Panel Urge End to Sugar-Coating Childhood Obesity

CHICAGO, June 13 -- A child who has a body mass index in the range of the 85^th to 95^th percentile for age and sex should be considered overweight, not "at risk of overweight".

Children or adolescents whose BMI is higher than the 95^th percentile, or exceeds 30 -- whichever is smaller -- should be considered obese.

Those are two recommendations issued by a committee whose members represent 15 professional societies, convened by the American Medical Association. It released a list of 22 recommendations aimed at preventing, assessing, and treating obese and overweight children and adolescents.

Among the recommendations was the decision to move to more precise terms. So it replaced the "at risk" terminology with medically appropriate terms.

Reginald Washington, M.D., a Denver pediatrician and a member of the committee, said that physicians often avoid using terms like overweight and obese for "fear that we're going to stigmatize children, we're going to take away their self-esteem, we're going to label them."

But faced with what has frequently been described as an epidemic of obesity among America's children, the committee decided that the time for soft-pedaling the problem had passed.

"We need to describe this in medical terms, which is 'obesity,'" he said.

To prevent obesity the committee said families should eat more meals at home-beginning with breakfast every day--should limit television and computer time to no more than two hours a day, and schools should have required physical activity programs for grades one through 12.

Other prevention recommendations include:

• Counseling for children whose BMI is above the 5^th percentile but below the 84^th percentile.
• Limiting consumption of sugar-sweetened beverages and encouraging consumption of fruits and vegetables.
• Sixty minutes of vigorous physical activity daily.

For assessment of obesity in children, the committee recommended using age and gender specific BMI percentiles.

The committee recommended against routine clinical use of skinfold thickness. In addition, waist circumference measurement, which is recommended for assessment of insulin resistance in adults, was not recommended for routine use in children because of "difficulty in measuring and the uncertainty of appropriate cut-offs."

Children with BMI in the 85^th to 94^th percentile who have no other risk factors should have fasting lipids, but when children have other risk factors such as family history of diabetes or obesity, the committee recommended that aspartate aminotransferase, alanine aminotransferase and fasting glucose should be obtained.

The committee recommended a staged approach to treatment of childhood overweight and obesity beginning with a diet that emphasizes fruits and vegetables while eliminating sugared drinks.

Lacking improvement after two to three months, the committee recommended initiating a balanced macronutrient diet emphasizing low amounts of energy-dense foods and exercise program-stage 2-- that includes limiting television or computer time to less than an hour a day.

Children who don't improve after three to six months on the stage 2 program should be advanced to stage 3, which adds a structured behavior modification program that includes family and friends to the stage 2 plan.