Nutrition Interventions for Children with Special Health Care Needs

Chapter 13
Section 3 - Condition-Specific Nutrition Interventions
Nutrition Interventions for Overweight
and Obesity
Betty Lucas, MPH, RD, CD
National surveys indicate that the prevalence of obesity in children in the United
States has increased dramatically over the last four decades. About 17% of schoolage
children and 12% of preschool children are obese, using body mass index (BMI)
of >95th percentile (1). An equally high percentage of the pediatric population is also
overweight, defined as BMI between the 85th-94th percentiles. These national studies
also show a shift of the heaviest children being markedly heavier now than in the
past. The increase in childhood obesity is influenced by environment and genes, but
the contributing factors are very complex (2).
The newer BMI percentiles and categories for children are (2):
95th obesity
The most recent consensus recommendations for childhood obesity focus on
prevention, thorough assessment, and intervention (2).
For most children, weight for length/height at the 50th percentile is considered ideal,
with an acceptable range of 10th to 90th percentile, depending on body composition
and stability in the percentile over time. Although using the above criteria will
identify most obese children, some children whose weight for height is at or above
the 95th percentile may be highly muscular and not obese. Others with weight for
height percentiles in the acceptable range could actually be “overfat”. For a child with
cerebral palsy, the reduced muscle mass may result in a BMI of 10th-25th percentile,
which may be appropriate considering the child’s altered body composition. In this
example, BMI at the 50th percentile may reflect excess fat stores, and obesity should
be assessed when BMI reaches the 75th percentile. On the other hand, for a preschool
or school-age child with Prader-Willi syndrome, a stable weight for length or
BMI within the 75th to 90th percentile range is considered clinically acceptable.
Nutrition Interventions for Children With Special Health Care Needs 143