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Childhood Obesity:
Part 2
Adapted with permission of Lucille Beseler, MS, RD, LD
Updated by Nutrition411.com staff
Review Date 6/13 K-0528
Evaluation of the
Overweight/Obese Child
Evaluation of the
Overweight Child
• Physical assessment, including visual acanthosis
nigricans
• Review of medical history, including the existence
of comorbidities:
– Document to help with insurance reimbursement
• Intake evaluation and assessment
• Assessment of home environment
Evaluation of Weight
Problems
Growth charts
• Anthropometrics: Use standard procedure for
measuring and weighing
Assessment of overweight involves
anthropometric evaluation of three key
measures:
• Body mass index
• Weight for age
• Height for age
Body Mass Index (BMI)
• Each of the Centers for Disease Control and
Prevention (CDC) BMI-for-age gender-specific
charts contains a series of curved lines indicating
specific percentiles
• Describes body weight relative to height; strongly
correlated with total body fat
• Established percentile cutoff points to identify
underweight and overweight in children
• Underweight BMI for age: <5th percentile
• At risk of overweight BMI-for-age: 85th percentile
to <95th percentile
• Overweight BMI-for-age: ≥95th percentile
Source: Centers for Disease Control and Prevention Web site. http//www.CDC.gov. Accessed
June 13, 2013.
Evaluation
Intake evaluation
• Using a combination of dietary survey tools helps
establish usual eating patterns:
–
–
–
–
24-hour recall
7-day food intake
Food frequency
Number of meals, snacks, and beverages—yes, what
you drink counts!
Evaluation of Overweight
Children
Evaluate the feeding environment
• Where does the child eat meals?
• Who eats meals with the child? Parent,
grandparents, other family members?
• If multiple generations are living together and/or
family members are on different schedules, does
the child eat more than one dinner?
• Who provides preschool/day-care meals or other
meals eaten away from home? Does preschool
have policy on trading snacks/meals with other
children?
Evaluation of Overweight
Children (cont’d)
• Does the family have the ability to provide
wholesome meals?
• Health/weight status of other members of the
family:
– Document to help with insurance reimbursement
• Evaluate feeding practices and stage of feeding
development:
– Is child on baby food longer than appropriate?
– Is child on a bottle longer than appropriate?
Evaluation of Overweight
Children (cont’d)
Evaluate readiness for change
• Does the parent understand the need for change?
• Is the parent motivated to make changes?
– In young children, the majority of change must come
from the parents and other caretakers
• “Whole-family concept” is necessary, regardless
of the weight status of the rest of the family
Source: Barlow SE; Expert Committee. Expert Committee recommendations regarding the prevention, assessment, and
treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(suppl 4):S164-S192.
Treatment for
Overweight Children
Treatment for Overweight
Children
Medical goals:
Improve/resolve
secondary complications
of obesity:
• Normal blood pressure
• Normal lipids
• Improving good
health—good
reinforcement for
parents and children
Treatment and Intervention
Medical complications: Mild hypertension, dyslipidemia, and insulin
resistance; acute complications: pseudotumor cerebri, sleep apnea,
obesity hypoventilation syndrome, or orthopedic problems
Age
2 to 7
years
2 to 7
years
BMI 85th-94th
Percentile
BMI ≥95th
Percentile
X
X
Absence
of Medical
Complication
Presence
of Medical
Complication
Weight
maintenance
Weight
maintenance
Weight
maintenance
Weight loss
according to
AAP:
1 lb/month
AAP=American Academy of Pediatrics, BMI=body mass index
Source: Barlow SE; Expert Committee. Expert Committee recommendations regarding the prevention, assessment, and
treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(suppl 4) S164-S192.
Treatment and Intervention
(cont’d)
Age
>7
years
>7
years
BMI
85th-94th
Percentile
BMI ≥95th
Percentile
X
X
Absence of
Medical
Complication
Presence of
Medical
Complication
Weight
maintenance
Weight
maintenance
Weight loss
Weight loss
Source: Barlow SE; Expert Committee. Expert Committee recommendations regarding the prevention, assessment, and
treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(suppl 4):S164-S192.
General Approach
to Treatment
• Treatment programs should institute permanent
changes in a gradual way
• No short-term diets aimed at rapid weight loss
• Family commitment is necessary for success
• As part of the treatment program, a family
should learn to monitor eating and activity
Treatment: Reversing the
Problem
What needs to change?
• The composition of the family’s and
child’s diet
• Frequency of eating out
• Activity level
Families Are Looking
for the Perfect Diet
We cannot give families
the “perfect diet,” but
we need to provide
them with useful
nutrition information
to help them make
informed changes
Nutrition Treatment: What
Works?
• Low-fat diets—obesity has increased even as the
total calories from fat has decreased in the
United States*
• ChooseMyPlate was not designed as a weightloss tool*
• Calorie-controlled diets—limited long-term effect*
*Evidence-based guidelines
Nutrition Treatment: What
Works? (cont’d)
• Family dinners—children consume more calories
in restaurants than at home because of larger
portions of energy-dense foods
• Family meals:
– Decrease television viewing
– Decrease unhealthy behaviors
– Have a positive effect on diet quality
Source: Fulkerson JA, Neumark-Sztainer D, Story M. Adolescent and parent views of family
meals. J Am Diet Assoc. 2006;106(4):526-532.
Nutrition Treatment: What
Works? (cont’d)
• Provide families with information on planning and
cooking healthy meals
• Find solutions to address time limitations for
cooking (batch cooking, semi-homemade meals)
• Give parents the information they need to make
necessary changes
• Recommend using the Internet as a source for
healthy recipes and meal planning:
– Food companies have many sites online
– Families can use the Internet for recipes/meal planning
Physical Activity
• Physical activity alone—effective for reducing
overweight
• Physical activity within a multicomponent familybased group intervention, along with dietary
counseling and family counseling in school-age
children
Source: Sothern MS, Loftin JM, Udall JN, et al. Safety, feasibility, and efficacy of a resistance training
program in preadolescent obese children. Am J Med Sci. 2000;319(6):370-375.
Recommended Daily Activity
• Encourage play activity and playtime, which are
important for young children at home and in
school
• Limit television and computer time to no more
than 2 hours/day
• Do not allow children to sit in front of the
television for long periods of time, whether at
home, with a babysitter, or while at child care
Source: Borzekowski DL, Robinson TN. The 30-second effect: an experiment revealing the impact of
television commercials on food preferences of preschoolers. J Am Diet Assoc. 2001;101(1):42-46.
Nutrition Treatment:
What Works?
Traffic light diet
• Calorie controlled
• Portion control
• Emphasis on food groups
• Family monitoring
Source: Epstein LH, Paluch RA, Gordy CC, Saelens BE, Ernst MM. Problem solving in the
treatment of childhood obesity. J Consult Clin Psychol. 2000;68(4):717-721.