The American Academy of Pediatrics (AAP) proposes strategies for early identification of excessive weight gain by using body mass index, advocacy, research, and dietary and physical activity interventions during health supervision encounters.
Traditionally, pediatricians have not routinely calculated BMI or provided weight management counseling for children and families. According to the AAP, that is starting to change, primarily because:
- Overweight and obese children now number in the millions – nearly one in six young people in the United States is overweight or obese. About the same number are considered heavy enough to be at risk for future obesity.
- Overweight adolescents have an 80 percent chance of becoming overweight adults, putting them at risk for diabetes, heart disease, and a variety of other serious, if not fatal, diseases. The trend is for these numbers and percentages to increase, not decrease. This is a dangerous trend.
- If one parent is overweight, his or her child's risk of becoming overweight is increased threefold. If both parents are overweight, the child's risk is increased tenfold!
- Children who exercise two or fewer times each week (one in five children) are at increased risk for becoming overweight.
- Children who watch an average of four hours of television a day (one in four children) are at higher risk for becoming overweight.
- The American Academy of Pediatrics (AAP) now recommends that obesity screening and weight management counseling be a routine part of the medical exam process for children.
- A BMI at the 85th percentile for age and height is considered a risk for being overweight and obesity in children. A BMI at the 95th percentile is considered overweight or obese.
AAP Conclusions
- Prevalence of being overweight has rapidly increased and has actually reached epidemic proportions.
- Prevention of being overweight is critical, because long-term outcome data for successful treatment approaches are limited.
- Genetic, environmental, or combinations of risk factors predisposing children to obesity can and should be identified.
- Early recognition of excessive weight gain should become routine in pediatric care settings. BMI should be calculated and plotted periodically.
- Families should be educated and empowered to recognize the impact they have on their children's development of lifelong habits of physical activity and nutritious eating.
- Dietary practices should be fostered that encourage moderation rather than over-consumption, and emphasizing healthful choices rather than restrictive eating patterns.
- Regular physical activity should be consciously promoted, prioritized, and protected within families, schools, and communities.
- Optimal approaches to prevention need to combine dietary and physical activity interventions.
- Advocacy is needed in the areas of physical activity and food policy for children; research into pathophysiology, risk factors, and early recognition and management of overweight and obesity; and improved insurance coverage and third-party reimbursement for obesity care.
AAP Recommendations
1. Health Supervision
- Identify and track patients at risk by virtue of family history, birth weight, or socioeconomic, ethnic, cultural, or environmental factors.
- Calculate and plot BMI once a year in all children and adolescents.
- Use change in BMI to identify rate of excessive weight gain relative to linear growth.
- Encourage, support, and protect breastfeeding.
- Encourage parents and caregivers to promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and whole grains; encouraging children's autonomy in self-regulation of food intake and setting appropriate limits on choices; and modeling healthy food choices.
- Routinely promote physical activity, including unstructured play at home, in school, in childcare settings, and throughout the community.
- Recommend limitation of television and video time to a maximum of two hours per day.
- Recognize and monitor changes in obesity-associated risk factors for adult chronic disease, such as hypertension, high cholesterol, type 2 diabetes, and symptoms of obstructive sleep apnea syndrome.
2. Advocacy
- Help parents, teachers, coaches, and others who influence youth to discuss health habits as part of their efforts to control overweight and obesity.
- Enlist policy makers from local, state, and national organizations and schools to support a healthful lifestyle for all children, including proper diet and adequate opportunity for regular physical activity.
- Encourage organizations that are responsible for healthcare and healthcare financing to provide coverage for effective obesity prevention and treatment strategies.
- Encourage public and private sources to direct funding toward research into effective strategies to prevent overweight and obesity and to maximize limited family and community resources to achieve healthful outcomes for youth.
- Support and advocate for social marketing intended to promote healthful food choices and increased physical activity.
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