Sample Solution

4. Tertiary care intervention
• Used for severely obese children who failed in comprehensive multidisciplinary intervention stage but are willing to maintain physical activity and healthy diet. Options include pharmacotherapy and bariatric surgery but children should be carefully selected for this intervention and only is absolutely required.

If there is no improvement after 3-6 months of stage1 adaptation, the patient can move on to stage 2. Similarly after 3-6 months in a structured weight management program, some patients who have not achieved goals can move to stage 3.
TABLE 10
Age Weight goals according to BMI percentiles
2-5y 85-94th: weight maintenance until BMI is <85th percentile, or slowing of weight gain as indicated by lowering of BMI
≥95th: weight maintenance until BMI is <85th percentile (weight loss of up to 0.5kg/month is acceptable)
6-11y 85-94th: weight maintenance until BMI is <85th percentile, or slowing of weight gain as indicated by lowering of BMI
95-99th: gradual weight loss (0.5kg/month)
>99th: weight loss (maximum 1kg/week)
12-18y 85-94th with no health risks: weight maintenance
85-94th with health risks: weight maintenance or gradual weight loss
95-99th: weight loss (maximum is 1kg/week)
>99th: weight loss (maximum is 1kg/week)

For infants, exclusive breastfeeding should be encouraged till 6months of age and continue breastfeeding after introduction of solid food till 12 months of age and beyond. Sugar sweetened beverages should be avoided in infants and there should be not television in the infant’s sleeping room.
For overweight/obese 12-24months old children, healthy diet and age appropriate physical activity is recommended. Three major meals should include healthy food, with plenty of fruits & vegetables. Fruit juices and sugar-sweetened beverages should be avoided. No television viewing during meals and overall screen time should be limited.
MARG intervention study (29) conducted in India aimed to evaluate the impact of a school-based health and nutritional education program on knowledge and behavior of Indian s