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...

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OBJECTIVE-The purpose of this study was to examine the associations of gestational weight gain with child adiposity.STUDY DESIGN-Using multivariable regression, we studied associations of total gestational weight gain and weight gain according to 1990 Institute of Medicine guidelines with child outcomes among 1044 mother-child pairs in Project Viva. CONCLUSION-New recommendations for gestational weight gain may be required in this era of epidemic obesity. RESULTS-

Our results indicate that support from clinicians and maternal depressive symptoms are associated with breastfeeding duration. Attention to these issues may help to promote breastfeeding continuation among mothers who initiate. Policies to enhance scheduling flexibility and privacy for breastfeeding mothers at work or school may also be important, given the elevated risk of discontinuation associated with return to work or school.

Background By the preschool years, racial/ethnic disparities in obesity prevalence are already present. Objective To examine racial/ethnic differences in early life risk factors for childhood obesity. Design, Setting, Participants 343 white, 355 black, and 128 Hispanic mother-child pairs in a prospective study. Main Exposure Mother’s report of child’s race/ethnicity. Main Outcome Measures Risk factors from the prenatal period through age 4 years known to be associated with child obesity. Results In multivariable models, compared to their white counterparts, black and Hispanic children exhibited a range of risk factors related to child obesity. In pregnancy, these included higher rates of maternal depression (OR: 1.55 for blacks; 1.89 for Hispanics); in infancy more rapid weight gain (OR: 2.01 for blacks; 1.75 for Hispanics), more likely to introduce solid foods before 4 months of age (OR: 1.91 for blacks; 2.04 for Hispanics), higher rates of maternal restrictive feeding practices (OR: 2.59 for blacks; 3.35 for Hispanics), and after age 2 years, more televisions in their bedrooms (OR: 7.65 for blacks; 7.99 for Hispanics), higher intake of sugar-sweetened beverages (OR: 4.11 for blacks; 2.48 for Hispanics), and higher intake of fast food (OR: 1.65 for blacks; 3.14 for Hispanics). Blacks and Hispanics also had lower rates of exclusive breastfeeding and were less likely to sleep at least 12 hours/day in infancy. Conclusions Racial/ethnic differences in risk factors for obesity exist prenatally and in early childhood. Racial/ethnic disparities in childhood obesity may be determined by factors operating at the earliest stages of life.

Among formula-fed infants or infants weaned before the age of 4 months, introduction of solid foods before the age of 4 months was associated with increased odds of obesity at age 3 years.

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Daily sleep duration of less than 12 hours during infancy appears to be a risk factor for overweight and adiposity in preschool-aged children.