Fitch A, Fox C, Bauerly K, Gross A, Heim C, Judge-Dietz J, Kaufman T, Krych E, Kumar S, Landin D, Larson J, Leslie D, Martens N, Monaghan-Beery N, Newell T, O'Connor P, Spaniol A, Thomas A, Webb B. Prevention and management of obesity for children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 94 p. [110 references]
- Prevention
Recommendations:
The following counseling messages should be directed to all parents, regardless of the weight status of their child.
Healthy Diet
Breastfeeding: Studies suggest that exclusive breastfeeding to six months of age is associated with decreased rates of obesity later in childhood [High Quality Evidence]. See the NGC Summary of the ICSI guideline Preventive services for children and adolescents for further information.
Milk: The American Academy of Pediatrics recommends that children be started on cow's milk at 1 year of age. Whole milk is recommended for most children ages 12 months to two years. However, if the child is at risk for overweight or if there is a family history of obesity or cardiovascular disease, 2% milk is recommended. For children ages two years and up, a low-fat (skim or 1%) milk should be used.
Sugar-sweetened beverages: Families should limit their child's consumption of sugar-sweetened beverages [High Quality Evidence]. Current evidence indicates a strong association between sugar-sweetened beverage consumption and total daily energy intake. Decreasing consumption of sugar-sweetened beverages is one strategy to decrease total daily energy intake [Reference].
Refer to the original guideline document for information regarding fruit juice and fruits and vegetables.
Meal Structure
- Children should eat breakfast daily [High Quality Evidence]. Evidence shows that skipping breakfast decreases the nutritional quality of the diets of both children and adults [Reference]. Families should eat meals together at the table as much as possible. Family meals are associated with a higher quality diet [High Quality Evidence].
- Snacking should be neither encouraged nor discouraged. The current data on meal frequency and snacking are inconclusive [Reference]. It is the opinion of the work group that if this issue is addressed with families, the focus should be on the quality of meals and snacks, not on the quantity.
Eating out: Eating out at restaurants, especially fast food restaurants, should be limited. Restaurants, especially fast food restaurants, serve energy-dense food that can contribute significantly to a child's daily energy intake [High Quality Evidence]. The frequency of eating out is associated with body fatness in children and adults [Reference].
Refer to the original guideline document for information about portion sizes, child self-regulation, physical exercise, sleep, television, and the importance of the community in promoting a healthy lifestyle.
For a detailed review of age appropriate "well care," including screening, assessment and anticipatory guidance, the work group recommends http://www.brightfutures.org .
- Screening and Diagnosis
Recommendations:
- BMI should be calculated and documented in the medical record on all children ages 2 to 18 at least annually, ideally at a well child visit (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007).
- The Centers for Disease Control and Prevention (CDC) growth charts should be used for children ages 2 to 18; World Health Organization (WHO) growth curves should be used from birth through 23 months of age (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007).
- Appropriate terminology should be used to classify pediatric overweight and obesity. (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007).
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