Recommendations for Treatment of Child and Adolescent Overweight and Obesity

Abstract

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...

Childhood obesity–related endothelial dysfunction: an update on pathophysiological mechanisms and diagnostic advancements

“…The current clinical guidelines to treat childhood obesity merely focus on weight stabilization (and thus reducing BMI by normal growth) in case of moderate obesity and weight reduction in case of severe obesity (90). Children are encouraged to reduce their time spent in sedentary behavior and to increase physical activity up to 60 min per day (91).…”

O modelo transteórico para auxiliar adolescentes obesos a modificar estilo de vida

“…A mudança de hábitos é um processo complexo especialmente na adolescência, o que requer estratégias específi cas para esta população, além de ações interdisciplinares (Spear et al, 2007). Ainda, é necessário que a estrutura dos programas de tratamento tenham foco em multicomponentes tais como a educação nutricional, educação física, apoio psicológico, envolvimento familiar e uso de recursos tecnológicos, além de adotar linguagem compatível à faixa etária (Boff, Liboni, Batista, de Souza, & Oliveira, 2016).…”

Family therapy as a model for treating childhood obesity: Useful tools for clinicians

“…It has been shown that improving the child's nutritional habits can best be accomplished by reducing intake of foods high in fat, simple sugars, and sweetened beverages, with an emphasis on eating more lowcalorie, high-fiber foods such as fruits, vegetables, and whole grains (Spear, et al, 2007). A more active lifestyle can be promoted by reducing sedentary behavior, encouraging spontaneous play, promoting everyday activities and sports, emphasizing the importance of physical education class, increasing the variety of activities, and encouraging hobbies (Spear, et al, 2007). For all that, the most useful source in creating successful interventions is the family system -the family's experiences with previous attempts to solve the problem, small changes already working, sometimes unnoticed by the environment, and the unique resources that every family possesses.…”