Materiały źródłowe

• #1 Childhood obesity: an overview of laboratory medicine, exercise and microbiome

  https://www.degruyter.com/document/doi/10.1515/cclm-2019-0789/html?lang=en

  In the last few years, a significant increase of childhood obesity incidence unequally distributed within countries and population groups has been observed, thus representing an important public health problem associated with several health and social consequences. Obese children have more than a 50% probability of becoming obese adults, and to develop pathologies typical of obese adults, that include type 2-diabetes, dyslipidemia and hypertension. […] The first clinical standard measure to estimate the level of adiposity in overweight children is the body mass index (BMI), that requires being adjusted for both age and gender. […] In our review, we intended to identify and describe a specific panel of parameters that allows the evaluation and characterization of childhood obesity status and, therefore, set up a preventive diagnostic approach directed to ameliorate health-related behaviors and identify predisposing risk factors.

• #1 Obesity in children – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1085

  Obesity in children has increased in recent decades. […] Calculating body mass index (BMI) is the most widely accepted method of screening for obesity in children. Abnormal BMI cut-offs in children are determined by age- and sex-specific percentiles. […] Impaired glucose tolerance and type 2 diabetes mellitus are prevalent in children with obesity. […] An age- and sex-adjusted BMI between the 85th and 94th percentiles is defined as overweight, and a BMI 95th percentile (or to 30 kg/m, which ever is lower) is defined as obesity. […] Severe obesity is defined as BMI of 120% of the 95th percentile. […] Key diagnostic factors include body mass index (BMI) 95th percentile and weight 95th percentile for height. […] Other diagnostic factors include increased waist-hip ratio and hypertension. […] Investigations to consider include fasting blood glucose, serum lipids, and liver function tests. […] Emerging tests include DEXA, bioelectric impedance analysis, and abdominal CT or MRI.

• #1 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6069785/

  The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. […] The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. […] The definition of overweight and obesity is based on the use of percentiles of the weight-to-length ratio or body mass index, depending on sex and age. […] In children up to 24 months, the diagnosis of overweight and obesity is based on the weight-to-length ratio, using the World Health Organization (WHO) 2006 reference curves. […] After the age of 2 years it is based on the Body Mass Index (BMI), using the WHO 2006 reference system up to 5 years and the WHO 2007 reference system thereafter.

• #1 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6069785/

  The cut-off to define severe obesity is represented by the BMI99th percentile. […] It has been demonstrated that the 99th percentile of BMI identifies subjects with higher prevalence of cardiometabolic risk factors and persistence of severe obesity in adulthood with respect to the lower percentiles. […] The clinical suspicion of secondary obesity arises after careful anamnestic, anthropometric and clinical evaluations. […] Obesity may be ascribed to a specific cause (endocrine, hypothalamic, genetic, iatrogenic). […] Therefore, clinical history, peculiar signs and symptoms must be accurately assessed such as: 1) onset of obesity before 5 years and/or rapid progression, especially in association with clues suggesting secondary causes (i.e. genetic forms); 2) continuous and/or rapid weight gain associated with reduced height velocity or short stature; 3) delayed cognitive development; 4) dismorphic features; and 5) use of drugs inducing hyperphagia.

• #1

  https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

  Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. The diagnosis of overweight and obesity is made by measuring peoples weight and height and by calculating the body mass index (BMI): weight (kg)/height (m). The body mass index is a surrogate marker of fatness and additional measurements, such as the waist circumference, can help the diagnosis of obesity. […] For children, age needs to be considered when defining overweight and obesity. […] For children under 5 years of age: overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median. […] Overweight and obesity are defined as follows for children aged between 5-19 years: overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and obesity is greater than 2 standard deviations above the WHO Growth Reference median.

• #1 Childhood obesity – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833

  Diagnosis involves the steps that a healthcare professional takes to find out if your child has obesity. A healthcare professional calculates your child’s BMI and figures out where it falls on a standard growth chart. […] Your child’s healthcare professional uses the growth chart to find out how your child’s weight compares with that of other children of the same sex and age. This is called your child’s BMI percentile. For example, a child in the 80th percentile has a higher BMI than 80% of other children of the same sex and age. […] Along with BMI and charting weight on the growth charts, the healthcare professional looks at: Your family’s history of obesity and weight-related health conditions, such as diabetes. Your child’s eating habits. This can include what your child eats and how often, and how big the portion sizes are. Your child’s activity level and amount of screen time. Your child’s blood pressure. Other health conditions your child has or medicines your child takes. Mental health history, including bouts of depression, sleep troubles, and whether your child feels isolated, alone or bullied.

• #1 Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6351475/

  The physical exam is both important and challenging in children with obesity. […] The clinician should take particular care to preserve the child or adolescent with obesity’s need to cover up while still examining the patient. […] A careful history that includes family history, prenatal, birth and postnatal care, followed by any medical complications in childhood and medications used both for the management of comorbid conditions and the management of obesity should be obtained. […] Comorbidity management complicates the treatment of children with obesity. […] The significance of these disease processes cannot be understated as they progress through adulthood and are associated with premature morbidity. […] The use of weight loss medications in children with obesity is limited. […] Bariatric surgery is reserved as treatment for severe obesity in adolescents. […] Identifying and classifying these children as early as possible is important, as is identifying comorbid conditions.

• #1 Childhood obesity – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833

  Your child’s healthcare professional also might do blood tests. These may include: A cholesterol test. A blood sugar test. A liver test. Other blood tests to check certain hormone levels or to look for other conditions linked with obesity. […] Your child’s healthcare professional likely will be first to tell you whether your child’s BMI is in the obese range. If your child has complications of obesity, you might be referred to other specialists to help manage these health concerns.

• #1 Childhood Obesity An Optimistic Review, Part 1: Diagnosis | Consultant360

  https://www.consultant360.com/articles/childhood-obesity-optimistic-review-part-1-diagnosis

  Ill health can be defined as any condition that limits function and enjoyment. […] Screening and specific laboratory tests should be based on the assessment of a patient’s risk and evidence-based standards of care. […] Fasting plasma glucose. Screen every 2 years for diabetes in overweight or obese children aged 10 years or older (younger if puberty has begun) with at least 2 risk factors (ethnicity, family history, signs of insulin resistance). […] Fasting lipid panel. Screen all children once between ages 9 and 11 years and again between ages 17 and 21 years. […] Liver screening. Transaminase measurement is useful to detect subclinical nonalcoholic fatty liver disease. […] Thyroid screening. Assess antithyroid antibodies (antithyroglobulin antibodies and antithyroid peroxidase antibodies) if there is a family history of Hashimoto thyroiditis or Graves disease.

• #1 Childhood Obesity An Optimistic Review, Part 1: Diagnosis | Consultant360

  https://www.consultant360.com/articles/childhood-obesity-optimistic-review-part-1-diagnosis

  Cortisol screening. This is necessary only if there is severe linear growth retardation (which is virtually always present in Cushing disease or Cushing syndrome) with increasing BMI percentile. […] Puberty assessment. Obesity is associated with earlier (or earlier for family pattern) pubertal development.

• #1 Diagnostic Methods in Childhood Obesity | IntechOpen

  https://www.intechopen.com/chapters/72628

  Childhood obesity, the most frequent pediatric disease, a worldwide public health problem, is considered a global epidemic and the main risk factor for obesity in adulthood. […] The importance of knowing diagnostic methods for better monitoring of childhood obesity is emphasized. […] The assessment of nutritional status aims to verify growth and body proportions in an individual or in a community, with a view to establishing intervention attitudes. […] Determining obesity is, establishing excess body fat. […] Among the various methods, anthropometric diagnosis and imaging diagnosis stand out. […] Anthropometry, which consists of assessing the physical dimensions and the global composition of the human body, has proved to be the single most used method for nutritional diagnosis at the population level, especially in childhood and adolescence, due to its ease of execution, low cost, and innocuity.

• #1 Diagnostic Methods in Childhood Obesity | IntechOpen

  https://www.intechopen.com/chapters/72628

  The body mass index (BMI) is obtained by dividing body weight, in kilos, by height in square meters; therefore, in kg/m2, it is an anthropometric measure widely used to identify excess weight in children, adolescents, and adults. […] The stratification of nutritional status is obtained from the percentiles in the BMI/age ratio according to gender, from WHO, and allows children to be classified as eutrophic, overweight, or obese. […] The waist circumference (WC) defined by measuring the smallest circumference between the iliac crest and the costal margin is, in particular, a better predictor of visceral obesity, a condition that represents a high risk for the development of chronic noncommunicable diseases such as diabetes mellitus type 2, MS, HE, and cardiovascular diseases. […] Imaging exams are the methods of choice to assess and quantify visceral fat, since anthropometric measurements are unable to differentiate intra-abdominal from subcutaneous fat, as they are indirect measures.

• #1 Obesity in children – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1085

  Obesity in children has increased in recent decades. […] Calculating body mass index (BMI) is the most widely accepted method of screening for obesity in children. Abnormal BMI cutoffs in children are determined by age- and sex-specific percentiles. […] Impaired glucose tolerance and type 2 diabetes mellitus are prevalent in children with obesity. […] An age- and sex-adjusted BMI between the 85th and 94th percentiles is defined as overweight, and a BMI 95th percentile (or to 30 kg/m, which ever is lower) is defined as obesity. […] Severe obesity is defined as BMI of 120% of the 95th percentile. […] Key diagnostic factors include body mass index (BMI) 95th percentile and weight 95th percentile for height. […] Other diagnostic factors include increased waist-hip ratio and hypertension.

• #1 Obesity in children – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1085

  Tests to consider include fasting blood glucose, serum lipids, and liver function tests. […] Emerging tests include DEXA, bioelectric impedance analysis, and abdominal CT or MRI. […] Body mass index (BMI) 85th to 94th percentile (overweight) and body mass index (BMI) 95th percentile (obesity) or BMI 120% of 95th percentile (severe obesity).

• #1 Diagnostic Methods in Childhood Obesity | IntechOpen

  https://www.intechopen.com/chapters/72628

  Ultrasonography appears as one of the methods of diagnosis and characterization of abdominal fat, allowing the correlation of its findings with data from anthropometric physical examination in all age groups, being of great value in the evolutionary monitoring of obesity treatments. […] Considering that the first signs and symptoms of obesity and its consequences can be determined in childhood, it becomes evident the importance of assessing subcutaneous and visceral fats in children, a population in which obesity may still be the only morbidity.

• #1 Obesity in Children Differential Diagnoses

  https://emedicine.medscape.com/article/985333-differential

  Two particularly useful clinical measures are the rate of linear growth and the timing of puberty. Most patients who have familial or diet-induced obesity grow at a normal or excessive rate and enter puberty at the appropriate age; many mature more quickly than children with normal weight, and bone age is commonly advanced. In contrast, growth rate and pubertal development are diminished or delayed in growth hormone deficiency, hypothyroidism, cortisol excess, and various genetic syndromes. Conversely, growth rate and pubertal development are accelerated in precocious puberty and in some girls with polycystic ovary syndrome (PCOS). […] Differential Diagnoses […] Diabetes […] Fatty Liver […] Growth Hormone Deficiency in Adults […] Hypothyroidism […] Iatrogenic Cushing Syndrome […] Polycystic Ovarian Disease […] Prader-Willis Syndrome […] Precocious Puberty.

• #1 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-018-0525-6

  Early-onset obesity occurring in a child with delayed psychomotor development, cognitive deficiency, short stature, cryptorchidism or hypogonadism, dysmorphisms and characteristic facial features, ocular and/or auditory alterations, is suggestive of a syndromic form. […] The monogenic forms, albeit uncommon, are nevertheless the most frequent causes of obesity with early onset compared to endocrine and syndromic forms and are due to dysregulated hunger satiety circuits. […] The diagnosis of prediabetes, i.e. high fasting blood glucose and impaired glucose tolerance (IGT) or overt type 2 diabetes (T2D) is based on fasting plasma glucose or oral glucose tolerance test (OGTT). […] The screening must be repeated after 3 years, unless rapid weight increase or the development of other cardiometabolic comorbidities occur.

• #1 Unexplained Childhood Obesity? Consider Genetic Causes | Children’s Hospital of Philadelphia

  https://www.chop.edu/news/unexplained-childhood-obesity-consider-genetic-causes

  James is a 3-year-old male with developmental delay and rapid weight gain/obesity. […] His rapid weight gain started when he was 2 years old. […] Many genetic diagnoses have been associated with obesity/rapid weight gain. […] The majority are syndromic forms of obesity associated with neurodevelopmental issues, structural birth defects, and/or systemic manifestations as exemplified in James case. […] Among the syndromic forms of obesity, the most common diagnosis in our outpatient clinic is 16p11.2 deletion syndrome. […] Other common genetic diagnoses causing syndromic obesity include Down syndrome and Prader-Willi syndrome. […] While these syndromes need to be considered as differential diagnoses for children with obesity, since they tend to cause neonatal problems due to hypotonia and feeding difficulties, the diagnosis of these syndromes tend to be made soon after birth.

• #1 Unexplained Childhood Obesity? Consider Genetic Causes | Children’s Hospital of Philadelphia

  https://www.chop.edu/news/unexplained-childhood-obesity-consider-genetic-causes

  While obese children with syndromic features tend to undergo genetic evaluation, those without syndromic features could have genetic mutations in genes encoding proteins regulating appetites and metabolism. […] In this class of genetic disorders, treatment with the melanocortin-4 receptor (MC4R) agonist setmelanotide improves hunger and obesity. […] Therefore, identification of pathogenic POMC, PCSK1, and LEPR mutations will have therapeutic implications. […] To screen for genetic diagnoses discussed above, we usually recommend chromosome microarray and a monogenic obesity panel, which allows genetic screening of genes associated with syndromic and non-syndromic forms of obesity.

• #1 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6069785/

  The presence of binge eating disorder should be considered in the multi-professional assessment of an obese child or adolescent. […] Binge Eating Disorder (BED) is the most common Nutrition and Eating Disorder found in pediatric obesity. […] It is indicative of psychopathology and is a serious risk factor for the development of obesity, especially in the presence of family history of obesity and marked negative experiences coupled with factors predisposing to psychiatric disorders.

• #1 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-018-0525-6

  The measurement of cholesterol, HDL-cholesterol and triglycerides is recommended in all children and adolescents with obesity since the age of 6. […] The dyslipidemic pattern associated with childhood obesity consists of a combination of elevated TG, decreased HDL-C, and low density lipoprotein cholesterol. […] The prevalence of NAFLD in obese children is 3846%. […] The assessment of transaminases and liver ultrasound is suggested in all children and adolescents with obesity starting at age of 6 years. […] The presence of binge eating disorder should be considered in the multi-professional assessment of an obese child or adolescent. […] Binge Eating Disorder (BED) is the most common Nutrition and Eating Disorder found in pediatric obesity. […] The presence of psychosocial discomfort may affect therapeutic success, therefore it should be identified as part of the multi-disciplinary assessment.

• #1 Evaluation and Treatment of Childhood Obesity | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0215/p861.html

  The prevalence of childhood obesity in the United States has risen dramatically in the past several decades. Although 25 to 30 percent of children are affected, this condition is underdiagnosed and undertreated. […] All obese children should be screened for cardiac risk factors, as well as for possible orthopedic, dermatologic and psychiatric sequelae. […] Evaluation of obesity in childhood is important for several reasons. First, it offers the best hope for preventing disease progression with its associated morbidities into adulthood. […] Only a small percentage of childhood obesity is associated with a hormonal or genetic defect, with the remainder being idiopathic in nature. […] Obese children must be evaluated for associated morbidity. This includes an assessment of cardiac risk factors, weight-related orthopedic problems, skin disorders and potential psychiatric sequelae.

• #1 Screening and Counseling for Obesity in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0201/p528.html

  Fifteen percent of patients six to 19 years of age are considered to be overweight or obese as defined by percentile growth charts. […] Of the 32,930 office visits evaluated, 281 (0.78 percent) were coded with a diagnosis of obesity, morbid obesity, or excess weight gain. […] Even though 15 percent of children are estimated to be obese, less than 1 percent visiting their primary care physician received an obesity diagnosis. […] The authors conclude that because increased screening for obesity is associated with increased diagnosis and counseling rates, programs should target methods that will increase screening rates. […] This study, which documents the underdiagnosis of childhood obesity at office visits, does not acknowledge the problem of treatment.

• #1 Obesity Rates Among Children: A Closer Look at Implications for Children Covered by Medicaid | KFF

  https://www.kff.org/medicaid/issue-brief/obesity-rates-among-children-a-closer-look-at-implications-for-children-covered-by-medicaid/

  Obesity in children is caused by a multitude of socioecological, environmental, and genetic factors and has increased in recent decades, with child obesity rates now three times higher than they were in the 1970s. […] Based on data from the 2020-2021 National Survey of Childrens Health (NSCH), 17% of children ages 10-17 in the U.S. have obesity. Obesity in children is typically defined as having a Body Mass Index (BMI) equal to or greater than the 95th percentile for their age and sex, although there has been recent pushback on BMI as a screening tool, and research has shown it can incorrectly classify individuals as overweight or obese, especially for people of color. […] In 2019, 7.4% of Medicaid children ages 10-17 had an obesity diagnosis clinically identified in the Medicaid claims data (T-MSIS), suggesting that obesity in children may be undertreated.

• #1 Obesity Rates Among Children: A Closer Look at Implications for Children Covered by Medicaid | KFF

  https://www.kff.org/medicaid/issue-brief/obesity-rates-among-children-a-closer-look-at-implications-for-children-covered-by-medicaid/

  For Medicaid children ages 10-17 with an obesity diagnosis, the most common co-occurring chronic condition is asthma, followed by certain mental health conditions, hyperlipidemia, anemia, hypertension, and diabetes. […] Obesity services can include screening, behavioral and nutritional counseling, anti-obesity medications, and bariatric surgery, and these services are covered for children under Medicaids Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. […] While children have access to obesity treatment though EPSDT, it is less clear how states are implementing and covering these services in practice. […] The AAP released a new set of clinical practice guidelines for evaluating and treating obesity and associated conditions in early 2023. The guidelines outline and describe evidence-based screening procedures, comorbidity evaluation and treatment for children ages 2 and older, and recommended obesity treatments. […] With Medicaid now covering half of all children in the U.S., and an even larger percentage of children who are likely to be obese, changes in physicians practice stemming from the updated treatment recommendations could have a sizable effect on Medicaid programs and enrollees.

• #1 Underdiagnosis and Lower Rates of Office Visits for Overweight/Obese Pediatric Patients in Rural Compared with Urban Areas | SMJ

  https://sma.org/southern-medical-journal/article/underdiagnosis-lower-rates-office-visits-overweightobese-pediatric-patients-rural-compared-urban-areas/

  Objectives: This study compared the number of children enrolled in Medicaid in rural and urban areas of South Carolina with an overweight/obesity diagnosis and the mean rates of office visits with overweight/obesity diagnosed. […] A total of 1233 children enrolled in Medicaid were diagnosed as being overweight/obese at any encounter in the designated counties. […] In the logistic regression rural high-resource children (adjusted odds ratio 0.58, 95% confidence interval 0.38–0.88) and rural low-resource children (adjusted odds ratio 0.16, 95% confidence interval 0.09–0.28) were less likely than urban children to be diagnosed as being overweight/obese at a well visit. […] Overweight/obesity is underdiagnosed in rural children enrolled in Medicaid in South Carolina, which affects the number of children who receive help to manage their weight. Interventions to overcome barriers of diagnosis and management are necessary to address childhood obesity properly.

• #1 Overview: childhood overweight and obesity diagnosis and treatment

  https://www.contemporarypediatrics.com/view/overview-childhood-overweight-and-obesity-diagnosis-and-treatment

  Dr Perrin pediatrician-parent communication about weight and body mass index (BMI) screening. Some of the research suggests that parents and pediatricians are not happy with their communication about weight, and there’s reason to believe these conversations often do not take place. […] In a study of nearly 5,000 children aged 2 to 15 years with BMIs in the 85th percentile or higher, Perrin and colleagues asked parents if their doctors or health care providers had ever told them their children were overweight. They found that fewer than one-quarter of parents of overweight children said they had been told their children were overweight. […] According to Perrin, parents of overweight children rarely know their children are overweight. This is especially true of younger children, when a healthier dietary pattern and more physical activity could make the most difference, she says.

• #1 Recorded diagnosis of overweight/obesity in primary care is linked to obesity care performance rates | Pediatric Research

  https://www.nature.com/articles/s41390-024-03619-0

  Periodical BMI measurement during visits with primary care pediatricians (PCP) can be central to diagnosing, managing, and treating overweight/obesity. […] The aim of this study was to evaluate among children and adolescents with similar BMI percentiles, whether recording a formal diagnosis of overweight or obesity by a PCP, is associated with improved performance rates of obesity-related care within the primary care setting. […] Early and accurate classifications of overweight and obesity, and identifying obesity-related comorbidities are fundamental to providing appropriate treatment. […] In clinical practice, body mass index (BMI) frequently serves as both a screening and diagnostic tool for detecting excess body adiposity, because it is easy to use and inexpensive. […] Periodical BMI measurement during regular visits with primary care pediatricians (PCP) is central to diagnosing overweight and obesity, and to managing and tracking overweight and obesity in children and adolescents.

• #1 Evaluation and Treatment of Childhood Obesity | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0215/p861.html

  The best way to significantly affect the prevalence of obesity is to prevent it. Therefore, the issue of obesity should be addressed during every well-child examination. […] When a child does develop obesity, a serious attempt to treat it should be undertaken. […] Weight loss goals should be obtainable and should allow for normal growth. […] The child should maintain a food record to aid in dietary assessment. […] Exercise is necessary to maintain weight loss and to redistribute body fat into muscle. […] It is important to involve the entire family when treating obesity in children.

• #1 Evidence-Based Guidelines for Child Obesity | Obesity | CDC

  https://www.cdc.gov/obesity/child-obesity-strategies/evidence-based-guidelines.html

  Many professional associations offer evidence-based guidelines for comprehensive care for children with obesity. The guidelines include obesity screening and referral to effective obesity interventions. These guidelines inform pediatricians and other pediatric health care providers about the standard of care for screening, evaluating, and treating obesity and related chronic diseases. […] In 2023, the American Academy of Pediatrics (AAP) released the Clinical Practice Guideline (CPG) for the Evaluation and Treatment of Children and Adolescents With Obesity. […] The AAP CPG recommends that pediatric health care providers (PHCPs) screen all children 2-18 years for overweight, obesity, and severe obesity at least annually. […] The AAP CPG also provides guidelines on how to treat and manage obesity. This includes guidelines for offering or referring patients to intensive health behavior and lifestyle treatment.

• #1 Evidence-Based Guidelines for Child Obesity | Obesity | CDC

  https://www.cdc.gov/obesity/child-obesity-strategies/evidence-based-guidelines.html

  In 2017, the USPSTF recommended that clinicians: Screen for obesity in children and adolescents 6 years and older, and Offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. […] In 2018, the association released the Clinical Practice Guideline for Multicomponent Behavioral Treatment of Obesity and Overweight in Children and Adolescents. […] In 2017, the society convened a task force of experts who released a clinical practice guideline titled Pediatric Obesity- Assessment, Treatment, and Prevention. It includes BMI screening, evaluating children with overweight or obesity for obesity-related comorbidities, and referring to intensive family-centered lifestyle programs.

• #1 Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6351475/

  Childhood obesity is a growing global health problem. Despite the highest rates of childhood obesity in the United States and other developed countries over the last 30 years, there is still no clear treatment strategy. […] The Pediatric Obesity Algorithm is an evidence based roadmap for the diagnosis and management of children with obesity. […] In this article, we summarize topics from the Pediatric Obesity Algorithm pertaining to pediatric obesity diagnosis, evaluation, and management including assessment, differential diagnosis, review of systems, diagnostic work up, physical exam, age specific management, comorbidities, use of medications and surgery, and medication associated weight gain. […] Identifying and treating children with obesity as early as possible is important, as is identifying comorbid conditions.

• #1 Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition

  https://www.e-cep.org/journal/view.php?number=20125553511

  We recommend to assess comorbidities: NAFLD, dyslipidemia, hypertension, prediabetes, type II diabetes mellitus (DM), polycystic ovary syndrome, obstructive sleep apnea, and psychosocial problems. […] We recommend a treatment algorithm to help physicians determine the appropriate weight management stage for each patient, on the basis of his or her age, BMI percentile, and comorbidities. […] We recommend a family-based, comprehensive, multidisciplinary team approach to succeed in behavioral interventions (active vigorous physical activity and reduction of inactivity, accompanied with calorie-controlled diet) for the treatment of obesity in children. […] We recommend that pharmacotherapy and bariatric surgery be considered only in patients with morbid obesity with major comorbidities after a formal program of intensive lifestyle modification has failed.

• #1 Childhood obesity: an overview of laboratory medicine, exercise and microbiome

  https://www.degruyter.com/document/doi/10.1515/cclm-2019-0789/html?lang=en

  It is essential to evaluate a possible impairment in glucose metabolism in children with obesity. Fasting blood glucose determination is recommended in all overweight children and adolescents starting at the age of 6, as the first step for the identification of prediabetic conditions and type 2-diabetes. […] In a small number of children showing a sudden onset of obesity, an endocrinopathy should be suspected. […] Early recognition of an endocrine disease allows physicians to start effective therapies with relevant benefits for the patients. […] In conclusion, childhood obesity represents one of the most pressing medical and public health problems of our day. The prevalence is unacceptably high, and the rate of increase in severe obesity continues to climb.

• #2 Childhood obesity – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833

  Diagnosis involves the steps that a healthcare professional takes to find out if your child has obesity. A healthcare professional calculates your child’s BMI and figures out where it falls on a standard growth chart. […] Your child’s healthcare professional uses the growth chart to find out how your child’s weight compares with that of other children of the same sex and age. This is called your child’s BMI percentile. For example, a child in the 80th percentile has a higher BMI than 80% of other children of the same sex and age. […] Along with BMI and charting weight on the growth charts, the healthcare professional looks at: Your family’s history of obesity and weight-related health conditions, such as diabetes. Your child’s eating habits. This can include what your child eats and how often, and how big the portion sizes are. Your child’s activity level and amount of screen time. Your child’s blood pressure. Other health conditions your child has or medicines your child takes. Mental health history, including bouts of depression, sleep troubles, and whether your child feels isolated, alone or bullied.

• #2 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-018-0525-6

  The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. […] The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. […] The definition of overweight and obesity is based on the use of percentiles of the weight-to-length ratio or body mass index, depending on sex and age. […] In children up to 24 months, the diagnosis of overweight and obesity is based on the weight-to-length ratio, using the World Health Organization (WHO) 2006 reference curves. […] After the age of 2 years it is based on the Body Mass Index (BMI), using the WHO 2006 reference system up to 5 years and the WHO 2007 reference system thereafter.

• #2 Obesity in children – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1085

  Obesity in children has increased in recent decades. […] Calculating body mass index (BMI) is the most widely accepted method of screening for obesity in children. Abnormal BMI cutoffs in children are determined by age- and sex-specific percentiles. […] Impaired glucose tolerance and type 2 diabetes mellitus are prevalent in children with obesity. […] An age- and sex-adjusted BMI between the 85th and 94th percentiles is defined as overweight, and a BMI 95th percentile (or to 30 kg/m, which ever is lower) is defined as obesity. […] Severe obesity is defined as BMI of 120% of the 95th percentile. […] Key diagnostic factors include body mass index (BMI) 95th percentile and weight 95th percentile for height. […] Other diagnostic factors include increased waist-hip ratio and hypertension.

• #2 Obesity in children – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1085

  Tests to consider include fasting blood glucose, serum lipids, and liver function tests. […] Emerging tests include DEXA, bioelectric impedance analysis, and abdominal CT or MRI. […] Body mass index (BMI) 85th to 94th percentile (overweight) and body mass index (BMI) 95th percentile (obesity) or BMI 120% of 95th percentile (severe obesity).

• #2 Obesity in children – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1085

  Obesity in children has increased in recent decades. […] Calculating body mass index (BMI) is the most widely accepted method of screening for obesity in children. Abnormal BMI cut-offs in children are determined by age- and sex-specific percentiles. […] Impaired glucose tolerance and type 2 diabetes mellitus are prevalent in children with obesity. […] An age- and sex-adjusted BMI between the 85th and 94th percentiles is defined as overweight, and a BMI 95th percentile (or to 30 kg/m, which ever is lower) is defined as obesity. […] Severe obesity is defined as BMI of 120% of the 95th percentile. […] Key diagnostic factors include body mass index (BMI) 95th percentile and weight 95th percentile for height. […] Other diagnostic factors include increased waist-hip ratio and hypertension. […] Investigations to consider include fasting blood glucose, serum lipids, and liver function tests. […] Emerging tests include DEXA, bioelectric impedance analysis, and abdominal CT or MRI.

• #2 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-018-0525-6

  The cut-off to define severe obesity is represented by the BMI99th percentile. […] It has been demonstrated that the 99th percentile of BMI identifies subjects with higher prevalence of cardiometabolic risk factors and persistence of severe obesity in adulthood with respect to the lower percentiles. […] The clinical suspicion of secondary obesity arises after careful anamnestic, anthropometric and clinical evaluations. […] Obesity may be ascribed to a specific cause (endocrine, hypothalamic, genetic, iatrogenic). […] Therefore, clinical history, peculiar signs and symptoms must be accurately assessed such as: 1) onset of obesity before 5 years and/or rapid progression, especially in association with clues suggesting secondary causes (i.e. genetic forms); 2) continuous and/or rapid weight gain associated with reduced height velocity or short stature; 3) delayed cognitive development; 4) dismorphic features; and 5) use of drugs inducing hyperphagia.

• #2 Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-018-0525-6

  The measurement of cholesterol, HDL-cholesterol and triglycerides is recommended in all children and adolescents with obesity since the age of 6. […] The dyslipidemic pattern associated with childhood obesity consists of a combination of elevated TG, decreased HDL-C, and low density lipoprotein cholesterol. […] The prevalence of NAFLD in obese children is 3846%. […] The assessment of transaminases and liver ultrasound is suggested in all children and adolescents with obesity starting at age of 6 years. […] The presence of binge eating disorder should be considered in the multi-professional assessment of an obese child or adolescent. […] Binge Eating Disorder (BED) is the most common Nutrition and Eating Disorder found in pediatric obesity. […] The presence of psychosocial discomfort may affect therapeutic success, therefore it should be identified as part of the multi-disciplinary assessment.

• #2 Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6351475/

  The Pediatric Obesity Algorithm (4) is an evidence based roadmap for the diagnosis and management of children with obesity. […] The differential diagnosis of children with obesity starts with an assessment of linear growth. […] The diagnostic work up of a child with obesity is driven by a careful history of prenatal factors, family history, feeding history, sleep duration and issues, exercise, family and cultural expectations, screen time, location and timing of meals, bullying or social isolation, motivation and ability to make modifications of the family, and finally financial constraints. […] Children with obesity presenting with deceleration of growth, symptoms of hypo or hyper thyroidism or other endocrinopathies, symptoms of diabetes, sustained hypertension, hirsutism, a family history of early cardiovascular disease, snoring, and/or daytime sleepiness will need additional workup.

• #3 Childhood obesity – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-treatment/drc-20354833

  Diagnosis involves the steps that a healthcare professional takes to find out if your child has obesity. A healthcare professional calculates your child’s BMI and figures out where it falls on a standard growth chart. […] Your child’s healthcare professional uses the growth chart to find out how your child’s weight compares with that of other children of the same sex and age. This is called your child’s BMI percentile. For example, a child in the 80th percentile has a higher BMI than 80% of other children of the same sex and age. […] Along with BMI and charting weight on the growth charts, the healthcare professional looks at: Your family’s history of obesity and weight-related health conditions, such as diabetes. Your child’s eating habits. This can include what your child eats and how often, and how big the portion sizes are. Your child’s activity level and amount of screen time. Your child’s blood pressure. Other health conditions your child has or medicines your child takes. Mental health history, including bouts of depression, sleep troubles, and whether your child feels isolated, alone or bullied.

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