Pediatric Obesity—Assessment, Treatment, and Prevention

Publication Date: January 31, 2017
Last Updated: December 16, 2022

Diagnosis

Diagnosing Overweight and Obesity

ES recommends using body mass index (BMI) and the Centers for Disease Control and Prevention (CDC) normative BMI percentiles to diagnose overweight or obesity in children and adolescents ≥2 years of age. ( 1-M )
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ES recommends diagnosing a child or adolescent >2 years of age as overweight if the BMI is ≥85th percentile but <95th percentile for age and sex, as obese if the BMI is ≥95th percentile, and as extremely obese if the BMI is ≥120% of the 95th percentile or ≥35 kg/m2. ( 1-L )
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ES suggests that clinicians take into account that variations in BMI correlate differently to comorbidities according to race/ ethnicity and that increased muscle mass increases BMI. ( 2-VL )
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ES suggests calculating, plotting, and reviewing a child's or adolescent's BMI percentile at least annually during well-child and/or sick-child visits. ( UGPS )
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ES suggests that a child <2 years of age be diagnosed as obese if the sex-specific weight for recumbent length is ≥97.7th percentile on the World Health Organization (WHO) charts, since US and international pediatric groups accept this method as valid. ( 2-VL )
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ES recommends against routine laboratory evaluations for endocrine etiologies of pediatric obesity unless the patient's stature and/or height velocity are attenuated (assessed in relationship to genetic/familial potential and pubertal stage). ( 1-M )
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ES recommends that children or adolescents with a BMI of ≥85th percentile be evaluated for potential comorbidities (see Table 2 and Fig. 1). (1-M)
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ES recommends against measuring insulin concentrations when evaluating children or adolescents for obesity. ( 1-M )
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Genetic Obesity Syndromes

ES suggests genetic testing in patients with extreme early onset obesity (before 5 years of age) and that have clinical features of genetic obesity syndromes (in particular extreme hyperphagia) and/or a family history of extreme obesity. (2-L)
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Prevention

ES suggests that clinicians promote and participate in the ongoing healthy dietary and activity education of children and adolescents, parents, and communities, and encourage schools to provide adequate education about healthy eating. ( 2-VL )
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ES recommends that clinicians prescribe and support healthy eating habits such as:
  • avoiding the consumption of calorie-dense, nutrient-poor foods (e.g., sugar-sweetened beverages, sports drinks, fruit drinks, most "fast foods" or those with added table sugar, high-fructose corn syrup, high-fat or high-sodium processed foods, and calorie-dense snacks)
  • encouraging the consumption of whole fruits rather than fruit juices.
( 1-L )
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ES recommends that children and adolescents engage in at least 20 minutes, optimally 60 minutes, of vigorous physical activity ≥5 days per week to improve metabolic health and reduce the likelihood of developing obesity. ( 1-L )
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ES suggests fostering healthy sleep patterns in children and adolescents to decrease the likelihood of developing obesity due to changes in caloric intake and metabolism related to disordered sleep. ( 2-L )
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ES recommends balancing unavoidable technology-related screen time in children and adolescents with increased opportunities for physical activity. ( 1-L )
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ES suggests that a clinician’s obesity prevention efforts enlist the entire family rather than only the individual patient. ( 2-VL )
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ES suggests that clinicians assess family function and make appropriate referrals to address family stressors to decrease the development of obesity. ( 2-L )
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ES suggests using school-based programs and community engagement in pediatric obesity prevention. (2-L)
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ES recommends using comprehensive behavior-changing interventions to prevent obesity. Such programs would be integrated with school- or community-based programs to reach the widest audience. (1-L)
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ES recommends breast-feeding in infants based on numerous health benefits. However, we can only suggest breast-feeding for the prevention of obesity, as evidence supporting the association between breast-feeding and subsequent obesity is inconsistent. (2-VL)
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Treatment

Obesity Lifestyle: General Considerations
ES recommends that clinicians prescribe and support intensive, age-appropriate, culturally sensitive, family-centered lifestyle modifications (dietary, physical activity, behavioral) to promote a decrease in BMI. ( 1-M )
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ES recommends that clinicians prescribe and support healthy eating habits in accordance with the following guidelines of the American Academy of Pediatrics and the US Department of Agriculture:
  • decreased consumption of fast foods
  • decreased consumption of added table sugar and elimination of sugar-sweetened beverages
  • decreased consumption of high-fructose corn syrup and improved labeling of foods containing high-fructose corn syrup
  • decreased consumption of high-fat, high-sodium, or processed foods
  • consumption of whole fruit rather than fruit juices
  • portion control education
  • reduced saturated dietary fat intake for children and adolescents >2 years of age
  • US Department of Agriculture recommended intake of dietary fiber, fruits, and vegetables
  • timely, regular meals, and avoiding constant "grazing" during the day, especially after school and after supper
  • recognizing eating cues in the child’s or adolescent’s environment, such as boredom, stress, loneliness, or screen time
  • encouraging single portion packaging and improved food labeling for easier use by consumers.
( UGPS )
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ES recommends that clinicians prescribe and support the reduction of inactivity and also a minimum of 20 minutes of moderate to vigorous physical activity daily, with a goal of 60 minutes, all in the context of a calorie-controlled diet. ( 1-L )
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ES suggests that clinicians encourage and support patients to limit nonacademic screen time to 1–2 hours per day and decrease other sedentary behaviors, such as digital activities. ( 2-VL )
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ES suggests that the health care team identify maladaptive rearing patterns related to diet and activity and educate families about healthy food and exercise habits. ( 2-VL )
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ES suggests that the health care team probe for and diagnose unhealthy intra-family communication patterns and support rearing patterns that seek to enhance the child’s or adolescent’s self esteem. ( 2-VL )
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ES suggests that the health care team evaluate for psychosocial comorbidities and prescribe assessment and counseling when psychosocial problems are suspected. ( 2-VL )
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ES suggests pharmacotherapy for children or adolescents with obesity only after a formal program of intensive lifestyle modification has failed to limit weight gain or to ameliorate comorbidities. ( 2-VL )
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ES recommends against using obesity medications in children and adolescents <16 years of age who are overweight but not obese, except in the context of clinical trials. ( 1-VL )
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ES suggests that Food and Drug Administration (FDA)–approved pharmacotherapy for obesity be administered only with a concomitant lifestyle modification program of the highest intensity available and only by clinicians who are experienced in the use of anti-obesity agents and are aware of the potential for adverse reactions. ( 2-VL )
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ES suggests that clinicians should discontinue medication and reevaluate the patient if the patient does not have a >4% BMI/BMI z score reduction after taking anti-obesity medication for 12 weeks at the medication’s full dosage. ( 2-VL )
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ES suggests bariatric surgery only under the following conditions:
  • The patient has attained Tanner 4 or 5 pubertal development and final or near-final adult height, the patient has a BMI of >40 kg/m2 or has a BMI of >35 kg/m2 and significant, extreme comorbidities.
  • Extreme obesity and comorbidities persist despite compliance with a formal program of lifestyle modification, with or without pharmacotherapy.
  • Psychological evaluation confirms the stability and competence of the family unit [psychological distress due to impaired quality of live (QOL) from obesity may be present, but the patient does not have an underlying untreated psychiatric illness].
  • The patient demonstrates the ability to adhere to the principles of healthy dietary and activity habits.
  • There is access to an experienced surgeon in a pediatric bariatric surgery center of excellence that provides the necessary infrastructure for patient care, including a team capable of long-term follow-up of the metabolic and psychosocial needs of the patient and family.
( UGPS )
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ES suggests against bariatric surgery in preadolescent children, pregnant or breast-feeding adolescents (and those planning to become pregnant within 2 years of surgery) and in any patient who has not mastered the principles of healthy dietary and activity habits and/or has an unresolved substance abuse, eating disorder, or untreated psychiatric disorder. ( 2-VL )
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Recommendation Grading

Overview

Title

Pediatric Obesity—Assessment, Treatment, and Prevention

Authoring Organization

Endorsing Organization

Publication Month/Year

January 31, 2017

Last Updated Month/Year

June 5, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity.

Inclusion Criteria

Female, Male, Adolescent, Child

Health Care Settings

Ambulatory, Childcare center, School

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D009765 - Obesity, D063766 - Pediatric Obesity

Keywords

obesity, pediatric obesity, childhood obesity

Source Citation

Dennis M. Styne, Silva A. Arslanian, Ellen L. Connor, Ismaa Sadaf Farooqi, M. Hassan Murad, Janet H. Silverstein, Jack A. Yanovski, Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 3, 1 March 2017, Pages 709–757, https://doi.org/10.1210/jc.2016-2573