KNOW ABOUT RISK FOR OBESITY

Children who are diagnosed with one or more primary risk factors or fall above the 85th percentile
on the BMI percentiles may benefit from monitoring more frequently than annually (e.g., every
6 months) to check for continued upward shifts in BMI [2,36,41]. In addition, anticipatory guidance
and brief negotiations for behavior change with parents should be undertaken to change risk eating
and physical activity habits.
OVERWEIGHT
Families of overweight children require consistent feedback from pediatric health care professionals
to determine whether nutrition and physical activity recommendations are providing successful
outcomes. Height, weight, and BMI should be calculated regularly (e.g., every 3 months).
SEVERE OVERWEIGHT
Severely overweight youth require intense interventions and regular medical monitoring. This is
ideally provided by a multidisciplinary team with experience working with pediatric patients and
their families. Patients should be examined at least monthly, especially if they are following a
calorie-restricted diet. Monitoring to determine the effect of the weight loss plan on lipid profiles
and diabetes risk should be conducted quarterly. An expert committee has provided an algorithm
to assist pediatric health care professionals with monitoring [29]. In general, a one-half pound/week
weight loss is optimal.
For all children, parental education in the medical office setting is strongly recommended regardless
of the child’s current weight condition, but especially if the parents are obese. Children who are
at risk for overweight by virtue of family history or other predisposing factors become increasingly
more susceptible as they mature. Thus, age-appropriate, targeted, family-based dietary and physical
activity preventive strategies should be consistently promoted, and basic therapeutic interventions
should be made available in pediatric clinical settings. The economic burden of obesity-associated
illness during childhood in the United States has increased by 43% in the last two decades [66].
Cost-effective individual and group treatment approaches are available and should be both encouraged
and financially supported by the pediatric medical community. Academic programs that work
simultaneously to conduct research, provide training opportunities for pediatric professionals, and
evaluate ongoing interventions to prevent and treat overweight children are also vitally important
to reverse this pediatric epidemic.