Wellness Hub

For children with overweight or obesity, the American Academy of Pediatrics recommends early treatment with the maximum intensity that is appropriate and available to the child, rather than a “wait‑and‑see” approach.

In the United States, almost one in every five children and adolescents has obesity.

In Latin America and the Caribbean, some 4 million children under the age of five have obesity, and that figure is even higher among adolescents. Because of this public health crisis, children are starting to be diagnosed with diseases that usually appear much later in life.

In practice, this new guideline recommends adapting the intensity of the treatment to each child and family according to the level of concern (obesity severity and body mass index [BMI] trend), the family’s priorities, and available local resources.

The following are excerpts from the study, edited for space and clarity.

Firstly, the guideline stresses that there is no “one‑size‑fits‑all” option for treating severe or progressively worsening obesity. Specialized childhood weight control medical programs are useful, but when these programs are not feasible or available, a primary care center can offer appropriate services by using community resources with an interdisciplinary approach, including:

Care by a nutritionist or behavioral specialist
Food assistance programs
Sports or recreational initiatives that promote physical activity

Primary care professionals play a key role in childhood obesity management, including prevention, diagnosis, monitoring, lifestyle change implementation, and family support with all appropriate treatment options that are available for the child.

The guidance on the approach is clear:

Counseling about weight and habits should be supportive, without blaming the child or the child's family.
The strategy should be collaborative, not prescriptive, and centered on long‑term behavioral change rather than imposing restrictive diets and short‑term exercise prescriptions.
And it should involve the entire family, rather than focusing only on the child.

Talking about weight

Researchers say that many families with children who have overweight or obesity are hesitant to talk about it. There is a stigma, even among health professionals. This causes the family to feel shame and affects the child and their self‑esteem, all obstacles to achieving behavioral change.

Narratives are essential to avoiding the blame game. Using understanding language, the clinician should show the child and family that their office is a place of support, not judgment, which is key to their positive involvement in lifestyle changes.

For example:

Begin the talk on weight control by acknowledging that some people gain weight more easily than others and recognizing the role of genetics, physiology, and environment. Due to a biological component, some bodies are “programmed” to be larger than others. Additionally, acknowledge the social and environmental factors that promote weight gain, such as ease of access to energy‑rich foods and motorized transport. These messages avoid blaming the patient or their family for the child’s obesity while encouraging them to invest in lifestyle change.
In general, it is better to use neutral terms like “overweight” or “body mass index” because these terms are perceived as less stigmatizing.

It is also important to emphasize that the main goal of the changes is not to change society’s view of the child, but to improve the child's health and functionality and prevent future conditions.

This narrative should be the core of every conversation and every physical exam, BMI measurement, and weight assessment of family members in the child’s household, which may reveal nutritional factors that need to be modified.

A roadmap

The following approaches, known collectively as intensive health behavior and lifestyle treatment, help children and families navigate the process of healthy weight loss that they can maintain for life:

Nutritional education and support for establishing healthy, sustainable dietary and nutritional habits
Physical activity education and support to make exercise part of the child’s daily life
Non‑stigmatizing behavioral change strategies that improve and maintain self‑efficacy and self‑esteem
Family participation in the program and focus on the household, not just the patient, for healthy changes
Intensive interventions, so called because they generally require at least 26 hours of face‑to‑face contact over 3 to 12 months to achieve the desired effect.

Comprehensive programs that offer all these approaches are sometimes unavailable and may be unaffordable. With a clear, evidence‑based endorsement in the American Academy of Pediatrics’ Clinical Practice Guideline, programs like these could become more accessible and affordable.

Primary care physicians should play a key role: they are the health professionals who initiate the talk on which lifestyle changes will be important for the child. If there are time constraints, counseling sessions can be brief and use pre‑printed handouts to educate the child and family members.

In some cases, a health professional from that or another medical team can provide all or part of the counseling. Implementation of these interventions at primary care visits can be facilitated through the use of a standardized curriculum and written, plain‑language training materials.

This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in links throughout the article.

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