Physical Therapy as Treatment for Childhood Obesity in Primary Health Care: Clinical Recommendation From AXXON (Belgian Physical Therapy Association)

The prevalence of obesity in children and adolescents has increased by 3- to 4-fold over the last 3 decades in the United States.¹ In Europe, current prevalence rates of overweight or obesity in preschool children are between 8% and 13%.² Obesity has major health and socioeconomic impacts, especially in children and adolescents.³ These populations are at greater risk for developing endothelial dysfunction, hypertension, insulin resistance, cholecystolithiasis, nonalcoholic fatty liver disease, and respiratory and orthopedic disorders and for having psychosocial or psychiatric problems, chronic pain, and lower quality of life.^4–8 Childhood obesity alone has been estimated to cost $14 billion in the United States annually in direct health expenses,⁹ and these high costs have been confirmed in Europe.¹⁰ Obesity in children and adolescents should be considered a severe pathologic state, and maximal efforts should be made to improve prevention of and therapy for obesity in children and adolescents. To generate fat mass loss in children and adolescents with obesity, an increase in caloric expenditure (activity promotion) and a reduction in caloric intake are important.^11,12 Physical activity related to recreation and transportation should be increased, sedentary activities should be reduced, and regular structured exercise should be achieved.^11,12

It is often implicitly assumed that increased physical activity is feasible and medically safe in children and adolescents with obesity. Given the increased likelihood for the development of comorbidities in children and adolescents with obesity (such as orthopedic injuries or limitations, asthma, exercise hypertension, insulin resistance, and diabetes)^4,13–17 and their potential role as exercise-limiting factors, a correct interpretation of someone's physical capacity and associated physical limitations is needed. Therefore, children and adolescents who have obesity and who intend to increase their level of physical activity should …