Weighing the Options Criteria for Evaluating Weight-Management Programs (1995) / Chapter Skim
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Appendix C: Pediatric Obesity
Appendix C: Pediatric Obesity
Pages 210-233
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From page 210... ...
However, a standard clinical definition of childhood (6 COMMITTEE'S NOTE: Time constraints prevented us from being able to address the important subject of pediatric obesity. However, given its importance and the fact that obesity among children and adolescents is increasing as it is among adults, we asked obesity specialist Beatrice Kanders to prepare the following background paper on the subject.
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From page 211... ...
The Quetelet index or body mass index (BMI) is an indirect measure of body fat, but it is easily and reliably measured, correlating well with more precise estimates of subcutaneous and total body fat (Deurenberg et al., 1991; Roche et al., 1981~.
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The recommended cutoff values are shown in Table C-2. Similar guidelines have yet to be developed for younger children.
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From page 213... ...
More recent data from NHANES III indicate that these trends for adolescents have continued (DHHS, 1991; Harlan, 1993~. Similarly, with respect to racial differences, obesity and superobesity are less prevalent among African-American than white children (see Table Cob; however, higher than average rates of obesity have been reported in other minority populations, including Native Americans, Puerto Ricans, and Cuban-Americans (Kumanyika, 1993~.
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From page 214... ...
While the self-report estimates of intake of the obese and lean subjects were similar, the doubly-labeled water results showed that obese adolescents underreported caloric intake by 40 percent, while nonobese adolescents underreported caloric intake by only 20 percent. The doubly-labeled water technology allows researchers to assess energy expenditure of free-living individuals accurately over repeated days.
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The authors attributed this energy difference to diminished physical activity and/or arousal rather than resting metabolic rate. Two additional studies support the hypothesis that low energy expenditure contributes to weight gain in infancy and childhood.
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However, resting metabolic rate per kilogram of body weight was significantly lower in the boys with obese parents compared with those with nonobese parents; no differences were noted between girls with obese and nonobese parents, though body fat was greater in the girls with the obese parents (not statistically significant, possibly owing to the small sample size) (Griffiths et al., 1990~.
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From page 217... ...
If children remain obese as they age, a greater percentage of them will become obese adults, especially among teenage children (Abraham and Nordsieck, 1960~. In addition, the weight status of other family members may affect childhood obesity; obese children are more likely to have obese siblings (Garn et al., 1980, 1981~.
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From page 218... ...
and increasing food and snack consumption, particularly of the nonnutritious foods frequently advertised (Clancy-Hepburn et al., 1974; Taras et al., 1989~. Television viewing has been shown to be associated with significant reductions in resting metabolic rate among obese and nonobese girls (Klesges et al., 1993)
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From page 219... ...
In addition, compared with adult-onset obesity, the persistence of child-onset obesity has been associated with higher rates of morbidity and mortality (Merlin, 1993~. Thus, childhood obesity is a public health concern owing both to its immediate impact on health status and to its potential impact on adult body weight.
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Severity of childhood obesity also predicts adult obesity. In one study, one-third of children who were 120 percent of ideal body weight were normal weight by follow-up (approximately 9 years later)
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Thus, longitudinal studies may actually show slower growth and a decrease in height percentiles in obese compared with nonobese children as they approach adulthood (Epstein et al., 1990a)
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This section reviews the literature on the basic components for treatment of childhood and adolescent obesity in both clinics and school settings. Simply stated, the goals of the treatment of childhood obesity are weight loss without adverse health effects, followed by weight mainte
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While treatment combines dietary change, an increase in exercise and physical activity, and behavior modification, what is unique to childhood treatment programs is the inclusion of parent training. Effect of Age Because of the wide variation in developmental capabilities between the ages of 1 and 18, the age of the obese child must be considered when planning the treatment (Epstein, 1985~.
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in conjunction with a hypocaloric diet in obese children. Both programs were isocaloric and included equivalent amounts of energy expenditure through exercise.
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The diet must provide adequate protein, calories, and micronutrients to ensure normal growth and development (Dietz, 1983; Dietz and Robinson, 1993; Epstein, 1986; Williams et al., 1993~. Because pediatric patients who undergo weight loss are in a period of growth and development, it is important to evaluate weight change as a function of stature.
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From page 226... ...
The diet provides 1.5 to 2.0 grams of high-quality protein per kilogram of ideal body weight per day, which is higher than the level recommended for adults because of the potential for complications from increased nitrogen losses in children (Dietz and Robinson, 1993; Dietz and Wolfe, 1985; Merritt et al., 1980~. In addition, at least 2 liters of water or calorie-free fluids are consumed daily, along with 2 cups of low-starch vegetables, one multivitamin tablet containing iron, 800 milligrams of calcium, and 25 milliequivalents of potassium.
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The details of the standard behavior modification program have been reviewed extensively by Epstein (1986) and Kramer et al.
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Each program included nutrition education, exercise, and behavior modification strategies, and interventions lasted from 10 to 18 weeks. The programs were administered only to overweight or obese children.
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Parental obesity is an important risk factor for childhood obesity (Garn and Clark, 1976~. In children of obese parents, careful monitoring of weight change could help to identify children for whom alterations in diet and physical activity are needed to prevent the disease.
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Etiology Despite several theories, the causes of obesity in children remain unclear, particularly those related to energy imbalance and age of onset. Fundamental to answering these questions is the development of improved techniques for measuring subtle changes in energy expenditure (including total energy expenditure, physical activity, resting metabolic rate, thermogenesis, and energy intake)
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Standard programs tend to be modeled after adult treatment programs and include dietary change, increasing physical activity, and behavior modification along with parent training. However, future work must continue to examine the efficacy of each component and to test variations in intervention in different populations.
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. These periods represent potential treatment targets for the prevention of adult obesity, and additional research is needed to identify the most effective time to target efforts to prevent and treat childhood obesity.
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