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Commentary: future research directions in pediatric obesity research.

research on critical periods in development and early introduction of carbohydrates that has immediate implications on pediatric obesity. Are high carbohydrate diets protective for obesity, or do they lead to obesity? There is often a wide gap between basic science and clinical science, and clinical science can benefit from clinical investigators paying closer attention to advances in basic science. A number of basic science areas are relevant to obesity treatment interventions, including factors that influence craving and satiety, individual differences in the reinforcing value of food, and environmental variables that influence the reinforcing value of physical activity, memory and relapse, behavioral momentum and maintenance, or the role of neurotransmitters regulating intake. The majority of pediatric obesity interventions have been with obese preadolescent children with mild obesity and without significant comorbidities. Behavioral interventions represent an important therapeutic modality for this population, but more aggressive treatments may be needed for those who are more obese, and those with significant comorbidities, such as sleep apnea, where large weight losses are needed. One type of aggressive interventions is represented by very low-calorie diets or protein-sparing modified fasts. These interventions have generally produced large weight losses in adults, with poor maintenance. The other type of aggressive intervention is pharmacological treatments, which have been associated in adults with either small weight changes, or when weight changes are large, other physiological side effects. Journal of Pediatric Psychology, Vol. 24, No. 3, 1999, pp. 251–252