From the Academy
Position Paper
Position of the Academy of Nutrition and Dietetics: Interventions for the Prevention and Treatment of Pediatric Overweight and Obesity

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Abstract

It is the position of the Academy of Nutrition and Dietetics that prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, as well as consistent and integrated messages and environmental support across all sectors of society to achieve sustained dietary and physical-activity behavior change. This position paper provides guidance and recommendations for levels of intervention targeting overweight and obesity prevention and treatment from preschool age through adolescence. Methods included a review of the literature from 2009 to April 2012, including the Academy's 2009 evidence analysis school-based reviews. Multicomponent interventions show the greatest impact for primary prevention; thus, early childhood and school-based interventions should integrate behavioral and environmental approaches that focus on dietary intake and physical activity using a systems-level approach targeting the multilevel structure of the socioecological model as well as interactions and relationships between levels. Secondary prevention and tertiary prevention/treatment should emphasize sustained family-based, developmentally appropriate approaches that include nutrition education, dietary counseling, parenting skills, behavioral strategies, and physical-activity promotion. For obese youth with concomitant serious comorbidities, structured dietary approaches and pharmacologic agents should be considered, and weight-loss surgery can be considered for severely obese adolescents. Policy and environmental interventions are recommended as feasible and sustainable ways to support healthful lifestyles for children and families. The Academy supports commitment of resources for interventions, policies, and research that promote healthful eating and physical-activity behaviors to ensure that all youth have the opportunity to achieve and maintain a weight that is optimal for health.

Section snippets

Scope of Paper

This position paper expands on the 2006 position paper7 by including the following:

  • 1.

    an overview of the problem;

  • 2.

    a summary of six evidence-based reviews conducted through 2009 on obesity prevention and related behaviors through school-based interventions;

  • 3.

    an updated review of additional primary, secondary, and tertiary childhood obesity prevention and treatment literature from 2006 through April 2012 not included in the school-based reviews; and

  • 4.

    recommendations.

Material in this position paper

Need for Pediatric Obesity Prevention and Treatment

Healthy People 2010 goals identified reducing the proportion of overweight and obesity in children and adolescents as a key health indicator, however, this was not achieved.15 No significant change in obesity prevalence by age group was observed between 1999-2000 and 2009-2010.1 Although a “leveling off” of obesity in youth is preferable to continual increases, the prevalence rates are still alarmingly high. In addition, certain race and ethnic groups are disproportionately affected. In

Review of Evidence

The focus of this position paper is to provide guidance and recommendations for interventions targeting overweight or obesity prevention or treatment based on the available evidence. The core of this review is the 2009 evidence-based analysis conducted by the Academy on review articles examining the effectiveness of school-based interventions for nutrition education, for physical activity, and multilevel interventions, including both nutrition and physical activity on both adiposity and

Challenges

Although significant progress in prevention and treatment of child and adolescent obesity has been made, several challenges remain, including identification of methods to effectively employ systems-level approaches; reimbursement for RDs and medical nutritional therapy for pediatric obesity treatment; optimal roles for dietetic technicians, registered (DTRs) in child obesity-prevention and treatment efforts; changes in the macro-environment of food availability and marketing to reinforce

Summary and Recommendations

For prevention of child and adolescent overweight and obesity, school-based evidence reviews, recent studies, and current recommendations all indicate the importance of multilevel approaches that involve various components or sectors of influence. Consistent messages across these sectors are critical and can be reinforced through community-level interventions and social marketing. For weight management, comprehensive, multicomponent interventions that include diet, physical activity, behavioral

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  • Cited by (218)

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    This Academy of Nutrition and Dietetics position was adopted by the House of Delegates Leadership Team on December 22, 2006 and reaffirmed on July 7, 2009. This position is in effect until December 31, 2017. Requests to use portions of the position or republish in its entirety must be directed to the Academy at [email protected].

    Authors: Deanna M. Hoelscher, PhD, RD, LD, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX; Shelley Kirk, PhD, RD, LD, Center for Better Health and Nutrition/HealthWorks!, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Lorrene Ritchie, PhD, RD, Atkins Center for Weight and Health, University of California, Berkeley, CA; Leslie Cunningham-Sabo, PhD, RD, Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.

    Reviewers: Mary Beth Arensberg, PhD, RD, LD, FADA (Abbott Nutrition Products Division, Columbus, OH); Jeanne Blankenship, MS, RD (Academy Policy Initiatives & Advocacy, Washington, DC); Academy Quality Management Committee (Terry Brown, MBA, MPH, RD, LD, CNSC, Medical City Hospital, Dallas, TX); Sharon Denny, MS, RD (Academy Knowledge Center, Chicago, IL); Public Health Community Nutrition dietetic practice group (Nicole Larson, PhD, MPH, RD, University of Minnesota, Minneapolis, MN); School Nutrition Services dietetic practice group (The University of Mississippi, Oxford, MS); Melissa Pflugh Prescott, MS, RD, CDN (Nutrition Consultant, New York, NY); Katryn Soltanmorad, RD (Tahoe Truckee Unified School District, Truckee, California); Alison Steiber, PhD, RD (Academy Research & Strategic Business Development, Chicago, IL); Weight Management dietetic practice group (Samantha Weiss, MPH, RD, LD, ARAMARK, Round Rock, TX); Pediatric Nutrition dietetic practice group (Tsun-Min “Mimi” Wu, MS, RD, New York City Department of Health and Mental Hygiene, New York, NY).

    Academy Positions Committee Workgroup: Aida Miles, MMSc, RD, LD (chair); Karen P. Lacey, MS, RD, CD; Nancy Cooperman, MS, RD, CDN (content advisor).

    Assistance in formatting and referencing provided by Whitney E. Chlon; Christina Ly, MPH; Tiffni E. Menendez, MPH, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX.

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