Clinical Excellence

June 11, 2007

Childhood and Adolescent Obesity Recommendations Reflect Core KP Care Protocols

Multidisciplinary committee identifies key treatment and prevention options to address the problem of overweight and obese children

After two years of study, a committee made of up of representatives from 15 health professional organizations released broad recommendations for the management of overweight and obese children.

The recommendations call for all physicians and health care providers to address weight management and lifestyle issues with all patients regardless of their weight, at a minimum of once a year; that the treatment of overweight children be approached as a staged method based upon the child's age, Body Mass Index (BMI); any related comorbidities, weight status of parents, and progress in treatment. They also stress the need for the child's primary caregivers/families become involved in the care process.

The recommendations also recognized for the first time that those individuals with a BMI at or above the 85th percentile but less than the 95th percentile for their age and sex, should be considered overweight as opposed to categorized as "at risk of overweight."

Kaiser Permanente, long a leader in preventive health education measures to address the problem of childhood obesity and overweight, was consulted directly by the National Institute of Child Health Care Quality (NICHQ) about KP's care management protocols in the area of childhood obesity as part of the two-year study. Many of KP's preventive care standards—such as targeted physician communication with families on the topic of weight, measuring BMI as a vital sign, were included in the group's final recommendations.

"The new guidelines basically confirm what we already know; that childhood obesity is a reality, and the sooner we start conversations with families, the more likely we are to have an impact," says Dr. Phil Wu, a Kaiser Permanente pediatric obesity expert who practices in Portland, Ore.

The best way to start a conversation with a family about weight is to bring up the subject in a non-judgmental fashion, notes Wu. "For example, I might first show the parent how the child compares with his peers on our height and weight charts. That gives me an opening to start the conversation." Wu says as a pediatrician, it is critical to judge a family's "stage of readiness" when determining the type of conversation to have on the subject of weight and weight management.

NICHQ, together with key partners, is creating an implementation guide to accompany the new recommendations. The implementation guide will be released the week of June 25th and will support providers with the tools and resources necessary to put the new recommendations into practice.

The recommendations, released by the Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity, which was convened by the American Medical Association and co-funded in collaboration with the Department of Health and Human Services' Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).

The committee began meeting in early 2005 to study scientific data on the assessment, prevention and treatment of overweight and obese children. It then created 22 recommendations for health care professionals who provide obesity care to apply in their practices. A complete list of the recommendations can be found on the AMA's Web site. The committee was made up of representatives from organizations involved in medicine, nutrition, mental health, epidemiology and psychology.

"Our committee worked diligently to identify new treatment and prevention options to address the growing problem of overweight and obese children," said Reginald Washington, MD, a Denver physician and spokesperson for the Expert Committee, in a statement. "We hope that health care professionals will apply these recommendations to their practice, so we can continue working to preserve the health of our children."