Table 1—

Consensus recommendations for the prevention and treatment of childhood obesity: implications of race, culture, and ethnicity

Prevention
  • Prevention efforts should fall within the framework of the socio-ecological model, which views children in the context of their families, communities, and cultures.

  • The primary care provider should routinely discuss obesity risk with children and families. These discussions need to vary in frequency based on the child's risk of obesity (which is particularly high in African American girls and Hispanic boys), should be culturally sensitive, and should take into account the education level and SES of the child/family.

  • Efforts should be made to prevent GDM and low birth weight. Breastfeeding should be encouraged.

  • Health care providers should play an active role in advocacy for local and national policies that foster a healthy environment for all children, including:

    • Restriction of youth-targeted television advertising of foods of low nutritional value

    • Promotion of regular physical activity and healthy food choices in schools

    • Provision of safe places for children to play and access to healthy food choices in poor and minority neighborhoods

Treatment
  • Treatment should begin early, targeting children at increased risk for long-term obesity and its complications.

  • The health care team, child, and caregivers should mutually agree on treatment goals. Health care providers should be aware of racial/ethnic and sex differences in the perception of obesity that may influence these goals.

  • Consider cultural, individual, and family preferences and the realities of time and money in advice about meal planning.

  • Consider cultural and gender preferences with regard to advice about physical activity.

  • Evidence for the benefits of comprehensive lifestyle interventions including behavioral modification, currently based primarily on studies of white middle-class children, needs to be expanded through more studies targeting children of lower SES and non-white race/ethnicity.

  • Although some evidence suggests that the effects of weight loss medications or bariatric surgery may differ among racial or ethnic groups, decisions about the use of these interventions in children should not be based on race or ethnicity.