To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

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Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Overweight and obesity in youth are important public health concerns and are of particular interest because of possible long-term associations with adult weight status and morbidity. The aim of this study was to systematically review the literature and update evidence concerning persistence of childhood overweight. A computerized bibliographical search--restricted to studies with a prospective or retrospective longitudinal design--was conducted. Two authors independently extracted data and assessed the methodological quality of the included studies in four dimensions (i) study population and participation rate; (ii) study attrition; (iii) data collection and (iv) data analysis. Conclusions were based on a rating system of three levels of evidence. A total of 25 publications were selected for inclusion in this review. According to a methodological quality assessment, 13 studies were considered to be of high quality. The majority of these high-quality studies were published after 2001, indicating that recently published data, in particular, provide us with reliable information. All included studies consistently report an increased risk of overweight and obese youth becoming overweight adults, suggesting that the likelihood of persistence of overweight into adulthood is moderate for overweight and obese youth. However, predictive values varied considerably. Limiting aspects with respect to generalizability and methodological issues are discussed.

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Tracking of childhood overweight into adulthood: a systematic review of the literature

The last systematic review on the health consequences of child and adolescent obesity found little evidence on consequences for adult health. The present study aimed to summarize evidence on the long-term impact of child and adolescent obesity for premature mortality and physical morbidity in adulthood. Systematic review with evidence searched from January 2002 to June 2010. Studies were included if they contained a measure of overweight and/or obesity between birth and 18 years (exposure measure) and premature mortality and physical morbidity (outcome) in adulthood. Five eligible studies examined associations between overweight and/or obesity, and premature mortality: 4/5 found significantly increased risk of premature mortality with child and adolescent overweight or obesity. All 11 studies with cardiometabolic morbidity as outcomes reported that overweight and obesity were associated with significantly increased risk of later cardiometabolic morbidity (diabetes, hypertension, ischaemic heart disease, and stroke) in adult life, with hazard ratios ranging from 1.1–5.1. Nine studies examined associations of child or adolescent overweight and obesity with other adult morbidity: studies of cancer morbidity were inconsistent; child and adolescent overweight and obesity were associated with significantly increased risk of later disability pension, asthma, and polycystic ovary syndrome symptoms. A relatively large and fairly consistent body of evidence now demonstrates that overweight and obesity in childhood and adolescence have adverse consequences on premature mortality and physical morbidity in adulthood.

Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review

Childhood obesity affects both the physical and psychosocial health of children and may put them at risk of ill health as adults. More information is needed about the best way to treat obesity in children and adolescents. In this review, 64 studies were examined including 54 studies on lifestyle treatments (with a focus on diet, physical activity or behaviour change) and 10 studies on drug treatment to help overweight and obese children and their families with weight control. No surgical treatment studies were suitable to include in this review. This review showed that lifestyle programs can reduce the level of overweight in child and adolescent obesity 6 and 12 months after the beginning of the program. In moderate to severely obese adolescents, a reduction in overweight was found when either the drug orlistat, or the drug sibutramine were given in addition to a lifestyle program, although a range of adverse effects was also noted. Information on the long-term outcome of obesity treatment in children and adolescents was limited and needs to be examined in some high quality studies.

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Interventions for treating obesity in children

Objective To identify risk factors in early life (up to 3 years of age) for obesity in children in the United Kingdom.

Design Prospective cohort study.

Setting Avon longitudinal study of parents and children, United Kingdom.

Participants 8234 children in cohort aged 7 years and a subsample of 909 children (children in focus) with data on additional early growth related risk factors for obesity.

Main outcome measures Obesity at age 7 years, defined as a body mass index 3 95th centile relative to reference data for the UK population in 1990.

Results Eight of 25 putative risk factors were associated with a risk of obesity in the final models: parental obesity (both parents: adjusted odds ratio, 10.44, 95% confidence interval 5.11 to 21.32), very early (by 43 months) body mass index or adiposity rebound (15.00, 5.32 to 42.30), more than eight hours spent watching television per week at age 3 years (1.55, 1.13 to 2.12), catch-up growth (2.60, 1.09 to 6.16), standard deviation score for weight at age 8 months (3.13, 1.43 to 6.85) and 18 months (2.65, 1.25 to 5.59); weight gain in first year (1.06, 1.02 to 1.10 per 100 g increase); birth weight, per 100 g (1.05, 1.03 to 1.07); and short (< 10.5 hours) sleep duration at age 3 years (1.45, 1.10 to 1.89).

Conclusion Eight factors in early life are associated with an increased risk of obesity in childhood.

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Early life risk factors for obesity in childhood: cohort study

The recent epidemic of childhood obesity(1) has raised concern because of the possible clinical and public health consequences.(2,)(3) However, there remains a widespread perception among health professionals that childhood obesity is a largely cosmetic problem, with minor clinical effects. No systematic review has yet focused on the diverse array of possible consequences of childhood obesity, though older non-systematic reviews are available.(4,)(5) In addition, no review to date has considered the vast body of evidence on the health impact of childhood obesity which has been published recently. The aim of the present review was therefore to provide a critically appraised, evidence based, summary of the consequences of childhood obesity in the short term (for the child) and longer term (in adulthood).

https://adc.bmj.com/content/archdischild/88/9/748.full.pdf

C J H Kelnar

Papers

Health consequences of obesity

Management of obesity in children and young people : a national clinical guideline.