TREATMENT OF CHILDHOOD OBESITY

What type of education is effective in treatment of childhood obesity?

Childhood Obesity

Childhood overweight is an increasingly prevalent condition in the United States. According to data from the National Health and Nutrition Examination Survey (NHANES), between 1976-80 and 2003-04, overweight among children aged 2-5 years almost tripled, from 5.0 percent to 13.9 percent. Even greater increases were seen in older age groups: for those aged 6-11 years, the prevalence of overweight increased from 6.5 percent to 18.8 percent, and the prevalence of overweight among those aged 12-19 years increased from 5.0 percent to 17.4 percent. Although previously it was believed that children would simply “grow out” of their weight problems, this is no longer the case as overweight in childhood and adolescence has been found to be a strong predictor of obesity in adulthood. In addition, overweight children suffer from higher rates of many serious health conditions, including Type 2 diabetes, high cholesterol, high blood pressure, and sleep apnea. Overweight children also suffer psychologically from the experience of prejudice and discrimination and have poorer body images than normal-weight children.

Definitions

Overweight for children and teenagers is usually calculated using the body mass index (BMI), a formula which combines information about height and weight. It is not a direct measure of body fat (an extremely muscular adolescent, for instance, might have low body fat but a high BMI) but correlates well for most people with direct measures of body fat such as underwater weighing. A child's BMI is compared to a gender-specific BMI age-for-growth chart (available, for instance, from the U.S. Center for Disease Control and Prevention) to obtain a percentile ranking, which shows the relative position of the child's BMI among others of the same gender and age. A BMI percentile at the 95th percentile or higher is classified as overweight, and from the 85th to 95th percentile as at risk for overweight. Recently, an alternative classification system has been developed using growth curves created using data from several different countries, which identify BMI scores for children age 2-18 years which project to a BMI of 25 (overweight) or 30 (obese) at 18 years of age.

Comprehensive Programs

Because childhood overweight is a complicated phenomenon, deciding which children require therapeutic intervention requires expert evaluation, possibly by a team of specialists, and devising an effective treatment plan may also require input from a team of specialists. Expert panel guidelines outlined in Barlow and Dietz (1998) describe a two-level screening process for children who are overweight or at risk. The first level involves calculating the child's BMI; those who are overweight (95th percentile or above) are referred for an in-depth medical assessment, while those at risk for overweight (85th-95th percentile) are referred to a second level of screening. This screening focuses on five elements: (1) family history of cardiovascular disease or diabetes, and parental hypercholesterolemia or obesity; (2) high blood pressure; (3) elevated cholesterol; (4) large recent increase in BMI; and (5) psychological or emotional problems related to weight, or child concerns ...