Professional Refreshers

Obesity: Treatment Recommendations for Children

January 11, 2017   /

The prevalence of overweight among children 6 to 11 years of age has more than doubled in the past 20 years and more than tripled in children 12 to 19 years of age. Children who are overweight or obese are likely to become overweight adults. Registered dietitians are key players in helping families prevent and treat childhood obesity.

While many causes of the obesity epidemic are likely, some important societal trends also may play a role. Understanding those trends will help dietitians treat obesity more effectively. Two articles on societal trends are available at  http://www.cdc.gov/pcd/issues/2005/jan/04_0038.htm and http://www.cdc.gov/pcd/issues/2005/apr/04_0039.htm. These articles suggest that food consumption patterns have changed dramatically, while physical activity trends have not.

People are shifting to eating more foods away from home. Soft drink consumption, which also has increased, is positively related to a higher-calorie intake. Carbohydrate intake has increased, especially from chips, crackers, popcorn, and pretzels. Eating as a primary activity has declined, suggesting a shift toward snacking or eating as a secondary activity. Surprisingly, time spent in sedentary activities, such as watching television and playing video games, has not increased, and more children are involved in organized activities, including sports.

Parents and adult caregivers play an important role in the development of proper eating habits by young children. Treatment by the family as a unit is recommended. Because childhood obesity is so complicated, a multidisciplinary approach that includes dietitians, physicians, psychologists, nurses, and social workers is crucial. For many families, the guidance and support of counselors are essential for success.

An excellent summary of expert recommendations for obesity evaluation and treatment is available at http://www.pediatrics.org/cgi/content/full/120/Supplement_4/S164. This article is useful for individuals who deal with childhood weight issues. Treatment should involve setting therapy goals, medical goals, and weight goals. The medical assessment should include a readiness assessment, completed prior to treatment, that includes information such as family history and a physical exam. Treatment goals should include behavior changes, medical goals, and weight goals.

Behavior goals are key to managing childhood obesity. When treatment focuses on behavior changes and is family-based, obesity programs can lead to sustained weight loss. The practitioner and family should identify problem behaviors, work to modify behaviors, and maintain awareness of the behaviors that contribute to the problem.  Parenting skills are key to behavior change.

Effective parenting techniques for the child who is overweight include:

  • Praising good behavior
  • Not using food as a reward
  • Establishing times for daily meals and snacks
  • Offering healthy food and beverage choices
  • Removing temptations
  • Serving as a role model
  • Providing consistent responses

Medical goals include improving or resolving medical problems, such as elevated blood pressure or blood lipids. Regular reassessment of medical parameters can show improvement, even if weight loss is not occurring.

Weight goals will vary depending on the child. For many, the best first step is maintenance of baseline weight. This will result in a decrease in body mass index as children get older. Weight-loss goals are appropriate for some older children who are extremely obese. Standard recommendations for weight maintenance or weight loss include increasing physical activity, eating smaller portions, and eating and drinking fewer “empty-calorie” foods, as well as other techniques recommended by registered dietitians.

Implications for practitioners
For the best success in managing childhood obesity, a dietitian should work with the family, not just the child, and work as a team to change behaviors and pursue a healthier lifestyle. Dietitians should consider societal trends that may contribute to obesity, as well as family habits and dynamics. This may require a referral to a therapist.

 

References and recommended readings
Barlow SH; 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. http://www.michigan.gov/documents/mdch/Barlow_Expert_Comm._Recommendations_351360_7.pdf. Accessed March 14, 2013.

Golan M, Weizman WA, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr. 1998;67:1130-1135. http://www.ajcn.org/cgi/reprint/67/6/1130. Accessed March 14, 2013.

Nutrition and the health of young people. Centers for Disease Control and Prevention. http://www.cdc.gov/HealthyYouth/nutrition/pdf/facts.pdf. Accessed March 6, 2013.

Sturm R. Childhood obesity—what we can learn from existing data on societal trends, part 1. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/pcd/issues/2005/jan/04_0038.htm. Accessed March 14, 2013.

Sturm R. Childhood obesity—what we can learn from existing data on societal trends, part 2. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/pcd/issues/2005/apr/04_0039.htm. Accessed March 6, 2013.