Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion.
Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion.
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DOI：
10.1210/jc.2007-2458
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发表时间：
2008-12
期刊：
影响因子：
--
通讯作者：
Endocrine Society
中科院分区：
文献类型：
--
作者：
August GP;Caprio S;Fennoy I;Freemark M;Kaufman FR;Lustig RH;Silverstein JH;Speiser PW;Styne DM;Montori VM;Endocrine Society
目的：我们的目标是制定治疗和预防儿童肥胖的实践指南。 结论：我们建议将超重定义为体重指数（BMI）至少在第85百分位数但<第95百分位数，肥胖定义为BMI至少在第95百分位数，而不是常规内分泌研究，除非身高增长速度减弱或不适合家庭背景或青春期阶段;如果有遗传综合征的证据，则将患者转诊给遗传学家;评估BMI至少在第85百分位数的儿童的肥胖相关合并症;并规定和支持强化生活方式（饮食，体力活动和行为）的改变作为任何治疗的先决条件。我们建议在以下情况下考虑药物治疗（结合生活方式改变）：1）肥胖儿童只有在强化生活方式改变的正式计划失败后; 2）超重儿童只有在强化生活方式改变后仍存在严重合并症的情况下，特别是有2型糖尿病或早发心血管疾病家族史的儿童。药物治疗只能由有使用减肥药经验并了解潜在不良反应的临床医生提供。我们建议对BMI高于50 kg/m2或BMI高于40 kg/m2且伴有严重合并症的青少年进行减肥手术，这些患者的生活方式改变和/或药物治疗均失败。手术的候选人及其家人必须心理稳定，能够坚持生活方式的改变。必须聘请经验丰富的外科医生和先进的多学科团队来评估手术的益处和风险。我们强调预防肥胖，建议母乳喂养婴儿至少6个月，并倡导学校为所有年级提供60分钟的中度至剧烈运动。我们建议临床医生通过对健康饮食和活动习惯的预期指导来教育儿童和家长，我们主张限制学校中不健康食品的选择，禁止向儿童宣传不健康食品选择的政策，以及社区重新设计，以最大限度地增加安全步行和骑自行车上学，体育活动和社区购物的机会。
Objective: Our objective was to formulate practice guidelines for the treatment and prevention of pediatric obesity. Conclusions: We recommend defining overweight as body mass index (BMI) in at least the 85th percentile but < the 95th percentile and obesity as BMI in at least the 95th percentile against routine endocrine studies unless the height velocity is attenuated or inappropriate for the family background or stage of puberty; referring patients to a geneticist if there is evidence of a genetic syndrome; evaluating for obesity-associated comorbidities in children with BMI in at least the 85th percentile; and prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment. We suggest that pharmacotherapy (in combination with lifestyle modification) be considered in: 1) obese children only after failure of a formal program of intensive lifestyle modification; and 2) overweight children only if severe comorbidities persist despite intensive lifestyle modification, particularly in children with a strong family history of type 2 diabetes or premature cardiovascular disease. Pharmacotherapy should be provided only by clinicians who are experienced in the use of antiobesity agents and aware of the potential for adverse reactions. We suggest bariatric surgery for adolescents with BMI above 50 kg/m2, or BMI above 40 kg/m2 with severe comorbidities in whom lifestyle modifications and/or pharmacotherapy have failed. Candidates for surgery and their families must be psychologically stable and capable of adhering to lifestyle modifications. Access to experienced surgeons and sophisticated multidisciplinary teams who assess the benefits and risks of surgery is obligatory. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. We suggest that clinicians educate children and parents through anticipatory guidance about healthy dietary and activity habits, and we advocate for restricting the availability of unhealthy food choices in schools, policies to ban advertising unhealthy food choices to children, and community redesign to maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.
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影响因子：
5.1
作者：
Adelman, RD;Restaino, IG;Blowey, DL
通讯作者：
Blowey, DL
DOI：
10.1002/j.1550-8528.1999.tb00701.x
发表时间：
1999-03-01
期刊：
OBESITY RESEARCH
影响因子：
--
作者：
Bray, GA;Blackburn, GL;Seaton, TB
通讯作者：
Seaton, TB
影响因子：
8
作者：
Barlow, SE;Dietz, WH
通讯作者：
Dietz, WH
影响因子：
--
作者：
Bertoli, A;Magnaterra, R;Bollea, MR
通讯作者：
Bollea, MR
影响因子：
158.5
作者：
Baker, Jennifer L.;Olsen, Lina W.;Sorensen, Thorkild I. A.
通讯作者：
Sorensen, Thorkild I. A.