Abstract
It is the position of the Academy of Nutrition and Dietetics that prevention and treatment
of pediatric overweight and obesity require systems-level approaches that include
the skills of registered dietitians, as well as consistent and integrated messages
and environmental support across all sectors of society to achieve sustained dietary
and physical-activity behavior change. This position paper provides guidance and recommendations
for levels of intervention targeting overweight and obesity prevention and treatment
from preschool age through adolescence. Methods included a review of the literature
from 2009 to April 2012, including the Academy's 2009 evidence analysis school-based
reviews. Multicomponent interventions show the greatest impact for primary prevention;
thus, early childhood and school-based interventions should integrate behavioral and
environmental approaches that focus on dietary intake and physical activity using
a systems-level approach targeting the multilevel structure of the socioecological
model as well as interactions and relationships between levels. Secondary prevention
and tertiary prevention/treatment should emphasize sustained family-based, developmentally
appropriate approaches that include nutrition education, dietary counseling, parenting
skills, behavioral strategies, and physical-activity promotion. For obese youth with
concomitant serious comorbidities, structured dietary approaches and pharmacologic
agents should be considered, and weight-loss surgery can be considered for severely
obese adolescents. Policy and environmental interventions are recommended as feasible
and sustainable ways to support healthful lifestyles for children and families. The
Academy supports commitment of resources for interventions, policies, and research
that promote healthful eating and physical-activity behaviors to ensure that all youth
have the opportunity to achieve and maintain a weight that is optimal for health.
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Article info
Publication history
Published online: September 20, 2013
Footnotes
This Academy of Nutrition and Dietetics position was adopted by the House of Delegates Leadership Team on December 22, 2006 and reaffirmed on July 7, 2009. This position is in effect until December 31, 2017. Requests to use portions of the position or republish in its entirety must be directed to the Academy at [email protected]
Authors: Deanna M. Hoelscher, PhD, RD, LD, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX; Shelley Kirk, PhD, RD, LD, Center for Better Health and Nutrition/HealthWorks!, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Lorrene Ritchie, PhD, RD, Atkins Center for Weight and Health, University of California, Berkeley, CA; Leslie Cunningham-Sabo, PhD, RD, Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.
Reviewers: Mary Beth Arensberg, PhD, RD, LD, FADA (Abbott Nutrition Products Division, Columbus, OH); Jeanne Blankenship, MS, RD (Academy Policy Initiatives & Advocacy, Washington, DC); Academy Quality Management Committee (Terry Brown, MBA, MPH, RD, LD, CNSC, Medical City Hospital, Dallas, TX); Sharon Denny, MS, RD (Academy Knowledge Center, Chicago, IL); Public Health Community Nutrition dietetic practice group (Nicole Larson, PhD, MPH, RD, University of Minnesota, Minneapolis, MN); School Nutrition Services dietetic practice group (The University of Mississippi, Oxford, MS); Melissa Pflugh Prescott, MS, RD, CDN (Nutrition Consultant, New York, NY); Katryn Soltanmorad, RD (Tahoe Truckee Unified School District, Truckee, California); Alison Steiber, PhD, RD (Academy Research & Strategic Business Development, Chicago, IL); Weight Management dietetic practice group (Samantha Weiss, MPH, RD, LD, ARAMARK, Round Rock, TX); Pediatric Nutrition dietetic practice group (Tsun-Min “Mimi” Wu, MS, RD, New York City Department of Health and Mental Hygiene, New York, NY).
Academy Positions Committee Workgroup: Aida Miles, MMSc, RD, LD (chair); Karen P. Lacey, MS, RD, CD; Nancy Cooperman, MS, RD, CDN (content advisor).
Assistance in formatting and referencing provided by Whitney E. Chlon; Christina Ly, MPH; Tiffni E. Menendez, MPH, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin, TX.
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© 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
