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Prevention and management of childhood obesity in a primary care setting

Prevention and management of childhood obesity in a primary care setting
This algorithm outlines a framework for prevention and management of childhood obesity in a primary care setting. The general approach and options are consistent with the clinical practice guideline from the American Academy of Pediatrics[1]. Strategies and implementation will vary widely depending on the patient's and family's values and preferences; financial or other barriers; and available medical, community, and programmatic resources. For details, refer to UpToDate content on management of childhood obesity and weight loss surgery.

BMI: body mass index; GLP-1: glucagon-like peptide 1; HBLT: health behavior and lifestyle treatment.

* HBLT includes:

  • Discuss a range of options for type and intensity of intervention
  • Assess for disordered eating patterns
  • Collaboratively identify specific goals for behavior change skills, nutrition, and physical activity
  • At each visit, review and discuss:
    • Progress, goals, and capacity
    • Community resources for physical activity and other lifestyle interventions
    • Options for intensity and type of HBLT intervention

¶ Greater intensity of counseling generally improves efficacy. The type and frequency of counseling should be selected collaboratively with the family, and the family should select a treatment path that they feel is feasible. Intensive treatment refers to length and frequency of visits and does not imply increased pressure or focus on dieting. If it is not possible to provide the necessary contact hours in the primary care setting, the primary care clinician still has an important role in overseeing longitudinal care and guiding the family to optimal care through community programs or consultants.

Δ Comorbidity screening depends on weight class and other risk factors; refer to UpToDate content on clinical evaluation of childhood obesity and related table.

◊ For pharmacotherapy, regulatory approvals for these drugs and the AAP guideline include class I obesity (BMI ≥95th percentile or ≥30 kg/m2). However, due to need for long-term treatment, high costs, and limited availability, we generally use a severe obesity threshold to select adolescents who might benefit from pharmacotherapy.

§ Severe obesity is defined as BMI ≥120% of the 95th percentile or ≥35 kg/m2 (whichever is lower). This corresponds to approximately the 98th percentile or BMI Z-score ≥2.2 (ie, 2.2 standard deviations above the mean) on the CDC extended BMI charts. Severe obesity is the threshold for considering weight loss surgery in the presence of comorbidities.

¥ This combination of services is most readily available in a comprehensive multidisciplinary weight management program.
Reference:
  1. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 2023; 151:e2022060640.
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