Primary Care and Pre-Natal Care
Routinely measuring body mass index (BMI) and counseling patients on healthy eating and activity are critically important ways that pediatricians and primary care providers can help prevent obesity. Prenatal providers can promote breastfeeding, stress the importance of staying at a healthy weight before and during pregnancy, and encourage pregnant women to quit smoking. All providers should work to avoid bias and discrimination against people who are overweight or obese.
Here is a summary of primary care and prenatal care obesity prevention recommendations, based on a review of expert guidance from the American Academy of Pediatrics, the American Medical Association, the Institute of Medicine, the Childhood Obesity Action Network, and others. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.
|Measure patients’ BMI percentile for age at every well-child visit for children ages 2 and older; for younger children, measure weight-for-length percentile(1,2,3,4,5,6,7,8,9)
|Counsel all patients and their families on healthy eating, physical activity, and healthy growth, regardless of current weight status (1,3,4,7,10)
|Counsel all patients and their families to limit television time to no more than two hours per day and to remove televisions from children’s bedrooms (1,3,5,7)
|Counsel all patients and their families to limit consumption of sugar-sweetened beverages and encourage other healthful eating behaviors: (1,5,7)|
|Counsel all patients and their families to help children achieve 60 minutes of moderate to vigorous physical activity per day (1,7)
|Establish procedures for follow-up assessment (including laboratory tests), counseling, and treatment plans for children who are overweight or obese(1,2,3,5,6,7,8,9)
|Establish policies to avoid weight bias in pediatric clinics, such as by requiring all employees to be trained on weight-bias prevention (1,5,7,9,10)
Talking to Patients about Obesity
Overweight and obese adults who report that their doctors have told them they are overweight are more likely to have accurate perceptions of their own weight, according to a U.S.-based survey. They are also more likely to be interested in losing weight, and to have tried losing weight. Yet a third of obese patients say their doctors did not tell them they were overweight.
|Routinely measure BMI in all adult patients(2,4,5,6,8,11,12, 13)
|Order appropriate follow-up laboratory tests for patients who are overweight and obese and prescribe a long-term treatment strategy, (4,5,6,8,9,11,12) which may include:
|Design physician offices to avoid stigmatizing overweight or obese patients, such as by providing private weighing areas and using scales that can measure weights greater than 300 pounds (9,11,12)
Early Life Influences on Obesity
Numerous factors during early life can affect a child’s obesity risk later in life: Maternal smoking, weight gain, and blood sugar levels during pregnancy, as well as an infant’s weight gain rate, breastfeeding, and sleep habits. Learn more about early life influences on obesity.
|Counsel patients on the importance of being at a healthy weight before pregnancy and gaining weight at a healthy rate during pregnancy (3,6,9,15,16)
|Recommend that mothers breastfeed and provide training and support for breastfeeding (3,5,15,17,18,19)
|Counsel patients on the importance of avoiding smoking during pregnancy (6, 20)|
|Screen pregnant women for gestational diabetes (21)|
1. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120 Suppl 4:S164-92.
2. National Committee for Quality Assurance. HEDIS 2009 Summary Table of Measures, Product Lines and Changes. Washington, D.C.: National Committee for Quality Assurance; 2008.
3. White House Task Force on Childhood Obesity. Solving the Problem of Childhood Obesity within a Generation: White House Task Force on Childhood Obesity Report to the President. White House Task Force on Childhood Obesity; 2010.
4. Let’s Move. Healthcare Providers Take Action. Accessed February 2, 2012.
5. Koplan JP, Liverman CT, Kraak VI, eds. Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: The National Academies Press; 2005.
6. U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation 2010. Rockville: U.S. Department of Health and Human Services, Office of the Surgeon General; 2010.
7. Childhood Obesity Action Network. Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity; 2007.
8. America’s Health Insurance Plans. Facing the Challenge of Unhealthy Weight: Recommendations for the Health Care Community; 2008.
9. Centre for Public Health Excellence. Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. London: National Institute for Health and Clinical Excellence; 2006.
10. The Obesity Society. Position Statement: Youth Weight Bias and Discrimination in Healthcare Settings. Silver Spring: The Obesity Society; 2010.
11. Klein S, Burke LE, Bray GA, et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. 2004;110:2952-67.
12. American Medical Association. Assessment and Management of Adult Obesity: A Primer for Physicians. Atlanta: American Medical Association; 2003.
13. U.S. Preventive Services Task Force. 2003. Screening for Obesity in Adults. Accessed March 8, 2012.
14. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults – The Evidence Report. National Institutes of Health. Obes Res. 1998;6 Suppl 2:51S-209S.
16. Rasmussen K, Yaktine A. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, D.C.: Food and Nutrition Board, Institute of Medicine, National Research Council; 2009.
17. American Medical Association. 2011. H-245.982. AMA Support for Breastfeeding.
18. Shealy K, Li R, Benton-Davis S, Grummer-Strawn L. The CDC Guide to Breastfeeding Interventions. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2005.
19. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
20. Smoking cessation during pregnancy. Committee Opinion No. 471. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;116:1241–4.
21. Screening and Diagnosis of Gestational Diabetes Mellitus. Committee Opinion No. 504. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2011; 118:751–3.
The aim of the Harvard School of Public Health Obesity Prevention Source Web site is to provide timely information about obesity’s global causes, consequences, prevention, and control, for the public, health and public health practitioners, business and community leaders, and policymakers. The contents of this Web site are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Web site. The Web site’s obesity prevention policy recommendations are based primarily on a review of U.S. expert guidance, unless otherwise indicated; in other countries, different policy approaches may be needed to achieve improvements in food and physical activity environments, so that healthy choices are easy choices, for all.