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.
Printed on recycled paper
9/2013