TABLE 10-1

Evidence-Based Recommendations for Management of Overweight and Obesity

Birth to 24 moNo weight-for-height–specific recommendations
CHILD-1 diet is recommended for pediatric care providers to use with their child and adolescent patients to reduce cardiovascular risk
2 to 5 yIdentify children at high risk for obesity because of parental obesity and excessive BMI increaseGrade B Recommend
    Focused CHILD-1 diet and physical activity education
        BMI percentile stable: reinforce current program, follow-up in 6 mo
        Increasing BMI percentile: RD counseling for energy-balanced diet, intensify physical activity change; 6-mo follow-up
    BMI = 85th–95th percentile
        Excess weight-gain prevention with parents as focus for energy-balanced diet; reinforce physical activity recommendations for 6 moGrade D Recommend
        Improvement in BMI percentile: continue current program
        Increasing BMI percentile: RD counseling for energy-balanced diet; intensify physical activity recommendations; 6-mo follow-up
    BMI ≥ 95th percentile
        Specific assessment for comorbiditiesaGrade B Strongly recommend
        Family-based weight-gain prevention with parents as focus; RD counseling and follow-up for energy-balanced diet; MVPA prescription; limit sedentary screen time; 3-mo follow-upGrade B Recommend
6 to 11 yIdentify children at increased risk for obesity because of parental obesity, change in physical activity ± excessive gain in BMI for focused CHILD-1 diet/physical activity educationGrade B Recommend
    BMI percentile stable: reinforce current program, 6-mo follow-up
    Increasing BMI percentile: RD counseling for energy-balanced CHILD-1 diet, intensified physical activity, 3 mo follow-up
    BMI = 85th–95th percentile
        Excessive weight-gain prevention with parents as focus for energy-balanced diet; reinforce physical activity recommendations, 6-mo follow-upGrade D Recommend
        Stable/improving BMI percentile: reinforce current program, 6-mo follow-up
        Increasing BMI percentile: RD counseling for energy-balanced CHILD-1 diet, intensified physical activity recommendations, 3-mo follow-up
    BMI ≥ 95th percentile
        Specific assessment for comorbiditiesaGrade B Strongly recommend
    BMI ≥ 95th percentile with no comorbidities
        Office-based weight-loss plan: family-centered program with parents as focus for behavior modification, (−) energy-balanced diet, counseling by RD, prescription for increased MVPA, decreased sedentary time for 6 moGrade A Strongly recommend
        Improvement in BMI percentile/comorbidities: continue current plan
        No improvement in BMI percentile: refer to comprehensive multidisciplinary lifestyle weight-loss program
    BMI ≥ 95th percentile with comorbidities, BMI > 97th percentile, or progressive rise in BMI despite therapyGrade A Strongly recommend
        Refer to comprehensive multidisciplinary weight-loss program for intensive management for 6 mo
        Improvement in BMI percentile: continue current program
        No improvement in BMI percentile: consider referral to another comprehensive multidisciplinary weight-loss program
12 to 21 yIdentify adolescents at increased risk for obesity because of parental obesity, change in physical activity ± excess gain in BMI for focused diet/physical activity education for 6 moGrade B Recommend
    BMI/BMI percentile stable: reinforce current program, 6-mo follow-up
    Increasing BMI/BMI percentile: RD counseling for energy-balanced CHILD-1 diet, intensified physical activity for 3 mo
BMI = 85th–95th percentile
    Excess weight-gain prevention with adolescent as change agent for energy-balanced CHILD-1 diet, reinforced physical activity recommendations for 6 moGrade B Recommend
    Improvement in BMI percentile: continue current program
    Increasing BMI percentile: RD counseling for energy-balanced weight-control diet, intensified physical activity, 3-mo follow-up
BMI ≥ 95th percentile
    Specific assessment for comorbiditiesaGrade B Strongly recommend
        BMI ≥ 95th percentile with no comorbidities
            Office-based weight-loss plan: family-centered with adolescent as change agent for behavior-modification counseling, RD counseling for (−) energy-balanced diet, prescription for increased MVPA, decreased sedentary time for 6 moGrade B Strongly recommend
            Improvement in BMI/BMI percentile: continue current program
            No improvement in BMI/BMI percentile: refer to comprehensive multidisciplinary weight-loss program with peers
            No improvement in BMI/BMI percentile: consider initiation of medication (orlistat) under care of experienced clinician for 6–12 mo
        BMI ≥ 95th percentile with comorbidities or BMI > 35
            Refer to comprehensive lifestyle weight-loss program for intensive management for 6–12 moGrade A Strongly recommend
            Improvement in BMI/BMI percentile: continue current program
            No improvement in BMI/BMI percentile: consider initiation of orlistat under care of experienced clinician for 6–12 mo
        If BMI is far above 35 and comorbidities unresponsive to lifestyle therapy for >1 y, consider bariatric surgery/referral to center with experience/expertise in procedures
  • Grades reflect the findings of the evidence review, and recommendation levels reflect the consensus opinion of the expert panel. RD indicates registered dietitian; MVPA, moderate-to-vigorous physical activity.

  • a Comorbidities: hypertension, dyslipidemia, and T2DM.