For individual treatment,  the currently recommended calorie prescriptions might be too conservative in view of evolving insight into the energy gap. Quality of scientific reports needs to improve to allow comparisons between interventions and pooling of studies. Because obesity is a chronic disorder needing continuing management, long-term clinical trials are needed to show safety and efficacy of treatments, not only for a few months, but also during the crucial period of active growth and maturation.  In children, safety of treatment needs to be examined as an equal outcome to efficacy.

Despite remaining challenges, glimmers of hope can be seen.  Recent statistics suggest that prevalence of childhood obesity might be stabilising in developed countries. All past efforts made towards prevention and treatment of obesity,  though not of notable individual effect in trials, might still have contributed collectively to this trend.¹⁰⁸

The increased attention that has been directed to obesity by the media might have helped to raise public awareness of energy balance. Expansion of food-product availability and more informative food labelling by the private sector might have helped the consumer to make better choices.

We cannot wait to delineate the complex causal web of the obesity epidemic. Unravelling of even one thread might allow an important degree of prevention.¹⁴⁰  Efforts to prevent obesity should continue at all levels, with the goal of an outcome that is greater than the sum of its parts.

These efforts should be made in tandem with an increased commitment to more robust research. We expect that the next 10 years will be a time of new discoveries and collective societal actions that will help to eliminate this scourge of the new millennium.

Contributors
All authors participated in deciding content, reviewing evidence, and writing of this Seminar.

Conflicts of interest
SYSK serves as a member of the Medical Advisory Board of the Aspartame Resource Center, from which she received no support for her research or her effort in this Seminar. JCH and DAL declare that they have no conflicts of interest.

Acknowledgments
JCH receives research support from the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and is a commissioned officer in the US Public Health Service, Department of Health and Human Services. The funding source had no direct role in writing of this Seminar. DAL receives funding from the US National Institutes of Health (R01 DK077659), UK Medical Research Council (G0600705 and G0801456), and National Institute for Health Research (RP-PG-0407-10044) for her work in the area of childhood obesity and determining causality from observational research. The opinions and assertions expressed in this report are those of the authors and are not to be construed as reflecting the views of the US Public Health Service or any other funding body.

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Joan C Han, Debbie A Lawlor, Sue Y S Kimm

Lancet 2010; 375 - 1737-48
Published Online May 6, 2010 DOI - 10.1016/ S0140- 6736(10)60171-7

Unit on Growth and Obesity, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD, USA (J C Han MD); MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol, UK (Prof D A Lawlor PhD); and Department of Internal Medicine/Epidemiology, University of New Mexico School of Medicine, Albuquerque, NM, USA (S Y S Kimm MD)

Correspondence to - Dr Sue Y S Kimm, University of New Mexico Health Sciences Center, Department of Internal Medicine/Epidemiology, University of New Mexico, MSC 10 5550 Albuquerque, NM 87131-0001, USA .(JavaScript must be enabled to view this email address)

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REFERENCES

1. Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002; 360: 473-82.
2. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006; 1: 11-25.
3. Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, 2003-2006. JAMA 2008; 299: 2401-05.
4. Kipping RR, Jago R, Lawlor DA. Obesity in children. Part 1: epidemiology, measurement, risk factors, and screening. BMJ 2008; 337: a1824.
5. Sundblom E, Petzold M, Rasmussen F, Callmer E, Lissner L. Childhood overweight and obesity prevalences levelling off in Stockholm but socioeconomic differences persist. Int J Obes (Lond) 2008; 32: 1525-30.
6. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240-43.

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