Obesity in Children and How your pediatrician can help

Obesity in children can be a sensitive topic, but it has also become an epidemic in the United States affecting more children than ever before.  

Obesity is a complex and chronic disease that often has multiple factors.  It may have serious health and social complications in children.   Childhood obesity often results in obesity as an adolescent and an adult.  It may lead to medical problems including heart disease, high blood pressure, high cholesterol, diabetes, and liver disease.  

The American Academy of Pediatrics released a comprehensive clinical practice guideline for pediatricians in 2023 on the evaluation and treatment of obesity in children.   

Prevention:   

Food/Meals/Snacks:  Children should have 3 balanced healthy meals with 2 healthy snacks between as needed.  

• Make sure healthy foods and snacks are readily available.  Keep fruits, veggies, and water on the counter or in the front of the fridge to make them easier to find. 
• Watch portion size – children do not require the same amount of food as adults.  Use smaller plates/bowls and serving utensils to encourage smaller portions of high calorie foods.  
• Give your children choices between two healthy options to help empower them with food choices.  For example, ask if they would like “broccoli or green beans” with dinner tonight.  Allowing them to assist in cooking healthy meals can also motivate better eating habits. 
• Avoid skipping meals, especially breakfast.  
• Eliminate or limit juice and other sugary drinks to 4oz or less per day. 
• Avoid eating meals or snacking during screen time.  

Sleep:  Children with poor or inadequate sleep are at increased risk of obesity. 

Monitor sleep and ensure children are getting the appropriate amount of sleep for their age.  Consistent bedtime and nighttime routines will assist with healthy sleep.  

Exercise/Activity:  Recommended 1 hour of active play per day. 

Sports are a great way to keep children physically active, but family activities such as bike rides, walks, hiking, and outdoor play are also perfect ways to promote an active healthy lifestyle starting at a young age.  

Make healthy foods, sleep, and physical activity a family goal and lead by example for your children.  Your pediatrician understands that access to healthy food and safe outdoor play/activities are not always easily accessible for everyone.  Speaking with your pediatrician to find options and strategies available for your family will be and important part of prevention or treatment of obesity.  

Evaluation and Treatment: Based on the updated 2023 Practice Guidelines 

Your pediatrician will monitor your child’s growth, weight, and body mass index at annual visits and obtain a more in-depth history and physical examination (including blood pressure checks) as needed based on their body mass index measurement and other factors.  

If your child is determined to be overweight or obese, your pediatrician will also work to determine if additional evaluation is needed for disorders associated with obesity such as sleep apnea, orthopedic problems, menstrual disorders in females, or depression. 

In addition, they may also screen for other related disorders including liver disease, diabetes, or high cholesterol by obtaining blood work.  

Treatment may include a combination of identifying areas of improvement in diet, exercise, sleep, and other factors as well as setting goals and plans for follow– up assessments. 

Frequent follow– up visits with your pediatrician and/or a specialist in obesity or nutrition are essential to the management of obesity.   

Evidence supports the use of intensive health behavior and lifestyle treatment (IHBLT) for the patient and family.  IHBLT is customized to every child and families’ circumstances but is always designed to have frequent encounters to encourage and help sustain behavioral change.   

At the same time, if your child has complications or medical conditions related to obesity your pediatrician will start a treatment plan for these, or refer to a specialist.  

For children 12-13 and older with severe obesity, your pediatrician may discuss referral to a multidisciplinary specialty center that manages adolescents with severe obesity and its complications when other treatment methods have failed.  These centers may include a combination of more intensive therapy and in some cases discussion about treatment with medication or surgery when necessary to prevent severe and potentially lifelong complications.  

Resources: 

https://www.myplate.gov/ 

HealthyChildren.org Obesity 

What is Intensive Health Behavioral Lifestyle Treatment (IHBLT)