Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years. Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings. Methods. We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched the Cochrane Library from 1996 to April 2004. We searched Medline, PsycINFO, DARE, and CINAHL from 1966 to April 2004. One reviewer abstracted relevant information from each included article into standardized evidence tables, and a second reviewer checked key elements. Two reviewers quality-graded each article with US Preventive Services Task Force criteria. Results. Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with ≥1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m 2 ) is ≥50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals. Conclusions. BMI measurements of overweight among older adolescents identify those at increased risk of developing adult obesity. Interventions to treat overweight adolescents in clinical settings have not been shown to have clinically significant benefits, and they are not widely available. Screening to categorize overweight among children under age 12 or 13 who are not clearly overweight may not provide reliable risk categorization for adult obesity. Screening in this age group is compromised by the fact that there is little generalizable evidence for primary care interventions. Because existing trials report modest short- to medium-term improvements (∼10–20% decrease in percentage of overweight or a few units of change in BMI), however, overweight improvements among children and adolescents seem possible.

https://pediatrics.aappublications.org/content/pediatrics/116/1/e125.full.pdf

Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force.

Purpose To quantify the number of required hours of nutrition education at U.S. medical schools and the types of courses in which the instruction was offered, and to compare these results with results from previous surveys.

/pdf/nutrition-education-in-u-s-medical-schools-latest-update-of-2724goevbb.pdf

Nutrition education in U.S. medical schools: latest update of a national survey

Status of nutrition education in medical schools

The prevalence of obesity in adults has been rising continually, as has the prevalence of childhood obesity, and a large number of epidemiological studies have demonstrated a direct relationship between parental obesity and childhood obesity. In this paper, we review the effect of diet, the intrauterine environment, and the genetic inheritance on obesity. We described a study in detail that used experimental animals as a model to investigate the effect of a parental high-fat diet on body-fat accumulation in their offspring. Fertilized eggs were transplanted in that study, and body-fat accumulation in the offspring of the parents fed a high-fat diet was found to be greater than in the offspring of the parents fed a low-fat diet, even when the experimental conditions were the same in the intrauterine and subsequent environment. The results suggested that a parental high-fat diet before intrauterine developmental stage may increase body-fat accumulation in the offspring. We discuss the possibility that parental diet may influence the lifelong health of offspring and epigenetic inheritance may be occurred.

Parental obesity and overweight affect the body‐fat accumulation in the offspring: the possible effect of a high‐fat diet through epigenetic inheritance

Systematic Review of Childhood Obesity Prevention

Is there a role for the paediatrician in the global epidemic of childhood obesity? The answer should be obvious. When parents and the society are concerned about child health, they still turn to health professionals caring for children and adolescents, such as paediatricians, family practitioners , general practitioners or nurses. The report of the International Obesity TaskForce to the World Health Organization in this issue of Obesity Reviews (1) estimates that about 10% of young people aged 5–17 years are overweight , among which 2–3% are obese, corresponding for the year 2000 to 155 million overweight children including 30–45 million obese children worldwide. This report also describes how the burden of paediatric obesity is unequally distributed between regions of the world, and even between populations within countries. While paediatric obesity is still a relatively marginal problem in Sub-Saharan Africa and in large parts of the Asia-Pacific region, it is rapidly becoming the most frequent chronic paediatric condition in many countries of the Americas, Europe and the Near/ Middle East. Therefore, at least in these regions, the primary health care providers for children can no longer ignore such a frequent problem. Most paediatricians actually are very concerned about obesity in their young patients, and feel that they have to do something about it, anything! But most also feel unprepared, ill-equipped, and frankly ineffective to address the problem (2). One of the reasons for the paediatrician's awkwardness with the obesity epidemic is that the approach of obese children and adolescents has almost only focused on weight loss. Pediatricians often do not have the training and the skills for weight management using behaviour modification (2), and such programmes are difficult to implement in the office setting under the classic acute paediatric care model. Most approaches involve a team, including a dietitian, a psychologist, or/and a physical activity specialist, resources that are usually not available in the paediatric office or even in referral centres. Therefore primary care providers are faced with pressing requests to which they are unable to respond alone. Even if they could, in many countries where medicine is not socialized, these efforts are not financially compensated (3), discouraging involvement outside the traditional boundaries of the paediatric practice. Clearly, considering the size of the obesity epidemic, not all obese children will be able to be treated by a specialized team, and creative solutions need to be generated for weight management in the …

N. Stettler

Papers

Comment: the global epidemic of childhood obesity: is there a role for the paediatrician?