Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 12
Table 12.1 Continued
Guideline reference Target audience Recommendations
American Academy
of Pediatrics ( AAP ),
USA 2003 (75)
American Medical
Association ( AMA ),
USA 2007 (13)
American Heart
Association ( AHA ),
USA 2005 (76)
Aimed at health care
providers, physicians
Targets all children
Aimed at clinicians
to offer practical
guidance and
recommendations in
all areas of
childhood obesity
care
Aimed at health care
providers, physicians
• Calculating and plotting BMI once a year in all children and adolescents
(BMI 85th – 95th percentile considered at risk of overweight. BMI > 95th
percentile is considered overweight or obese).
• Health care providers advised to encourage breastfeeding, healthy
eating, physical activity in multiple settings and the limitation of television
viewing to < 2 hrs per day.
• Combination of dietary and physical activity interventions for an optimal
approach. Families to be educated with regards to the impact they can
have on their children ’ s development of physical activity and eating habits.
• Recommends documentation of BMI at each well child visit (In children
over 2 years BMI 85th – 94th percentile = overweight; BMI > 95th
percentile = obese. In youths obesity defined as BMI > 30 kg/m 2 . In
children < 2 years weight for height values > 95th percentile categorized
as overweight).
• Recommends targeting of at risk children with one or both obese parents.
• Role of universal assessment and evidence - based preventive
recommendations including limited consumption of sugary drinks,
appropriate levels of fruit and vegetables in diet, no television before 2
years of age and thereafter < 2 hrs per day, breakfast, limiting portion size
and regular family meals.
• Three treatment stages according to BMI and other risk factors:
(i) prevention; (ii) prevention plus structured weight management;
(iii) comprehensive multi - disciplinary intervention with a consistent focus
on dietary factors and eating and physical activity behaviors.
• Emphasizses the importance of parental involvement, relevant to the age
and level of independence of the child.
• Recommends yearly screening of BMI percentiles (BMI 85th – 95th
percentile considered at risk of overweight; BMI > 95th percentile
considered overweight or obese).
• Recommends age specific prevention advice including breast feeding,
healthy home environments, 5 - a - day fruit and vegetables, family meals, 1
hour of active play per day, < 2 hrs television per day.
• The principal intervention strategies for children are similar to those for
adults (dietary modification and increased physical activity), but stress
that family involvement was critical and the interventions had to be
age - specific and tailored to degree of overweight.
NB : all BMI reference values cited are percentiles for age and sex unless stated.
and at three - month follow up, the intervention group
had greater improved BMI scores than controls. 40
The patient - centered assessment and counseling for
exercise and nutrition (PACE+) is a RCT of a joint
primary care and home - based intervention of 878
adolescent boys and girls aged 11 – 15 years, recruited
through primary care providers in California, USA. 41
This was a primary prevention intervention focused
on improving physical activity and dietary behaviors.
It had two stages: primary care based computer -
assisted diet and physical activity assessment and goal
setting followed by brief counseling, and then 12
months of monthly mail and telephone counseling at
home. The comparison group received an interven-
100