by Rebecca L. Carl, M.D., M.S.C.I., FAAP
A 14-year-old boy presents to your
office for a sports preparticipation
physical evaluation. In your discussion with the boy, he asks the best
way to lose weight quickly when he
wants to “make weight” for wrestling. How do you
advise this young athlete?
Many children and adolescents participate in sports
and physical activities that emphasize a particular
physique. A wrestler may desire to lose weight quickly
and temporarily prior to a match. A football player
may want to add muscle mass to his frame. A dancer
may try to maintain a very thin body habitus.
The updated clinical report Promotion of Healthy
Weight-Control Practices in Young Athletes, from the
AAP Council on Sports Medicine and Fitness, provides guidelines for counseling child and teenage athletes about healthy and unhealthy methods of gaining
and losing weight for sports. The report is available
at https://doi.org/10.1542/peds.2017-1871 and is
published in the September issue of Pediatrics.
Weight loss: no quick fix
Coaches and youths who participate in weight-class
sports, such as wrestling and boxing, may feel there is
a competitive advantage to losing weight quickly to
qualify for the lowest possible weight class. Children
and teens involved in aesthetic sports, including dance
and gymnastics, also may believe that weight loss will
increase their success in these activities. Therefore,
these athletes may restrict calories to lose weight even
though they typically have increased caloric needs
compared to their less active peers.
Some athletes will attempt other weight loss methods, including use of diuretics, vomiting and excessive
exercise to increase sweat production. In addition to
being risky, these methods may actually impair sports
performance. Several national sports governing bodies
have enacted rule changes to prevent the use of acute
weight loss practices by wrestlers.
Pediatricians can counsel young athletes about
appropriate methods for achieving gradual weight
loss when needed.
Healthy gains from varied diet, strength training
For sports where a muscular physique is considered
advantageous, young athletes often aspire to increase
lean muscle mass. However, an athlete who simply
consumes more calories may increase body fat percent-
age rather than muscle mass, which can have adverse
Some children and teens take supplements to
help augment muscle mass, but the safety of most
supplements is not well-established, particularly for
Female athletes and pre-pubescent boys typically
will not see big increases in muscle mass with strength
training and increased caloric intake.
To achieve beneficial changes in body composition,
young athletes must incorporate a healthy, varied diet
and an appropriate strength-training program.
Recommendations for pediatricians
Key points in the updated statement include:
• Encourage young athletes to follow dietary and exer-
cise practices that promote good health rather than
a competitive advantage in sports.
• Be prepared to counsel young athletes about
weight-control practices that can be detrimental
to health, such as dehydration, calorie restriction
and supplement use.
• When weight loss is deemed appropriate, children
and teens should be educated about healthy methods of gradual weight loss. Athletes attempting to
gain weight should be counseled about the importance of healthy dietary changes in conjunction with
an appropriate strength-training program to achieve
the desired body composition.
Dr. Carl, a lead author of the clinical
report, is a member of the AAP Council
on Sports Medicine and Fitness.
Dr. Flynn Dr. Kaelber
• The plenary session “2017 AAP Guidelines for Childhood Hypertension: Highlights (P4049)” will be held
from 10:30-10: 50 a.m. Sept. 19 at the AAP National
Conference & Exhibition in Chicago.
• An updated Education in Quality Improvement for Pediatric Practice (EQIPP) module on the new clinical practice guideline will be available later this fall at https://
Hypertension continued from front page
diseases in children and adolescents. The diagnosis is
missed in up to 75% of pediatric patients in primary
care settings, and appropriate medication initiation
occurs much less frequently than is indicated, according to current guidelines.
Beginning in 2014, the multidisciplinary subcommittee, which included a parent representative,
reviewed approximately 15,000 articles published
since the prior guideline was issued.
Highlights of the new pediatric hypertension
• development based on a strict evidence-based
approach as recommended by the National
Academy of Medicine and the NHLBI;
• replacement of the term “prehypertension” with
“elevated blood pressure”;
• new normative blood pressure tables based on
children with normal weight;
• simplified screening table for identifying blood
pressures needing further evaluation;
• simplified blood pressure classification in ad-
olescents 13 years of age and older that aligns
with forthcoming American Heart Association/
American College of Cardiology adult blood
• a more limited recommendation to perform
screening blood pressure measurement only at
preventive care visits;
• streamlined recommendations on initial evaluation and management of abnormal blood
• expanded role for ambulatory blood pressure
monitoring in both diagnosis and ongoing management of pediatric hypertension;
• more limited recommendation on when to perform an echocardiogram in the evaluation of
newly diagnosed hypertensive pediatric patients
(generally only before medication initiation);
• revised definition of left ventricular hypertrophy;
• revised treatment goals based on published ev-
• 30 evidence-based key action statements and an
additional 27 clinical recommendations based
on expert opinion.
Dr. Flynn and Dr.
Kaelber are among the
co-authors of the clinical
practice guideline and
served as co-chairs of the
Talking to young athletes about healthy weight loss, gain
Online interactive tool to calculate caloric needs based
on gender, age and activity level, https://www.nal.usda.
In hopes of gaining a competitive advantage, some
athletes try quick-fix ways to lose or gain weight.
A clinical report advises on practices that promote