Here's the representative case study from the journal article:
At the age of 4 years, Jade* was referred to child Weight Management Services. She was 110 (43.3 in) cm tall, weighed 40 kg (88 lbs), and had a body mass index (BMI) of 33 kg/m2 (100th percentile for age; BMI z score, 4.05). She had acanthosis nigricans, hyperinsulinaemia, fatty liver identified on ultrasound, and abnormal sleep study results indicative of moderate obstructive sleep apnoea.
Jade came from a family with a strong history of obesity and obesity-related disorders. Her mother had a history of gestational diabetes and postnatal depression, and her father had a history of abuse as a child. Jade’s parents were separated and a social worker was already supporting the family.
Jade led a very sedentary lifestyle, watching television up to 6 hours a day, and there were issues about food, with Jade having temper tantrums if not allowed whatever she wanted to eat.
A family-focused multidisciplinary approach was taken, involving both parents with input from a clinical nurse consultant, dietitian, physiotherapist, clinical psychologist and paediatrician. The family found it very difficult to keep appointments and adhere to lifestyle changes, and Jade’s mother felt unsupported by her ex-partner who continued to allow Jade to snack on high-energy foods and watch television. Jade’s weight steadily increased.Twenty months after initial referral, Jade, now hypertensive with symptoms of marked obstructive sleep apnoea, was referred to the hospital’s Department of Psychological Medicine, for assessment of her progressively violent behaviour, and Child Protection Unit, because of concerns about her persistent weight gain.
Subsequently, because all these interventions had not led to any significant improvement in Jade’s condition, the relevant state child protection authorities were notified. Notification led to hospital admission, during which Jade underwent an adenotonsillectomy. With the institution of simple weight-management interventions of reduced dietary intake and a daily program of physical activity, Jade lost 3 kg in 2 weeks.
Community-based support was established, visits to the father were supervised, and Jade continued to lose weight as an outpatient. At her most recent clinic visit, Jade had reduced a dress size, and her mother now feels much more confident in making healthy food and lifestyle choices.
http://www.mja.com.au/public/issues/190_03_020209/ale11409_fm.htmlObviously, these sorts of treatment programs are more readily accomplished in countries with universl health care.