Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion

• Published in: The journal of clinical endocrinology and metabolism 2008-12, Vol.93 (12), p.4576-4599
• Main Authors: August, Gilbert P., Caprio, Sonia, Fennoy, Ilene, Freemark, Michael, Kaufman, Francine R., Lustig, Robert H., Silverstein, Janet H., Speiser, Phyllis W., Styne, Dennis M., Montori, Victor M.
• Format: Article
• Language: English
• Subjects: Adult; Anti-Obesity Agents - therapeutic use; Bariatric Surgery; Biological and medical sciences; Body Mass Index; Child; Child, Preschool; Diet; Endocrinopathies; Evidence-Based Medicine; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Infant; Infant, Newborn; Life Style; Medical sciences; Motor Activity; Obesity - diagnosis; Obesity - prevention & control; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - diet therapy; Pregnancy Complications - drug therapy; Pregnancy Complications - prevention & control; Social Support; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2007-2458

Objective: Our objective was to formulate practice guidelines for the treatment and prevention of pediatric obesity. Conclusions: We recommend defining overweight as body mass index (BMI) in at least the 85th percentile but < the 95th percentile and obesity as BMI in at least the 95th percentile against routine endocrine studies unless the height velocity is attenuated or inappropriate for the family background or stage of puberty; referring patients to a geneticist if there is evidence of a genetic syndrome; evaluating for obesity-associated comorbidities in children with BMI in at least the 85th percentile; and prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment. We suggest that pharmacotherapy (in combination with lifestyle modification) be considered in: 1) obese children only after failure of a formal program of intensive lifestyle modification; and 2) overweight children only if severe comorbidities persist despite intensive lifestyle modification, particularly in children with a strong family history of type 2 diabetes or premature cardiovascular disease. Pharmacotherapy should be provided only by clinicians who are experienced in the use of antiobesity agents and aware of the potential for adverse reactions. We suggest bariatric surgery for adolescents with BMI above 50 kg/m2, or BMI above 40 kg/m2 with severe comorbidities in whom lifestyle modifications and/or pharmacotherapy have failed. Candidates for surgery and their families must be psychologically stable and capable of adhering to lifestyle modifications. Access to experienced surgeons and sophisticated multidisciplinary teams who assess the benefits and risks of surgery is obligatory. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. We suggest that clinicians educate children and parents through anticipatory guidance about healthy dietary and activity habits, and we advocate for restricting the availability of unhealthy food choices in schools, policies to ban advertising unhealthy food choices to children, and community redesign to maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping. Pediatric obesity can lead to concurrent co-morbidities. Intensive lifestyle modification remains the pr