Obesity
Obesity is one of the most common chronic conditions throughout childhood and can lead to serious health consequences even at early ages. Focusing on healthy lifestyles at every age is important to help prevent and treat obesity and its health complications.
Evaluation and management are based on four key components:
- Identification of overweight and obesity using BMI charts (or weight for length charts if under age 2)
- Consideration of causes including genetics, environment, medical issues and medications
- Evaluation for health consequences
- Treatment
Suggested format for the visit:
- Determine if the patient or parent has any concerns about weight
- History
- daily eating patterns
- sugary beverages and junk food
- eating out
- screen time apart from schoolwork
- indoor and outdoor activity
- sleep quality, timing and duration
- symptoms of anxiety or depression
- current medications
- family history of diabetes, hypertension, high cholesterol or heart disease if not previously documented
- Physical exam
- ask family to check weight on a home scale if available
- look at overall distribution of body fat
- check the neck for acanthosis nigricans
- check the throat for enlarged tonsils
- look at standing posture
- Discuss or look at growth charts with families to identify range and trajectory of weight and height
- Labs and studies
- assess yearly or more often as indicated for metabolic co-morbidities of obesity including fatty liver, dyslipidemia and prediabetes/diabetes
- consider PCOS in adolescent females with irregular menses
- order a sleep study for any significant history of snoring or daytime somnolence
- Treatment
- use motivational interviewing to set 1-2 healthy lifestyle goals to work on before the next visit
- aim for 3 meals per day including breakfast, 1-2 snacks per day and 60 minutes of physical activity per day whether indoors or outdoors
- mention the option of referral to a specialty center for pharmacologic treatment and/or bariatric surgery to adolescents with a BMI ≥35
- determine a follow up interval depending on the family’s preference (in general within 1-3 months)
Resources for families:
- AAP healthychildren.org:
- Chop Chop Family: https://www.chopchopfamily.org/
- Choose My Plate: https://www.myplate.gov/
- FDA: Nutrition Facts Read the Label Tips for Parents (also in Spanish)
- The Obesity Society Information for Healthcare Providers and Patients
- Packing A Healthy Lunch for Your Kids
- Help Your Child Have a Healthy Weight
- DHHS Office of Disease Prevention and Health Promotion: Move Your Way-60 a Day
References:
- Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab. 2017 Mar 1;102(3):709-757.
- Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management Front Pediatr. 2019 Jan 23;6:431
- Pediatric, Metabolic and Bariatric Surgery: Evidence, Barriers and Best Practices Pediatrics. 2019 Dec;144(6)
- American Academy of Pediatrics Institute for Healthy Childhood Weight Algorithm for the Assessment and Management of Childhood Obesity in Patients 2 Years and Older
By: Elizabeth Shepard MD
Last updated: January 2021