[Options and limits in the treatment of overweight children and adolescents and their families in primary care].

The general practitioner or pediatrician mostly is the first point of contact for overweight children and may recognize adiposity early enough in order to start therapy of obesity or comorbidity or to initiate measures of prevention. Interventions against overweight are most efficient before age 7 in terms of short-and long-term results and should not be delayed. As obesity requires care of the entire family, close or recurring contact with the overweight child and its family is important as well as the treatment nearby their residence. In preschoolers, targeting parents exclusively for obesity therapy is highly effective. Changing cherished habits and style of education is the biggest challenge to parents. Therefore, various techniques of treatment of alcohol or tobacco addiction can be used and recommendations for improvement of self-worth as well as healthy eating behavior and exercise are presented. First feasible objectives include modest lifestyle changes and reduction of comorbidities; if an extreme obesity with a BMI above 99.5th percentile or mental disorders are present or if it becomes apparent within the first 6 months that the patient cannot achieve his own goals for changes in lifestyle and body weight, a referral to a specialized center is indicated. There, a multi-professional treatment of the child and his family is performed in common by specialists for nutrition, exercise and psychology. Childhood obesity is a chronic disease that requires a very long-term treatment and usually persists into adulthood.