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Childhood Overweight

Childhood Overweight. Obesity will be the most significant nutrition issue in the 21 st century (CDC, MMWR, 1999) Overweight is one of the top five reasons for health care visits among children and adolescents.

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Childhood Overweight

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  1. Childhood Overweight • Obesity will be the most significant nutrition issue in the 21st century (CDC, MMWR, 1999) • Overweight is one of the top five reasons for health care visits among children and adolescents.

  2. Obesity Evaluation and Treatment: Expert Committee RecommendationsS Barlow and WH Dietz PEDIATRICS, Sept 1998

  3. Weight Status Assessment Underweight: BMI-for-age less than the 5th percentile At risk for overweight: BMI-for-age ≥ 85th but < 95th percentile Overweight: BMI-for-age ≥ 95th percentile

  4. Recommended OverweightScreening Procedures In-depth medical assessment Overweight BMI • Family history • Blood pressure • Total cholesterol • Large ∆ BMI • Concern about weight At risk of overweight If any positive + Not atrisk of overweight If all negative - • Note in chart • No therapeutic action • Return next year for screen Return next year for screen

  5. Complications Associated with Child and Adolescent Overweight • Hypertension • Hyperlipidemia • Insulin resistance, type II diabetes mellitus • Ventilation Disorders • Sleep apnea, hypoventilation disorders • Orthopedic Disorders • Psychological Disorders • Eating disorders, body image disturbances

  6. Recommendations for Weight Goals 2 to 7 years BMI 85th-94th % tile BMI ≥ 95 % tile ComplicationNo ComplicationYes Weight Maintenance Weight Maintenance Weight Loss

  7. Recommendations forWeight Goals 7 years or older BMI 85th-94th % tile BMI ≥ 95 % tile ComplicationNo ComplicationYes Weight Maintenance Weight Loss Weight Maintenance

  8. Weight Goals for Overweight Youth • Maintenance of baseline weight for allchildren >2 • Weight loss, if warranted, should be only1 lb per month • Appropriate weight goal: BMI ≤ 85th %tile • Goal should be healthy eating and activity, not ideal body weight

  9. Treatment Goals for Obese Youth “Achieving ideal weight for height should be considered an unrealistic goal.” From AHA, Circulation 1996 (94)3383-3387

  10. General Approaches to Obesity Treatment • Interventions should begin early • Family must be ready for change • Involve family • Programs should institute permanent changes

  11. Parenting Skills • Praise child’s behavior • Don’t use food as a reward • Establish daily family meals/snack times • Parents should determine what food is offered and when, child should decide whether or not to eat • Offer only healthy options - remove temptations • Encourage physical activity • Limit TV and video/computer games to 1-2 hrs per day

  12. Prevention • Anticipatory guidance for caregivers of children • especially those at risk of developing overweight • Screening of parents/caregivers for risk-enhancing behaviors at all routine medical encounters • Parental eating habits, attitudes and beliefs • Over restriction of type or amounts of foods offered to child or adolescent • Signs of disinhibited eating/eating disorders among parents or caregivers

  13. www.brightfutures.org

  14. Barriers to Effective Treatment Lack of parental involvement Lack of reimburse- ment Lack of pt. motivation Lack of support services

  15. Barriers to Effective Treatment Treatment futility Lack of time Eating disorder concerns

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