Article Figures & Tables
Tables
- Table 1:
Recommended cut-offs by the World Health Organization for screening for undernutrition and overnutrition21,22
Variable Age Birth to 2 yr 2 to 5 yr 5 to 19 yr Measure Weight-for-length BMI-for-age BMI-for-age Wasted < 3rd centile < 3rd centile < 3rd centile Overweight > 97th centile > 97th centile > 85th centile Obese 99.9th centile 99.9th centile 97th centile Note: BMI = body mass index.
- Table 2:
Summary of recommendations on prevention and management of overweight and obesity in children and youth in Canada and elsewhere12,13,20,35–37
Organization Recommendation Prevention of overweight and obesity CTFPHC (2015) We recommend that practitioners not routinely offer interventions aimed at preventing weight gain. CTFPHC (1994)13 Insufficient evidence to support screening; physicians should plot height and weight. Regular physical activity is recommended for all Canadians to maintain healthy weight. USPSTF (2010)20 No guideline on prevention; recommend screening children aged six years and older for obesity. NICE (2006)35 A variety of recommendations aimed at health professionals in all primary care settings should ensure that preventing and managing obesity is a priority; interventions should aim to improve diet and increase physical activity. Discuss weight, diet and activity at times when weight gain is more likely. SIGN (2010)36 Focus is on school-based interventions to prevent obesity (as that is where most trials have been undertaken) with parent and family involvement. Obesity Canada (2007)12 Multisectoral approach, including programs that combine a low-fat or energy-reduced diet for obesity prevention. Discussion of the prevention of childhood obesity with the pregnant mother is encouraged, as is exclusive breastfeeding for the first six months. Management of overweight and obesity CTFPHC (2015) Offer or refer to formal, structured behavioural interventions aimed at modest weight loss in ages 2 to 17 years; do not offer pharmacologic or surgical interventions. CTFPHC (1994)13 Insufficient evidence to recommend for or against screening for or treatment of childhood obesity; recommend against very low kilojoule diets for preadolescents; insufficient evidence to recommend for or against exercise programs or intensive family-based programs for most obese children. USPSTF (2010)20 Screen children aged six years and older for obesity, and offer them or refer them to intensive counselling and behavioural interventions to promote improvements in weight status. NICE (2006)35 Offer multicomponent interventions that include behavioural change strategies to increase physical activity levels, decrease inactivity, and improve eating behaviour and diet quality. Consider drugs treatment only if multicomponent diet, exercise and behavioural strategies have been tried and evaluated (not recommended under 12 years, only recommended over 12 years if severe comorbidities are present). Surgery is not recommended. SIGN (2010)36 Incorporate behavioural change components, be family-based and aim to change the whole family’s lifestyle. Programs should target decreasing overall dietary energy intake, increasing levels of physical activity and decreasing time spent in sedentary behaviours. Orlistat should only be prescribed for severely obese adolescents with comorbidities or those with very severe to extreme obesity attending a specialist clinic. Bariatric surgery can be considered for postpubertal adolescents with very severe to extreme obesity and severe comorbidities. Obesity Canada (2007)12 Comprehensive healthy lifestyle intervention, including an energy-reduced diet and regular physical activity, is the first treatment option. Consider orlistat to aid in weight reduction and weight maintenance when added to a regimen of lifestyle intervention among adolescents. The use of pharmacologic agents in prepubertal children should be considered only within the context of a supervised clinical trial. Bariatric surgery in adolescents should be limited to exceptional cases. National Health and Medical Research Council (Australia) (2013)37 Lifestyle change including reduced energy intake and sedentary behaviour, increased physical activity and measures to support behavioural change. Note: CTFPHC = Canadian Task Force on Preventive Health Care, NICE = National Institute for Health and Care Excellence (UK), SIGN = Scottish Intercollegiate Guideline Network, USPSTF = U.S. Preventive Services Task Force.
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