Childhood Overweight and Obesity

The prevalence of overweight and obesity and its significant co-morbidities in pediatric populations has rapidly increased and reached epidemic proportions. In 2000, 17 percent of children and adolescents less than 19 years of age were overweight or obese, and this rate continues to rise at an alarming rate. The prevention of overweight is critical. Overweight children are more likely to become overweight adults and long-term outcome data for successful treatment approaches is dismal.

Clinical Presentation, Diagnosis and Treatment

Genetic, environmental or combinations of risk factors predisposing children to obesity can and should be identified. Early recognition of excessive weight gain relative to linear growth should become routine in pediatric ambulatory care settings. BMI (kg/m2 [see www.cdc.gov/growthcharts]) should be calculated and plotted periodically.
See Body Mass Index-for-Age—Children at the CDC.

Families can be educated and empowered through anticipatory guidance to recognize the impact they have on their children’s development of lifelong habits of physical activity and nutritious eating.

Healthy Eating

Dietary practices should be fostered that encourage moderation rather than over consumption, emphasizing healthful choices rather than restrictive eating patterns.

Physical Activity

Regular physical activity should be consciously promoted, prioritized and protected within families, schools and communities. Children under 18 years of age should achieve 60 minutes of physical activity a day.

Optimal approaches to prevention need to combine dietary and physical activity interventions. Click here for ideas about healthy eating and activity.

Guidelines: The American Academy of Pediatrics guidelines recommend the following:

  • Identify and track patients at risk by virtue of family history, birth weight, socioeconomic, ethnic, cultural or environmental factors.
  • Calculate and plot BMI once a year in all children and adolescents.
  • Use change in BMI to identify rate of excessive weight gain relative to linear growth.
  • Encourage, support and protect breastfeeding.
  • Encourage parents and caregivers to promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and whole grains. Encourage children’s autonomy in self-regulation of food intake and set appropriate limits on choices; thereby modeling healthy food choices.
  • Routinely promote physical activity, including unstructured play at home, in school, in childcare settings and throughout the community.
  • Recommend limitation of television and video time to a maximum of 2 hours per day.
  • Recognize and monitor changes in obesity-associated risk factors for adult chronic disease, such as hypertension, dyslipidemia, hyperinsulinemia, impaired glucose tolerance and symptoms of obstructive sleep apnea syndrome.

Additional Resources

Readings

Links

Patient Handouts