Nutrition: Foundations for Life
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How do we decide which children truly need our attention?
Management of obesity is dependent on whether or not the child is having complications from their obesity. The algorithm recommended by Barlow and Dietz (3) suggests the following management:
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Management of Overweight in Children |
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Children ages 2-7 years |
BMI 85-94 %tile
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Weight maintenance |
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BMI > 95 %tile without complications |
Weight maintenance |
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BMI > 95 %tile with complications |
Weight loss |
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Children > 7 years |
BMI 85-94 %tile without complications |
Weight maintenance |
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BMI 85-94 %tile with complications |
Weight loss |
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BMI > 95 %tile
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Weight loss |
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Complications include mild hypertension, dyslipidemias, and insulin resistance. Acute complications include pseudotumor cerebri, sleep apnea, obesity hypoventilation syndrome or orthopedic problems should be referred to a pediatric obesity center if possible, and should be managed aggressively. |
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Interventions to prevent and treat an overweight condition are not simple. Usually involvement of the whole family is required. It is important to help families assess their own readiness for change and to identify saboteurs, such as indulgent grandparents. Healthy eating may involve change for all members of the family, including those whose weight is normal. And finally, it is important that health professionals working with families give positive feedback for small successes—a slight drop in BMI even if weight has increased, or cutting television from 4 hours to 2 per day.