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

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

Zimmet P, Alberti K George MM, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S; IDF Consensus Group. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatric Diabetes 2007: 8: 299–306. Paul Zimmet, K George MM Alberti, Francine Kaufman, Naoko Tajima, Martin Silink, Silva Arslanian, Gary Wong, Peter Bennett, Jonathan Shaw and Sonia Caprio; IDF Consensus Group International Diabetes Institute, Melbourne, Victoria, Australia; Department of Endocrinology and Metabolic Medicine, St Mary’s Hospital, London, UK; Center for Diabetes, Endocrinology and Metabolism, Children’s Hospital, Los Angeles, CA, USA; Division of Diabetes, Metabolism and Endocrinology, Jikei University School of Medicine, Tokyo, Japan; Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Division of Endocrinology, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong; Phoenix Epidemiology and Clinical Research Branch, NIDDK, National Institutes of Health, Phoenix, AZ, USA; and Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1399-5448.2007.00271.x

The metabolic syndrome in children and adolescents - an IDF consensus report.

OBJECTIVE
To identify factors in childhood which might influence the development of obesity in adulthood.


BACKGROUND
The prevalence of obesity is increasing in the UK and other developed countries, in adults and children. The adverse health consequences of adult obesity are well documented, but are less certain for childhood obesity. An association between fatness in adolescence and undesirable socio-economic consequences, such as lower educational attainment and income, has been observed, particularly for women. Childhood factors implicated in the development of adult obesity therefore have far-reaching implications for costs to the health-services and economy.


SEARCH STRATEGY
In order to identify relevant studies, electronic databases--Medline, Embase, CAB abstracts, Psyclit and Sport Discus-were searched from the start date of the database to Spring 1998. The general search structure for electronic databases was (childhood or synonyms) AND (fatness or synonyms) AND (longitudinal or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts.


INCLUSION CRITERIA
Longitudinal observational studies of healthy children which included measurement of a risk factor in childhood (<18 y), and outcome measure at least 1 y later. Any measure of fatness, leanness or change in fatness or leanness was accepted. Measures of fat distribution were not included. Only studies with participants from an industrialized country were considered, and those concerning minority or special groups, e.g. Pima Indians or children born preterm, were excluded.


FINDINGS
Risk factors for obesity included parental fatness, social factors, birth weight, timing or rate of maturation, physical activity, dietary factors and other behavioural or psychological factors. Offspring of obese parent(s) were consistently seen to be at increased risk of fatness, although few studies have looked at this relationship over longer periods of childhood and into adulthood. The relative contributions of genes and inherited lifestyle factors to the parent-child fatness association remain largely unknown. No clear relationship is reported between socio-economic status (SES) in early life and childhood fatness. However, a strong consistent relationship is observed between low SES in early life and increased fatness in adulthood. Studies investigating SES were generally large but very few considered confounding by parental fatness. Women who change social class (social mobility) show the prevalence of obesity of the class they join, an association which is not present in men. The influence of other social factors such as family size, number of parents at home and childcare have been little researched. There is good evidence from large and reasonably long-term studies for an apparently clear relationship for increased fatness with higher birth weight, but in studies which attempted to address potential confounding by gestational age, parental fatness, or social group, the relationship was less consistent. The relationship between earlier maturation and greater subsequent fatness was investigated in predominantly smaller, but also a few large studies. Again, this relationship appeared to be consistent, but in general, the studies had not investigated whether there was confounding by other factors, including parental fatness, SES, earlier fatness in childhood, or dietary or activity behaviours. Studies investigating the role of diet or activity were generally small, and included diverse methods of risk factor measurement. There was almost no evidence for an influence of activity in infancy on later fatness, and inconsistent but suggestive evidence for a protective effect of activity in childhood on later fatness. No clear evidence for an effect of infant feeding on later fatness emerged, but follow-up to adulthood was rare, with only one study measuring fatness after 7y. Studies investigating diet in childhood were limited and inconc

Childhood predictors of adult obesity: a systematic review.

A prototype decision support IT-tool for the food industry was developed in the STARTEC project. Typical processes and decision steps were mapped using real life production scenarios of participating food companies manufacturing complex ready-to-eat foods. Companies looked for a more integrated approach when making food safety decisions that would align with existing HACCP systems. The tool was designed with shelf life assessments and data on safety, quality, and costs, using a pasta salad meal as a case product. The process flow chart was used as starting point, with simulation options at each process step. Key parameters like pH, water activity, costs of ingredients and salaries, and default models for calculations of Listeria monocytogenes, quality scores, and vitamin C, were placed in an interactive database. Customization of the models and settings was possible on the user-interface. The simulation module outputs were provided as detailed curves or categorized as "good"; "sufficient"; or "corrective action needed" based on threshold limit values set by the user. Possible corrective actions were suggested by the system. The tool was tested and approved by end-users based on selected ready-to-eat food products. Compared to other decision support tools, the STARTEC-tool is product-specific and multidisciplinary and includes interpretation and targeted recommendations for end-users.

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The STARTEC Decision Support Tool for Better Tradeoffs between Food Safety, Quality, Nutrition, and Costs in Production of Advanced Ready-to-Eat Foods

Objective: To develop waist circumference percentile curves for British children and to compare these curves with those from other countries. Design: Cross-sectional study. Setting: School-aged population. Subjects: A representative sample of school children from the geographical regions of Great Britain, approximately in proportion to their age distribution. The sample population consisted of 8355 children (3585 males, 4770 females) with ages ranging between 5.0 and 16.9 y. Interventions: Waist circumferences were measured with a flexible non-elastic tape and waist circumference percentiles were constructed and smoothed using the LMS method. Main outcome measures: Smoothed waist circumference percentile curves. Results: Mean waist circumference increased with age in both boys and girls. For girls, curves began to plateau after the age of 13 y whereas, for boys, waist percentile curves continued to increase more sharply after this age. However, these curves mainly reflect the patterns of waist circumference in Caucasian children. Conclusions: These curves represent the first waist circumference percentiles for British children and could be used provisionally for both clinical and possibly epidemiological use, although they should be validated against equivalent longitudinal data. Sponsorship: This project has been sponsored by UNL Diversity and Development Fund. European Journal of Clinical Nutrition (2001) 55, 902–907

The development of waist circumference percentiles in British children aged 5.0–16.9 y

Iron deficiency in older people: Interactions between food and nutrient intakes with biochemical measures of iron; further analysis of the National Diet and Nutrition Survey of people aged 65 years and over

Iron deficiency in older people: interactions between food and nutrient intakes with biochemical measures of iron; further analysis of the National Diet and Nutrition Survey of people aged 65 years and over.

OBJECTIVE To examine the influence of teenage smoking habits on nutrient intake, food choice and body size. DESIGN Data was collected cross-sectionally: smoking habits were evaluated by questionnaire; heights and weights were measured and dietary intakes were quantitatively assessed via 4-day unweighed dietary diaries. SUBJECTS The subjects studied (n = 3430) were participants in the 1970 Longitudinal Birth Cohort, and were nationally distributed throughout Britain. RESULTS Male and female smokers consumed significantly (P < 0.005) more alcohol and less fibre, thiamin and vitamin C than occasional or never smokers. Male smokers also consumed significantly more fat when expressed as a percentage of energy intake, and significantly less non-milk extrinsic sugar (P < 0.01) and iron (P < 0.005) than occasional or never smokers. Regular and occasional female smokers consumed significantly (P < 0.005) less protein and calcium than never smokers, and regular smokers also reported lower intakes of zinc, selenium, riboflavin, carotene and folates (P < 0.005) and iodine (P < 0.01) than never or occasional smokers. Both male and female smokers were less likely to be consumers of puddings, biscuits and wholemeal bread, but were more likely (P < 0.005) to consume alcoholic beverages and coffee. Intakes of chips, alcoholic beverages and coffee were significantly (P < 0.005) higher among smokers and intakes of puddings, fruit, fruit juices and breakfast cereals lower. Regular female smokers also consumed significantly (P < 0.005) fewer vegetables. Smoking habit did not appear to be related to body size in this cohort. CONCLUSION The diets of teenage smokers, particularly teenage girls, appear to be significantly different to those of non-smokers, but smoking was not related to body size. Lower intakes of antioxidant nutrients, fruits, vegetables and cereals by teenage smokers are of particular concern.

The diet and body weight of British teenage smokers at 16-17 years.

Dietary and lifestyle differences between Scottish teenagers and those living in England and Wales

H F Crawley

Papers

The development of waist circumference percentiles in British children aged 5.0–16.9 y

Iron deficiency in older people: interactions between food and nutrient intakes with biochemical measures of iron; further analysis of the National Diet and Nutrition Survey of people aged 65 years and over.

The diet and body weight of British teenage smokers at 16-17 years.

Dietary and lifestyle differences between Scottish teenagers and those living in England and Wales.