Recommendations Summary
Pediatric Weight Management (PWM) Obesity in Children Ages Two to Five
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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Recommendation(s)
PWM: Children Two to Five Years Old
Weight maintenance is generally recommended in overweight children two to five years old, within a multi-component weight-management intervention with active participation of a parent or caregiver. Weight loss may be recommended when the child has serious medical complications. Research was not identified on the efficacy and safety of weight-loss interventions among children ages two to five years old. The practitioner should refer to the Expert Committee Recommendations (Pediatrics Dec 2007, Vol 120 / Issue Supp4) for weight goals (Table 8) for children two to five years old.
Rating: Consensus
ImperativePWM: Children Two to Five Years Old, Interventions
The practitioner should refer to the Expert Committee Recommendations for interventions (Table 8) with children two to five years old.
Rating: Consensus
Imperative-
Risks/Harms of Implementing This Recommendation
- A negative energy balance during this period of rapid growth and development may have detrimental effects
- Nutrition interventions should be monitored by a registered dietitian to ensure adequate nutrition and growth and to prevent micro-nutrient deficiencies (see PWM Energy Restricted Diets).
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Conditions of Application
Strategies for increasing physical activity among preschool children need not be highly structured. Regular outdoor play and decreased television viewing have been shown to be beneficial among some subpopulations of preschool children. The recent Expert Committee report recommends no television for children less than two years old. (Sarah E. Barlow and the Expert Committee. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics, 2007; 120; S164-S192. P.S182).
Medical monitoring of growth and development is critical in the treatment of this age group, since a negative energy balance, during this period of rapid growth and development, may have detrimental effects.
Adequate screening of family risk factors is critical for this age group: See the PWM Assessing Child and Family Diet Behaviors in Pediatric Obesity recommendation and the PWM Assessing Family Climate Factors recommendation.
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Potential Costs Associated with Application
None.
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Recommendation Narrative
Research was not identified on the efficacy and safety of weight-loss interventions among children ages two to five.
The ADA Pediatric Weight Management Work Group refers the reader to the Expert Committee Recommendations regarding weight goals and approaches to weight management within this age group (Sarah E. Barlow and and the Expert Committee. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics, 2007; 120; S164-S192).
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Recommendation Strength Rationale
The rating of "consensus" was based on the lack of direct research on this age group and because the ADA Work Group drew on the consensus recommendations in Sarah E. Barlow and the Expert Committee. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics, 2007; 120; S164-S192).
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Minority Opinions
None.
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Risks/Harms of Implementing This Recommendation
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Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).