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.
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December 2007
Supplement Articles|
December 01 2007
Recommendations for Treatment of Child and Adolescent Overweight and Obesity
Bonnie A. Spear, PhD, RD;
Bonnie A. Spear, PhD, RD
aDepartment of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Sarah E. Barlow, MD, MPH;
Sarah E. Barlow, MD, MPH
bDepartment of Pediatrics, Saint Louis University, St Louis, Missouri
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Chris Ervin, MD, FACEP;
Chris Ervin, MD, FACEP
cGeorgia Diabetes Coalition, Atlanta, Georgia
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David S. Ludwig, MD, PhD;
David S. Ludwig, MD, PhD
dObesity Program, Division of Endocrinology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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Brian E. Saelens, PhD;
Brian E. Saelens, PhD
eDepartments of Pediatrics and Psychiatry and Behavioral Sciences, University of Washington–Child Health Institute, Seattle, Washington
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Karen E. Schetzina, MD, MPH;
Karen E. Schetzina, MD, MPH
fDepartment of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
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Elsie M. Taveras, MD, MPH
Elsie M. Taveras, MD, MPH
gObesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
hDivision of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts
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Address correspondence to Bonnie A. Spear, PhD, RD, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave S, MTC 201, Birmingham, AL 35233. E-mail: [email protected]
Pediatrics (2007) 120 (Supplement_4): S254–S288.
Article history
Accepted:
August 31 2007
Citation
Bonnie A. Spear, Sarah E. Barlow, Chris Ervin, David S. Ludwig, Brian E. Saelens, Karen E. Schetzina, Elsie M. Taveras; Recommendations for Treatment of Child and Adolescent Overweight and Obesity. Pediatrics December 2007; 120 (Supplement_4): S254–S288. 10.1542/peds.2007-2329F
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Comments
Definitions of child overweight and obesity
Carrying out a review on interventions for the prevention and treatment of overweight and obesity in children under five years of age, as part of the activities of Work Package 3 within the HOPE Project (Health Promotion through Obesity Prevention across Europe, www.hopeproject.eu), we ran into the review by Spear and colleagues.1
In the introductory paragraphs the authors define as threshold for overweight a BMI between the 85th and the 94th percentile and for obesity a BMI ¡Ý95th percentile. No mention to what growth chart the authors are referring to.
Without a reference to specific growth charts, the transformation of a BMI value into a percentile does not make much sense. One of the two references cited2 takes us to a new reference3 from which we gather the authors base their affirmations on the CDC 2000 charts. The second cited article gets in a lot more detail about national and international definitions of child overweight and obesity.4
We feel an important and useful revue such as the one published by Spear and colleagues should more clearly define the terms of the problem.
1. Spear BA, Barlow SE, Ervin C, et al. Recommendations for Treatment of Child and Adolescent Overweight and Obesity. Pediatrics. 2007;120;S254- S288
2. Weiss R, Dziura J, Burgert TS, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350:2362¡§C2374
3. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States. Advanced data from vital and health statistics. No. 314. Hyattsville, Md.: National Center for Health Statistics, 2000:1-27 (DHHS publication no. (PHS) 2000-1250 0-0431)
4. Speiser PW, Rudolf MC, Anhalt H, et al. Childhood obesity. J Clin Endocrinol Metab. 2005;90:1871¡§C1887
Conflict of Interest:
None declared