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 Complications
Reinforce Prevention Recommendations (See also Michigan Quality Improvement Consortium (MQIC) Prevention and Identification of Childhood Overweight & Obesity Guideline)
History and Physical Exam [D]:
- Family history, evaluate general co-morbidities including but not limited to cardiovascular disease and diabetes
- Symptoms of gallbladder disease, Type 2 diabetes, obstructive sleep disorders, hypothyroidism
- History of medication use including nutritional supplements
- Patient/parental concern about weight
- Blood pressure, using appropriate technique and cuff size for age
- Skin problems, especially presence of acanthosis nigricans
- Weight related orthopedic problems
- 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.
- Consider screening for insulin resistance or type 2 diabetes mellitus (DM) with a fasting glucose and insulin level. [D]
Frequency: Each periodic health exam, more frequently as case requires.
Children 2 Years or Older with a BMI ≥ 85th – 94th Percentile without Complication ("At risk for overweight")
Lifestyle Intervention to Reach Weight Maintenance
Consider all of the above plus:
Intervention to promote weight management/treatment [D]:
- Reinforce lifestyle intervention/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 complications/co-morbidities
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 Complication
Lifestyle Intervention with Concomitant Treatment of Complication 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 complications as needed
- Substantial slowing of weight gain may be achieved by relatively small but consistent changes in energy (200–500 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/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, with or without Complication
Weight Loss with Concomitant Treatment of 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 severely overweight patients after conservative approaches have failed
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
