Pediatric Weight Management

PWM: Introduction (2007)

Pediatric Weight Management Guideline Overview

Guideline Title

Pediatric Weight Management (2007) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on the treatment of pediatric overweight and obesity in a multicomponent, multidisciplinary context.

Unlike adults, who are defined as overweight or obese depending on the absolute value of their body mass index (BMI) (kg/m2), BMI percentiles are used for children and adolescents. BMI percentile indicates the position of a child’s BMI relative to children of the same sex and age (see the US Centers for Disease Control Growth Charts). Throughout this guideline the terms “obese” and “obesity” will be used as a general designation for children whose BMI is greater than or equal to the 95^th percentile.

Use of the Term Obese

The Expert Committee Recommendations, released in 2007, recommended changes for childhood overweight and obesity terminology. (See, 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. Online at: http://pediatrics.aappublications.org/cgi/reprint/120/Supplement_4/S164.) The ADA PWM work group has opted to use the Expert Committee's terminology for framing treatment recommendations.

However, all of the research analyzed for this guideline was published before 2007 and so uses the former terms “overweight” or ‘at risk for overweight’. To complicate matters, researchers in this area have used different measures to define overweight/obesity including: BMI>95^th percentile, >120% of ideal body weight and ponderal index (cube root of body weight times 100 divided by height in cm). In the evidence analysis, when recommendations draw on other metrics of body size (e.g., 120% of ideal body weight), we will use these specific measures and researchers’ criteria.

The focus of this guideline is on pediatric weight management interventions within the context of a multidisciplinary program. The ADA PWM guideline focuses what the Expert Committee designates “Stage 3: Comprehensive Multidisciplinary Intervention.” Because the Expert Committee recommends this level of care only for children and teens BMI>=95^th percentile, and because they use the term “obese” to designate this BMI level, it makes sense to use the term “obese” in this guideline even though the previous research uses the term “overweight.”

The table below compares the childhood overweight terminology from the Expert Committee Recommendations with the previous terminology.

TABLE 1 Terminology for BMI Categories

BMI Category	Former Terminology	Recommended Terminology
<5th percentile	Underweight	Underweight
5th–84th percentile	Healthy weight	Healthy weight
85th–94th percentile	At risk of overweight^ab	Overweight^c
>=95th percentile	Overweight^ab or obesity^a	Obesity^cd

^aExpert committee recommendations, 1998.

^bCDC recommendations, 2002.

^cInternational Obesity Task Force, 2000.

^dInstitute of Medicine, 2005.

(Note: Table reproduced from Table 1 in See (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. (P. S168)

Comprehensive Pediatric Obesity Treatment

Obesity is a complex multifactoral chronic disease that develops from an interaction between genetics and the environment. The development of obesity involves the integration of family, behavioral, cultural, physiological, metabolic and genetic factors. Treatment of obesity should be based on a comprehensive weight management program. Because of child growth (especially during growth spurt periods) weight loss may not be appropriate—as the child’s relative BMI will drop as they get taller even though they maintain a constant weight.

Guideline Development

This guideline is intended to provide the current research on pediatric obesity based on the systematic review of the literature. The recommendations developed in this guideline involved the review of multiple articles to determine the most appropriate course of action for the practitioner.

It is important for the reader to keep in mind that the development of guidelines based on a rigorous evidence analysis process takes time, and so only research up to a certain date is included—though progress in the field continues apace. The benefit of an online guideline is that it allows frequent and regular updates. Additionally, not all topics have the same currency. While all topics have been updated through September 2004, many topics have been updated through April 2006. The reader is urged to take note of the last date the evidence analysis was updated.