Published online November 30, 2007
PEDIATRICS Vol. 120 Supplement December 2007, pp. S164-S192 (doi:10.1542/peds.2007-2329C)
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SUPPLEMENT ARTICLE


Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Sarah E. Barlow, MD, MPH and the Expert Committee

Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child';s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient's age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

Key Words: obesity • prevention • assessment • treatment • clinical practice pattern • chronic care model • office management • motivational interviewing • overweight • patient education • nutrition assessment

Abbreviations: AST—aspartate aminotransferase • ALT—alanine aminotransferase • CDC—Centers for Disease Control and Prevention • NAFLD—nonalcoholic fatty liver disease • USDA—US Department of Agriculture • CE—consistent evidence • ME—mixed evidence

Accepted Aug 31, 2007.




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