A Primary Health Care Approach To Obesity Prevention And Management In Children And Adolescents

Obesity in all age groups, including children and adolescents, is a public health challenge across all settings. Obesity is now classified as a complex multifactorial chronic disease and not just a risk factor for other noncommunicable diseases and comorbidities. Recognizing the significance of primary health care for an effective and efficient response to the obesity epidemic, the World Health Organization (WHO) has developed guidance on how to build capacity in the health system to deliver health services for prevention and management of obesity across the life course. This policy brief discusses the challenges and opportunities for preventing obesity in children and adolescents, and providing health services to treat and manage those already living with obesity. It outlines possible interventions through the primary health care approach.

This volume, containing 24 papers and 19 poster papers, reviews the etiology and epidemiology of childhood obesity. It explores genetic and contributory environmental factors. It also describes recent research and educational efforts in prevention of the condition, including programmes aimed at high-risk minority populations.

Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality. Given this trajectory toward a healthier childhood, we begin the 21st-century with a shocking developmentâ€"an epidemic of obesity in children and youth. The increased number of obese children throughout the U.S. during the past 25 years has led policymakers to rank it as one of the most critical public health threats of the 21st-century. Preventing Childhood Obesity provides a broad-based examination of the nature, extent, and consequences of obesity in U.S. children and youth, including the social, environmental, medical, and dietary factors responsible for its increased prevalence. The book also offers a prevention-oriented action plan that identifies the most promising array of short-term and longer-term interventions, as well as recommendations for the roles and responsibilities of numerous stakeholders in various sectors of society to reduce its future occurrence. Preventing Childhood Obesity explores the underlying causes of this serious health problem and the actions needed to initiate, support, and sustain the societal and lifestyle changes that can reverse the trend among our children and youth.

This targeted systematic review was undertaken to assist the United States Preventive Services Task Force (USPSTF) in updating its previous recommendation on screening and interventions for overweight in children and adolescents. Based on our previous systematic review in 2005, the USPSTF found insufficient evidence to recommend screening for overweight, due to uncertainties about the effectiveness of behavior counseling or other interventions with overweight children and adolescents that could be conducted in primary care settings or to which primary care clinicians can make referrals. Given recent work on another systematic review, Effectiveness of Weight Management Programs in Children and Adolescents, the USPSTF determined to focus its update on what was considered the critical evidence gap at the time of our last systematic review to allow an efficient and timely updating of their recommendation. Thus, for this targeted updated systematic review, we examine previous and newly available evidence on behavioral and pharmacological weight management interventions for overweight and/or obese children and adolescents (defined as those between 2 and 18 years of age that meet criteria for increased body mass index [BMI] appropriate to their age and sex) that are relevant to primary care practice. Attention to these differences in terminology is key, as children and adolescents defined as “overweight” in the 2005 report would now be defined as “obese”. And, while the current review is intended to fill the critical evidence gap about intervention effectiveness identified during the 2005 review, our previous review also found that there was insufficient evidence to ascertain the magnitude of the potential harms of screening or intervention. In this targeted update, the USPSTF focused our attention on updating both the benefits and potential harms of primary care feasible interventions, but did not choose to update the evidence on screening benefits or harms. Evidence on the harms as well as benefits of BMI screening programs, along with good data on the diagnostic accuracy of BMI as a measure of obesity in children, still appear to be lacking, resulting in arguments against the use of BMI screening of individuals in schools or in other screening programs that go beyond its use as a tool by clinicians for monitoring growth and development. The previous review also found fair evidence that obese adolescents and children (i.e., those at or above the 95th BMI percentile for age and sex) aged 8 years and older are at increased risk for becoming obese adults. Evidence on the benefits and harms of screening and on the risk of pediatric obesity persisting into adulthood will not be updated in the current review. Additionally, in keeping with the USPSTF focus on primary and secondary clinical preventive services, surgical treatment of obesity was considered out of scope for this updated review, since surgical treatment is only considered for extremely obese young people, particularly those who are experiencing negative health effects as a result of their obesity necessitating treatment. We therefore focus on behavioral and pharmacological interventions, both of which may be appropriate for less obese or overweight children who would be identified and treated in or in coordination with primary care. While prevention is a critical component of an overall public health strategy to address the dramatic increase in childhood and adolescent overweight in the United States and elsewhere, recent reviews indicate little empirical evidence of effective interventions for preventing development of overweight in clinical settings and are not included in this report. Guidance on obesity prevention thereby generally focuses on pragmatic advice for clinicians or on settings with evidence, as in schools and, to a lesser extent, community settings.

This issue of Primary Care: Clinics in Office Practice, devoted to Obesity Management, is guest edited by Dr. Mark Stephens of the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Articles in this important issue include: Obesity: What Do the Statistics Say?; Economic Impact of Obesity; The Future of Pediatric Obesity; Obesity Prevention and Screening; Behavior Modification in Obesity Management; Nutritional Therapy; Physical Activity: Cornerstone or Roadblock?; Pharmacologic Therapy for Obesity; Surgical Approaches to Obesity; Multidisciplinary Teams and Obesity: Role of the Modern Patient Centered Medical Home (PCMH); Healthcare Systems and National Policy: Role of Leadership in the Obesity Crisis; and Special Populations in Obesity Management.

Childhood obesity is an international public health concern, with a high profile in both the media and government policy. Controversial issues in the prevention of childhood obesity need to be considered early in the development of school, clinical or community prevention programs, as these issues are often the ones that promote the success or failure of attempts to ameliorate the problem at hand. This book combines health education theory, research, and practice to guide researchers, students, educators, community health workers and practitioners in the prevention of childhood obesity and the promotion of child and adolescent health and well-being. It examines controversy in childhood obesity, including the link with poverty and the difficulty of addressing obesity whilst also tackling the issue of eating disorders. The prevalence of childhood obesity is covered, with international chapters examining the importance of factors such as social class and ethnic differences, and global and local trends are identified. Approaches to prevention are presented, and the book concludes with the successful outcome of various interventions, demonstrating how the whole school community can collaborate to promote health among young people.