OBESITY
Intervention
Strategies to prevent overweight and interventions to treat overweight are not simple. The following strategies are important:
- Studies indicate that parents are more likely to recognize their child's problem when health professionals interpret growth patterns and verbalize their own concerns.
- It is important to help families assess their own readiness for change and to identify saboteurs, such as indulgent grandparents.
- Although parents often ask for a "diet plan," what is more important is to help the family establish a healthy, balanced diet and exercise pattern.
- Stress the importance of involving the whole family. Changes for healthy eating may need to involve changes for all members of the family, including the non-overweight members.
It is important that health professionals working with families give positive feedback even for small successes, such as a slight drop in BMI even if weight has increased, or the family cutting television from four hours to two per day.
Additional reasonable recommendations include
- No television with food and no food with television-including at meal times
- Limit total screen time for children to 2 hours per day
- Maintain a minimum of 30 minutes of activity per day
- Limit sweet drinks (sodas, sweetened tea or juice) to 4-8 oz total per day
- Serve more reasonable portions
How do we decide which children truly need our attention?
Management of obesity is dependent on whether or not the child is having complications from their obesity. The algorithm recommended by Barlow and Dietz (3) suggests the following management
Management of Overweight in Children
|
Children ages 2-7 years |
BMI 85-94 %tile |
Weight maintenance |
|
Children ages 2-7 years |
BMI > 95 %tile without complications |
Weight maintenance |
|
Children ages 2-7 years |
BMI > 95 %tile with complications |
Weight loss |
|
Children > 7 years |
BMI 85-94 %tile without complications |
Weight maintenance |
|
Children > 7 years |
BMI 85-94 %tile with complications |
Weight loss |
|
Children > 7 years |
BMI > 95 %tile |
Weight loss |
Complications include mild hypertension, dyslipidemias, and insulin resistance. Acute complications include pseudotumor cerebri, sleep apnea, obesity hypoventilation syndrome or orthopedic problems should be referred to a pediatric obesity center if possible, and should be managed aggressively.
Interventions to prevent and treat an overweight condition are not simple. Usually involvement of the whole family is required. It is important to help families assess their own readiness for change and to identify saboteurs, such as indulgent grandparents. Healthy eating may involve change for all members of the family, including those whose weight is normal. And finally, it is important that health professionals working with families give positive feedback for small successes-a slight drop in BMI even if weight has increased, or cutting television from 4 hours to 2 per day.
At this site are many tools to assist healthcare professionals and their patients and families in making small but significant changes:http://www.choosemyplate.gov. Especially note "10 Tips Nutritional Education Series" which allows patients to choose one thing they could change and provides strategies for success.
