenda ions on sc een- ee imes
•Desc ibe sc eens habi s o a oid (e.g., sc een du ing meals)
•Di e en ia e be ween p e en ion and ea men ecommenda ions i possible
Sleep •S a i ica ion in age g oups
•Indica e du a ion o sleep
•Indica e speci ic sleep hygiene beha io s
•Indica e egula sleep schedule ecommenda ions
•Di e en ia e be ween p e en ion and ea men ecommenda ions i possible
Pha maco he apy •Include upda ed pha macological ea men op ions
•Indica e speci ic indica ions acco ding o age and como bidi ies
•Indica e equency o ollow-up
Su ge y •Include speci ic indica ions acco ding o age, BMI, anne , and como bidi ies
•Indica e equency o ollow-up
Pa en al ole Speci ic ecommenda ions o pa en s ega ding hei child en:
•Nu i ion
•Physical ac i i y
•Sleep
•Sc een ime
•Pa icipa ion in hei child en’s medical appoin men s
BMI: body mass index.
Speci ically, while mos guidelines use he same BMI cu -o poin s o diagnose o e -
weigh (
≥
85 h pe cen ile, <95 h pe cen ile o age and sex) and obesi y (
≥
95 h pe cen ile
o age and sex) [
8
,
15
], some u ilize di e en cu -o poin s [
9
,
15
,
19
]. These disc epancies
in diagnos ic h esholds pose challenges in se e al a eas, including accu a ely diagnosing
obesi y, conduc ing clinical s udies wi h compa able esul s, managing da a consis en ly,
and uni ying in o ma ion ac oss Eu opean coun ies and global heal hca e sys ems. To
add ess hese challenges, he s anda diza ion o BMI cu -o poin s ac oss Eu opean and
global heal hca e sys ems is impe a i e. Fu he mo e, he de elopmen and s anda d-
iza ion o adipose- issue- ocused diagnos ic and s a i ica ion ools a e u gen ly needed.
Recommenda ions o he pe iodic assessmen o BMI, such as annual calcula ion and
plo ing o BMI pe cen iles du ing well-child o sick-child isi s, o mon hly measu emen
o body weigh , may be o help o p opose in u u e guidelines as an adequa e pe iodici y
o he measu emen o hese pa ame e s [13].
