Primary Care Treatment of Childhood Obesity

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Cantaloupe smiles. Mike Kemp/Blend Images/Getty Images

If your child’s body mass index (BMI) resides in the obese category, his or her pediatrician will probably suggest taking steps to help your child slim down. What exactly these steps are depends on your child’s weight, current diet, overall health status, and activity level. The reality is, every obese child has his or her own combination of contributing factors, such as genetic influences, metabolic programming (early life events that impact later physiological outcomes), and environmental influences.

At this point, only the environmental factors can be modified so these are the focus of treatment for childhood obesity and overweight in the primary-care setting.

There’s also a silent but key question in the equation: Who should be the target for change? Especially with younger children, parents are likely to be the most effective agents of change so they should be actively involved in a child’s quest for a healthier weight. Even with older kids and teens, however, parents play a vital role.  

When it comes to treating obesity, the obvious approach is for pediatricians or family doctors to simply counsel kids and their parents about dietary and activity matters. This advice typically includes eliminating or minimizing junk food (sodas and other sugar-sweetened beverages, chips and other snack foods, sweets and desserts, and the like), eating less in general, exercising more, and limiting screen time.

But that’s not always sufficient.

Usually behaviour changes need to be part of the conversation. These often include: environmental control measures such as parents’ modeling of healthy eating and exercise habits or confining all eating to one location such as the kitchen; setting personal goals for behavior changes (such as eating 5 servings of fruits and vegetables each day and getting 60 minutes or two 30-minute sessions of physical activity per day); monitoring a child’s eating and physical activity patterns, including what and how much he consumes and under what circumstances, as well as what a child does in the way of exercise and for how long; and contingency management, using positive reinforcement (from rewards to praise) or negative reinforcement (unwanted consequences) for healthy and unhealthy behaviors, respectively.

Besides increasing their awareness of healthy versus unhealthy behavior patterns, these strategies can help motivate kids to develop and continue their health-promoting efforts. 

Under the guidance of a primary-care physician, parents can often introduce these measures at home. But sometimes a formal behavior management program is recommended. In a 2011 study involving 101 kids, ages 9 to 12, researchers from the University of Wisconsin-Madison compared the effects of a family-based behavioral weight management program—in which kids and their families learned how to set daily goals for calorie intake and specific food groups, monitor daily food intake as well as physical activity and sedentary behavior, and other skills related to behavior change—with a control group. After 15 weeks, kids who participated in the behavior program lost an average of 2.4 pounds while the control group gained an average of 3.45 pounds.

Often primary-care physicians treat obesity in kids with a stage-by-stage approach.

The first stage involves healthy lifestyle changes such as those previously mentioned. If this doesn’t lead to sufficient improvements in a child’s lifestyle habits or body weight, the next step is often to develop a structured weight management plan (including creating specific guidelines for meals and snacks, an increase in physical activity to more than an hour per day, and closely monitoring the child’s eating and activity habits). If that approach doesn’t yield enough progress, the next step is to introduce a multidisciplinary approach that may involve a community or commercial weight management program, or nutrition, exercise, and behavioral counseling by trained professionals—with frequent follow-up visits to the primary-care physician. If a more aggressive approach becomes warranted, medication or surgery may be considered, in addition to continuing diet and activity counseling. The progression from one stage to the next depends on the child’s evolving weight and health status and the physician’s assessment and judgment.                         

Whatever approach your child’s doctor recommends, it’s important to work closely with him or her so that together you can help your child develop healthy eating and exercise habits and improve his weight trajectory. With guidance and support from you and the primary-care physician, your child will have a better chance of losing excess weight and gaining a sense of accomplishment in the process. This really needs to be a team-effort, one that will hopefully lead to long-term weight control and better physical and psychological health for your child.

Sources:

Medscape, Managing Early Childhood Obesity in the Primary Care Setting: A Behavior Modification Approach. Accessed online September 13, 2014.
Spear BA, Barlow SE, Ervin C, Ludwig DS, Saalens BE, Schetzina KE, Taveras EM. Recommendations for Treatment of Child and Adolescent Overweight and Obesity. Pediatrics, December 1, 2007 [Accessed online September 13, 2014]; 120(Suppl 4): S254-S288.
UpToDate, Management of childhood obesity in the primary care settingAccessed online September 13, 2014.
Wald ER, Moyer SC, Eickhoff J, Ewing LJ. Treating childhood obesity in primary care. Clinical Pediatrics, November 2011 [Accessed online September 13, 2014]; 50(11): 1010-7.

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