Obesity Prevention and Screening

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Key points

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    Screen for weight status at every primary care visit. Screening tools vary by age.

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    Communicate appropriately and effectively with patients to maximize the success of prevention efforts. Motivational interviewing promotes patient willingness to engage in behavioral change.

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    Prevention recommendations vary by age and stage of development, and cultural context is critical. Core behaviors include dietary intake, physical activity, and sleep.

Screening and prevention

The lack of broadly effective treatments for obesity10 highlights the importance of efficacious screening and prevention.11, 12 From a population health perspective, everyone should be screened for obesity and obesity risk, and targeted prevention applied. The risk for becoming obese is present across at all ages. However, prevention targets differ by age group and cultural context so this must also be taken into account. Primary care practices should be aware of contextual considerations by

Infants (birth–12 months), toddlers (1–3 years), and preschoolers (3–5 years)

There is a unique opportunity for obesity prevention at very young ages.13 The first 4 to 6 months of life (when birth weight typically doubles) can set the foundation for future weight trajectories. Infants who have excess fat at birth or who rapidly gain weight in the first 6 months of life are at risk for adult obesity.14, 15, 16 Interventions to promote appropriate weight gain during the first 6 months of life have a substantial impact on future weight trajectories.

The toddler and preschool

School-aged children (ages 5–12 years)

During the school years, parents continue to influence food intake, sleep, and physical activity. Importantly, ages 5 to 6 years is typically the period of adiposity rebound. Visually reflected on youth growth charts, the adiposity rebound is a (normal) increase in BMI that occurs after BMI has decreased in the first years of life.33 Early adiposity rebound (before 5.5 years of age) confers a higher risk for adult obesity than later obesity rebound (after 7 years of age).33

Adolescents (ages 13–18 years)

Adolescence, around the time of puberty, is a risk period for excessive weight gain. The hormonal and physical changes of puberty often lead to changes in body composition36 and eating behaviors.37 These changes also heighten genetic risk for disordered eating.38 Adolescence is a time when youth are developing autonomy from their parents.39 This autonomy likely includes more independence in food choices and ad libitum consumption. Adolescents have lower abilities to self-regulate caloric intake

Adults

Although obesity is often an established health condition for adults, there are several at-risk time periods for developing obesity. In particular, the perinatal period,44, 45 the initiation of some psychiatric medications, traumatic life events, or the onset of depression with associated development of maladaptive eating behaviors46 are periods in which individuals are at particular risk for developing obesity as adults.

Special populations: autistic spectrum disorder and mild traumatic brain injury

The pediatric special needs population, including children with autistic spectrum disorder (ASD), is especially prone to obesity51, 52 because of a tendency to inactivity and difficulty with participating in structured physical activities,53 rigid preferences for certain foods and textures,54 and medication effects.55 There seems to be a particular propensity for obesity in children with ASD,56 among whom up to 25% of children are overweight or obese.51 Among behaviorally challenged children

Cultural considerations

The percentage and distribution of adiposity for a given BMI varies by race and ethnicity.70 BMI therefore should not be used as a universal proxy for adiposity. Screens for obesity should include additional measures, such as body fat percentage, waist circumference, and indicators of the metabolic syndrome. In addition, behavioral screening tools should be culturally appropriate when assessing mood, body image, and eating behaviors in diverse groups.71 If culturally specific measurements are

Summary

Obesity prevention across the lifespan is vital. Each developmental period provides unique challenges and opportunities to improve health. Primary care providers have a critical role in screening, conveying important information to families, and providing tools for prevention. This relationship between provider and patient should be based on trust and have good lines of culturally appropriate communication. There are many resources available for patients and families who are trying to improve

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    Disclosures: The authors have no commercial or financial conflicts of interest or any funding sources to disclose.

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