Prevention and management of childhood obesity in a primary care setting^[1]

BMI: body mass index; HBLT: health and behavior lifestyle treatment.

* A sharp rise in BMI refers to an upward deflection on the BMI curve that is substantially steeper than the nearby centile curves over 6 to 12 months.

¶ For weight management counseling, at least 2 contact hours/month are suggested, but the timing of follow-up depends on the level of concern and availability and schedule of the patient, family, and clinician. Greater intensity of counseling (length and frequency of visits) generally improves efficacy.

Δ Severe obesity is ideally defined as BMI ≥120% of the 95^th percentile or ≥35 kg/m² (whichever is lower). This corresponds to approximately the 98^th percentile or BMI Z-score ≥2 (ie, 2 standard deviations above the mean).

◊ Appropriate use of pharmacotherapy requires specific expertise in the use of these drugs, ongoing intensive HBLT, and close follow-up. This combination of services is most readily available in a comprehensive multidisciplinary weight management program. Refer to UpToDate content on obesity management in the primary care setting and on pharmacotherapy for obesity.

§ Weight loss surgery is an appropriate consideration for adolescents with severe obesity and with medical comorbidities who have failed to lose weight through conventional dietary interventions and behavioral modification. It should only be performed in the context of a multidisciplinary program with expertise in adolescent medicine and extensive expertise in bariatric surgery. Early surgical intervention may improve outcomes compared with intervention at an older age or higher BMI. Refer to UpToDate content on surgical management of severe obesity in adolescents.