Screening Overweight

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Now that we have an accepted standardized screening tool for identifying overweight and risk of overweight in children, it is important that all infants and children be evaluated for their weight status by their primary care physician. As mentioned previously, Figure 1 gives recommendations for weight goals and referrals to pediatric obesity centers recommended by the Expert Committee on Pediatric Obesity (37).

The evidence that childhood overweight increases the risk ofcomorbidity in both childhood and in adulthood emphasizes the need to identify overweight children with other risk factors as early as possible. The Expert Committee (37) also recommends that all children and adolescents with a BMI >85th centile be screened for complications, evaluated, and possibly treated, depending on the findings. The complications that should be sought include hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gallbladder disease, and insulin resistance. In addition, a recent large change in a child's BMI should also be evaluated. The Expert Committee emphasized that clinicians should also seek signs of exogenous obesity such as genetic syndromes, endocrinologic disease, and psychologic disorders. In addition to screening, the committee advocated that an in-depth medical assessment be done for all children and adolescents with a BMI >95th centile.

This committee also recommended early treatment that involved the family as much as possible. The family's readiness to make changes in diet and lifestyle should determine the pace and intensity of treatment. The family's ability to take responsibility for the lifestyle changes is key to progress and success.

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