Obesity Guidelines: Prevention, Treatment, Diagnosis

October 28, 2007

To this day, a child scoring in the 85th to 95th percentile of weight is "at risk of overweight." To parents, this may not sounds like a serious concern. It is. Nancy Krebs, MD, of the University of Colorado School of Medicine, Children's Hospital, Denver, hosted a talk at Sunday's plenary session about the new wording that would soon be adopted to describe overweight children.

To this day, a child scoring in the 85th to 95th percentile of weight is "at risk ofoverweight." To parents, this may not sounds like a serious concern.

It is. Nancy Krebs, MD, of the University of Colorado School of Medicine, Children's Hospital,Denver, hosted a talk at Sunday's plenary session about the new wording that would soon be adopted todescribe overweight children.

Currently, only at over 95% is a child "overweight." Obesity is not on the scale, because that wordwas felt to have a negative stigma. Stigma or not, the new rankings will relabel the 85% to 95% scoreas "overweight," and above 95% as "obese." The cutpoints remain the same, merely renamed. Less bluntnames can still be used when talking to parents.

Also being reevaluated is the body-mass index (BMI) chart, graphing a child's BMI score and age in aseries of upward curves. The current chart does not extend high enough to include scores above the99th percentile. But that high percentile is also the minimum score needed for the consideration ofbariatric surgery. Without a proper BMI charting, the surgical option can't be properly considered.

That's a long way off from an initial talk about a child's weight, though. Practitioners should firstfocus on preventative measures. Move onto a structured weight management plan, and then acomprehensive multidisciplinary approach. If none of those options work, only then should bariatricsurgery be an option.

Using the EPE acronym can help with counseling patients and parents. First, Emphasize by commiserateabout how tough weight management is, and hear out their concerns about staying with a diet. Then,Provide the information they need to make a positive difference. Finally, Elicit feedback about how they think and feel about their upcoming efforts.

The three best things overweight children can do, Dr. Krebs said, are to stop eating out so often,cut back on sodas and other sugary drinks, and scale back excessive portion size. Other discussedoptions include cutting back on unwatered fruit juice, eating breakfast, avoiding foods high in fatand energy, and adding more fruits and vegetables. Of course, upping the physical activity whiledecreasing sedentary time helps, too. (See Treating Childhood Obesity for more on this.)