Question

what are some Recommendations of treatment for stage 1 obesity in children/adolescents and adults ?

Answer 1

The Expert Committee Recommends for physicians and allied health professionals to perform at a minimum a yearly assessment beginning at the age of two of the child’s weight status to include a calculation of height, weight, and BMI (Body Mass Index) for age and plotting of the measurements on standard growth charts. Weight category Diagnosis using BMI percentile:  

 Underweight‐BMI for age < 5th percentile

 Healthy‐ BMI for age‐ 5th percentile to < 85th percentile

 Overweight‐ BMI for age 85th percentile to 94th percentile

 Obese‐BMI for age > 95th percentile

Conduct a thorough history to include child’s medical History,  Family Medical History, Presence of co‐ morbidities Dietary behaviors, Physical activity ,environmental and socioeconomic factors, cultural and ethnic factors.   Prevention: Prevention for all patients should include promotion and support for breastfeeding, family meals, limited screen time, regular physical activity, and yearly BMI monitoring.

Stage 1: Prevention Plus Within this category, the goal should be weight maintenance with growth resulting in decreasing BMI with increase of age. Monthly follow-ups are recommended with primary care giver. Weight management and behavioral counseling to include dietary habits and physical activity:

 5 or more servings of fruit and vegetables every day

 2 or fewer hours of screen time, no television in the room where the child sleeps

 1 hour or more of daily physical activity

 0 sugar-sweetened beverages Behavioral Counseling:

 Eat a nutritious breakfast everyday

 Limit meals outside of the home

 Family meals 5-6 times per week

 Allow child to self-regulate his or her meal.

Advance to Stage 2 if no improvement in BMI/weight status after 3-6 months.

Stage 2: Structured Weight Management Protocol Goal within this category should be weight maintenance resulting in a decreasing BMI with increasing age and height. Weight loss not to exceed 1 lb. /month in children 2-11 years or an average of 2 lbs. /wk. in older overweight/obese children and adolescents.

 Development of daily diet plan of a balanced macronutrient diet, emphasizing foods high in water or fiber content

 Increased structure of daily meals and snacks

 Supervised active play of at least 60 minutes per day

 Decrease television or screen time to 1 hour or less/day

 Increased monitoring using logs (e.g. screen time, physical activity, dietary intake, restaurant logs) by provider, patient, and or family. Advance to Stage 3 if no improvement in BMI/weight status after 3‐6 months. Stage 3: Comprehensive Multidisciplinary protocol.Within this category, the goal should be weight maintenance or gradual weight loss until the BMI is less than 85th and should not exceed 1lb/month in children ages 2 to 5 years or 2lbs in older obese children and adolescents. At this level of intervention, the child should be referred to a multidisciplinary obesity team.

 Eating and activity goals are same as in Stage 2

 Structured program in behavioral modification, including food and activity monitoring, and creation of short‐term diet and physical activity goals.             

 Involvement of primary caregivers/families for behavioral modification in children under age 12 and training of primary caregivers/families for all children.

The Expert Committee recommends the following for children with BMI>95th percentile with significant comorbidities and who have not been successful with stages 1‐3 or children with >99th percentile who have shown no improvement under stage 3.  

Stage 4: Tertiary Care Protocol Pediatric tertiary weight management center with access to a multidisciplinary team with expertise in childhood obesity and operates under a designed protocol. This protocol should include continued diet and activity counseling and consideration of such additions as meal replacement, very low calorie diet, medication, and surgery.

Expert Committee recommended weight loss Targets for Stage 4

Age 2-5 years:

85th-94th BMI-Weight maintenance until BMI< 85th or slowing of weight gain is indicated with downward reflection in BMI curve.

>95th BMI - Weight maintenance until BMI 21 or 22 Gradual weight loss not to exceed 1 lb. per month.

Ages 6‐11 years:

85th‐94th BMI‐Weight maintenance until BMI< 85th or slowing of weight gain is indicated with downward reflection in BMI curve.

95th‐ 98th BMI‐Weight maintenance until BMI< 85th percentile gradual weight loss not to exceed 1 lb. per month. >99th BMI‐Weight loss not to exceed an average of 2lbs/week.

Age 12‐18 years:

85th‐94th BMI‐Weight maintenance until BMI< 85th or slowing of weight gain is indicated with downward reflection in BMI curve.

95th‐ 98th BMI‐Weight maintenance until BMI< 85th percentile‐no more than an average of 2 lbs. per week.

>99th BMI‐Weight loss not to exceed an average of 2 lbs. per week.