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Between 1970 and 2000, the prevalence of obesity increased almost fourfold in children ages 6 to 11, according to the Endocrine Society. And many children who are obese are developing grown-up complications, including kidney stones, hypertension, and type 2 diabetes.


Overall, the prevalence of pediatric obesity is about 17%. Pediatric practitioners say the obesity epidemic is primarily linked to poor diet (including too much high-sodium processed food) and sedentary lifestyle. To combat pediatric obesity, the Endocrine Society has released new clinical practice guidelines that include these points and recommendations.

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* Obesity is defined as a body mass index (BMI) above the 95th percentile in weight for height. By definition, overweight is a BMI between the 85th and 95th percentile.


* The first line of therapy is to encourage intensive lifestyle modification, including changes in diet and increased physical activity. Drug therapy (in combination with lifestyle modification) should be considered in obese children only after failure of a formal program of intensive lifestyle modification and in overweight children only if severe comorbidities persist despite lifestyle changes.


* Bariatric surgery should be an option only for adolescents with BMI greater than 50 kg/m2 or greater than 40 kg/m2 with severe comorbidities in whom drug therapy and lifestyle modifications have failed.


* Clinicians should encourage mothers to breast-feed for at least 6 months to lower the risk of childhood obesity and advocate for 60 minutes/day of moderate to vigorous exercise in all school grades.



Available online, the guidelines will also appear in the December issue of the Journal of Clinical Endocrinology & Metabolism.