Prevention and management of obesity for children and adolescents.

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: Obesity prevention messages should be targeted at all families, starting at the time of the child's birth (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). An assessment of diet, physical activity and sedentary behaviors should be done annually, preferably at a well child visit. This assessment should be used to target appropriate messages to each family (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). Clinicians may suggest that children get at least 60 minutes of moderate exercise daily (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). Clinicians should counsel children and families to: Limit their child's consumption of sugar-sweetened beverages Eat a diet with the recommended quantities of fruits and vegetables Eat breakfast daily Eat meals together as much as possible Limit eating out, especially eating at fast food restaurants Adjust portion sizes appropriately for age Avoid television for children under the age of two Limit television and "screen time" to less than two hours per day (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007) 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).