Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care

The prevalence of obesity in Canadian children has risen dramatically from the late 1970s, more than doubling among both boys and girls.1 Based on growth curves generated by the World Health Organization, the prevalence of overweight and obesity in Canadian children aged 2 to 17 years in 2004 was about 35%.1,2 More recent estimates from 2009 to 2011 based on measured weight and height for children aged 5 to 17 years suggest that 32% are overweight (20%) or obese (12%), with the prevalence of obesity almost twice as high in boys (15%) than in girls (8%)3 (Appendix 1, available at www.cmaj.ca/lookup/suppl /doi :10.1503/cmaj.141285/-/DC1). Studies suggest that excess weight in children often persists into adulthood.4–6 Childhood obesity is associated with an increased risk of cardiovascular disease and diabetes in adolescence7 and later in life.8,9 It is now recognized that obesity is a complex problem that will require action from multiple sectors and “systems thinking.”10 Within primary care, the chronic disease model has been proposed as a framework for managing obesity, supporting children and families to manage body weight over time.10 For childhood obesity, the complexity may include parents’ knowledge, parenting style and the family activity environment.11 Whereas options for management of childhood obesity include behavioural, pharmacologic and surgical approaches offered or referred by primary care,10 it is recognized that interventions must be familycentred and may involve services delivered by an interdisciplinary team.11 The 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children provided recommendations for the prevention and management of obesity in Canadians of all ages.12 The last task force guidance specifically on childhood obesity was in 1994; it focused on screening for and treatment of obesity in children, but did not address primary prevention.13 The current guideline provides recommendations for growth monitoring and prevention of overweight and obesity in healthy-weight children and adolescents aged 17 years and younger in primary care settings, and guidance for primary care practitioners on the effectiveness of overweight and obesity management in children and youth aged 2 to 17 years.