Obesity is becoming increasingly prevalent among children and adolescents, along with its complications. There are no clear guidelines to help improve lifestyle to avoid obesity, and individual compliance varies widely with the typical primary treatments. Lifestyle modification is the only treatment option for children because the medical treatment is limited to adolescents or older.

In this context, the research results in the letter of Auckburally et al.¹ are alarming as a cornerstone for developing a methodology to adhere to lifestyle modification. Although the overall number of patients participating in the study was small, important information was obtained. In the majority of cases, patients replied that they received nutrition and exercise information from the clinic, indicating receipt of information on basic methods to resolve obesity. Even though most patients are aware of the benefits of tracking calories and weight, few keep a food diary due to an expectation of psychological stress, which has been observed in clinical practice. Additionally, the tasks involved in maintaining a food diary can be tedious and time consuming. However, it is also true that children who weigh themselves every day and keep a food diary succeed in controlling weight. According to a recently published report, self-monitoring through daily weighing resulted in greater weight loss.² For widespread use of a food diary, education of patients on the importance of self-monitoring and continuous development of lifestyle modification methods with simple and convenient tasks or tools are needed to reduce the stress associated with a food diary.

In order to create an appropriate program for children and adolescents, it is best to classify the child’s propensity. In addition, knowledge about a healthy diet and exercise and a suitable weight target can be dispensed simultaneously. Development of a smartphone application that can provide advice and psychological support based on the individual would be of great help in weight management. Also, a program to filter false information from websites and online videos will be important, as well as personal recommendations for diet and exercise.

The importance of parents in the treatment of childhood obesity should not be overlooked as parents are responsible for the diet of their children. A link between parental obesity and obesity in children has been reported in several studies. Since it is important for the whole family to adjust their diet and exercise together, it will be important to develop such a program, expand facilities, and create a social atmosphere for families aiming to improve their lifestyle.

The complications of childhood obesity are not as severe as those in adults, and there is insufficient support for development of such family programs. Establishment of a National Health Service (NHS) clinic for severe obesity in children and adolescents would become a cornerstone for development of such a program.³

The authors declare no conflict of interest.

Drafting of the manuscript: YLC; critical revision of the manuscript: all authors; and study supervision: YJR.