July 17, 2008 — A 4-stage approach to treatment of childhood obesity is recommended by the American Medical Association (AMA), according to a review for primary care clinicians in the July 1 issue of the American Family Physician. The study authors note that many of these recommendations for treatment and prevention can be carried out by family clinicians.

"Childhood obesity has become so severe that diseases that once affected only adults are now appearing in children," writes Goutham Rao, MD, from Children's Hospital of Pittsburgh in Pittsburgh, Pennsylvania. "The long-term implications of this epidemic are extremely serious. Obese children are much more likely than children of healthy weight to become obese adults."

The statistics are alarming, with "overweight" youth (those with age-adjusted and sex-adjusted body mass index [BMI] above the 95th percentile, which is equivalent to the "obese" classification for adults) consisting of 13.9% of children 2 to 5 years old, 18.8% of children 6 to 11 years old, and 17.4% of adolescents and teenagers 12 to 19 years old.

Although type 2 diabetes in children was rare 2 decades ago, it now accounts for nearly one half of all new cases of diabetes among children in some settings. In adults, correlates of obesity include not only type 2 diabetes but also hypertension, osteoarthritis, gout, dyslipidemia, cardiovascular disease, and biliary tract disease as well as cancers of the colon, breast (in postmenopausal women), endometrium, and esophagus.

Recognizing the scarcity of practical strategies available to primary care clinicians to combat the problem of childhood obesity, the AMA recently convened an expert panel to review evidence about how best to manage and prevent obesity and to write a series of reports.

Specific recommendations of The Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity, and their accompanying level of evidence, are as follows:

• At least once a year, measure height and weight and calculate BMI plus BMI percentile for all children (level of evidence, C).

• To achieve or maintain a healthy weight, encourage all children to participate in at least 60 minutes of moderate to vigorous physical activity on most, and preferably all, days of the week (level of evidence, A).

• Advise children not to drink more than 1 serving per day of sweetened beverages, such as fruit juice, fruit drinks, regular-calorie soft drinks, sports drinks, energy drinks, sweetened or flavored milk, or sweetened iced tea (level of evidence, B).

• Advise families to limit their children's television viewing and other screen time to 2 hours per day or less (level of evidence, B).

• Recommend that children's fast-food consumption be limited to no more than once per week (level of evidence, C).

• Advise families with children to eat meals together as often as possible, on most, and preferably all, days of the week (level of evidence, C).

During the annual visit, family clinicians should evaluate key dietary and lifestyle habits, including consumption of sweetened beverages and physical activity; willingness to improve dietary and lifestyle habits; and family history of obesity and related illnesses.

Dietary habits that contribute to obesity include frequent consumption of fast food and large volumes of sweetened beverages, eating large portions, skipping breakfast, eating high-fat snacks or other foods high in energy density, low intake of fruits and vegetables, and irregular meal frequency and snacking patterns.   

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