• Scottish Intercollegiate Guidelines Network (SIGN). Management of obesity in children and young people. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2003 Apr. 24 p. (SIGN publication; no. 69). [117 references]

Note from the Scottish Intercollegiate Guidelines Network (SIGN) and National Guideline Clearinghouse (NGC): In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the full-text guideline document.

The grades of recommendations (A-D) and levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4) are defined at the end of the "Major Recommendations" field.

Definitions and Prevalence of Obesity

Definition of childhood obesity

D - Obesity should be identified by objective (anthropometric) means.

C - The body mass index (BMI) percentile should be used to identify childhood obesity.

D - For clinical use, obese children are those with a BMI >98th centile of the United Kingdom (UK) 1990 reference chart for age and sex.

D - For epidemiological (research) purposes:

• Overweight should be defined as BMI >85th centile of the 1990 reference data
• Obesity should be defined as BMI >95th centile of the 1990 reference data for age and sex

Consequences of Childhood Obesity

Do obese children become obese adults?

C - Prevention and treatment of obesity should be initiated in childhood.

C - Parental obesity should be recognised as a risk factor for childhood obesity to persist into adulthood.

Prevention

Preventive interventions for childhood obesity

C - School, family and societal interventions should be considered for the prevention of obesity in children.

Treatment/Management

Treatment in the community

D - Treatment should only be considered where:

• A child is defined obese (BMI >98th centile) and
• The child and family are perceived to be ready and willing to make the necessary lifestyle changes

D - In most obese children (BMI >98th centile) weight maintenance is an acceptable goal.

D - Weight maintenance and/or weight loss can only be achieved by sustained behavioural changes, e.g.:

• Healthier eating (Refer to Annex 2 of the original guideline document)
• Increasing habitual physical activity (e.g., brisk walking) to a minimum of 30 minutes per day. In healthy children, 60 minutes of moderate-vigorous physical activity/day has been recommended
• Reducing physical inactivity (e.g., watching television and playing computer games) to <2 hours/day on average or the equivalent of 14 hours/week

D - In overweight children (BMI >91st centile) weight maintenance is an acceptable goal. Annual monitoring of BMI percentile may be appropriate to help reinforce weight maintenance and reduce the risk of children becoming obese.

D - The following groups should be referred to hospital or community paediatric consultants before treatment is considered:

• Children who may have serious obesity-related morbidity that requires weight loss (e.g., benign intracranial hypertension, sleep apnoea; obesity hypoventilation syndrome, orthopaedic problems and psychological morbidity)
• Children with a suspected underlying medical (e.g., endocrine) cause of obesity including all children under 24 months of age who are severely obese (BMI >99.6th centile)
• All children with BMI >99.6th centile (who are at higher risk of obesity-related morbidity)

D - For obese children over the age of seven years, who can demonstrate prolonged weight maintenance and who are cared for by secondary care services, modest weight loss (no more than 0.5 kg/month) is an acceptable goal.

Definitions

Grades of Recommendations

A - At least one meta-analysis, systematic review of randomised controlled trials (RCTs), or randomised controlled trial rated as 1++ and directly applicable to the target population; or

A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results

B - A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or

Extrapolated evidence from studies rated as 1++ or 1+

C - A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or

Extrapolated evidence from studies rate as 2++

D - Evidence level 3 or 4; or

Extrapolated evidence from studies rated as 2+

Levels of Evidence

1++ - High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias

1+ - Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias

1- - Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias

2++ - High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal

2+ - Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal

2- - Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal

3 - Non-analytic studies, e.g. case reports, case series

4 - Expert opinion

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Scottish Intercollegiate Guidelines Network (SIGN). Management of obesity in children and young people. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2003 Apr. 24 p. (SIGN publication; no. 69). [117 references]

Not applicable: The guideline was not adapted from another source.

2003 Apr

Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]

Scottish Executive Health Department

Not stated

Guideline Development Group: Dr David Wilson (Chairman); Dr David Alexander; Ms Francesca Chappell; Dr Ann Dunbar; Dr Belinda Hacking; Dr Cathy Higginson; Ms Christine Hinch; Dr Chris Kelnar; Dr Zoe McDowell; Mrs Emily Methven; Dr Safia Qureshi; Dr Beth Rimmer; Dr John Reilly; Mrs Laura Stewart; Dr Carolyn Summerbell; Mrs Michelle Wilson; Mr Mehran Zabihollah

All members of the Scottish Intercollegiate Guidelines Network (SIGN) guideline development groups are required to complete a declaration of interests, both personal and non-personal. A personal interest involves payment to the individual concerned, e.g., consultancies or other fee-paid work commissioned by or shareholdings in the pharmaceutical industry; a non-personal interest involves payment which benefits any group, unit or department for which the individual is responsible, e.g., endowed fellowships or other pharmaceutical industry support. SIGN guideline group members should be able to act as independently of external commercial influences as possible, therefore, individuals who declare considerable personal interests may be asked to withdraw from the group. Details of the declarations of interest of any guideline development group member(s) are available from the SIGN executive.

This summary was completed by ECRI on November 20, 2003. The information was verified by the guideline developer on January 16, 2004.