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

BACKGROUNDThese Guidelines for Paediatric Parenteral Nutrition have been developed as a mutual project of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN; www.espghan.org) and the European Society for Clinical Nutrition and Metabolism (ESPEN; www.espen.org). T

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1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR).

Metabolic syndrome (MetS) is a complex disorder defined by a cluster of interconnected factors that increase the risk of cardiovascular atherosclerotic diseases and diabetes mellitus type 2. Currently, several different definitions of MetS exist, causing substantial confusion as to whether they identify the same individuals or represent a surrogate of risk factors. Recently, a number of other factors besides those traditionally used to define MetS that are also linked to the syndrome have been identified. In this review, we critically consider existing definitions and evolving information, and conclude that there is still a need to develop uniform criteria to define MetS, so as to enable comparisons between different studies and to better identify patients at risk. As the application of the MetS model has not been fully validated in children and adolescents as yet, and because of its alarmingly increasing prevalence in this population, we suggest that diagnosis, prevention and treatment in this age group should better focus on established risk factors rather than the diagnosis of MetS.

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Metabolic syndrome: definitions and controversies

Accurate appropriate assessment of overweight and obesity in children and adolescents is a critical aspect of contemporary medical care. However, physicians and other health care professionals may find this a somewhat thorny field to enter. The BMI has become the standard as a reliable indicator of overweight and obesity. The BMI is incomplete, however, without consideration of the complex behavioral factors that influence obesity.Because of limited time and resources, clinicians need to have quick, evidence-based interventions that can help patients and their families recognize the importance of reducing overweight and obesity and take action. In an era of fast food, computers, and DVDs, it is not easy to persuade patients to modify their diets and to become more physically active. Because research concerning effective assessment of childhood obesity contains many gaps, this report is intended to provide a comprehensive approach to assessment and to present the evidence available to support key aspects of assessment. The discussion and recommendations are based on 300 studies published since 1995, which examined an array of assessment tools. With this information, clinicians should find themselves better equipped to face the challenges of assessing childhood overweight and obesity accurately.

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Assessment of Child and Adolescent Overweight and Obesity

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

Aim: To identify the best anthropometric predictor of the metabolic syndrome in children. Methods: Screening performance was evaluated in a clinical setting. The study included 140 children: 72 non-obese and 68 with non-syndromal obesity. Body mass index (BMI), waist circumference and triceps/subscapular skinfolds ratio were used as predictor variables, and systolic blood pressure, diastolic blood pressure, glucose, uric acid, fasting insulin, triglycerides and HDL-C as metabolic syndrome variables. Results: The areas under the receiver operating characteristic (ROC) curves were 0.849 (95% CI: 0.780,0.919) for BMI, 0.868 (95% CI: 0.801,0.934) for waist circumference and 0.834 (95% CI: 0.757,0.910) for the triceps/subscapular skinfolds ratio. No statistically significant differences were found for the three areas under the ROC curves. The point on the ROC curve closest to 1 corresponded to the 65th percentile for BMI, to the 70th percentile for waist, and to the 40th percentile for the triceps/subscapular skinfolds ratio.



Conclusion: Waist circumference seems to be the best predictor of children with the metabolic syndrome in paediatric clinical settings.

Waist circumference for the screening of the metabolic syndrome in children

To compare the most commonly used equations to predict body fatness from skinfold thickness, in male and female adolescents, with dual-energy X-ray absorptiometry (DXA) as a reference method of fatness measurement. Cross-sectional nutrition survey. General adolescent population from Zaragoza (Spain). A total of 238 Caucasian adolescents (167 females and 113 males), aged 13.0–17.9 y, were recruited from 15 school groups in 11 public and private schools. The percentage fat mass (%FM) was calculated by using skinfold-thickness equations. Predicted %FM was compared with the reference %FM values, measured by DXA. The lack of agreement between methods was assessed by calculating the bias and its 95% limits of agreement. Most equations did not demonstrate good agreement compared with DXA. However, in male adolescents, Slaughter et al equations showed relative biases that were not dependent on body fatness and the limits of agreement were narrower than those obtained from the rest of equations. In females, Brook's equation showed nonsignificant differences against DXA and the narrowest 95% limits of agreement. Only biases from Brook and Slaughter et al equations were not dependent on body fatness in female adolescents. Accuracy of most of the skinfold-thickness equations for assessment of %FM in adolescents was poor at the individual level. Nevertheless, to predict %FM when a relative index of fatness is required in field or clinical studies, Slaughter et al equations may be used in adolescents from both sexes and the Brook equation in female adolescents. Instituto de Salud Carlos III, Spain.

Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry.

OBJECTIVE: To analyse trends in body mass index (BMI) and overweight prevalence for children and adolescents in the region of Aragon (Spain), from 1985 to 1995. DESIGN: Nine cross-sectional examinations of schoolchildren conducted yearly from 1985 to 1995. SUBJECTS: A total of 90,997 children (45,970 males and 45,027 females) in the first school year (6–7 y of age); 106,284 scholars (52,772 males and 53,512 females) in the last school year (13–14 y of age). MEASUREMENTS: Heights and weights were measured and BMI (kg/m2) was calculated. RESULTS: We observed a trend to higher BMI values across the surveys, by sex and age. The secular trends in BMI showed the largest increases at the upper ends of the distribution, especially in males. In children in the first school year, prevalences of overweight were higher in females than in males (P<0.001); however, in adolescents in the last school year, prevalences were higher in males than in females (P<0.001). We observed a significant trend in overweight prevalence from 1985 to 1995 in children from the first school year (P=0.0183, in males and P=0.0168, in females). In children in the last school year there was only a significant trend in males (P<0.0001). CONCLUSION: Significant changes in BMI occurred in the population studied during the period 1985–1995, but these changes differ by age and sex. The increasing skewness of BMI in the upper percentiles of the population, especially in boys, suggests that, not only is the pediatric population getting fatter, but the fatter members are becoming more obese. Our results also show a striking increase in the prevalence of overweight children in the region of Aragon (Spain) during the 1985–1995 decade.

Trends in body mass index and overweight prevalence among children and adolescents in the region of Aragón (Spain) from 1985 to 1995.

Lifestyle plays an important role in the development of obesity during childhood and adolescence. We provide up-to-date information about the relationship between obesity and food intake and dietary patterns in adolescents. Scientific evidence is increasing about the dietary factors associated with this relationship, specifically a low meal frequency, skipping breakfast, and a high consumption of sugar sweetened beverages. Maybe some of the reviewed dietary factors could cluster in the same population of adolescents, increasing the individual risk. There is little information about dietary patterns and current time trends in adolescents; however, the available data seem to show that the tendency in the adolescent population worldwide is to increase those dietary factors related with obesity development. Public health efforts should be emphasized in order to decrease the current tendency. Regular family meals could serve as role models for healthy eating behaviors. Educational intervention programs for par...

Trends of dietary habits in adolescents.

Objective: To develop equations, from some simple anthropometric measurements, for the prediction of body density from underwater weighing in male spanish children and adolescents. Subjects: One hundred and seventy-five males, aged 7.0–16.9 y, participated in this study, they were recruited from primary and secondary schools. Measurements: Body weight and height and skinfold thicknesses by anthropometry, body density by underwater weighing. Results: Correlations between body density and body mass index (BMI) were high until 14.0–16.9 y. Correlations between body density and log Σ 4 skinfolds were higher than those with BMI at all ages. Log Σ 4 skinfolds explained between 61% (14.0–16.9 y) and 68% (11.0–13.9 y) of the body density variance. Regression equations for body density from BMI and triceps skinfold thickness explained between 51% (14.0–16.9 y) and 68% (7.0–10.9 y) of the body density variance. Conclusions: The best estimators of body density in the children and adolescents studied were log Σ 4 skinfolds and a combination of BMI and triceps skinfold. Sponsorship: Universidad de Zaragoza

J. Fleta

Papers

Waist circumference for the screening of the metabolic syndrome in children

Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry.

Trends in body mass index and overweight prevalence among children and adolescents in the region of Aragón (Spain) from 1985 to 1995.

Trends of dietary habits in adolescents.

Skinfold thickness measurements are better predictors of body fat percentage than body mass index in male Spanish children and adolescents.