Pediatric algorithm for children at risk for obesity NUTRITION, PHYSICAL ACTIVITY, AND SCREEN TIME Integrating nutrition, physical activity, and screen time messages into the clinic visit is important for children at risk for obesity. A few brief sentences can educate and help motivate families to make behavioral changes that could prevent the progression of weight gain. ASSESSMENT Providers should ask about what children typically eat and drink and about their daily activity. Note unhealthy choices like large portions, fast food, and sugar-sweetened drinks. Also note time allotted to sedentary behavior, including television viewing and using computers and electronic games. Discuss opportunities for physical activity at home, at school, and in after-school programs. Office of Statewide Health Improvement Initiatives www.health.state.mn.us/divs/oshii
TALKING POINTS The following are talking points clinicians can deliver that support CDC s healthy eating and active living objectives. MESSAGE TO PHYSICIANS Family physicians have a role in promoting preventive measures and identifying and treating obesity-related comorbidity. Pediatric obesity is not an individual child s problem, but a problem that involves the whole family and even the community. Recommending a healthy diet and increased physical activity, and counseling families on behavior change, are important approaches to preventing and managing childhood obesity. MORE INFORMATION Report and Treatment of Child and Adolescent Overweight and Obesity: Summary Expert Committee Recommendations Regarding the Prevention, Assessment Sarah E. Barlow, Pediatrics 2007;120;S164, SOURCES Barlow SE and the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120 supplement December 2007:S164 S192. Pediatric Algorithm for Children at Risk for Obesity Office of Statewide Health Improvement Initiatives PO Box 64882 St. Paul, MN 55164-0882 9/2013
Child BMI Healthy weight BMI<84% Overweight 85%-94% Obese BMI>95% Note in chart Assess behavior risk Family history Blood pressure Total cholesterol Lg change in BMI Wt Concern In-depth medical assessment Initiate stage treatment Negative Positive Promote healthy lifestyle to families Nutrition messages Physical activity messages Screen time messages
5 Fruits and veggies The goal: Five servings of fruits and veggies Messages for parents: Make half your plate fruits and veggies. More matters. You and your children should eat as many fruits and vegetables as you want. It doesn t matter if they are canned, fresh, frozen or dried. Eat a rainbow. Kids need to eat five colors every day to keep their bodies healthy. Different colored fruits and vegetables have different nutritional values and they are all important. Introduce a No Thank You bite. Introducing new fruits and vegetables is hard. Have the whole family decide on and prepare a different fruit or vegetable at least once a week to try. It s OK for family members to say, No thank you. New foods may be offered again and again before they are actually eaten.
2 TV/screen time The goal: Two hours or less of recreational screen time Messages for parents: Pull the plug. Get out of the habit of leaving the TV on. Unless you are watching a show, pull the plug. It leaves more time for play. Keep TVs out of bedrooms. Don t put a TV or computer in your child's bedroom. Kids who have TVs in their room watch about 1.5 hours more TV a day than those that don t. Plus, it keeps them in their room instead of spending time with the rest of the family. Learn to eat screen-free. Having the TV on during mealtime means it s harder for your family to talk with each other. People who eat in front of a screen pay less attention to what they re eating and often overeat.
1 Physical activity The goal: One hour or more of physical activity Messages for parents: Get toys for active play. Give children toys that encourage activity like balls, kites, Frisbees and jump ropes. Think outside the gym. Kids are naturally active when they are playing. Give them time and space for games like tag, kickball and hopscotch. Walk or bike when you can. Children who walk or bike to school are more active. Choose to walk when you can to the library, a park or the grocery store.
0 Drinks The goal: Zero sugary drinks, more water and low-fat milk Messages for parents: Pop is candy. Most canned soft drinks have the same amount of sugar in one can as a sixinch candy bar. Limit Juice and Sports Drinks. Fruit juice drinks and sports drinks contain mostly high-fructose corn syrup. They have a lot of empty calories, sugar and little or no nutrition. Water and Milk are Best. Water is always the best choice, even for exercise. Always serve low-fat milk at meals.
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