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

CONTEXT\nAbout 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.\n\n\nOBJECTIVE\nTo determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).\n\n\nDATA SOURCES AND STUDY SELECTION\nElectronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.\n\n\nDATA EXTRACTION\nA total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).\n\n\nDATA SYNTHESIS\nA random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.\n\n\nCONCLUSIONS\nEffective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

Bariatric surgery. A systematic review and meta-analysis

The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, children's learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in children's eating behavior, providing both genes and environment for children. For example, they influence children's developing preferences and eating behaviors by making some foods available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for children's growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices.

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Parental Influence on Eating Behavior: Conception to Adolescence

The economics of obesity: dietary energy density and energy cost

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: Eating frequently in restaurants is one of the behaviors associated with obesity. This study examined whether increasing the portion size of an entree affected energy intake at a restaurant meal.



Research Methods and Procedures: In a cafeteria-style restaurant on different days, the size of a pasta entree was varied from a standard portion (248 g) to a large portion (377 g). The entree price was not changed. Intake of the entree was determined by covertly weighing each dish before and after the meal; intake of all other foods was determined by estimating the percent consumed. The 180 adult customers who purchased the entree also completed a survey in which they rated characteristics of the meal, including the appropriateness of the entree portion size and the amount that they ate compared with their usual meal.



Results: Portion size had a significant effect on intake of the entree (p < 0.0001). Compared with customers who purchased the standard portion, those who purchased the larger portion increased their energy intake of the entree by 43% (719 kJ; 172 kcal) and of the entire meal by 25% (664 kJ; 159 kcal). There was no difference between the two groups of customers in ratings of the appropriateness of the portion size or of the amount that was eaten in relation to their usual meal.



Discussion: In a restaurant setting, increasing the size of an entree results in increased energy intake. These results support the suggestion that large restaurant portions may be contributing to the obesity epidemic.

https://onlinelibrary.wiley.com/doi/pdf/10.1038/oby.2004.64

Increased portion size leads to increased energy intake in a restaurant meal.

BackgroundAvocados are a nutrient‐dense source of monounsaturated fatty acids (MUFA) that can be used to replace saturated fatty acids (SFA) in a diet to lower low density lipoprotein cholesterol (...

Effect of a Moderate Fat Diet With and Without Avocados on Lipoprotein Particle Number, Size and Subclasses in Overweight and Obese Adults: A Randomized, Controlled Trial

BackgroundEvidence consistently shows that almond consumption beneficially affects lipids and lipoproteins. Almonds, however, have not been evaluated in a controlled‐feeding setting using a diet de...

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Effects of daily almond consumption on cardiometabolic risk and abdominal adiposity in healthy adults with elevated LDL-cholesterol: a randomized controlled trial.

The objective of this study is to evaluate the dietary practices of 28 football athletes on a National Collegiate Athletic Association (NCAA) Division I team using 3-day diet records. Student athletes completed 3-day diet records at 2 individual points of time, when no training table was available. Diet records were evaluated and were compared with the Third National Health and Nutrition Survey (NHANES III) data for the same ages and gender group. No differences in dietary practices of collegiate football athletes were observed when compared with data for the same ages and gender group culled from NHANES III. Inadequacies in energy intake for activity level were significant (p < 0.05). Influences of fad dieting trends were noted when the diets were mapped onto the United States Department of Agriculture (USDA) food guide pyramid. Changes in diet would be necessary to sustain the activity level of these athletes.

Evaluation of dietary practices of National Collegiate Athletic Association Division I football players.

https://www.mccormickscienceinstitute.com/content/msi/assets/Penn%20State%20Herb%20Dip.pdf

Peter L. Bordi

Papers

Increased portion size leads to increased energy intake in a restaurant meal.

Effect of a Moderate Fat Diet With and Without Avocados on Lipoprotein Particle Number, Size and Subclasses in Overweight and Obese Adults: A Randomized, Controlled Trial

Effects of daily almond consumption on cardiometabolic risk and abdominal adiposity in healthy adults with elevated LDL-cholesterol: a randomized controlled trial.

Evaluation of dietary practices of National Collegiate Athletic Association Division I football players.

The Addition of a Plain or Herb-Flavored Reduced-Fat Dip Is Associated with Improved Preschoolers' Intake of Vegetables