Childhood obesity: highlights of AMA Expert Committee recommendations

Childhood obesity is an increasingly serious problem; 13.9 percent of children two to five years of age, 18.8 percent of children six to 11 years of age, and 17.4 percent of adolescents 12 to 19 years of age in America are obese. Practical strategies that primary care physicians can use to tackle the problem are scarce. The American Medical Association recently convened an expert panel to address this need. Evidence about how best to manage and prevent obesity was reviewed and incorporated into a series of reports. The Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity recommends addressing the issue of weight with all children at least once a year. Family physicians are urged to assess key dietary habits (e.g., consumption of sweetened beverages), physical activity habits, readiness to change lifestyle habits, and family history of obesity and obesity-related illnesses. Laboratory testing recommendations depend on the degree of obesity and associated illnesses. For children with a body mass index between the 85th and 94th percentiles but who have no obesity-related illnesses, a fasting lipid profile should be done. Those with the same body mass index and obesity-related illnesses should also have tests for alanine transaminase, aspartate transaminase, and fasting blood glucose levels. Measurement of blood urea nitrogen and creatinine levels should be added in children with a body mass index above the 95th percentile. A four-stage approach to treatment of childhood obesity is recommended. Many of these recommendations can be carried out by family physicians for treatment and prevention. These include advising families to limit consumption of sweetened beverages and fast food, limit screen time, engage in physical activity for at least 60 minutes per day, and encourage family meals on most, and preferably all, days of the week.