MANAGEMENT OF CHILDHOOD OBESITY--OFFICE-BASED MANAGEMENT OF CHILDHOOD OBESITY/OVERWEIGHT
Posted May 08 2009 11:36pm
Prevention and treatment of childhood overweight should be part of the anticipatory guidance provided during routine health supervision visits, particularly in families with children at risk for overweight. Calculating and plotting the BMI yearly will identify children experiencing rapid weight gain or early adiposity rebound. Anticipatory guidance includes discussion of the benefits of increased physical activity and decreased sedentary activity, and the promotion of healthy eating habits. Identifying particular parenting styles can alter the management approach to an overweight child. Rigid, controlling styles of feeding may decrease a child's preference for healthier foods. Alternatively, if parents avoid conflict by allowing the child to dictate all choices, the result may be poor nutritional choices. In the overweight child, the principles elucidated during anticipatory guidance need to be reinforced as being central to the child's success in achieving weight loss. Behavioral change within the entire family will need to focus on decreasing sedentary activity, increasing physical activity, improving nutrition, addressing unhealthy eating practices (fast food, skipped meals), and improving family interactions. Helpful measures in this educational process include the use of food and activity logs, which give the physician insight into eating practices as well as busy family schedules and provide opportunities to educate the family on portion sizes and sweetened beverage intake. By identifying obstacles to care, goal-setting can be more focused. For example, instead of a goal of “eat out less,” the goal can be “find a meal that the family can prepare together and freeze for later in the week.” Recognition of a lack of resources for obtaining healthy foods may allow referral of the family to a food pantry or co-op that can provide healthier alternatives for less expense. Many parents lack any knowledge of food preparation or have inadequate parenting skills. Others live in unsafe communities, where access to playgrounds or recreational activities is limited due to concerns about safety. Enlistment of community resources that can overcome these barriers is of utmost importance in the overall management strategy. Identification of small, achievable goals is useful to promote success and subsequent compliance. Regular follow-up with the patient and family, with reassessment of the goals and identification of any barriers to compliance with the plan, is important. Unfortunately, office-based management is rarely successful due to the frequency of follow-up visits required and the lack of payment for services. Multidisciplinary and community-based approaches to overweight management may be more successful in promoting family change.