PEDIATRICS Vol. 121 No. 4 April 2008, pp. 833-834 (doi:10.1542/peds.2008-0061)
COMMENTARY |
A Response to the Expert Committee's Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity
School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
In 2007, the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity released guidelines1 to help physicians prevent and treat childhood obesity. The American Academy of Pediatrics and other members of the Expert Committee should be commended for recognizing the gravity of the childhood obesity epidemic and for devoting resources in an attempt to address this problem. The guidelines are concrete, clear, and specific; provide quantifiable and measurable criteria by which they should be applied; and differentiate between the needs of normal weight, overweight, and obese children. In addition, the Expert Committee should be applauded for explicitly advocating for the regular and routine assessment of dietary patterns and physical activity levels of all children and not just those who are identified as being overweight or obese. Despite these strengths, the recommendations are insufficient in several ways.
First, some of the recommendations may be too vague for physicians to apply in their practices. For instance, the recommendation that "all physicians should address weight management and lifestyle issues with all patients"1 should be accompanied or supplemented by specific examples of how weight management and lifestyle issues can be addressed in medical practices. In addition, the Expert Committee and its members should advocate for additional training in pediatric weight management and behavioral counseling for all pediatricians and health care professionals who work with children.
Second, the recommendations fail to acknowledge the impact of poverty, neighborhood violence, and family stress on children's dietary habits and physical activity levels. Low-income families, especially those living in inner cities, may have particular difficulty complying with pediatricians’ recommendations that children should have 1 hour or more of daily physical activity and 5 or more servings of fruits and vegetables per day. Limited access to recreation facilities, well-maintained and safe parks, and grocery stores in their neighborhoods may impose additional barriers beyond those faced by higher income families. Similarly, single parents and parents who work multiple jobs may be unable to comply with recommendations to have family meals in which parents and children eat together, to limit the number of meals children have outside the home, to model physical activity, and to supervise their children's play. The Expert Committee and its members should advocate for:
- increased funding for and expansion of public and nonprofit recreation programs and facilities
- school breakfast and lunch programs that comply with nutrition recommendations for children and adolescents
- additional grocery stores, farmers’ markets, and fruit and vegetable markets in low-income areas
- increased collaboration between public safety officials, public planning departments, community development organizations, and public health professionals in the planning and implementation of real estate and community development projects to minimize barriers to physical activity
- increased funding for Medicaid, child care subsidies, and other work support programs that reduce the financial burdens on families with children
- increased funding and support for local public safety initiatives to prevent gang activity, drug-related crime, and violence, particularly in low-income neighborhoods
Third, the Expert Committee did not discuss or acknowledge the need for modified recommendations for children with physical, mental, or developmental disabilities. Some medications, particularly antipsychotics, can cause metabolic syndrome and/or excessive weight gain in children.2,3 Children with disabilities may have limited access to handicapped-accessible recreation facilities, may not have the skills necessary to participate in competitive sports programs, and may be discouraged from participating in community recreation programs that do not have the staffing or resources necessary to accommodate their needs. In addition, anecdotal evidence from parents suggests that many schools may not adequately support the participation of students with disabilities in physical activity and after-school programs. The Expert Committee recommendations should be accompanied or supplemented by specific examples of how physical activity can be promoted for children with disabilities. In addition, the Expert Committee and its members should advocate for:
- additional handicapped-accessible public and nonprofit recreation facilities in each community
- increased funding for public and nonprofit recreation programs that serve the needs of children and adolescents with disabilities
- promotion of noncompetitive sports and recreation programs for children and adolescents of all ages
- promotion of in-school and after-school physical activity programs for students with disabilities
Fourth, the Expert Committee recommends that physicians and others advocate for the federal government to increase physical activity at school,1 but the Expert Committee does not recommend that these groups advocate for improved nutrition at school. Children and adolescents spend a substantial amount of their time and eat a large proportion of their meals at school. Schools can play a critical role in promoting good nutrition by removing soda and vending machines from student areas, providing students of all ages with nutrition education, offering fresh fruits and vegetables as snacks, and providing school breakfasts and lunches that comply with current nutrition recommendations for children and adolescents. The Expert Committee should recommend that physicians and others advocate for federal, state, and local governments to improve nutrition at school, such as through the mechanisms identified above.
Finally, the Expert Committee excludes children under the age of 2 from nearly all of the recommendations and provides no specific recommendations for children ages 0–2. Studies have found that children's eating habits are established early in life4,5 and that breastfeeding is associated with a decreased risk of overweight and obesity later in childhood.6,7 The Expert Committee should provide specific recommendations to physicians to promote healthy eating and physical activity habits among children beginning in infancy.
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FOOTNOTES |
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Accepted Jan 16, 2008.
Address correspondence to: Jennifer J. Bowdoin, MS, 85 Edgewood Avenue, Cranston, RI 02905. E-mail: jbowdoin{at}schoolph.umass.edu
Financial Disclosure: The author has indicated she has no financial relationships relevant to this article to disclose.
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
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