Childhood obesity is increasingly recognized as a significant public health issue, with a growing global prevalence and serious consequences for cardiometabolic health that can persist into adulthood. Lifestyle interventions, especially those focused on nutrition, are vital for managing pediatric obesity, although evidence is inconsistent across regions, measurement tools, and clinical models. This review consolidates European research on Mediterranean diet (MD) adherence, outcomes from multidisciplinary interventions, and comparisons with global approaches to pediatric obesity management.
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The Mediterranean diet is established as the most well-supported dietary framework for preventing cardiometabolic issues in children and adolescents. The KIDMED index, a validated 16-item questionnaire, effectively assesses MD adherence across various European pediatric populations. It commonly reveals deficiencies in legume, whole grain, and extra-virgin olive oil consumption, associated with higher body mass index (BMI) Z-scores and age- and sex-specific BMI percentiles. The Children’s Eating Behaviour Questionnaire (CEBQ) also serves as a useful behavioral indicator; certain food-approach traits correlate positively with BMI Z-scores, while food-avoidance traits correlate negatively. These patterns are observed consistently among diverse populations, including in Europe, Latin America, and the Middle East.
Multidisciplinary interventions typically result in moderate reductions in BMI Z-scores, generally ranging from 0.10 to 0.25 units over periods of three to twelve months. Key factors predicting positive outcomes include younger children, lower initial obesity severity, breakfast habits, and the absence of obese parents. A low KIDMED score may also indicate a higher risk for pediatric metabolic dysfunction-associated fatty liver disease (MAFLD). While dietary quality indicators remain relatively consistent across regions, the feasibility of implementing Mediterranean-style dietary practices varies significantly based on local food availability, cultural culinary practices, and economic conditions.
The review highlights the importance of integrating KIDMED and CEBQ assessments into structured multidisciplinary interventions, particularly in less studied areas of Central and Eastern Europe. Given the multifactorial nature of childhood obesity, an effective treatment approach requires a combination of dietary education, physical activity, behavioral strategies, and family involvement, as well as supportive public health policies to foster long-term success in this demographic.
The Mediterranean diet emphasizes a plant-based eating approach featuring fruits, vegetables, whole grains, legumes, nuts, and olive oil, while limiting the intake of red and processed meats. Recognized by UNESCO as part of the Intangible Cultural Heritage, the MD serves as a chief model for lifelong cardiometabolic health.
A comprehensive literature review reveals the need for additional research to support the application of MD principles and related assessments tailored for local contexts. The review suggests that routine KIDMED and CEBQ screening should be incorporated into clinical pathways, enhancing intervention strategies for pediatric obesity, particularly in populations with higher prevalence rates in Central and Eastern Europe. Overall, the dietary patterns associated with childhood obesity globally align on major themes, and a culturally adaptive approach to intervention is essential for effective obesity management.