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Revised Guidelines on Childhood Obesity

Expert committee recommendations on prevention, assessment, and treatment of child and adolescent overweight and obesity

Anyone in clinical practice is aware of the obesity epidemic and its frightening implications. Most of us have struggled with this issue and are frustrated by our ineffective strategies. Recently revised guidelines on the prevention, assessment, and treatment of child and adolescent overweight and obesity are the product of an expert panel of representatives from 15 national professional organizations. These guidelines provide a uniform approach to childhood obesity for which outcomes can be measured and management modified when appropriate.

One of the most important components is the recommendation of a standard nomenclature. The expert committee recommends that patients between ages 2 and 18 years with BMIs at or above the 95th percentile for age and sex, or with BMIs above 30 kg/m², should be considered obese (rather than overweight) and that those with BMIs from the 85th to 95th percentile should be classified as overweight (rather than at risk for overweight). Obviously, clinicians must calculate the BMI to follow these guidelines, and this should be done at least yearly and plotted on standard growth charts. Also, because the degree of obesity has increased, the committee proposes recognition of 99th percentile BMI cutoff points for severe obesity. The report includes a table with 99th percentile cutoff points by age and sex to supplement the CDC growth charts that stop at the 97th percentile.

The recommendations also call for evaluation of obesity risk, including assessment of dietary patterns and physical activity, during every well-child visit.

For children whose BMI is at the 5th to 85th percentile, recommendations for prevention focus on dietary intake, physical activity, and eating behaviors. For children whose BMI is above the 85th percentile, a staged approach to treatment is provided with recommendations for advancement if milestones are not met.

Comment: I believe physicians will welcome these guidelines into their clinical practices because they provide an organized approach to the assessment, prevention, and treatment of overweight and obesity. Also, the guidelines have many clinical practice pearls, including a terrific table on motivational interviewing of parents and adolescent patients about obesity. Implementation will require changes in office practices and identification of resources and expertise to assist in the management of obese patients, but we now have a uniform approach. I encourage everyone to review these guidelines, digest their content, and incorporate them and the approaches into their practices. Evaluation of the effectiveness of these guidelines will be important so that necessary modifications can be made. We all need to be engaged in obesity prevention and treatment, because the long-term effects of the epidemic are frightening. I would also welcome guidelines for the evaluation and treatment of obesity in the entire family.

— William P. Kanto, Jr. MD

Published in Journal Watch Pediatrics and Adolescent Medicine February 6, 2008

Citation(s):

Barlow SE and the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics 2007 Dec; 120:S164. (http://pediatrics.aappublications.org/cgi/content/full/120/Supplement_4/S164)

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