Overweight Children and Adolescents: Recommendations to Screen, Assess and Manage

5. Management of Overweight Children and Adolescents

Strategies used in a management plan are based on information obtained from the assessment. Weight loss is recommended if complications such as hyperlipidemia or hypertension are identified, and for children 7 years or older with a BMI-for-age > 95th percentile. Otherwise, weight maintenance is recommended.

Recommendations for Weight Management

Infants and children up to age 2 years

Since infancy is a period of rapid growth and appropriate weight gain is important during infancy, weight loss is generally not recommended (Kleinman, 1998). However, health care providers may determine that follow up is appropriate in certain circumstances (e.g., delayed motor development due to excess body weight) and refer children younger than 2 years to a pediatric obesity center.

Children age 2 to 7 years

Weight maintenance
For those at risk of overweight or overweight with no identified complications, maintenance of current weight is recommended which can be achieved with changes in diet and activity. Promote healthy eating and increased physical activity and follow up with an annual screening. Prolonged maintenance will allow a gradual decline in BMI units (and BMI-for-age percentile) as children grow in height.

Weight loss
If complications are identified and BMI-for-age is > 95th percentile, gradual weight loss is recommended. Weight loss in children should be recommended with caution and should generally be no more than one pound per month.

Children age 7 years and older

Weight maintenance
For those at risk of overweight with no identified complications, weight maintenance is recommended.

Weight loss
For those overweight and those at risk of overweight with complications, weight loss is indicated. In older children and adolescents who are markedly overweight i.e., a BMI > 35, and whose health risks are acute, 1 to 2 pounds per week may be warranted. An appropriate final goal for all children and adolescents who are overweight or at risk of overweight is a BMI-for-age below the 85th percentile. The rate of weight loss should be based on health risks and balancing the costs and benefits of loss versus those risks.

Recommendations for weight management for
children and adolescents 2-20 years old

Graphic showing Weight Loss for children 2 to 7 years with BMI greater than or equal to 95th percentile and with complications; Weight Loss also for children 7 years or older with BMI 85th - 94th percentile with complications and BMI greater than or equal to 95th percentile; otherwise, Weight Maintenance.