An obesity action plan for children

Key Points

The new recommendations designate children who are at or above the 95th percentile for body mass index (BMI) as "obese" (formerly these children were referred to as "overweight"), and those at or between the 85th and 94th percentile as "overweight" (formerly "at risk for overweight"). The recommendations go further, and empower pediatricians to aggressively manage the overweight child, beginning as early as age 2. No longer are pediatricians just advising children to eat less and get more exercise, ending a well visit with the parting phrase "...and we will see you next year." We are now encouraged to become more involved in the process of preventing obesity, screening for comorbidities in the overweight child, and managing a child's weight using age- and weight-appropriate management strategies.

This article summarizes the new recommendations, emphasizing the ways pediatricians can deploy them in a realistic way to develop an effective practice strategy for obesity prevention and management.

Prevention

The dramatic rise in childhood obesity in the United States over the past several decades stems from changes in the lifestyles of American families. The major causes of childhood obesity are simply stated: 1) a decline in the amount of vigorous exercise, 2) an associated rise in passive entertainment, combined with 3) an almost universal adoption of unhealthy eating habits among American adults and their offspring. As 33.6% of children in the US are either overweight or obese,¹ pediatricians should seek every opportunity to address this issue with parents.

Here are the Committee's recommendations for how health care providers can work toward preventing obesity via anticipatory guidance at well visits.

Counsel non-obese patients

All children should be encouraged to be active. This can be accomplished by limiting television viewing and computer usage to only one or two hours a day, and removing these technologies from children's sleeping areas. Children should be encouraged to eat breakfast, limit consumption of fast food, and restrict portion size. Families should also eat together, and not rush through meals.

Advocate to increase physical activities in school and community

The Committee recommends that physicians and health advocacy groups encourage the federal government as well as local governments to increase physical activity in the primary grades. The Committee also supports efforts to encourage communities to develop initiatives to increase both the quantity and quality of community resources for physical activities, such as parks and bicycle paths.