From the seemingly slim to the truly chubby, all children should have their body-mass index measures evaluated yearly as part of efforts to identify and prevent obesity, the American Academy of Pediatrics says.
Prompted by worrisome data on the prevalence of obesity and obesity-related disorders in children, the academy has developed its first-ever policy statement dealing solely with identifying and preventing the problem.
It's been suggested that obesity-related health costs "may outstrip the costs of cigarette smoking, so I don't think we have a choice but to find ways to deal with it," said Dr. Marc Jacobson, a pediatrician at New York City's Schneider's Children's Hospital and co-author of the new policy. "It's not just pediatricians who can solve this, it's going to be the whole society."
While most pediatricians already track children's height and weight, the new policy asks doctors to keep obesity prevention in mind as they're doing so and to specifically measure body-mass index, a height-to-weight ratio. This will help them spot unusually rapid growth that might signal an increased risk of obesity, Jacobson said.
In adults, a BMI of 30 or higher is considered obese but in youngsters the index depends on gender and age.
Recent data indicate that about 15 percent of U.S. youngsters aged 6 through 19 are severely overweight or obese based on their body-mass index, or BMI - a doubling of the rate over the past two decades. Studies also have shown increasing rates in children of obesity-related diseases including adult-onset diabetes.
In addition to yearly BMI checks, the new policy encourages pediatricians to:
-actively promote anti-obesity programs in their communities, including discouraging the sale of sugary sodas at schools and encouraging physical education programs that focus on personal fitness, not just team sports.
The new policy is published in the August issue of Pediatrics, the academy's monthly medical journal.
It recommends that pediatricians monitor all children for weight problems, even those who appear fit, because many may face an increased risk of obesity due to family history or environment, Jacobson said.
The policy also aims to avoid stigmatizing youngsters who already are overweight or obese, and to focus less on labeling them than on advocating healthful activities for all kids, he said.
"I don't want people to go out there and say, 'You're fat,"' Jacobson said. "It's important ... that we talk to them more about their habits, about eating right ... and getting the right amount of exercise."
Chicago pediatrician Dr. Rebecca Unger praised the new policy.
"It's great that the AAP is saying this because we (pediatricians) have a unique opportunity to watch these kids from when they're born through when they go to college," Unger said. "We can look at their pattern of growth, we know their family history."
Unger says her private-practice patients include several overweight children and that she frequently sees youngsters who "may be heading toward a weight problem."
"It is very important for health care providers to start identifying children at risk early because it's much easier" to make small but healthy changes in eating and exercise habits than to treat obesity, she said.
By Lindsey Tanner