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.
Children 2 Years or Older with a Body Mass Index (BMI) ≥ 85th Percentile
Identify Presence of Weight Related Risk Factors and Complications
Reinforce Prevention Recommendations (See also the National Guideline Clearinghouse [NGC] summary of the Michigan Quality Improvement Consortium [MQIC] guideline Prevention and Identification of Childhood Overweight)
History and Physical Exam [D]:
- Family history, evaluate general co-morbidities including but not limited to cardiovascular disease and diabetes
- History of medication use including nutritional supplements
- Symptoms of gallbladder disease, Type 2 diabetes, obstructive sleep disorders, hypothyroidism
- Presence of acanthosis nigricans
- Weight-related orthopedic problems
- Pulse and blood pressure, using appropriate technique and cuff size for age
- Be alert to secondary causes of obesity. If aberrant findings are noted (short stature, hypotonia, hirsutism, etc.) then consider genetic and other endogenous causes of obesity.
- Patient or parental concern about weight
- Testing: Annual lipid profile and fasting glucose
Frequency
Each periodic health exam, more frequently as case requires.
Children 2 Years or Older with a BMI ≥ 85th – 94th Percentile (Overweight) without Risk Factors or Complications
Lifestyle Intervention to Reach Weight Maintenance
Consider All of the Above, Plus
Intervention to promote weight management/treatment [D]:
- Reinforce lifestyle intervention and behavior modification. Focus is appropriate weight maintenance.
- Family must be involved; small gradual changes are recommended towards the stated goal.
- Monitor for increasing BMI percentile
- Monitor for the development of risk factors or complications
Frequency
Consider management of childhood obesity as a medium- to long-term intervention.
Children 2 Years or Older with a BMI ≥ 85th – 94th Percentile with Risk Factors or Complications
Lifestyle Intervention with Treatment of Risk Factors and Complications as Needed
All of the Above, Plus
- Primary goal of childhood weight interventions is regulation of body weight and fat with adequate nutrition for growth and development
- Treat risk factors and complications as needed
- Substantial slowing of weight gain may be achieved by relatively small but consistent changes in energy (200 to 500 kcal/day) intake, expenditure or both. If weight loss is desired, an appropriate starting goal is about 1 lb of weight loss per month.
- Consider referral to multidisciplinary pediatric obesity treatment center, pediatric endocrinologist or registered dietitian
Frequency
Consider management of childhood obesity as a medium- to long-term intervention.
Children 2 Years or Older with a BMI ≥ 95th Percentile (Obese), with or without Risk Factors or Complications
Weight Loss with Concomitant Treatment of Risk Factors and Complications as Needed
All of the Above Plus
- Long-term goal should be a body mass index below 85th percentile for age and sex
- Consider aggressive approach to weight loss and treatment for patients after conservative approaches have failed
- Consider aspartate transaminase (AST), alanine transaminase (ALT), blood urea nitrogen (BUN), and creatinine
Frequency
Consider management of childhood obesity as a medium- to long-term intervention.
Definitions:
Levels of Evidence for the Most Significant Recommendation
- Randomized controlled trials
- Controlled trials, no randomization
- Observational studies
- Opinion of expert panel
