Welcome to the training on Management of Overweight and Obesity in Children and Adolescents provided by the Texas Department of State Health Services (DSHS) and the Texas Health and Human Services Commission (HHSC).
The goal of this module is to equip Texas Health Steps providers and others to apply best practices in the assessment, treatment, and prevention of overweight and obesity in children and adolescents birth through age 20.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Assess risk factors for overweight and obesity as part of routine clinical practice.
- Apply best practices in the diagnosis, treatment, and management of overweight and obesity.
- Employ practical intervention guidelines and resources to help prevent overweight and obesity by promoting healthy nutrition, physical activity, and lifestyle habits.
Please note this module expires on 9/23/2019.
Continuing Medical Education
The Texas Department of State Health Services is accredited by the Texas Medical Association (TMA) to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service (TMA provider #4006803) designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is an accredited provider (P0180) of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) of Continuing Social Work Education.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.5 total entry-level Category I contact education contact hours.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.5 contact hour/s of continuing education for Certified Community Health Workers.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service certifies that this attendee participated in the educational activity listed above. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. Planning Committee/ Author Name of Commercial interest Nature of the Relationship LeAnn Kridelbaugh Salary Employment (Director of Medical Home Initiatives).
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
- Academy of Nutrition and Dietetics. (2013). Kids eat right.
- Alliance for a Healthier Generation. (2012).
- American Academy of Pediatrics. (2015). Growth Charts for Children With Down Syndrome in the United States.
- American Academy of Pediatrics, Council on School Health, Committee on Nutrition. (2015). Policy Statement: Snacks, Sweetened Beverages, Added Sugars, and Schools.
- American Academy of Pediatrics Policy Statement. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3): e827-e841.
- American Academy of Pediatrics. (2002, reaffirmed 2008). Policy Statement: The Medical Home. Pediatrics, 110: 184–186.
- American Academy of Pediatrics. (2011). Policy Statement: Media Use by Children Younger Than 2 Years. Pediatrics, 128(5).
- American Academy of Pediatrics, Committee on School Health. (2004). Soft drinks in schools. Pediatrics, 113(1): 152-154.
- American Academy of Pediatrics. (2002, reaffirmed 2008). Policy Statement: The Medical Home. Pediatrics, 110: 184–186.
- American Academy of Pediatrics, Committee on Nutrition. (2003). Prevention of pediatric overweight and obesity. Pediatrics, 112(2): 424-430.
- American Academy of Pediatrics. (n.d.). Breastfeeding initiatives.
- American Academy of Pediatrics, Committee on Public Education. (2001). Children, adolescents, and television. Pediatrics. 107(2): 423-426.
- American Academy of Pediatrics. Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. (n.d.). Promoting physical activity.
- American Academy of Pediatrics. (n.d.). HALF Implementation Guide.
- American Academy of Pediatrics. (n.d.). Policy opportunities tool.
- American Academy of Pediatrics, Healthy Children.org. (n.d.). Healthy Active Living for Families.
- American Medical Association. (n.d.). Family medical history.
- Arons, A. for the Children's Hospital Association of Texas. (2011). Childhood obesity in Texas: The costs, the policies, and a framework for the future.
- Barlow, S. E., & American Academy of Pediatrics Expert Committee. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120 (Supplement 4): S164–S192.
- Berge, J. M., Meyer, C. S., Loth, K., MacLehose, R., & Neumark-Sztainer, D. (2015). Parent/Adolescent Weight Status Concordance and Parent Feeding Practices. Pediatrics, 136(3): 591-598.
- Bleich, S. N., Herring, B. J., Flagg, D. D., & Gary-Webb, T. L. (2012). Reduction in purchases of sugar-sweetened beverages among low-income black adolescents after exposure to caloric information. American Journal of Public Health, 102(2): 329-335.
- Briefel, R. R., Reidy, K., Karwe, V., & Devaney, B. (2004). Feeding infants and toddlers study: Improvements needed in meeting infant feeding recommendations. Journal of the American Dietetic Association, 104: S31-S37.
- California Medical Foundation Association. (2012). Child and adolescent obesity provider toolkit.
- Carlson, J. A., Schipperijn, J., Kerr, J., Saelens, B. E., Natarajan, L., Frank, L. D., … Sallis, J. F. (2016). Locations of Physical Activity as Assessed by GPS in Young Adolescents. Pediatrics, 137(1): 2015-2430.
- Centers for Disease Control and Prevention. (2015). Physical activity: Community strategies.
- Centers for Disease Control and Prevention. (2015). Childhood obesity facts.
- Centers for Disease Control and Prevention. (2015). Growth chart training modules.
- Centers for Disease Control and Prevention. (2014). Breastfeeding Report Card, United States.
- Centers for Disease Control and Prevention. (2014). Prevalence of childhood obesity in the United States, 2011-2012.
- Centers for Disease Control and Prevention. (2013). Breastfeeding.
- Centers for Disease Control and Prevention. (2013). National health and nutrition examination survey.
- Centers for Disease Control and Prevention. (2012). Basics about childhood obesity.
- Centers for Disease Control and Prevention. (2012). Childhood Obesity Causes and Consequences.
- Centers for Disease Control and Prevention. (2012). Childhood overweight and obesity.
- Centers for Disease Control and Prevention. (2015). Healthy Schools. School health guidelines.
- Centers for Disease Control and Prevention. (2015). How much physical activity do children need?
- Centers for Disease Control and Prevention. (2010). WHO growth standards are recommended for use in the U.S. for infants and children 0 to 2 years of age.
- Centers for Disease Control and Prevention. (2009). Clinical growth charts.
- Centers for Disease Control and Prevention. (2009). Obesity: Halting the epidemic by making health easier.
- Centers for Disease Control and Prevention. (2009). Obesity prevalence among low-income, preschool-aged children—United States, 1998-2008. Morbidity and Mortality Weekly Report (MMWR) 58(28): 769-773.
- Centers for Disease Control and Prevention. (2006). Does drinking beverages with added sugars increase the risk of overweight? Research to Practice Series, No. 3.
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity. (n.d.). Low-energy-dense foods and weight management: Cutting calories while controlling hunger. Research to Practice Series, No. 5.
- Centers for Disease Control and Prevention. (n.d.). BMI calculator for child and teen.
- Clayton, H. B., Li, R., Perrine, C. G., & Scanlon, K. S. (2013). Prevalence and reasons for introducing infants early to solid foods: Variations by milk feeding type. [Abstract]. Pediatrics. 131(3): 2012–2265.
- Common Sense. (2015). Media Use by Tweens and Teens.
- de Beer, M., Vrijkotte, T. G. M., Fall, C. H. D., van Eijsden, M., Osmond, C., & Gemke, R. J. B. J. (2014). Associations of infant feeding and timing of linear growth and relative weight gain during early life with childhood body composition. International Journal of Obesity, doi:10.1038/ijo.2014.200.
- Directors for Health Promotion and Education. (2009). Active Texas 2020: Taking Action to Promote Physical Activity.
- Eschbach, K., & Fonseca, V. (2009). Findings about the obesity epidemic in Texas. Texas State Data Center, Institute for Demographic and Socioeconomic Research, The University of Texas at San Antonio.
- Frías, J. L., & Davenport, M. L. (2003). Health supervision for children with Turner syndrome. Pediatrics, 76(3): 653-658.
- Fuel Up to Play 60. (2016). National Dairy Council, National Football Players Incorporated.
- Gozal, D., & Kheirandish-Gozal, L. (2012). Childhood obesity and sleep: Relatives, partners, or both?--A critical perspective on the evidence. Annals of the New York Academy of Sciences, 1264(1): 135–41.
- Grummer-Strawn, L. M., & Mei, Z. (2004). Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention pediatric nutrition surveillance system. Journal of Pediatrics, 113(2): e81–e86.
- Harder, T., Bergmann, R., Kallischnigg, G., & Plagemann, A. (2005). Duration of breastfeeding and risk of overweight: A meta-analysis. American Journal of Epidemiology, 162(5): 397–4037.
- Harvard T. H. Chan School of Public Health. (2016). Obesity Prevention Source.
- Hassink, S. G., & Hampl, S. E. (2016). Clinical Care of the Child with Obesity. McGraw-Hill Education.
- Hill, A. P., Zuckerman, K. E., & Rombonne, E. (2015). Obesity and Autism. Pediatrics, 136(6).
- Hoelscher, D. M., Springer, A. E., Menendez, T., Cribb, P. W., & Kelder, S. H. (2011). From NIH to Texas schools: Policy impact of the coordinated approach to child health (CATCH) program in Texas. Journal of Physical Activity & Health, 8(Suppl)1: S5-S7.
- Kimmons, J., Gillespie, C., Seymour, J., Serdula, M., & Blanck, H. M. (2009). Fruit and vegetable intake among adolescents and adults in the United States: Percentage meeting individualized recommendations. The Medscape Journal of Medicine, 11(1): 26.
- Laursen, K. R., Eisenmann, J. C., Welk, G. C., Wickel, E. E., Gentile, D. A., & Walsh, D. A. (2008). Combined influence of physical activity and screen time recommendations on childhood overweight. The Journal of Pediatrics, 153: 209-214.
- Let's Move. (n.d.).
- Levi, J., Segal, L. M., St. Laurent, R., Lang, A., & Rayburn, J. (2012). F as in fat: How obesity threatens America’s future 2012.
- Liang, L., Meyerhoefer, C., & Wang, J. (2012). Obesity counseling by pediatric health professionals: An assessment using nationally representative data. Pediatrics, 130(1): 67-77.
- Lloyd, L. J., Langley-Evans, S. C., & McMullen, S. (2012). Childhood obesity and risk of the adult metabolic syndrome: A systematic review. International Journal of Obesity, 36: 1–11.
- March of Dimes. (2013). Tummy Time.
- Michael & Susan Dell Center for Healthy Living at The University of Texas at Austin School of Public Health. School Physical Activity and Nutrition Survey.
- Must, A., Naumova, E. N., Phillips, S. M., Blum, M., Dawson-Hughes, B., & Rand, W. M. (2005). Childhood overweight and maturational timing in the development of adult overweight and fatness: The Newton girls study and its follow-up. Pediatrics 116(3): 620–627.
- Myrelid, A., Gustafsson, J., Ollars, B., & Annerén, G. (2002). Growth charts for Down's syndrome from birth to 18 years of age. Archives of Disease in Children, 87: 97–103.
- National Association for Sport and Physical Education. (n.d.). Active start: A statement of physical activity guidelines for children from birth to age 5, 2nd edition.
- National Fiber Council. (2013). Fiber Calculator.
- National Heart, Lung, and Blood Institute. (2011). Childhood Obesity Prevention & Treatment Research Consortium.
- National Institute of Diabetes and Digestive and Kidney Diseases, Weight-control Information Network. (2007). Talking with patients about weight loss: Tips for primary care professionals.
- North Carolina School Action Committee. (2003). Portion sizes and school-age children: What's in a serving size?
- O'Brien, S. H., Holubkuv, R., & Reis, E. C. (2004). Identification, evaluation, and management of obesity in an academic primary care center. [Abstract]. Pediatrics, 114(2): e154–e159.
- Ogden, C., Carroll, M., Fryar, C.D., & Flegal, K. M. (2015). Prevalence of obesity among children and adolescents: United States, 2011-2014.
- Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007–2008. Journal of the American Medical Association, 303(3): 242–249.
- Ong, K. K., Emmett, P., Northstone, K., Golding, J., Rogers, I., Ness, A. R., & Dunger, D. B. (2009). Infancy weight gain predicts childhood body fat and age at menarche in girls. The Journal of Clinical Endocrinology & Metabolism, 94(5): 1527–1532.
- Paruthi, S., Brooks, L. J., D’Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., … Wise, M. S. (2016). Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6): 785-786.
- Patel, A. I., Madsen, K. A., Maselli, J. H., Cabana, M. D., Stafford, R. S., Hersh, A. L. (2010). Under-diagnosis of Pediatric Obesity during Outpatient Preventive Care Visits. Academic Pediatrics, 10(6): 405-409.
- Pont, S. (n.d.). Motivational interviewing. Texas Pediatric Society.
- Rolland-Cachera, M. F., Deheeger, M., Maillot, M., & Bellisle, F. (2006). Early adiposity rebound: Causes and consequences for obesity in children and adults. International Journal of Obesity, 30: S11–S17.
- Rollins, B. Y., Loken, E., Savage, J.S., & Birch, L. L. (2014). Effects of restriction on children’s intake differ by child temperament, food reinforcement, and parent’s chronic use of restriction. Appetite, 73: 31-9.
- Saari, A., Virta, L. J., Sankilampi, U., Dunkel, L., & Saxen, H. (2015). Antibiotic Exposure in Infancy and Risk of Being Overweight in the First 24 Months of Life. Pediatrics, 135(4): 617-626.
- Simpson, L. A., & Cooper, J. (2009). Paying for obesity: A changing landscape. Pediatrics, 123: S201–S207.
- Singh, A. S., Mulder, C., Twisk, J. W. R., van Mechelen, W., & Chinapaw, M. J. M. (2008). Tracking of childhood overweight into adulthood: A systematic review of the literature. Obesity Reviews, 9: 474–488.
- Snell, E. K., Adam, E. K., & Duncan, G. J. (2007). Sleep and the body mass index and overweight status of children and adolescents. Child Development, 78(1): 309-23.
- Spruyt, K., Molfese, D. L., & Gozal, D. (2011). Sleep duration, sleep regularity, body weight, and metabolic homeostasis in school-aged children. [Abstract]. Pediatrics, 127(2): e345–52.
- Texas AgriLife Extension. (n.d.). Dinner tonight!
- Texas Department of State Health Services. (2016). Growing community video series.
- Texas Department of State Health Services. (2016). Texas Health Steps provider information.
- Texas Department of State Health Services. (2016). Texas 10 Step Program.
- Texas Department of State Health Services. (2016) School Health Advisory Councils.
- Texas Department of State Health Services. (2016). Texas Health Steps.
- Texas Department of State Health Services. (2015). Texas Department of State Health Services position statement on infant feeding.
- Texas Department of State Health Services. (2013). Grand Rounds, Health Needs a Hero: A Story of Transformation. Past Presentations – Spring 2013.
- Texas Department of State Health Services, Texas WIC. (2016). Breastfeeding promotion and support.
- Texas Department of State Health Services, WIC Program, Nutrition Education/Clinic Services. (2012). One-stop breastfeeding resource.
- Texas Department of Transportation. (n.d.). Safe Routes Texas.
- Texas Medicaid & Healthcare Partnership. (2016). Texas Medicaid Provider Procedures Manual.
- Texas Pediatric Society. (n.d.). Family readiness questionnaire.
- Texas Pediatric Society. (2012). Texas Pediatric Society obesity toolkit.
- Trust for America's Health. (2012). Bending the obesity cost curve: Reducing obesity rates by five percent could lead to more than $29 billion in health care savings in five years.
- Trust for America's Health. (2011). F as in fat: How obesity threatens America's future 2011.
- Trust for America’s Health and the Robert Wood Johnson Foundation. (n.d.). The State of Obesity in Texas.
- U.S. Department of Agriculture, U.S. Department of Health and Human Services. (2015). 2015-2020 Dietary Guidelines for Americans.
- U.S. Department of Agriculture. (n.d.). ChooseMyPlate.gov.
- U.S. Department of Agriculture. (n.d.). Super Tracker.
- U.S. Department of Agriculture. (2013). Nutrition standards for school meals.
- U.S. Department of Health and Human Services. (2016). Healthy People 2020.
- U.S. Department of Health and Human Services. (2016). Physical activity guidelines for Americans: Strategies to increase physical activity among youth.
- U.S. Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. (2012). Talking with Patients about Weight Loss: Tips for Primary Care Providers.
- U.S. Department of Health and Human Services. (2011). The Surgeon General's call to action to support breastfeeding.
- U. S. Department of Health and Human Services Office on Women’s Health. (2010). Why breastfeeding is important.
- Walk Bike to School. International Walk to School Day.
- U.S. Surgeon General. (2015). Step it Up! The U.S. Surgeon General’s Call to Action for Walking and Walkable Communities.
- Wang, Y. C., Long, M., & Gortmaker, S. (2009). The negative impact of sugar-sweetened beverages on children’s health. Robert Wood Johnson Foundation.
- Wang, L. Y., Chyen, D., Lee, S., & Lowry, R. (2008). The association between body mass index in adolescence and obesity in adulthood. Journal of Adolescent Health, 42(5): 512-8.
- Zimmerman, G. L., Olsen, C. G., & Bosworth, M. F. (2000). A 'stages of change' approach to helping patients change behavior. American Family Physician, 61(5): 1409–1416.
- Academy of Nutrition and Dietetics, Kids Eat Right.
- Alliance for a Healthier Generation, Make Health a Habit.
- ChooseMyPlate. 10 Tips Nutrition Education Series.
- Healthy Community Food Systems Module.
- Let’s Move!
- Texas Department of State Health Services. Texas Health Steps. Information about finding a health-care provider and getting a ride to a checkup.
- U.S. Department of Agriculture, SuperTracker.
The medical definitions provided in this module were obtained or adapted from the Mayo Clinic, Medical Dictionary by TheFreeDictionary, Merriam-Webster, the Prader-Willi Syndrome Association, and the U.S. National Library of Medicine.