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Management of childhood obesity in the primary care setting

Joseph A Skelton, MD, MS
Section Editors
Martin I Lorin, MD
Kathleen J Motil, MD, PhD
Melvin B Heyman, MD, MPH
Deputy Editor
Alison G Hoppin, MD


A variety of mechanisms participate in weight regulation and the development of obesity in children, including genetics, developmental influences ("metabolic programming," or epigenetics), and environmental factors. The relative importance of each of these mechanisms is the subject of ongoing research and probably varies considerably between individuals and populations. (See "Definition; epidemiology; and etiology of obesity in children and adolescents", section on 'Etiology' and "Obesity in adults: Etiology and natural history".)

Among these potential mechanisms, only environmental factors are potentially modifiable during infancy and childhood. Therefore, prevention and treatment of overweight and obesity in children in the primary care setting focuses on modifying behaviors that lead to excessive energy intake and insufficient energy expenditure. Experts who focus on cardiovascular health (rather than obesity per se) recommend very similar health behaviors, with a slightly different perspective. (See "Pediatric prevention of adult cardiovascular disease: Promoting a healthy lifestyle and identifying at-risk children".)

This topic review will address interventions to prevent and treat childhood obesity in the primary care setting. The definitions, epidemiology, and comorbidities of childhood obesity are discussed in separate topic reviews. Surgical treatment of severe obesity in adolescents also is discussed separately. (See "Definition; epidemiology; and etiology of obesity in children and adolescents" and "Comorbidities and complications of obesity in children and adolescents" and "Surgical management of severe obesity in adolescents".)


Few long-term randomized trials are available to determine which techniques to prevent or treat obesity are effective. Moreover, several of the techniques that have been addressed in clinical trials may not be practical for use in a clinical setting. Nonetheless, a number of approaches are recommended by expert consensus, based on clinical experience, inferences drawn from observing obesity-associated behaviors, and short-term evidence-based trials [1-9].

Recommendations for primary care providers center on:

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Literature review current through: Nov 2017. | This topic last updated: Dec 08, 2017.
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  1. Barlow SE, Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120 Suppl 4:S164.
  2. Davis MM, Gance-Cleveland B, Hassink S, et al. Recommendations for prevention of childhood obesity. Pediatrics 2007; 120 Suppl 4:S229.
  3. Oude Luttikhuis H, Baur L, Jansen H, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009; :CD001872.
  4. Spear BA, Barlow SE, Ervin C, et al. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007; 120 Suppl 4:S254.
  5. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011; 128 Suppl 5:S213.
  6. Daniels SR, Hassink SG, COMMITTEE ON NUTRITION. The Role of the Pediatrician in Primary Prevention of Obesity. Pediatrics 2015; 136:e275.
  7. Colquitt JL, Loveman E, O'Malley C, et al. Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database Syst Rev 2016; 3:CD012105.
  8. Society for Adolescent Health and Medicine. Preventing and Treating Adolescent Obesity: A Position Paper of the Society for Adolescent Health and Medicine. J Adolesc Health 2016; 59:602.
  9. US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, et al. Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2017; 317:2417.
  10. Pont SJ, Puhl R, Cook SR, et al. Stigma Experienced by Children and Adolescents With Obesity. Pediatrics 2017; 140.
  11. Howard JB, Skinner AC, Ravanbakht SN, et al. Obesogenic Behavior and Weight-Based Stigma in Popular Children's Movies, 2012 to 2015. Pediatrics 2017; 140.
  12. Skinner AC, Payne K, Perrin AJ, et al. Implicit Weight Bias in Children Age 9 to 11 Years. Pediatrics 2017; 140.
  13. Majdan JF. Memoirs of an obese physician. Ann Intern Med 2010; 153:686.
  14. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health 2010; 100:1019.
  15. Puhl RM, Peterson JL, Luedicke J. Parental perceptions of weight terminology that providers use with youth. Pediatrics 2011; 128:e786.
  16. Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004; 12:357.
  17. Janicke DM, Sallinen BJ, Perri MG, et al. Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORY. Arch Pediatr Adolesc Med 2008; 162:1119.
  18. Boutelle KN, Cafri G, Crow SJ. Parent-only treatment for childhood obesity: a randomized controlled trial. Obesity (Silver Spring) 2011; 19:574.
  19. Golden NH, Schneider M, Wood C, et al. Preventing Obesity and Eating Disorders in Adolescents. Pediatrics 2016; 138.
  20. Loth KA, Neumark-Sztainer D, Croll JK. Informing family approaches to eating disorder prevention: perspectives of those who have been there. Int J Eat Disord 2009; 42:146.
  21. Neumark-Sztainer DR, Wall MM, Haines JI, et al. Shared risk and protective factors for overweight and disordered eating in adolescents. Am J Prev Med 2007; 33:359.
  22. Berge JM, Maclehose R, Loth KA, et al. Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors. JAMA Pediatr 2013; 167:746.
  23. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol 1994; 13:373.
  24. Epstein LH, Myers MD, Raynor HA, Saelens BE. Treatment of pediatric obesity. Pediatrics 1998; 101:554.
  25. Ross MM, Kolbash S, Cohen GM, Skelton JA. Multidisciplinary treatment of pediatric obesity: nutrition evaluation and management. Nutr Clin Pract 2010; 25:327.
  26. De Santis-Moniaci D, Altshuler L. Comprehensive behavioral treatment of overweight and the pediatric practice. Pediatr Ann 2007; 36:102.
  27. Robinson TN. Behavioural treatment of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999; 23 Suppl 2:S52.
  28. Faith MS, Van Horn L, Appel LJ, et al. Evaluating parents and adult caregivers as "agents of change" for treating obese children: evidence for parent behavior change strategies and research gaps: a scientific statement from the American Heart Association. Circulation 2012; 125:1186.
  29. Boutelle KN, Rhee KE, Liang J, et al. Effect of Attendance of the Child on Body Weight, Energy Intake, and Physical Activity in Childhood Obesity Treatment: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:622.
  30. Quattrin T, Cao Y, Paluch RA, et al. Cost-effectiveness of Family-Based Obesity Treatment. Pediatrics 2017; 140.
  31. Skelton JA, Buehler C, Irby MB, Grzywacz JG. Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management. Int J Obes (Lond) 2012; 36:891.
  32. Bronfenbrenner U, Ceci SJ. Nature-nurture reconceptualized in developmental perspective: a bioecological model. Psychol Rev 1994; 101:568.
  33. Fox LA. Bowen Family Systems Theory: a theoretical framework for organizational change agents. J AHIMA 1994; 65:49.
  34. Schwartz RP, Hamre R, Dietz WH, et al. Office-based motivational interviewing to prevent childhood obesity: a feasibility study. Arch Pediatr Adolesc Med 2007; 161:495.
  35. Irby M, Kaplan S, Garner-Edwards D, et al. Motivational interviewing in a family-based pediatric obesity program: a case study. Fam Syst Health 2010; 28:236.
  36. Huang JS, Barlow SE, Quiros-Tejeira RE, et al. Childhood obesity for pediatric gastroenterologists. J Pediatr Gastroenterol Nutr 2013; 56:99.
  37. Suarez M, Mullins S. Motivational interviewing and pediatric health behavior interventions. J Dev Behav Pediatr 2008; 29:417.
  38. Resnicow K, McMaster F, Bocian A, et al. Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics 2015; 135:649.
  39. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983; 51:390.
  40. Hill D, Chapman S, Donovan R. The return of scare tactics. Tob Control 1998; 7:5.
  41. Freedman DS, Wang J, Ogden CL, et al. The prediction of body fatness by BMI and skinfold thicknesses among children and adolescents. Ann Hum Biol 2007; 34:183.
  42. Freedman DS, Wang J, Thornton JC, et al. Classification of body fatness by body mass index-for-age categories among children. Arch Pediatr Adolesc Med 2009; 163:805.
  43. Reilly JJ. Descriptive epidemiology and health consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab 2005; 19:327.
  44. Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128:1689.
  45. Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr 2014; 168:561.
  46. Flegal KM, Wei R, Ogden CL, et al. Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. Am J Clin Nutr 2009; 90:1314.
  47. Krebs NF, Himes JH, Jacobson D, et al. Assessment of child and adolescent overweight and obesity. Pediatrics 2007; 120 Suppl 4:S193.
  48. Lohman TG. Anthropometric assessment of fat-free body mass. Wile-Liss, 1991.
  49. Sarría A, Moreno LA, García-Llop LA, et al. Body mass index, triceps skinfold and waist circumference in screening for adiposity in male children and adolescents. Acta Paediatr 2001; 90:387.
  50. Rollins BY, Savage JS, Fisher JO, Birch LL. Alternatives to restrictive feeding practices to promote self-regulation in childhood: a developmental perspective. Pediatr Obes 2016; 11:326.
  51. Whitaker RC, Wright JA, Pepe MS, et al. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337:869.
  52. Rudolf M. Predicting babies' risk of obesity. Arch Dis Child 2011; 96:995.
  53. Dennison BA, Erb TA, Jenkins PL. Television viewing and television in bedroom associated with overweight risk among low-income preschool children. Pediatrics 2002; 109:1028.
  54. Kalakanis LE, Goldfield GS, Paluch RA, Epstein LH. Parental activity as a determinant of activity level and patterns of activity in obese children. Res Q Exerc Sport 2001; 72:202.
  55. Fulton JE, Garg M, Galuska DA, et al. Public health and clinical recommendations for physical activity and physical fitness: special focus on overweight youth. Sports Med 2004; 34:581.
  56. Kohl HW 3rd, Hobbs KE. Development of physical activity behaviors among children and adolescents. Pediatrics 1998; 101:549.
  57. Dietz WH, Robinson TN. Clinical practice. Overweight children and adolescents. N Engl J Med 2005; 352:2100.
  58. Centers for Disease Control and Prevention (CDC). School health guidelines to promote healthy eating and physical activity. MMWR Recomm Rep 2011; 60:1.
  59. Austin SB, Field AE, Wiecha J, et al. The impact of a school-based obesity prevention trial on disordered weight-control behaviors in early adolescent girls. Arch Pediatr Adolesc Med 2005; 159:225.
  60. United States Department of Agriculture, "Choose my plate." Available at: www.choosemyplate.gov (Accessed on October 09, 2015).
  61. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 1990; 264:2519.
  62. Ludwig DS. Clinical update: the low-glycaemic-index diet. Lancet 2007; 369:890.
  63. Ebbeling CB, Leidig MM, Sinclair KB, et al. A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med 2003; 157:773.
  64. Lean ME, Han TS, Prvan T, et al. Weight loss with high and low carbohydrate 1200 kcal diets in free living women. Eur J Clin Nutr 1997; 51:243.
  65. Ebbeling CB, Leidig MM, Sinclair KB, et al. Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults. Am J Clin Nutr 2005; 81:976.
  66. Due A, Larsen TM, Mu H, et al. Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6-mo randomized, controlled trial. Am J Clin Nutr 2008; 88:1232.
  67. Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr 2003; 142:253.
  68. Demol S, Yackobovitch-Gavan M, Shalitin S, et al. Low-carbohydrate (low & high-fat) versus high-carbohydrate low-fat diets in the treatment of obesity in adolescents. Acta Paediatr 2009; 98:346.
  69. Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA 1999; 282:1561.
  70. Epstein LH, Valoski AM, Vara LS, et al. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol 1995; 14:109.
  71. Waters E, de Silva-Sanigorski A, Hall BJ, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011; :CD001871.
  72. Guide to Community Preventive Services. Obesity prevention and control: behavioral interventions that aim to reduce recreational sedentary screen time among children. Available at: http://www.thecommunityguide.org/obesity/behavioral.html (Accessed on January 09, 2015).
  73. Epstein LH, Roemmich JN, Paluch RA, Raynor HA. Influence of changes in sedentary behavior on energy and macronutrient intake in youth. Am J Clin Nutr 2005; 81:361.
  74. Generation M2: Media in the lives of 8- to 18-year olds. The Kaiser Family Foundation. Available at: http://www.kff.org/entmedia/mh012010pkg.cfm. (Accessed on January 19, 2011).
  75. COUNCIL ON COMMUNICATIONS AND MEDIA. Media and Young Minds. Pediatrics 2016; 138.
  76. COUNCIL ON COMMUNICATIONS AND MEDIA. Media Use in School-Aged Children and Adolescents. Pediatrics 2016; 138.
  77. Physical fitness and activity in schools. American Academy of Pediatrics. Pediatrics 2000; 105:1156.
  78. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at: http://health.gov/dietaryguidelines/2015/guidelines/ (Accessed on January 09, 2016).
  79. Burdette HL, Whitaker RC, Daniels SR. Parental report of outdoor playtime as a measure of physical activity in preschool-aged children. Arch Pediatr Adolesc Med 2004; 158:353.
  80. Anderson SE, Whitaker RC. Household routines and obesity in US preschool-aged children. Pediatrics 2010; 125:420.
  81. Paruthi S, Brooks LJ, D'Ambrosio C, et al. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016; 12:785.
  82. Recommended Amount of Sleep for Pediatric Populations. Pediatrics 2016; 138.
  83. Maine Youth Overweight Collaborative "5210 Let's Go" website. Available at: http://www.letsgo.org/resources/Healthcare_Professionals_Toolkit.php?id=greenHealth&vid=v8 (Accessed on October 20, 2011).
  84. Reinehr T, Kleber M, Lass N, Toschke AM. Body mass index patterns over 5 y in obese children motivated to participate in a 1-y lifestyle intervention: age as a predictor of long-term success. Am J Clin Nutr 2010; 91:1165.
  85. de Silva-Sanigorski AM, Bell AC, Kremer P, et al. Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program. Am J Clin Nutr 2010; 91:831.
  86. Baidal JA, Taveras EM. Childhood obesity: shifting the focus to early prevention. Arch Pediatr Adolesc Med 2012; 166:1179.
  87. Quattrin T, Roemmich JN, Paluch R, et al. Efficacy of family-based weight control program for preschool children in primary care. Pediatrics 2012; 130:660.
  88. Bocca G, Corpeleijn E, Stolk RP, Sauer PJ. Results of a multidisciplinary treatment program in 3-year-old to 5-year-old overweight or obese children: a randomized controlled clinical trial. Arch Pediatr Adolesc Med 2012; 166:1109.
  89. Danielsson P, Kowalski J, Ekblom Ö, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med 2012; 166:1103.
  90. Danielsson P, Svensson V, Kowalski J, et al. Importance of age for 3-year continuous behavioral obesity treatment success and dropout rate. Obes Facts 2012; 5:34.
  91. Davoli AM, Broccoli S, Bonvicini L, et al. Pediatrician-led motivational interviewing to treat overweight children: an RCT. Pediatrics 2013; 132:e1236.
  92. Brotman LM, Dawson-McClure S, Huang KY, et al. Early childhood family intervention and long-term obesity prevention among high-risk minority youth. Pediatrics 2012; 129:e621.
  93. McCallum Z, Wake M, Gerner B, et al. Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. Int J Obes (Lond) 2007; 31:630.
  94. Taveras EM, Gortmaker SL, Hohman KH, et al. Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Arch Pediatr Adolesc Med 2011; 165:714.
  95. Campbell KJ, Lioret S, McNaughton SA, et al. A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial. Pediatrics 2013; 131:652.
  96. McGuire S. Institute of Medicine (IOM) Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011. Adv Nutr 2012; 3:56.
  97. DeBar LL, Stevens VJ, Perrin N, et al. A primary care-based, multicomponent lifestyle intervention for overweight adolescent females. Pediatrics 2012; 129:e611.
  98. O'Connor EA, Evans CV, Burda BU, et al. Screening for Obesity and Intervention for Weight Management in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2017; 317:2427.
  99. Saelens BE, Sallis JF, Wilfley DE, et al. Behavioral weight control for overweight adolescents initiated in primary care. Obes Res 2002; 10:22.
  100. Sim LA, Lebow J, Wang Z, et al. Brief Primary Care Obesity Interventions: A Meta-analysis. Pediatrics 2016; 138.
  101. Ho M, Garnett SP, Baur L, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics 2012; 130:e1647.
  102. Centers for Disease Control and Prevention (CDC). CDC grand rounds: childhood obesity in the United States. MMWR Morb Mortal Wkly Rep 2011; 60:42.
  103. Gortmaker SL, Polacsek M, Letourneau L, et al. Evaluation of a primary care intervention on body mass index: the Maine Youth Overweight Collaborative. Child Obes 2015; 11:187.
  104. Rogers VW, Hart PH, Motyka E, et al. Impact of Let's Go! 5-2-1-0: a community-based, multisetting childhood obesity prevention program. J Pediatr Psychol 2013; 38:1010.
  105. Klein JD, Sesselberg TS, Johnson MS, et al. Adoption of body mass index guidelines for screening and counseling in pediatric practice. Pediatrics 2010; 125:265.
  106. Sesselberg TS, Klein JD, O'Connor KG, Johnson MS. Screening and counseling for childhood obesity: results from a national survey. J Am Board Fam Med 2010; 23:334.
  107. National Physical Activity Plan, 2016. Available at: http://www.physicalactivityplan.org/index.html (Accessed on May 06, 2016).