Pediatricians Told to Become Proactive in Children's Battle of the Bulge

Only 20 percent of overweight children and 50 percent of obese children are being identified by doctors, nurses and parents.

The Israel Ambulatory Pediatric Association has formulated the first-ever guidelines in Israel to treat overweight children and teens, placing pediatricians at the front lines of the battle against childhood obesity.

The recommendations are to be presented today at a conference on obesity with pediatricians, family physicians and clinical dietitians to be held at the Wingate Institute near Netanya.

fat - Amos Biderman - January 21 2010
Amos Biderman

"Pediatricians are the most common medical authority families encounter, and together with their other obligations to treat childhood illnesses, they should also deal with overweight and obesity," said Dr. Zachi Grossman, secretary general of the pediatrics group and chairman of the committee that wrote the guidelines.

According to a Health Ministry Survey from 2004, 20 percent of teenage boys and 17 percent of teenage girls are overweight. Of this number, 5.7 percent are chronically obese.

A child is defined as overweight when his or her body mass index (weight in kilograms divided by the square of the height in meters ), is equal or greater than the 85th percentile of the age and gender of the child. Obesity is defined as a BMI greater or equal to the 95th percentile.

The guidelines state that it is the physician's duty to weigh children and measure their height at least once every two years beginning in kindergarten.

"Research over the past few years has shown that doctors, nurses and parents have difficulty identifying overweight and obese children, and do so only in 20 percent of overweight children and in 50 percent of obese children. Only weighing will allow precise identification of these phenomena," said Dr. Gal Dubnov-Raz of Safra Children's Hospital at Sheba Medical Center, who helped draw up the guidelines.

Grossman says doctors should weigh children during a regular checkup, although on the average the doctor spends only 10 minutes with each patient. Grossman said they were working on explanatory aids that doctors could use so they would not have to personally take time to lecture young patients and their parents on the damage of obesity.

The committee, consisting of family physicians and pediatricians and HMO and hospital doctors dealing with obesity, took 18 months to produce the guidelines. They hope their recommendations will lead to a change in the way parents look at the fight against obesity, beginning in early childhood.

"While there is not enough research about the influence of nutrition in early childhood on obesity, we want to prevent the idea that it is not important what babies eat as long as they thrive and don't look too thin," Grossman said.

Parents should not give their infants too much solid food, and get them used to drinking water instead of sweetened juices, Grossman said. They should also expose them to stimuli that keep them moving rather than staring at the television, he added.

The new guidelines even talk about preventing obesity before birth. It has been proven that pregnant mothers' nutrition affects babies later, so expectant mothers should avoid fatty foods, Dubnov-Raz said.

After a child is diagnosed as overweight or obese, the guidelines recommend the physician remain involved in that aspect of a child's care, referring children to community centers for physical activities that will help them shed pounds.

"The recommendations for overweight or obese children are the same as for all children - at least 60 minutes a day of physical activity from a young age," Dubnov-Raz said.

Doctors should pay special attention to obese or overweight children with a family history of diabetes or heart disease at a young age, in which case treatment should be more aggressive because of increased risk.

In extreme cases, doctors should refer patients to counselling prior to gastric bypass surgery. In October 2009, the Health Ministry issued guidelines for this type of surgery in children over 13.

The Israeli guidelines for treating overweight and obese children stress children's mental health, an aspect missing from other Western countries' approaches. Doctors are encouraged to seek psychological causes for overweight and obesity in their patients, such as depression or social isolation, and if these are present, to refer them to specialists.

Doctors should also be on the lookout for symptoms of eating disorders during a weight-loss program and make sure it is carried out in a "good atmosphere" Dubnov-Raz said.

Teamwork is another aspect of the recommendations, among doctors, dietitians and relevant government agencies as well as schools and the food industry, restaurants and fitness clubs.

"That's the only way the fight will be effective," Dubnov-Raz said.