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.
Parents of Children Younger than 2 Years Old
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 months and 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].
Frequency
At each periodic health exam
Children 2 Years or Older
Assessment of Body Mass Index (BMI), Risk Factors for Overweight, and Excessive Weight Gain Relative to Linear Growth
General Assessment
- History (including focused family history) and physical exam
- 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] (see http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx).
- Dietary patterns (e.g., frequency of eating outside the home, consumption of breakfast, adequate fruits and vegetables, excessive portion sizes, etc.)
- Risk factors for overweight (i.e., low or high birth weight, low income, minority, television or computer screen time > 2 hours, low physical activity, poor eating, depression) including pattern of weight change [C]. Watch for increases of 3 to 4 BMI units/year.
Frequency
At each periodic health exam
Children 2 years or Older, BMI for Age <85th Percentile
Prevention to Promote Healthy Weight
Age Specific Prevention Messages
Preschool
- Limit television and computer screen time to 1 to 2 hours per day; remove television and computer screens from primary sleeping area.
- Replace whole milk with skim, avoid high calorie, nutrient poor beverages (soda, fruit punch, juice drinks); limit intake of 100% juice.
- Eat breakfast daily; limit eating out and portion sizes, particularly fast foods.
- 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., social support, 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.
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
