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Am Fam Physician. 2006;74(8):1434

Societal, financial, technologic, and commercial factors have caused childhood obesity in the United States to triple since the 1960s. The American Academy of Pediatrics (AAP) policy statement, “Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity,” was published in the May 2006 issue of Pediatrics and addresses how physicians can encourage physical activity in children and adolescents who are currently or are at risk of becoming overweight or obese.

Children who are overweight or obese are more likely to have diabetes mellitus, insulin resistance, obstructive sleep apnea, hypertension, nonalcoholic steatohepatitis, or low self-esteem compared with children of normal weight. These health implications are profound, particularly because 80 percent of children and adolescents who are obese continue this trend into adulthood.

To address the obesity epidemic in children, it is recommended that physicians assess and accurately measure the body fat in their young patients. Some children may be genetically predisposed to obesity, but insufficient infant breastfeeding, the consumption of sugar-sweetened beverages and oversized fast-food meals, and reduced intake of fiber, fruit, and vegetables also contribute to childhood obesity.

Twenty-six percent of children and adolescents in the United States spend more than four hours a day watching television, and they have become even more sedentary with access to computers and video games. Sixty-two percent of children nine to 13 years of age do not participate in organized physical activities, and 23 percent do not participate in nonorganized physical activities outside of school hours. However, inactive role models, unsafe play environments, or inadequate access to physical education also may explain the lack of physical activity in children.

Treatment programs that combine nutritional intervention and exercise are recommended over diet modification alone because they have better success rates. Regular physical activity should be made available to children during school hours because it is important in weight reduction and improves insulin sensitivity in children and adolescents with type 2 diabetes. It also is psychologically beneficial to children regardless of weight and is associated with increased self-esteem and reduced depression and anxiety.

Aerobic exercise is suggested because it can reduce systolic and diastolic blood pressure measurements. However, lifestyle-related physical activity programs should be tailored to each child, and the physician should not measure the child’s progress through weight loss alone but in terms of the effects on associated morbidities.

Adolescents and children older than two years should watch no more than two hours of television per day. It is recommended that physicians ask parents to record the number of hours a day their child spends in front of the television or how long he or she plays computer or video games; however, giving the child a pedometer may be a more accurate measure of activity. A goal of at least 11,000 steps a day is recommended for children.

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