Special Obesity Syndromes and Weight Loss Strategies: Management of Childhood Obesity and PWS Syndrome

I. Management of Childhood Obesity The management model for childhood obesity differs from that for adults. The goal is normal height growth, with no or slow weight gain, gradually reaching a normal BMI. Energy supply should generally not be less than 1200 kcal, with targets set based on height, age, and gender. Dietary management: The main purpose is to improve and correct poor eating habits. A restricted energy diet (CRD) is adopted, with the energy ratio of the three macronutrients as follows: protein 15%~20%, carbohydrates 55%-65%, and fat 20%. 9. Daily exercise should be no less than 60 minutes. II. Management of Adolescent Obesity The management goal is to correct poor habits and minimize excessive weight gain. Once height growth gradually stops, adult weight loss models can be referenced. III. Management of Obesity Due to Genetic Defect Syndromes Prader-Willi Syndrome (PWS) is the most common obesity syndrome. The pathogenesis is the loss of expression of the paternal gene in the discrete region of the long arm of chromosome 15. Clinical manifestations are classified by age group: 1. Prenatal: Decreased fetal movement, small for gestational age, polyhydramnios. 2. Infancy: The most obvious manifestations are hypotonia, weak sucking, and feeding difficulties, which can lead to growth retardation and may also be accompanied by cryptorchidism or scrotal hypoplasia. 3. Early Childhood: Major motor development is delayed (e.g., walking, speaking). 4. 16 years: Often presents with polyphagia and progressive obesity. Children with this condition have reduced lean body mass and lower resting energy expenditure. 5. Puberty: Premature adrenal function is observed, but secondary sexual characteristics are usually delayed or incomplete, and menarche is late. Obesity complications (sleep apnea, diabetes, osteoporosis) and behavioral problems are common. Feeding and Obesity Management in Children with PWS: Swallowing assessments should be performed in newborns and infants, and a thick, high-energy-density formula should be given. A nutritionist should be involved in setting energy goals. The core of management in childhood/adolescence and adulthood is strict restriction of food intake. To maintain a healthy weight, energy goals are often set far below the expected levels for children without PWS. When on a low-energy diet, additional vitamins and minerals (such as calcium) should be supplemented. Food access must be strictly controlled through physical barriers (locks) and close monitoring. Theft and hoarding of food are common behaviors, requiring a multidisciplinary team and family collaboration. Currently, there is limited evidence regarding drug treatments and bariatric surgery for this population.