Published online November 30, 2007
PEDIATRICS Vol. 120 Supplement December 2007, pp. S254-S288 (doi:10.1542/10.1542/peds.2007-2329F)
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SUPPLEMENT ARTICLE


Recommendations for Treatment of Child and Adolescent Overweight and Obesity

Bonnie A. Spear, PhD, RDa, Sarah E. Barlow, MD, MPHb, Chris Ervin, MD, FACEPc, David S. Ludwig, MD, PhDd, Brian E. Saelens, PhDe, Karen E. Schetzina, MD, MPHf and Elsie M. Taveras, MD, MPHg,h

a Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
b Department of Pediatrics, Saint Louis University, St Louis, Missouri
c Georgia Diabetes Coalition, Atlanta, Georgia
d Obesity Program, Division of Endocrinology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
e Departments of Pediatrics and Psychiatry and Behavioral Sciences, University of Washington–Child Health Institute, Seattle, Washington
f Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
g Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
h Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts

In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or staged-care approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions.

Key Words: obesity • treatment

Abbreviations: GI—glycemic index • PSMF—protein-sparing modified fast • CDC—Centers for Disease Control and Prevention • FDA—Food and Drug Administration • CE—consistent evidence • ME—mixed evidence

Accepted Aug 31, 2007.


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