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INTRODUCTION

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  • What are the epidemiologic trends in childhood obesity?

  • What demographic factors are associated with childhood obesity? Which children are in the high-risk groups?

  • How can I help families understand the steps they can take to reduce pregnancy-related risk factors for childhood obesity?

  • What are effective ways to screen for obesity and to communicate about the screening?

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This chapter will address the following American College of Graduate Medical Education competencies: patient care, medical knowledge, and interpersonal and communication skills.

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Patient Care: This chapter will enable pediatric health care providers to help families understand the risk of obesity in their child and work to optimize healthy family lifestyle behaviors and environments, allowing mothers to modify the risk of obesity in their subsequent pregnancies as well.

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Medical Knowledge: This chapter will help pediatric health care providers improve their assessment of individual risk in light of the population risk factors and population risk of their practice.

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Interpersonal and Communication Skills: Understanding the value of communicating body mass index (BMI) screening results, framing recommendations in a health context, and relaying ways to reduce barriers to screening and communication are core skills that this chapter will review so that pediatric health care providers can help families achieve effective strategies for obesity prevention and treatment.

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PREVALENCE OF OBESITY IN CHILDREN AND ADOLESCENTS

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Since large, national cross-sectional data of height and weight became available in the 1960s through the National Health Examination Survey (NHES) and in the 1970s through the National Health and Nutrition Examination Survey (NHANES), it has become clear that obesity prevalence has increased dramatically across all ages, races, and ethnic groups. First estimations of prevalence of children with obesity were around 5% in the 1960s.1 Recent estimates of prevalence suggest that roughly 17% of children and adolescents have obesity, while nearly a third have either overweight or obesity. Strikingly, 12% are above the 97th percentile for BMI.2 While obesity in children and adolescents has tripled in the period since data became available, certain populations that are followed longitudinally have demonstrated a 5-fold increase in the rates of obesity.3 Understanding which groups may be at higher risk allows tailoring of population and individualized prevention measures.

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The United States leads developed nations in the number of children and adolescents with overweight and obesity. Our federal government aimed to reduce the proportion of children and adolescents who have obesity to 5% in its Healthy People 2010, a goal that was far from attained. In Healthy People 2020, reducing the proportion of children with obesity and overweight by 10% (from 16.1%-14.5%) is 1 of the 26 highest priority health issues (http://www.healthypeople.gov/).

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Compared with increases in obesity prevalence in the latter part of the 20th century, prevalence in the last decade shows some stability, especially in females and non-Hispanic white ...

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