Clinical Resources

The AAP recommends the following approach to assessing, preventing and treating pediatric obesity:

Assess

• Conduct thorough history including family history, eating and physical activity with all patients. Review selected behaviors (including screen time, sweetened beverages, eating out and fruits and vegetables).

• For each patient, consider patients risk by virtue of family history, height and weight gain pattern, socioeconomic, ethnic, cultural, presence of co-morbidities and/ or environmental factors.
  
  
• Beginning at age 2, calculate and plot BMI for all patients on a yearly basis.
  
  Assessment resources (parent/child assessment survey, BMI charts, etc.)
  

Prevent

• Prevention is for all patients and should include promotion and support for breastfeeding, family meals, limited screen time, regular physical activity and yearly BMI monitoring.
  
  
• Prevention Plus is for children between the 85th - 94th percentiles BMI. Specifically encourage 5 servings of fruits and vegetables/day, 2 hours or less of screen time, 1 hour or more of physical activity and 0 sugared drinks. Also discuss the importance of family meal time, limiting eating out, consuming a healthy breakfast, preparing your own foods, and promotion of breastfeeding.
  
  Prevention resources (patient education, goal trackers, prescription for healthy living, helpful links and websites, etc.)
  

Treat

• Structured Weight Management is used if prevention plus has not been effective and BMI is between 95th - 98th percentiles. This approach combines more frequent follow-up with written diet and exercise plans.
  
  
• Comprehensive Multidisciplinary Intervention is used when 3 - 6 months of structured weight management has failed to achieve targets. This approach combines more frequent visits with an MD and a dietician and could also include exercise and behavioral specialists.
  
  
• Tertiary Care Intervention is for patients with BMI 99th percentile or greater and with associated co-morbidities or for those who structured weight management and comprehensive multidisciplinary intervention were not effective. This approach consists of all that is contained in the previous delivered interventions plus consideration of more aggressive therapies including meal replacements, pharmacotherapy, and even bariatric surgery in selected adolescents.
  
  Treatment resources (local pediatric weight management clinics, registered dieticians, local YMCAs, coding help, etc.)

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