Childhood antecedents of adult obesity. Do chubby infants become obese adults?

Management of the obese adolescent

Obesity as a health problem appears to be increasing in incidence. Adolescent obesity is generally exogenous in type. The teenagers are basically healthy with advanced sexual and bone maturation. They suffer from peer ridicule and exclusion from activities. The weight problem bars them from successful adult adjustment in their social lives and career choice. To the physician who treats the obese adolescent, it would be wise to review the pitfalls of previous programs. The multidisciplinary approach is an attempt to combine dietary restriction and increased physical activity to gradually mobilize fat stores and provide psychologic support. Motivation is reinforced by a committed staff and by the patients' own obese peers with whom they meet weekly. Despite the repeated record of failure in adolescent weight reduction programs, it is hoped that the challenge of obesity management spurs the interest of physicians to increase their knowledge of nutrition and to intervene with early effective preventive measures.

Nutritional management of the chronically ill child. Congenital heart disease and myelomeningocele

We have presented some of the nutritional complications encountered in two major pediatric congenital disorders. Although these conditions represent two more common major defects, it is unlikely that many health care providers will manage large numbers of these patients. Nevertheless, the nutrition principles apply to other nutritional dilemmas of chronically ill children. When an infant consumes a low volume intake, regardless of etiology, concerns such as provision of adequate nutrition, within the confines of the infant's water balance, become paramount. Methods have been discussed for increasing caloric density and for monitoring dietary safety and adequacy. When an infant has a propensity for becoming obese one needs to consider preventive measures such as providing sound nutrition information, support, and follow-up for both patient and family. Nutritional problems can become magnified unless adequate support is provided for total health and social needs of the family. The role of the dietitian must be one active participation within the the framework of an interdisciplianry team so that appropriate innovative nutrition programs can be developed and implemented.