A new tool against childhood obesity

An AMA-convened expert commission offers recommendations to doctors about how to assess, treat and prevent excess pounds for their young patients.

Posted July 9, 2007.

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The lure of the sofa, the television, soda pop and supersized meals hasn't expanded only American adults' waistlines. Children have put on excessive weight, too.

The Centers for Disease Control and Prevention's statistics are startling. Survey data taken in 1971 to 1974 and 2003 to 2004 show that the percentage of overweight children jumped from 5% to 13.9% for children ages 2 to 5, from 4% to 18.8% for ages 6 to 11, and from 6.1% to 17.4% for kids 12 to 19.

The trend didn't escape physicians' attention.

The American Medical Association in 2004 declared obesity in children (and adults) a major public health problem. The Association adopted policy promising to collaborate on recommendations to address the issue.

Now, that effort has borne fruit.

Last month, the AMA-convened Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity released recommendations for physicians on how to help their young patients with weight problems. The project, which began in 2005, was co-funded in collaboration with the Centers for Disease Control and Prevention and the Health Resources and Services Administration.

The 22 recommendations cover assessment, treatment and prevention. The panel, consisting of representatives from 15 health professional organizations, says doctors should assess kids yearly for height, weight and body mass index and plot the results on standard growth charts.

It recommends that during well-child visits, physicians assess the dietary and physical activity patterns of all youngsters, not just those with weight problems, and discuss weight management and lifestyle with them and their caregivers. The full list of recommendations is online (link).

Children ages 2 to 18 with BMIs in the 95th percentile or higher should be considered obese, a classification the Institute of Medicine used in its 2005 report, "Preventing Childhood Obesity."

The expert panel also recommends for the first time that kids between the 85th and 95th percentiles be considered overweight, as opposed to the previous classification of "at risk of overweight."

The committee offers practical suggestions about how to treat these children. It has developed a four-tiered system, with the recommendations about diet and exercise getting stricter if the patient shows no improvement.

The recommendations aim to help doctors prevent their patients from getting to the point at which intervention is needed. They suggest that physicians counsel young patients and their caregivers about the culprits in the obesity epidemic -- sugary beverages, too much TV, not enough exercise, fast food and skipped breakfasts. The AMA House of Delegates is to consider further action on obesity prevention at its June Annual Meeting (meeting coverage is in our next issue). Proposed resolutions call for limits on high-fructose syrups and a move to nonfructose sweeteners, use of healthy foods in school lunches and food assistance programs, and requirements that fast-food restaurants post nutrition information.

Meanwhile, the National Initiative for Children's Healthcare Quality is developing an implementation guide to give doctors the tools and resources needed to put the expert committee's new recommendations into practice.

The health problems associated with childhood overweight make action crucial. Overweight children and adolescents are more likely to have risk factors associated with cardiovascular disease, such as high blood pressure and cholesterol, according to the CDC. A population-based sample of 5- to 17-year-olds found that almost 60% of overweight children had at least one heart disease risk factor and that 25% had two or more.

Heavy children also are at higher risk for asthma, hepatic steatosis, sleep apnea and type 2 diabetes than their peers, the CDC reports. Kids with weight problems also face social discrimination and the low self-esteem and stress that results.

The expert committee recognizes that physicians are leaders in the campaign against childhood overweight and obesity. Its slate of recommendations now makes doctors' jobs easier.

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External links

"Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity," June, in pdf (link)

National Initiative for Children's Healthcare Quality (link)

Centers for Disease Control and Prevention on childhood overweight (link)

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