Guideline: assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition

Overview

As part of its response to the global epidemic of obesity, WHO has issued guidelines to support primary healthcare workers to identify and manage children who are overweight or obese. Specifically, all infants and children aged less than 5 years presenting to primary health-care facilities should have both weight and height measured in order to determine their weight-for-height and their nutritional status according to WHO child growth standards. Comparing a child's weight with norms for its length/height is an effective way to assess for both wasting and overweight.

Where infants and children are identified as overweight, WHO recommends providing counselling to parents and caregivers on nutrition and physical activity including promotion and support for exclusive breastfeeding in the first 6 months and continued breastfeeding until 24 months or beyond. If children are obese, they should be further assessed and an appropriate management plan should be developed. This can be done by a health worker at primary health-care level if adequately trained, or at a referral clinic or local hospital.

Additionally, stunting is a potential risk factor for children becoming overweight or obese. WHO recommends not providing formulated supplementary foods on a routine basis to children who are moderately wasted or stunted who present to primary health-care facilities. However, there may be a role for the provision of supplementary foods to children with moderate wasting in settings where there is food insecurity, at community or household level, and as part of the continuum of care for the individual child.