Monitor patient's weight and provide appropriate guidance regarding nutrition and physical activity toprevent adult diseases

Monitor patient's weight and provide appropriate guidance regarding nutrition and physical activity toprevent adult diseases: Excerpt from Avoiding Common Pediatric Errors

Author: Brian Kit, MD

What to Do - Gather Appropriate Data

Scope of the Problem. According to the Centers for Disease Control and Prevention (CDC), the prevalence of obese children in the United Sates tripled to 16% from 1980 to 2002. Despite this, pediatricians often both overlook and fail to disclose the diagnosis in affected children and teens. The increased prevalence of obesity has resulted in an increase in associated medical problems, including diabetes, hypertension, and dyslipidemia. These conditions are beginning to present during childhood. The focus on childhood obesity is based on evidence that obese children become obese adults and will be at risk for significant and lifelong comorbidity.

Definitions

To thwart the rise in childhood obesity and to avoid its associated complications, pediatricians and other providers must have an understanding of the definition of obesity and related terms. The key definitions are listed below.
• BodyMassIndex(BMI):BMI,definedasweightinkilogramsdividedby height in meters squared(kg/m2),isanindirectmeasurementof adiposity. Although there are limitations of its ability to measure adiposity, it is the most acceptable screen for obesity in children ages 2 to 18 years.
• Underweight: BMI <10th percentile for age.
• Normal Weight: BMI between the 10th and 85th percentile for age.
• Overweight: BMI >85th percentile for age.
• Obese: BMI >95th percentile for age.

Health Supervision for Overweight and Obese Children

All patients should have a BMI calculated at least annually during a well- child visit and charted on the CDC's National Center for Health Statistics charts for BMI. The charts are available online at http://www.cdc.gov/ growthcharts. If the child is overweight or obese, the practitioner should take into consideration the following points:
• Discuss with the family the clinical definition of obesity and the importance of early identification. Focus the discussion on the health benefits of addressing obesity and the child's positive qualities.
• Afullhistory,includingdietaryhistoryandactivityhistory,shouldbetaken from both the child and the parent. Questions regarding eating patterns and food choices may provide the clinician with opportunities to address areas of concerns, including consumption of foods with high calories but low nutritional value. Encourage the child and family to maintain a food journal, detailing the foods consumed during the day. Time spent in physical education and playing outdoors should be determined. Availability of community resources that promote exercise should be explored.
• Family history of obesity, hypertension, diabetes, and heart disease should be ascertained to identify the child's risks factors.
• Physical examination should be complete, with particular emphasis on items that may indicate complications of obesity, including hypertension, hirsutism, and acanthosis nigricans.
• Although there are no standards for laboratory evaluation, many clinicians will screen for diabetes (using a fasting glucose), insulin resistance (measuring an insulin level), and hyperlipidemia (measuring total cholesterol, triglycerides, and high-density lipoprotein [HDL]-cholesterol) in children who are obese.
• Develop a plan with the family that employs dietary and activity modifications. Evidence from the medical literature has confirmed the advantages of a combined dietary and exercise approach. Individual exercise routines will vary depending on needs and available resources. Ensure that the child is part of the process of developing the goals and meet with the family regularly to monitor progress.
• Psychosocial support, particularly for those children who are depressed, is a vital component of the treatment of obesity.
• Recognize that management of obesity is best done using a multidisciplinaryapproach,whenever possible,involvingtrainednurses,nurse practitioners, nutritionists, physicians, psychologists, and social workers. All these professionals can effectively help patients and their families monitor and change behavior.

Conclusion

The pediatrician and other providers of services for children are in a position to alter the course of obesity and its complications. Identifying the problem and developing an action plan that includes exercise and dietary modifications will have positive outcomes. Attention to the child's psychosocial needs is another key element of treatment.

Suggested Readings

Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics. 1998;102(3):e29.
Centers for Disease Control and Prevention. Children and teens told by doctors that they were overweight–United States, 1999–2002. MMWR Morb Mortal Wkly Rev. 2005;54(34):848– 849.
Centers for Disease Control and Prevention. Prevalence of overweight among children and adolescents: United States, 1999–2002. National Health and Nutrition Examination Survey. Hyattsville, MD: U.S. Department of Health and Human Services, CDC, National Center for Health Statistics. Available at: www.cdc.gov/nchs/products/pubs/pubd/ hestats/overwght99.htm. Accessed on December 28, 2007.
Cook S, Weitzman M, Auinger P, Barlow SE. Screening and counseling associated with obesity diagnosisinanationalsurveyofambulatorypediatricvisits.Pediatrics.2005;116(1):112–116.
Dietz WH, Robinson TN. Clinical practice. Overweight children and adolescents. N Engl J Med. 2005;352:2100–2109.
Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998;101(3 Pt 2):518–525.
HillJO,TrowbridgeFL.Childhoodobesity:futuredirections andresearch priorities. Pediatrics. 1998;101(3 Pt 2):570–574.
Hills AP, Parker AW. Obesity management via diet and exercise intervention. Child Care Health Dev. 1988;14:409–416.
Whitaker RC, Wright JA, Pepe MS, et al. Predicting obesity in young adulthoodfrom childhood and parental obesity. N Engl J Med. 1997;337:869–873.

Book Source Details

• Book Title: Avoiding Common Pediatric Errors
• Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
• Year of Publication: 2008
• Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.

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More About This Book: Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6

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