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Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as Social Security and Medicare. Although the Social Security Administration recently raised its estimates of how long Americans are going to live in the 21st century, current trends in obesity in the United States suggest that these estimates may not be accurate. From our analysis of the effect of obesity on longevity, we conclude that the steady rise in life expectancy during the past two centuries may soon come to an end.

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In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or stagedcare approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions. S254SPEAR et al by guest on August 28, 2018 www.aappublications.org/news Downloaded from T REATMENT FOR CHILDREN who are overweight or obese seems easy, that is, just counsel children and their families to eat less and to exercise more. In practice, however, treatment of childhood obesity is time-consuming, frustrating, difficult, and expensive. In fact, choosing the most effective methods for treating overweight and obesity in children is complex at best. This is especially true for primary care providers, who have limited resources to offer interventions within their offices or programs and few providers to whom they can refer patients.The need for evidence-based treatment recommendations is a critical health care issue, because obese children and adolescents are at risk for developing many of the comorbidities seen in obese adults. Studies demonstrated that fasting serum glucose, insulin, and triglyceride levels and the prevalence of impaired glucose tolerance and systolic hypertension increase significantly as children become obese (BMI of Ն95th percentile). 1 Even children and adolescents who are overweight (BMI of 85th to 94th percentile) are at risk for comorbidities. Therefore, interventions using dietary modifications, increased physical activity, and behavioral therapy may be beneficial for overweight children and adolescents, with more-aggressive intervention directed toward obese children and adolescents. 2 Health care professionals, however, may find it difficult to determine which interventions will be most efficacious for their patients. To date, no clinical trials have determined whether specific dietary modifications alone (ie, without behavioral interven...

Consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity.

BACKGROUND Consumption of sugar-sweetened beverages may cause excessive weight gain. We aimed to assess the effect on weight gain of an intervention that included the provision of noncaloric beverages at home for overweight and obese adolescents. METHODS We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention. We hypothesized that the experimental group would gain weight at a slower rate than the control group. RESULTS Retention rates were 97% at 1 year and 93% at 2 years. Reported consumption of sugar-sweetened beverages was similar at baseline in the experimental and control groups (1.7 servings per day), declined to nearly 0 in the experimental group at 1 year, and remained lower in the experimental group than in the control group at 2 years. The primary outcome, the change in mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) at 2 years, did not differ significantly between the two groups (change in experimental group minus change in control group, −0.3; P = 0.46). At 1 year, however, there were significant between-group differences for changes in BMI (−0.57, P = 0.045) and weight (−1.9 kg, P = 0.04). We found evidence of effect modification according to ethnic group at 1 year (P = 0.04) and 2 years (P = 0.01). In a prespecified analysis according to ethnic group, among Hispanic participants (27 in the experimental group and 19 in the control group), there was a significant between-group difference in the change in BMI at 1 year (−1.79, P = 0.007) and 2 years (−2.35, P = 0.01), but not among non-Hispanic participants (P>0.35 at years 1 and 2). The change in body fat as a percentage of total weight did not differ significantly between groups at 2 years (−0.5%, P = 0.40). There were no adverse events related to study participation. CONCLUSIONS Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up (the prespecified primary outcome). (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT00381160.)

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