Childhood obesity is a growing problem that we are battling in the United States. According to data from the Centers for Disease Control and Prevention from 2011 to 2014, 12.7 million children and adolescents were obese in the United States, or every 1 in 6 children. Obesity has been shown to increase the risk of disease in multiple systems of the child’s body:

• Insulin resistance and Type 2 Diabetes
• Asthma, sleep apnea, and other respiratory conditions
• Cardiovascular health- high blood pressure and high cholesterol
• Musculoskeletal and joint problems
• Fatty liver disease, gallstones, and heartburn

Furthermore, children with obesity are far more likely to grow up to be adults with obesity. Pediatricians need to vigilantly monitor and treat obesity early.

Identify the Problems at the Office

• Review growth charts during every visit. Overweight is defined as a BMI between the 85^th percentile and the 95^th percentile for age and sex. Obesity is defined as a BMI at or above the 95^th
• Ask questions about exercise and nutrition:
  • How many meals a day and what kind of foods? How about snacks?
  • How many cups of juice a day? How about soda?
  • How many servings of fruits or vegetables a day?
  • How many hours of ‘screen time’ a day?
  • How many hours of physical activity a day?

What to Recommend

• Studies have shown that addressing the issues of screen time, limiting sugary beverages, and increasing activity level are associated with a reduction in BMI.
• Set goals with advice for your patient, 1 or 2 a visit, for example:
  • Control portion sizes: 3 meals and 2 healthy snacks a day and make half the plate fruits and veggies.
  • Encourage water drinking. Limit juice per day to 4 oz for ages 1-3 yrs, 4-6 oz for ages 4-6 yrs, and 8 oz for ages 7-18 yrs.
  • Encourage at least 5 servings of fruits and vegetables a day. Children can participate by helping to choose fruits or veggies to eat for meal or snack.
  • Limit screen time to 2 hours a day. Remove televisions from the bedrooms and turn off screens during meal times.
  • 60 minutes of physical activity a day. You can take your child to the park every day.

 

Resources and Recipes for Families

• Texas WIC website has web classes regarding nutrition and healthy recipes. http://texaswic.dshs.state.tx.us/wiclessons/english/recipes/default.asp
• Choose My Plate website has more information regarding portion control, eating healthy on a budget, and how to choose healthy foods. https://www.choosemyplate.gov/
• For additional support, refer families to Nutrition or the COACH program.

References

1. https://www.cdc.gov/obesity/index.html
2. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Recommends-No-Fruit-Juice-For-Children-Under-1-Year.aspx
3. http://texaswic.dshs.state.tx.us/wiclessons/english/recipes/default.asp
4. https://www.choosemyplate.gov/
5. https://www.cnpp.usda.gov/2015-2020-dietary-guidelines-americans
6. Perrin EM, Finkle JP, Benjamin JT. Obesity prevention and the primary care pediatrician’s office. Current opinion in pediatrics. 2007;19(3):354-361. doi:10.1097/MOP.0b013e328151c3e9.

Jennifer Ni, MD