The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.
Education of Parents Regarding Obesity and Prevention of Risk
Prevention to Promote Healthy Weight
- Encourage breastfeeding; discourage overfeeding of bottle fed infants [A].
- Avoid premature introduction of solids and base timing for introduction of solids on child's development, usually between 4 to 6 months of age.
- Preserve natural satiety by respecting a child's appetite.
- Educate caregivers on the importance of age-specific meals and snacks, consistent mealtimes, appropriate snacking, serving sizes, reading nutritional labeling, and daily physical activity.
- Educate parents about the importance of parental role modeling for healthy lifestyle behaviors and of parental controls [D].
- Avoid high calorie, nutrient poor beverages (e.g., soda, fruit punch, or any juice drink less than 100% juice).
- Limit intake of 100% juice to <6 oz per day; may offer in a cup, starting at 6 months of age.
- Evaluate general co-morbidities, including but not limited to cardiovascular disease of parents.
- No television or computer screen time [D].
Eligible Population
Parents of children under 2 years old
Frequency
At each periodic health exam
Assessment of Body Mass Index (BMI), Risk Factors for Overweight, and Excessive Weight Gain Relative to Linear Growth
General Assessment
- Measure and record weight and height on U.S. Centers for Disease Control and Prevention (CDC) BMI-for-age growth chart, calculate and plot patients' BMI [weight (kg)/height squared (m2) or (pounds x 703)/inches2]
(e.g., http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx).
- Assess risk factors for overweight1 including pattern of weight change [C].
Watch for increases of 3 to 4 BMI units/year.
Eligible Population
Children 2 years or older
Frequency
At each periodic health exam
1Low/high birth weight, low income, minority, television or computer screen time >2 hrs, low physical activity, poor eating, depression
Prevention to Promote Healthy Weight
Age Specific Prevention Messages
Preschool:
- Replace whole milk with skim, avoid high calorie, nutrient poor beverages (soda, fruit punch, juice drinks).
- Limit intake of 100% juice.
- Limit television and computer screen time to two hours or less daily.
- Promote a healthy diet (include fruit and vegetables and low-fat dairy) that encourages family mealtimes, regular eating times, and minimizes nutritionally poor food prepared outside the home.
- Respect the child's appetite and allow him or her to self-regulate food intake.
- Provide structure and boundaries around healthy eating with adult supervision.
- Promote physical activity including unstructured play at home, during childcare, and in the community.
School-aged, the above plus:
- Accumulate at least 60 minutes, and up to several hours, of age appropriate physical activity on all or most days of the week (emphasize lifestyle exercise, i.e., outdoor play, yard work, and household chores).
- Consider barriers (e.g., unsafe neighborhoods or lack of school-based physical education) and explore individualized solutions.
- Reinforce making healthy food and physical activity choices at home and outside of parental influence
Eligible Population
Children 2 years or older, BMI for age <85th percentile
Frequency
At each periodic health exam
Definitions:
Levels of Evidence for the Most Significant Recommendation
- Randomized controlled trials
- Controlled trials, no randomization
- Observational studies
- Opinion of expert panel
