**7. Conclusions**

Childhood and adolescent obesity is a major health problem. The prevalence of childhood obesity in Europe is ten times higher than it was in the 1970s. The increasing occurrence in children of disorders, such as type 2 diabetes, is a consequence of this obesity epidemic. Initial assessments of these patients should include taking a careful history (investigating comorbidities, family history and potentially modifiable behaviors) and physical examination. The degree of investigation is dependent on the patient's age and severity of obesity, the findings on history and physical examination, and associated familial risk factors. The increased prevalence of obesity in childhood and adolescence highlights the need for effective treatment approaches. There are several broad principles of conventional management: management of comorbidities, family involvement, the use of a range of behavior change techniques, longterm dietary change, increased physical activity and decreased sedentary behaviors. Pediatric patients and their families should be counselled on nutritional interventions including limiting sugar-sweetened beverages, eating nutrient-dense breakfasts, limiting eating out at fast food restaurants, families eating together, increased exercise and decreased time in front of computer and TV screens. For adolescents with severe obesity, lifestyle changes are mandatory. This change must be supported with medical therapy (the only drugs approved by the health organizations are Orlistat and Metformin; these treatments do not exclude metabolic surgery). Finally, given the high prevalence and chronic nature of obesity, coordinated models of care for health service delivery for the management of pediatric obesity are needed.
