Primary prevention
Preventing childhood obesity is of paramount importance in controlling the obesity epidemic. Preventive strategies must begin early in life, as obesity is difficult to treat at all ages, and obesity tends to persist into adulthood.[39][50]
Breastfeeding has been shown to be associated with a lower incidence of obesity in childhood.[51] However, the data are inconsistent, with other studies showing no obvious effect.[52] Promotion of breastfeeding is still recommended based on other health benefits.
The American Academy of Pediatrics' recommendation to avoid offering juice to infants ages 6 months and under has been expanded to include infants ages 12 months and under, as juice offers infants no nutritional benefits and can predispose to inappropriate weight gain. Consumption should be limited to 170 mL (6 ounces) per day for children ages 4 to 6 years, and 230 mL (8 ounces) per day for children ages 7 to 18 years.[53]
Meta-analysis of 153 randomized controlled trials reported that combined dietary and physical activity interventions appear to reduce the risk of obesity in children ages 0 to 5 years.[54] Physical activity interventions reduce the risk of obesity in children ages 6 to 18 years. Combined dietary and physical activity interventions may be effective in children ages 6 to 18 years. Dietary interventions alone do not appear to be effective in this age group. The authors detected heterogeneity between the trial results that could not be fully explained by the setting or duration of the intervention.[54]
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Labeling food with physical activity calorie equivalents has been shown to decrease calorie consumption.[55] This approach could benefit older children and adolescents who are making independent food choices outside the home.
Schools need to offer healthy food choices, and children should have daily physical education. In addition, fun and safe places to exercise should be provided in the community.
Advertising of fast foods and energy-dense foods directly to children should be restricted.
Prospective cohort studies of mother-child pairs in the US showed that adherence to a healthy lifestyle (including healthy body mass index [BMI], high-quality diet, regular exercise, no smoking, and limited alcohol intake) by mothers during their offspring's childhood and adolescence is associated with a substantially reduced risk of obesity in the children.[56] These findings highlight the potential benefits of multifactorial interventions in the family to reduce the risk of childhood obesity.[56]
A child's BMI should be calculated and plotted at least annually to identify those children with overweight or obesity, or who may be at risk for obesity, and the child's dietary history and physical activity history should be reviewed during routine well-child visits. Family history of obesity and the child's BMI trajectory should also be assessed. Anticipatory guidance encouraging healthy behaviors to decrease obesity risk should be provided routinely to all children, regardless of current BMI.[3]
Secondary prevention
Discussion of healthy nutrition and physical activity for children should be part of the anticipatory guidance given at all well-child visits.
Public health strategies need to be further developed to promote healthy lifestyle choices for children in the schools, with extension to the community.[164][165] School- and community-based physical activity interventions, as part of an obesity prevention or treatment program, can improve executive functions of children with obesity or overweight specifically. Dietary strategies in school may also benefit general school achievement in children with obesity. These findings may be used to influence public policy.[166] However, one Cochrane systematic review found low evidence that school‐based interventions may improve physical fitness but may have little to no impact on body mass index.[167]
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