Khuyến nghị của Ủy ban Chuyên gia về Phòng ngừa, Đánh giá và Điều trị Thừa cân và Béo phì ở Trẻ em và Thanh thiếu niên: Báo cáo tóm tắt

American Academy of Pediatrics (AAP) - Tập 120 Số Supplement_4 - Trang S164-S192 - 2007
Sarah E. Barlow1
1Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas

Tóm tắt

Để sửa đổi các khuyến nghị năm 1998 về béo phì ở trẻ em, một Ủy ban Chuyên gia bao gồm đại diện từ 15 tổ chức chuyên môn đã bổ nhiệm các nhà khoa học và bác sĩ lâm sàng giàu kinh nghiệm vào 3 nhóm viết để xem xét tài liệu và đề xuất các phương pháp tiếp cận phòng ngừa, đánh giá và điều trị. Vì các chiến lược hiệu quả vẫn chưa được xác định rõ ràng, các nhóm viết sử dụng cả bằng chứng có sẵn và quan điểm chuyên gia để phát triển các khuyến nghị. Các nhà cung cấp dịch vụ chăm sóc sức khỏe ban đầu nên đánh giá nguy cơ béo phì ở trẻ em một cách thống nhất để cải thiện việc xác định sớm Chỉ số Khối cơ thể (BMI) tăng cao, các nguy cơ y tế, và thói quen ăn uống và hoạt động thể chất không lành mạnh. Các nhà cung cấp dịch vụ có thể đưa ra thông điệp phòng ngừa béo phì cho hầu hết trẻ em và đề xuất các biện pháp kiểm soát cân nặng cho những trẻ có cân nặng dư thừa. Các nhóm viết cũng khuyến nghị thay đổi hệ thống của văn phòng để hỗ trợ nỗ lực giải quyết vấn đề. BMI nên được tính toán và vẽ biểu đồ ít nhất hàng năm, và phân loại nên được tích hợp với thông tin khác như mô hình phát triển, béo phì gia đình và các nguy cơ y tế để đánh giá nguy cơ béo phì của trẻ. Đối với phòng ngừa, các khuyến nghị bao gồm cả cụ thể hành vi ăn uống và hoạt động thể chất, giúp duy trì cân nặng lành mạnh, và sử dụng các kỹ thuật tư vấn tập trung vào khách hàng như phỏng vấn động lực, giúp gia đình xác định động lực của họ cho sự thay đổi. Đối với đánh giá, các khuyến nghị bao gồm các phương pháp sàng lọc cho các điều kiện y tế hiện tại và cho các nguy cơ trong tương lai, và các phương pháp đánh giá hành vi ăn uống và hoạt động thể chất. Đối với điều trị, các khuyến nghị đề xuất 4 giai đoạn chăm sóc béo phì; đầu tiên là tư vấn ngắn gọn có thể được thực hiện trong văn phòng chăm sóc sức khỏe, và các giai đoạn sau cần thêm thời gian và nguồn lực. Sự phù hợp của các giai đoạn cao hơn bị ảnh hưởng bởi tuổi của bệnh nhân và mức độ thừa cân. Những khuyến nghị này công nhận tầm quan trọng của sự thay đổi xã hội và môi trường để giảm dịch bệnh béo phì nhưng cũng xác định cách mà các nhà cung cấp dịch vụ chăm sóc sức khỏe và các hệ thống chăm sóc sức khỏe có thể là một phần của nỗ lực rộng hơn.

Từ khóa

#béo phì trẻ em #phòng ngừa béo phì #đánh giá béo phì #điều trị béo phì #chỉ số khối cơ thể #động lực gia đình #chăm sóc sức khỏe trẻ em

Tài liệu tham khảo

Davis MM, Gance-Cleveland B, Hassink S, Johnson R, Paradis G, Resnicow G. Recommendations for prevention of childhood obesity. Pediatrics.2007;120(suppl 4):228–252

Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics.2007;120(suppl 4):192–227

Spear BA, Barlow S, Ervin C, Ludwig D, Saelens B, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics.2007;120(suppl 4):253–287

Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA.2006;295:1549–1555

Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11.2002;(246):1–190

Zephier E, Himes JH, Story M, Zhou X. Increasing prevalences of overweight and obesity in Northern Plains American Indian children. Arch Pediatr Adolesc Med.2006;160:34–39

Gordon-Larsen P, Adair LS, Popkin BM. The relationship of ethnicity, socioeconomic factors, and overweight in US adolescents. Obes Res.2003;11:121–129

Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW. Trends in the association of poverty with overweight among US adolescents, 1971–2004. JAMA.2006;295:2385–2393

Maes HH, Neale MC, Eaves LJ. Genetic and environmental factors in relative body weight and human adiposity. Behav Genet.1997;27:325–351

Gale SM, Castracane VD, Mantzoros CS. Energy homeostasis, obesity and eating disorders: recent advances in endocrinology. J Nutr.2004;134:295–298

Bandini LG, Schoeller DA, Cyr HN, Dietz WH. Validity of reported energy intake in obese and nonobese adolescents. Am J Clin Nutr.1990;52:421–425

Johnson RK. Dietary intake: how do we measure what people are really eating?Obes Res.2002;10(suppl 1):63S–68S

Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfield SB. Body mass index as a measure of adiposity among children and adolescents: a validation study. J Pediatr.1998;132:204–210

Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI, Dietz WH. Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. Am J Clin Nutr.2002;75:978–985

Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics.2001;108:712–718

Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord.1999;23(suppl 2):S2–S11

Field AE, Cook NR, Gillman MW. Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obes Res.2005;13:163–169

Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations: the Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics.1998;102(3). Available at: www.pediatrics.org/cgi/content/full/102/3/e29

Koplan J, Liverman CT, Kraak VI, eds. Preventing Childhood Obesity: Health in the Balance. Washington, DC: National Academies Press;2005

Strauss RS. Childhood obesity and self-esteem. Pediatrics.2000;105(1). Available at: www.pediatrics.org/cgi/content/full/105/1/e15

Strauss RS, Pollack HA. Social marginalization of overweight children. Arch Pediatr Adolesc Med.2003;157:746–752

Latner JD, Stunkard AJ. Getting worse: the stigmatization of obese children. Obes Res.2003;11:452–456

Gortmaker SL, Peterson K, Wiecha J, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med.1999;153:409–418

McKay B. In Arkansas, schools to score a child's weight. Wall Street Journal. August 20,2004:1B

Wadden TA, Didie E. What's in a name? Patients’ preferred terms for describing obesity. Obes Res.2003;11:1140–1146

Cohen ML, Tanofsky-Kraff M, Young-Hyman D, Yanovski JA. Weight and its Relationship to Adolescent Perceptions of their Providers (WRAP): a qualitative and quantitative assessment of teen weight-related preferences and concerns. J Adolesc Health.2005;37:163

Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr.2007;150:12–17

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA.2002;288:1775–1779

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA.2002;288:1909–1914

Margolis PA, Lannon CM, Stuart JM, Fried BJ, Keyes-Elstein L, Moore DE Jr. Practice based education to improve delivery systems for prevention in primary care: randomised trial. BMJ.2004;328:388

Story MT, Neumark-Stzainer DR, Sherwood NE, et al. Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals. Pediatrics.2002;110:210–214

Kimm SY, Barton BA, Berhane K, Ross JW, Payne GH, Schreiber GB. Self-esteem and adiposity in black and white girls: the NHLBI Growth and Health Study. Ann Epidemiol.1997;7:550–560

Jain A, Sherman SN, Chamberlin DL, Carter Y, Powers SW, Whitaker RC. Why don't low-income mothers worry about their preschoolers being overweight?Pediatrics.2001;107:1138–1146

Hughes SO, Power TG, Orlet Fisher J, Mueller S, Nicklas TA. Revisiting a neglected construct: parenting styles in a child-feeding context. Appetite.2005;44:83–92

Gordon-Larsen P, Adair LS, Popkin BM. Ethnic differences in physical activity and inactivity patterns and overweight status. Obes Res.2002;10:141–149

Gordon-Larsen P, McMurray RG, Popkin BM. Adolescent physical activity and inactivity vary by ethnicity: the National Longitudinal Study of Adolescent Health. J Pediatr.1999;135:301–306

Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med.1997;337:869–873

American Academy of Pediatrics, Committee on Public Education. Children, adolescents, and television. Pediatrics.2001;107:423–426

US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed. Washington, DC: Government Printing Office;2005

Krebs NF, Jacobson MS. Prevention of pediatric overweight and obesity. Pediatrics.2003;112:424–430

Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics.2005;115:1367–1377

Strong WB, Malina RM, Blimkie CJ, et al. Evidence based physical activity for school-age youth. J Pediatr.2005;146:732–737

Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol.1994;13:373–383

Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res.2004;12:357–361

Golan M, Weizman A, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr.1998;67:1130–1135

Prochaska JO, DiClemente CC. The Transtheoretical Approach: Crossing Traditional Boundaries of Change. Homewood, IL: Dorsey Press;1991

Rhee KE, De Lago CW, Arscott-Mills T, Mehta SD, Davis RK. Factors associated with parental readiness to make changes for overweight children. Pediatrics.2005;116(1). Available at: www.pediatrics.org/cgi/content/full/116/1/e94

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ.2000;320:1240–1243

Sardinha LB, Going SB, Teixeira PJ, Lohman TG. Receiver operating characteristic analysis of body mass index, triceps skinfold thickness, and arm girth for obesity screening in children and adolescents. Am J Clin Nutr.1999;70:1090–1095

Savva SC, Tornaritis M, Savva ME, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord.2000;24:1453–1458

Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tato L. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res.2001;9:179–187

Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr.2006;148:188–194

Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr.2000;136:664–672

Muratova VN, Islam SS, Demerath EW, Minor VE, Neal WA. Cholesterol screening among children and their parents. Prev Med.2001;33:1–6

Wing YK, Hui SH, Pak WM, et al. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child.2003;88:1043–1047

Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children: associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med.1999;159:1527–1532

Kalra M, Inge T, Garcia V, et al. Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery. Obes Res.2005;13:1175–1179

Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol.2005;115:897–909

Lavine JE, Schwimmer JB. Nonalcoholic fatty liver disease in the pediatric population. Clin Liver Dis.2004;8:549–558

American Diabetes Association. Type 2 diabetes in children and adolescents. Pediatrics.2000;105:671–680

Kaechele V, Wabitsch M, Thiere D, et al. Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. J Pediatr Gastroenterol Nutr.2006;42:66–70

Kiewiet RM, Durian MF, van Leersum M, Hesp FL, van Vliet AC. Gallstone formation after weight loss following gastric banding in morbidly obese Dutch patients. Obes Surg.2006;16:592–596

Fishman L, Lenders C, Fortunato C, Noonan C, Nurko S. Increased prevalence of constipation and fecal soiling in a population of obese children. J Pediatr.2004;145:253–254

Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med.2005;143:199–211

Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf).1999;51:779–786

Hunter I, Greene SA, MacDonald TM, Morris AD. Prevalence and aetiology of hypothyroidism in the young. Arch Dis Child.2000;83:207–210

Lindholm J, Juul S, Jorgensen JO, et al. Incidence and late prognosis of Cushing's syndrome: a population-based study. J Clin Endocrinol Metab.2001;86:117–123

Gordon K. Pediatric pseudotumor cerebri: descriptive epidemiology. Can J Neurol Sci.1997;24:219–221

Scott IU, Siatkowski RM, Eneyni M, Brodsky MC, Lam BL. Idiopathic intracranial hypertension in children and adolescents. Am J Ophthalmol.1997;124:253–255

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics.2004;114(suppl):555–576

National Cholesterol Education Program. Highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics.1992;89:495–501

Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA.2003;289:1813–1819

Grilo CM, Masheb RM, Brody M, Toth C, Burke-Martindale CH, Rothschild BS. Childhood maltreatment in extremely obese male and female bariatric surgery candidates. Obes Res.2005;13:123–130

Gustafson TB, Sarwer DB. Childhood sexual abuse and obesity. Obes Rev.2004;5:129–135

Dietz WH Jr, Gross WL, Kirkpatrick JA Jr. Blount disease (tibia vara): another skeletal disorder associated with childhood obesity. J Pediatr.1982;101:735–737

Lehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop.2006;26:286–290

Manoff EM, Banffy MB, Winell JJ. Relationship between body mass index and slipped capital femoral epiphysis. J Pediatr Orthop.2005;25:744–746

Taylor ED, Theim KR, Mirch MC, et al. Orthopedic complications of overweight in children and adolescents. Pediatrics.2006;117:2167–2174

Nguyen TT, Keil MF, Russell DL, et al. Relation of acanthosis nigricans to hyperinsulinemia and insulin sensitivity in overweight African American and white children. J Pediatr.2001;138:474–480

Robinson TN. Behavioural treatment of childhood and adolescent obesity. Int J Obes Relat Metab Disord.1999;23(suppl 2):S52–S57

Goldfield GS, Epstein LH, Kilanowski CK, Paluch RA, Kogut-Bossler B. Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obes Relat Metab Disord.2001;25:1843–1849

Molnar D. New drug policy in childhood obesity. Int J Obes (Lond).2005;29(suppl 2):S62–S65

Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL. Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial. JAMA.2003;289:1805–1812

Berkowitz RI, Fujioka K, Daniels SR, et al. Effects of sibutramine treatment in obese adolescents: a randomized trial. Ann Intern Med.2006;145:81–90

Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA.2005;293:2873–2883

Sothern MS, Loftin M, Blecker U, Udall JN Jr. Impact of significant weight loss on maximal oxygen uptake in obese children and adolescents. J Invest Med.2000;48:411–416

Strauss RS, Bradley LJ, Brolin RE. Gastric bypass surgery in adolescents with morbid obesity. J Pediatr.2001;138:499–504

Inge TH, Krebs NF, Garcia VF, et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics.2004;114:217–223