Obesity, Overweight, and Dyslipidemia in Children and Adolescents

Table of Contents

1. OBESITY, OVERWEIGHT, AND DYSLIPIDEMIA IN CHILDREN AND ADOLESCENTS
2. DEFINITIONS
3. BODY MASS INDEX (BMI)
4. EPIDEMIOLOGY
5. ETIOLOGY
6. ASSESSMENT
7. CO-MORBIDITIES
8. HYPERLIPIDEMIA
9. DIET AND EXERCISE RECOMMENDATIONS
   1. Four Stage Treatment Recommendations
   2. For Children Under Age 2
10. PHARMACOLOGIC INTERVENTIONS
11. REFERRING TO SUBSPECIALISTS
12. TAKE HOME POINTS
13. RESOURCES & REFERENCES
14. ABOUT THE MODULE

For Children Under Age 2

For patients < 2 years of age, the following recommendations are made:

• Plot weight for height values instead of BMI. Children with weight-for-height values above the 95th percentile are considered overweight. There is no cutoff for obesity.

• Assess parental weight status because this can identify future obesity risk and predicts obesity in young adulthood.

• Diets aimed at reducing weight are not recommended for this age group.

• Dietary reference intakes for macronutrients (from the Institute of Medicine) can be found HERE
• Energy requirements for newborns - 2 months of age: 100-120 kcal/kg/day (from Rudolph's Pediatrics, 21^st ed.)
  • Protein: 1.8-2 g/100kcal/day
  • Fat: 3-5 g/100kcal/ day
  • Carbohydrate: 10-12 g/100kcal/ day
• Energy requirements for infants 3 months of age: 95 kcal/kg/day (from Harriet Lane)
• Energy requirements for infants/toddlers 4 months - 35 months of age: 82 kcal/kg/day

• For example, a 4 month old baby that weighs 8 kg:
  • Should get 82 kcal/kg/day = 656 kcal/day * 1/6 (number of feedings per day) * 30 cc/20 kcal = ~164 cc/feed
    [or 5 ounces (30 ounces per day) every 4 hours if using a formula with 20 kcal/30 cc ]

• Practitioners should discuss long-term risks associated with the development of obesity and establish obesity prevention strategies.

• Patients 0-12 months - encourage breastfeeding exclusively until 6 months of age and continued to 12 months or beyond, after introduction of solid foods. Offer new foods repeatedly and avoid sugar sweetened beverages and snack foods.

• No televisions in the room where the infant sleeps.

• All caregivers should follow the prevention steps, not just parents (grandparents too!)

• Patients 12-24 months - avoidance of sugar sweetened beverages, excessive juice intake, excessive milk intake (no more than 16-24 ounces per day and switching to skim or 1% milk, as early as 12 months of age), establish an eating routine - 3 meals per day eaten at the table with other family members and no television, make sure healthy foods and snacks are available at all times, especially fruit and vegetables, offer water between snacks, increase opportunity for active play