Evaluation and Management of Childhood and Teen Obesity
Tips from the WATCH clinic at the UCSF (University of California in San Francisco) Children’s Hospital
The number of American children and adolescents who are overweight has more than tripled over the past three decades. According to the most recent statistics*, 17.5 percent of children (ages 6–11) and 17.0 percent of adolescents (ages 12–19) are overweight. Together with those who are at risk for becoming overweight, 30% (one in three) children and adolescents are struggling when it comes to weight.
- The most recent statistics on childhood and adolescent obesity from the National Institute of Diabetes & Digestive & Kidney Diseases can be found at: http://www.niddk.nih.gov/health/nutrit/pubs/statobes.htm
- The most recent statistics on childhood and adolescent obesity from the Centers for Disease Control can be found at: http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm)
Why should we treat childhood and adolescent obesity?
The notion that obese children and adolescents will “grow out of it” is waning. About 50% of obese school-age children and 75 % of obese teenagers go on to become obese adults. In adulthood, obesity is a chronic disease with health consequences that account for almost as many deaths as smoking. Obesity is responsible for the explosion of Type 2 diabetes, which is now seen in children and adolescents at an average age of 13. Children and adolescents need the resources and support to deal with their weight before it becomes a life-long problem.
What should I do if my child has a weight problem?
If you are a parent and believe that your child has a weight problem, first make an appointment with your primary care doctor. Your doctor will follow the steps below, to evaluate and address the problem with you and your child.
Step 1: Evaluate the problem
The current tool for clinical assessment of obesity is the Body Mass index (BMI). Calculate BMI by dividing weight in kilograms by height in meters squared (kg/m2) and plot it on a BMI curve.
- Children who fall over the 95th percentile are overweight or obese. Those who are not done growing may not have to lose weight, they might be better off maintaining their weight so that they can indeed “grow into it”. Weight loss is appropriate for those who have already gone through puberty and are at their tallest. Those who fall between the 85th and 95th percentile are considered at risk and should be treated depending upon cardiovascular risk.
- The most recent CDC growth charts include BMI curves for boys and girls ages 2 to 20 years and can be found at: http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/charts.htm
Step 2: Address the problem
Try not to place blame or guilt on children and teenagers by saying “you’re too heavy.” Negative comments are not helpful and may make the problem worse. Focus on health (eating and activity habits, see below), not weight. It is crucial to begin by asking “how do you feel about your weight or body size?” Let the child or teenager provide a self-evaluation. Most obese teens have already struggled with their weight and attempted to diet in the past.