Pediatric Obesity Resources

For Clinicians:

  • Pediatric Obesity Algorithm®
    The Pediatric Obesity Algorithm was developed by practicing pediatricians and clinicians who treat obesity in infants, children, and adolescents. It combines scientific evidence, medical literature, and clinical experience into one document to educate clinicians and help them implement evidence-based practices. Clinicians can use the Pediatric Obesity Algorithm as a resource when making treatment recommendations or when referring their patients to childhood obesity specialists.

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  • Pediatric Obesity Medicine Office Forms

    The Pediatric Obesity Medicine Office Forms provide outlines for common forms used in a pediatric obesity clinic, including questionnaires and screeners. Clinicians can personalize these forms to any practice and use them to evaluate a pediatric patient with obesity. 

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  • Obesity Algorithm®

    The Obesity Algorithm® is a clinical tool to help health care providers both understand the complexity of the disease of obesity and implement effective, evidence-based obesity treatment strategies with their patients.

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  • Growth Charts for Children Ages 0-2 Years (WHO and CDC)

    Body mass index (BMI) is not used to measure obesity in children until age 2. Prior to age 2, growth charts from the World Health Organization (WHO) and Centers for Disease Control (CDC) provide information on how to assess obesity.

    View the WHO growth charts

    View the CDC growth charts

  • AAP's Institute for Healthy Childhood Weight

    The Institute for Healthy Childhood Weight serves as a translational engine for pediatric obesity prevention, assessment, management, and treatment, and moves policy and research from theory into practice in American healthcare, communities, and homes.

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  • Childhood Obesity Research Demonstration Project

    CORD (Childhood Obesity Research Demonstration) project is a CDC-funded project to look at different community-based levels of intervention in Texas, Massachusetts, and California. Provides references and outcomes discussions from the studies.

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  • Team Nutrition

    USDA resource for wellness advocacy in schools and resources for families.

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  • Center for Healthy Weight and Nutrition

    The Center for Healthy Weight and Nutrition has developed several tools intended to provide primary care physicians with practical guidance on the approach to the child with obesity.

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  • Rudd Center for Food Policy and Obesity

    Rudd Center for Food Policy & Obesity has great pediatric information, sensitive pictures, guidelines for media, etc. In addition, there are full text articles available for any manuscripts that the Center’s researchers produce, which is very helpful for those without access to an academic library.

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  • Parenting at Mealtime and Playtime Learning Collaborative

    The Parenting at Mealtime and Playtime (PMP) Learning Collaborative offers resources to pediatric practices to help counsel families of infants and young children (ages birth to 5 years) about good nutrition and positive parent-child interactions during mealtime and playtime. This quality improvement program provides tools for physicians to enhance prevention counseling strategies, become adept at assessing “risk,” and intervene at the earliest possible stage before a child develops overweight or obesity.

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  • CHAMPS Overweight and Obesity Treatment and Prevention Resources

    Site provided as a resource for community health centers in western regions with a list of provider and family resources for obesity treatment and prevention.

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  • Healthy Active Living for Families

    The Healthy Active Living for Families (HALF): Right from the Start program is a project developed by the American Academy of Pediatrics to address early childhood obesity prevention that integrates the parent perspective and evidence-informed pediatric health guidance.

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  • National Institutes of Health We Can!® Campaign

    Resource for providers with templates for talking with patients about obesity and prevention, as well as handouts, posters, and other resources.

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  • Childhood Overweight Fact Sheet

    The Obesity Society’s fact sheet on obesity in pediatrics.

  • ChopChop for Doctors

    ChopChop is a quarterly cooking magazine and website for kids and their families. The print edition is given out by doctors to children and their parents as part of pediatric visits to promote healthy eating and cooking together. Available in English and Spanish.

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  • The Dr. Yum Project

    In response to the growing rates of childhood obesity, pediatrician Nimali Fernando MD, MPH, started doctoryum.org in 2011 to teach her patients and her families about the benefits of healthy eating. What started out as a recipe and parenting site grew to a bigger project of teaching a healthy lifestyle to the greater community. In 2012, The Dr. Yum Project, a 501 (c)3 organization, was born.

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  • Focus on a Fitter Future: A Survival Guide for Planning, Building, and Sustaining a Pediatric Obesity Program

    Provided by the Children’s Hospital Association as a template for developing an obesity program.

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  • Children's Healthcare of Atlanta

    The provider page of Children’s Healthcare of Atlanta is a great resource for a wide range of obesity interventions with provider and patient resources.

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  • Nutrition, Physical Activity, and Obesity: Data, Trends, and Maps

    Keep up to date with nutrition, physical activity, and obesity data. CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) has made important updates to the Data, Trends and Maps database.

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  • Alliance for a Healthier Generation

    The Alliance for a Healthier Generation and Voices for Healthy Kids are working to elevate the importance of strong wellness policies in schools. The #WellnessWins campaign celebrates district wellness success and inspires everyone to create healthier school environments grounded in strong wellness policies. School leaders, community members, and parents can visit WellnessWins.org to download resources, read success stories, and learn how to support and advance school wellness policies.

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  • Join POWER – Enrollment Open

    Enrollment
    Enrollment is now open for POWER, the Pediatric Obesity Weight Evaluation Registry – Cycle 4 (July 1, 2020 – June 30, 2022).

    POWER is a consortium of hospital-based multi-component pediatric weight management (PWM) programs across the country that collect demographic and clinical data to submit to a centralized data repository. Multi-component PWM programs include medical, nutrition, physical activity and behavioral strategies for the treatment of youth with obesity. POWER enables collaborations to pursue research initiatives that access the aggregate POWER data set. Participating sites also have opportunities to share best practices among members through monthly interactive webinars and the POWER News Update.

    Goals for POWER are:

    1) Establish a national registry of treatment-seeking children and adolescents with obesity – this registry serves as a resource to promote high quality research as it relates to the evaluation and management of youth with obesity. As of 12/31/2019, there are 13,208 patients enrolled in POWER.

    2) Improve patient care – advance evidence-based guidelines for the management of pediatric obesity; help to standardize and improve quality of care for youth with obesity and their families in the United States.

    3) Promote collaborative research – conduct quality improvement projects and multi-center clinical trials to test innovative and promising treatment options for youth with obesity.

    Currently POWER is led by Principal Investigator, Shelley Kirk, PhD, RD, LD, at Cincinnati Children’s Hospital Medical Center. POWER has established a governance structure that determines goals, policies and procedures for POWER, including research initiatives that involve access and use of the aggregate POWER data set. To enroll in POWER, each site submits a fully-executed POWER Data Use Agreement, obtains IRB approval at their site to recruit patients for participation in POWER, and submits the $5,000 enrollment fee. These enrollment fees support POWER’s Data Coordinating Center, which is led by Eileen King, PhD and located at Cincinnati Children’s Hospital Medical Center. These fees also cover POWER’s administrative support services.

    If interested, we now offer an online Intent to Enroll form you can access on our POWER website https://www.powerregistry.org/enroll. Our new POWER website also includes a number of updates about POWER and more information about the enrollment process.

    Please send any questions about enrollment to power@cchmc.org

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For Families:

Pediatric Obesity Research Update – December Review

Each month, the pediatric committee posts a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update was written by Marcella House, MD, FAAP.

Longitudinal associations between facets of sleep and adiposity in youth

Slaght JL, Wicklow BA, Dart AB, et al. Physical activity and cardiometabolic health in adolescents with type 2 diabetes: a LeMay-Russell, S, Schvey, NA, Kelly, NR, et al. Longitudinal associations between facets of sleep and adiposity in youth. Obesity (Silver Spring). 2021; 29: 1760– 1769. https://onlinelibrary.wiley.com/doi/10.1002/oby.23281

Shorter sleep duration has been associated with increased risk for higher BMI, overweight and obesity in youth, but the relationship between sleep duration and obesity is still poorly understood. Studies have attempted to demonstrate that restricting sleep is associated with increased energy intake, poorer diet quality and changes in physical activity and sedentary behaviors, but results have been inconsistent and many limited by self- and parent reported sleep patterns. The intent of this study was to utilize objective measures to examine other facets of sleep besides duration in order to better understand the relationship between sleep and weight.

Methods

Participants 8-17 years of age who were in good health were recruited from the greater Washington DC area and communities near Bethesda, MD. Youth were eligible if they had the cognitive ability of completing study procedures and had a BMI > 5th percentile.

Participants were seen for a preliminary visit where fasting body weight, height, body composition and percentage of fat mass (calculated from dual-energy x-ray absorption (DEXA) scan), medical histories, physical exam, pubertal staging, and screening for depression and socioeconomic status was obtained.

Wrist-worn actigraphy measured sleep behavior of participants for 14 days following their preliminary visit. Participants were required to have data for three or more weekday nights of sleep and one or more weekend nights of sleep. Sleep periods were confirmed by cross-referencing self-reported sleep logs from participants.

Actigraphy was used to collect a variety of facets of sleep including bedtime, waketime, average weekly sleep duration (hrs/night for 7 days) and weekend catch-up sleep (calculated by subtracting average hours per night of weekday (Sunday-Thursday) from average hours per night of weekend (Friday/Saturday) sleep). Within-person sleep duration variability was calculated as the intrasubject standard deviation of average sleep duration across the 14 days. Bedtime shift was calculated by determining the difference between average weekday sleep onset time and average weekend sleep onset time. Wake time shift was calculated by determining the difference between the average weekday and average weekend wake time. Sleep midpoint was calculated as the halfway point between sleep onset and wake time. Social jet lag was calculated as the difference between the mean sleep midpoint during weekdays and weekend days.

Participants returned one year later to repeat anthropometric measurements, body composition and physical examination. All data was collected prior to the COVID-19 pandemic.

Results

Data were collected from 137 youths with a mean age of 12.5 years. Fifty-four percent of participants were female, 28.4% were Non-Hispanic Black or African American, 28.5 % had overweight or obesity at baseline as measured at the preliminary visit. A mean baseline fat mass of 15.3 kg with a standard deviation of 8.9 and a mean 1-yr fat mass of 17 kg
with a standard deviation of 10 at follow-up were obtained from the 137 participants.

Average weekly sleep duration was 7.2 hrs per night (SD of 1.1hrs), weekend catch-up sleep was 0.3 hrs per night (SD of 1.0 hrs), within-person sleep duration variability was 1.2 hrs (SD 0.5 hrs), Bedtime shift was 0.9 hrs (SD 0.7), wake time shift was 1.3 hrs (SD 1.1), social jet lag was 1.1 (SD 1.0). Average bedtime was 11:31pm (SD 1.3) and average wake time was 7:53am (SD 1.1). Sleep midpoint was 3:46am (SD 1.1)

After analysis, no facet of sleep variability (weekend catch-up sleep, within-person sleep duration variability, bedtime shift, wake time shift, social jet lag) or actual bedtime was significantly associated with 1-year fat mass. Interestingly, wake time and sleep midpoint were both inversely associated with 1-year fat mass, meaning participants with earlier wake times and earlier sleep midpoints were more likely to have increased fat mass after 1 year (wake time p value = 0.03, sleep midpoint p value = 0.02).

Discussion

This study’s strengths were that it used objective measurements for sleep and adiposity with actigraphy and DEXA respectively. It was limited by a small sample size and a lack of consistency in the timing of data collection (participation occurred over various seasons, some participating during school and some during summer break).

Participants in this study had relatively short average weekly sleep duration with little variability (7.2 hrs with SD of 1.1hrs) and little variability in the other facets of sleep. This lack of variability combined with a small sample size and a wide range of ages could account for the many facets of sleep with null findings. The authors also point out that there is more evidence supporting an association between shorter sleep duration and increased weight in younger children, ages 0-5 than in the 8-17yr old population studied.

Additionally, since the social jet lag (absolute difference between the mean sleep midpoint during weekdays and midpoint of sleep on weekend days) was only 1.1 (SD 1.0) it may not have been a large enough difference to represent a true circadian rhythm misalignment. Other studies have demonstrated an association with larger shifts in sleep (2 hrs or more) and weight gain.

Further research should examine sleep timing using similar objective measures but on a larger, more varied population, over a longer period of time and with observation of more variations in sleep patterns (throughout the school year and summer break).

Additionally, future research should evaluate the application of this knowledge in the clinical setting and measure the effects of sleep questionnaires and recommendations on sleep behavior and weight to determine best practices.

Research should also take a deeper dive into earlier wake times to evaluate for contributing factors like lower socioeconomic status, home environment, screen time, chronic stress, or depression. For example, a child may need to wake up earlier due to lack of transportation (taking multiple buses), food insecurity (trying to get to school for a free breakfast program), or needing to help parents in caring for siblings.

Lastly, since the results suggest that earlier wake times and sleep midpoints are associated with greater weight gain over time, this study along with others may be useful in advocating for obesity prevention policy initiatives that delay school start times for youth.