Abstract
Despite extensive public health and clinical interventions, obesity rates remain high,
and evidence-based preventive strategies are elusive. Many consensus guidelines suggest
that providers should screen all children after age 2 years for obesity by measuring
height and weight, calculating body mass index (BMI), and sensitively communicating
weight status in the context of health to the family at each visit. However, preventive
counseling should begin in infancy and focus on healthy feeding, activity, and family
lifestyle behaviors. For children with overweight or obesity, the American Academy
of Pediatrics outlines 4 stages of treatment: 1) Primary care providers should offer
“prevention plus,” the use of motivational interviewing to achieve healthy lifestyle
modifications in family behaviors or environments; 2) children requiring the next
level of obesity treatment, structured weight management, need additional support
beyond the primary care provider (such as a dietitian, physical therapist, or mental
health counselor) and more structured goal setting with the team, including providers
adept at weight management counseling; 3) children with severe obesity and motivated
families may benefit from referral to a comprehensive multidisciplinary intervention,
such as an obesity treatment clinic; and 4) tertiary care interventions are provided
in a multidisciplinary pediatric obesity treatment clinic with standard clinical protocols
for evaluation of interventions, including medications and surgery. Although it is
certainly a challenge for providers to fit in all the desired prevention and treatment
counseling during preventive health visits, by beginning to provide anticipatory guidance
at birth, providers can respond to parents’ questions, add to parents’ knowledge base,
and partner with parents and children and adolescents to help them grow up healthy.
This is especially important in an increasingly toxic food environment with numerous
incentives and messages to eat unhealthfully, barriers to appropriate physical activity,
and concomitant stigma about obesity. Focusing on key nutrition and physical activity
habits and establishing these healthy behaviors at an early age will allow children
to develop a healthy growth trajectory. However, much more work is needed to determine
the best evidence-based practices for providers to counsel families on improving target
behaviors, environmental modifications, and parenting skills and to decrease abundant
disparities in obesity prevalence and treatment.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of childhood and adult obesity in the United States, 2011–2012.JAMA. 2014; 311: 806-814
- Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012.JAMA Pediatr. 2014; 168: 561-566
Skinner AC, Ravanbakht SN, Skelton JA, et al. Prevalence of obesity and severe obesity in US children, 1999–--2016. Pediatrics. 2018:e20173459.
- Brief primary care obesity interventions: a meta-analysis.Pediatrics. 2016; 138e20160149
Armstrong SC, Skinner AC. Defining “success” in childhood obesity interventions in primary care. Pediatrics. 2016:e20162497.
- Recommendations for treatment of child and adolescent overweight and obesity.Pediatrics. 2007; 120: S254-S288
- Cardiometabolic risks and severity of obesity in children and young adults.N Engl J Med. 2015; 373: 1307-1317
- Body mass index as a measure of adiposity among children and adolescents: a validation study.J Pediatr. 1998; 132: 204-210
- Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: the Bogalusa Heart Study.Am J Clin Nutr. 2009; 90: 210-216
- Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood.Obes Res. 2005; 13: 163-169
- The effect of obesity in adolescence on adult health status.Pediatrics. 2013; 132: 1098-1104
- Early Childhood Obesity Prevention Policies.National Academies Press, Washington, DC2011
- the Expert Committee. Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.Pediatrics. 2007; 120: S164-S192
- Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.Pediatrics. 2010; 125: 361-367
- Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.JAMA. 2017; 317: 2417-2426
- Pediatricians' and family physicians' weight-related care of children in the US.Am J Prev Med. 2011; 41: 24-32
- Adoption of body mass index guidelines for screening and counseling in pediatric practice.Pediatrics. 2010; 125: 265-272
- Recognition of childhood overweight during health supervision visits: does BMI help pediatricians.Obesity (Silver Spring). 2007; 15: 225-232
- Underdiagnosis of pediatric obesity during outpatient preventive care visits.Acad Pediatr. 2010; 10: 405-409
- Identification of overweight status is associated with higher rates of screening for comorbidities of overweight in pediatric primary care practice.Pediatrics. 2007; 119: e148-e155
- Color-coding improves parental understanding of body mass index charting.Acad Pediatr. 2009; 9: 330-338
- CDC growth charts: United States.Adv Data. 2000; : 1-27
- Use of a pediatrician toolkit to address parental perception of children's weight status, nutrition, and activity behaviors.Acad Pediatr. 2010; 10: 274-281
- Exploring the relationship between parental concern and the management of childhood obesity.Matern Child Health J. 2012; 16: 902-908
- Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey.Int J Obes Relat Metab Disord. 2002; 26: 717-724
- Factors associated with parental readiness to make changes for overweight children.Pediatrics. 2005; 116: e94-e101
- Differences in lifestyle behaviors, dietary habits, and familial factors among normal-weight, overweight, and obese Chinese children and adolescents.Int J Behav Nutr Phys Act. 2012; 9: 1
- Parental ability to discriminate the weight status of children: results of a survey.Pediatrics. 2007; 120: e112-e119
- Maternal perceptions of overweight preschool children.Pediatrics. 2000; 106: 1380-1386
- Why don't low-income mothers worry about their preschoolers being overweight.Pediatrics. 2001; 107: 1138-1146
- Maternal perceptions of weight status of children.Pediatrics. 2003; 111: 1226-1231
- Parents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21).BMJ. 2005; 330: 23-24
- Parental recall of doctor communication of weight status: national trends from 1999 through 2008.Arch Pediatr Adolesc Med. 2012; 166: 317-322
- Telling parents their child's weight status: psychological impact of a weight-screening program.Pediatrics. 2008; 122: e682-e688
- Parents' healthy weight perceptions and preferences regarding obesity counseling in preschoolers: pediatricians matter.Clin Pediatr. 2010; 49: 790-798
- A systematic review of responsive feeding and child obesity in high-income countries. jn.J Nutr. 2011; 110130047
- Parental perceptions of weight terminology that providers use with youth.Pediatrics. 2011; 128: e786-e793
- Perspectives on pediatric obesity survey findings.(Available at:) (Accessed April 23, 2018)
- Maternal and child undernutrition and overweight in low-income and middle-income countries.Lancet. 2013; 382: 427-451
- Prediction of childhood obesity by infancy weight gain: an individual‐level meta‐analysis.Paediatr Perinat Epidemiol. 2012; 26: 19-26
- Being big or growing fast: systematic review of size and growth in infancy and later obesity.BMJ. 2005; 331: 929
- Responsive feeding is embedded in a theoretical framework of responsive parenting.J Nutr. 2011; 141: 490-494
- Association between bottle size and formula intake in 2-month-old infants.Acad Pediatr. 2016; 16: 254-259
Wood CT, Skinner AC, Yin HS, et al. Bottle size and weight gain in formula-fed infants. Pediatrics. 2016:e20154538.
- Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review.Int J Obes (Lond). 2013; 37: 1295-1306
Heyman MB, Abrams SA. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017:e20170967.
- What kind of exposure reduces children's food neophobia?: looking vs. tasting.Appetite. 1987; 9: 171-178
- Early childhood family intervention and long-term obesity prevention among high-risk minority youth.Pediatrics. 2012; 129: e621-e628
- Parental influence and obesity prevention in pre‐schoolers: a systematic review of interventions.Obes Rev. 2011; 12: 315-328
- A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial.Pediatrics. 2013; 131: 652-660
- The feeding relationship.J Am Diet Assoc. 1986; 86: 352-356
- Feeding dynamics: helping children to eat well.J Pediatr Health Care. 1995; 9: 178-184
- The Start Healthy feeding guidelines for infants and toddlers.J Am Diet Assoc. 2004; 104: 442-454
- Food-related parenting practices and adolescent weight status: a population-based study.Pediatrics. 2013; 131: e1443-e1450
- Parenting styles, feeding styles, feeding practices, and weight status in 4–12 year-old children: a systematic review of the literature.Front Psychol. 2015; 6: 1849
- Coaching to improve mealtime parenting in treating pediatric obesity.Clin Pract Pediatr Psychol. 2017; 5: 232
- Physical activity and BMI in a nationally representative sample of children and adolescents.Clin Pediatr. 2012; 51: 122-129
- Behaviors and motivations for weight loss in children and adolescents.Obesity (Silver Spring). 2016; 24: 446-452
- Improving primary care for patients with chronic illness: the chronic care model, part 2.JAMA. 2002; 288: 1909-1914
- Recommendations for prevention of childhood obesity.Pediatrics. 2007; 120: S229-S253
- Defining and measuring the patient-centered medical home.J Gen Intern Med. 2010; 25: 601-612
- Effectiveness of Primary Care Interventions for Weight Management in Children and Adolescents.Agency for Healthcare Research and Quality, Rockville, MD2010
- Targeting parents exclusively in the treatment of childhood obesity: long-term results.Obes Res. 2004; 12: 357-361
- Parents as the exclusive agents of change in the treatment of childhood obesity.Am J Clin Nutr. 1998; 67: 1130-1135
- Ten-year outcomes of behavioral family-based treatment for childhood obesity.Health Psychol. 1994; 13: 373
- Where are family theories in family-based obesity treatment: Conceptualizing the study of families in pediatric weight management.Int J Obes. 2012; 36: 891-900
- Family-based interventions for pediatric obesity: methodological and conceptual challenges from family psychology.J Fam Psychol. 2006; 20: 175-189
- Motivational interviewing (patient-centered counseling) to address childhood obesity.Pediatr Ann. 2010; 39: 154-158
- Motivational interviewing for pediatric obesity: Conceptual issues and evidence review.J Am Diet Assoc. 2006; 106: 2024-2033
- GO GIRLS!: results from a nutrition and physical activity program for low-income, overweight African American adolescent females.Health Educ Behav. 2000; 27: 616-631
- Motivational interviewing in childhood obesity treatment.Front Psychol. 2015; 6: 1732
- Office-based motivational interviewing to prevent childhood obesity: a feasibility study.Arch Pediatr Adolesc Med. 2007; 161: 495-501
- Effects of motivational interviewing to promote weight loss in obese children.J Clin Nurs. 2013; 22: 2519-2530
- Population-based childhood overweight prevention: outcomes of the “Be Active, Eat Right” study.PloS One. 2013; 8: e65376
- Pediatrician-led motivational interviewing to treat overweight children: an RCT.Pediatrics. 2013; 132: e1236-e1246
- Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study.Arch Pediatr Adolesc Med. 2011; 165: 714-722
- The preliminary effects of a primary care–based randomized treatment trial with overweight and obese young children and their parents.J Pediatr Health Care. 2014; 28: 198-207
- Motivational interviewing and dietary counseling for obesity in primary care: an RCT.Pediatrics. 2015; 135: 649-657
- The transtheoretical model of health behavior change.Am J Health Promot. 1997; 12: 38-48
- Treating pediatric obesity in the primary care setting to prevent chronic disease: perceptions and knowledge of providers and staff.N C Med J. 2012; 73: 9
- Self-weighing and weight control behaviors among adolescents with a history of overweight.J Adolesc Health. 2009; 44: 424-430
- Self-weighing throughout adolescence and young adulthood: implications for well-being.J Nutr Educ Behav. 2015; 47 (e501): 506-515
- The effects of repeated weighing on psychological state.Eur Eat Disord Rev. 1997; : 121-130
- Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2017; 317: 2427-2444
- Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial.JAMA. 2003; 289: 1805-1812
- Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial.JAMA. 2005; 293: 2873-2883
- Preventing obesity and eating disorders in adolescents.Pediatrics. 2016; 138e20161649
- What is the evidence for paediatric/adolescent bariatric surgery?.Curr Obes Rep. 2017; 6: 278-285
- ASMBS pediatric committee best practice guidelines.Surg Obes Relat Dis. 2012; 8: 1-7
- Secondary causes of obesity.Am Fam Physician. 2011; 83: 972-973
- Treatment of obesity in underserved rural settings (TOURS): a randomized trial of extended-care programs for weight management.Arch Intern Med. 2008; 168: 2347
- TeleFIT: adapting a multidisciplinary, tertiary-care pediatric obesity clinic to rural populations.Telemed J E Health. 2012; 18: 247-249
- An integrated clinic-community partnership for child obesity treatment: a randomized pilot trial.Pediatrics. 2018; 141e20171444
- Thirty‐day outcomes for children and adolescents undergoing laparoscopic sleeve gastrectomy at a free‐standing children's hospital.Clin Obes. 2017; 7: 86-91
Brenner Children's Hospital. Brenner FIT. Available at: https://www.brennerchildrens.org/Pediatric-Obesity/Brenner-FIT-Works/About-Brenner-FIT.htm. Accessed May 11, 2017.
Article Info
Publication History
Published online: May 28, 2018
Accepted:
May 12,
2018
Received:
September 26,
2017
Footnotes
☆The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2018 by Academic Pediatric Association
