The most aggressive, thorough guidelines ever issued for preventing and treating childhood obesity were delivered to U.S. doctors today by a panel of medical experts.

The specialists, convened by government agencies and the American Medical Association, call for weight checks at least yearly, counseling about weight even if children aren't overweight, and a four-stage treatment plan that could end in medication or surgery for the most persistently obese children.

The recommendations, published in Pediatrics, "are long overdue," said Melinda Sothern, pediatric obesity specialist at Louisiana State University Health Sciences Center and author of "Trim Kids." "Lots of parents and doctors are frustrated because there are no specific guidelines for treating overweight children."

About 17 percent of U.S. kids are obese, more than triple the rate in 1970, the report says. Extra weight raises a child's risk for diabetes, high blood pressure and later heart disease and stroke.

Weight-related guidance should be given at every checkup of even normal-weight kids, whose body mass index (weight compared with height) is less than at the 85th percentile, the authors say.

Children need an hour of physical activity a day, along with limits on sweetened beverages, computer and TV time and fast-food meals. Also, doctors should take a family history of obesity, diabetes and heart disease. Doctors also are advised to check cholesterol levels of overweight children.

For overweight kids (85th to 94th percentile) and the obese (95th percentile and above), diet and exercise guidelines are more specific and follow-up times are shorter.

Prevention, emphasized in the guidelines, was hardly mentioned in the far vaguer 1998 recommendations they replace, said Reginald Washington, an author of the new report and chief medical officer at Rocky Mountain Hospital for Children in Denver.

Treatment of childhood obesity must be a family affair, added William Dietz, director of the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention.

Parents must be involved "because overweight is linked to lifestyle, not just genes, and parents make the decisions here."

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