Table 1.

Summary of Recommendations for Nutritional Management in Obesity

Nutritional Management	Examples of details assessed
1. Nutritional assessment	Diagnosis based on World Health Organization or national definition
	Plot anthropometric measurements on BMI and growth curves
	Food/nutrition history: quantity, quality, meal cotext/emnvironment
	Emotional eating signals
	Body signals: hunger, satiety
	Screen for eating disorders
	Physical activity
	Personal history: co-morbidity, mental health
	Family history including mother’s pregnancy, obesity
	Social and Cultural History: Socioeconomic status, ethnicity
	Motivation for behavioral change
	Medications: steroids, psychotropics
	Biochemical Test results: blood pressure, fasting glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipids
2. Nutrition diagnosis	Overweight or obesity
	Excessive or undesirable food intake
	Disordered eating pattern
	Physical inactivity
	Inability to manage self-care
3. Nutritional intervention	Daily food balance: >5 portions of fruits/vegetables; high fiber, reduce added sugar, avoid processed food and sweetened beverages
	Food structure and environment: 3 meals, 2 snacks; avoid other snacking; eat with family at table
	Portion size adjusted to age, gender, physical activity
	Read food labels to educate regarding content
	Physical activity
	Behavioral change including setting goals, self-monitoring
	Involve the family including positive reinforcement
	Coordination with entire obesity management team
4. Nutritional management and evaluation	Individual or group therapy adapted to child’s situation and needs
	Monitor anthropometric measurements: weight, BMI, growth
	Review diet, weight goals, activity goals
	Establish goals for weight stabilization or progressive weight loss
	If needed, refer for pharmacotherapy, bariatric surgery