Childhood Obesity Treatment Toolkit and Resources

Obesity Toolkit Cover

 

 

 

 

The U.S. Preventive Services Task Force recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral intervention to promote improvement in weight status. Baptist Community Ministries and Pennington Biomedical Research Center provide the following toolkit as a summary of best practices to assist primary care providers in providing preventive and treatment services for childhood obesity

 

 

 

 

Children are at higher risk if:

  • The child is already overweight or obese
  • One or both parents are obese
  • One or more siblings are obese
  • The child has a disease/disability that limits mobility or promotes weight gain
  • The child is taking medications that promote weight gain
  • The child does not engage in regular physical activity or spends > 2 hrs/day in sedentary activities
  • The child has poor eating habits and/or a family environment with poor understanding of proper nutrition

 

  • Body mass index (BMI) should be calculated at every well child visit, regardless of age or weight.  BMI can be calculated here http://nccd.cdc.gov/dnpabmi/ and interpreted using the following table:
BMI Category

 

 Terminology

 
< 5th Percentile Underweight

 
5th - 84th Percentile Healthy Weight
85th - 94th Percentile Overweight
≥ 95th Percentile Obesity
  • Check for fasting lipid levels every 2 years starting at age 10 in children with a BMI of 85th to 94th percentile.   If other risk factors are present, fasting glucose, ALT, and AST levels should also be measured.  Children with a BMI ≥ 95th percentile should be checked for fasting glucose, ALT, and AST levels every 2 years starting at age 10.
BMI Tests
> 85th - 94th Percentile with No Risk Factors Fasting lipid levels

 
> 85th - 94th Percentile with Risk Factors
(e.g., family history of obesity-related diseases, elevated blood pressure, elevated lipid levels, or tobacco use)		 Fasting lipid levels, AST and ALT levels, ad fasting glucose levels
≥ 95th Percentile Fasting lipid levels, AST and ALT levels, and fasting glucose levels

*AST indicated aspartate aminotransferase; ALT, alanine aminotransferase.

  • Assess dietary and physical activity habits with simple questions about modifiable behaviors, such as how many fruit/vegetable servings are consumed each day, how many sweetened beverages are consumed each day, and how much time is spent in moderate to vigorous activity or sedentary activities each day
  • Pay attention to family history (parents and grandparents) of obesity, type 2 diabetes mellitus, and cardiovascular risk factors
  • Assess for family understanding of proper nutrition and the importance of physical activity
  • Assess for genetic-based and endocrine-related causes like Prader-Willi syndrome, Turner’s syndrome, hypothyroidism, and Cushing’s syndrome
  • Monitor medications like antipsychotic agents, selective serotonin reuptake inhibitors, tricyclic antidepressants, anticonvulsants, mood stabilizers, prednisone, and oral contraceptives and their association with weight gain

 

  • Stage 1:  Prevention Plus – Concentrate on lifestyle changes related to  diet and physical activity, such as consuming ≥ 5 servings of fruits and vegetables per day, minimizing sugary beverages, limiting screen time to ≤ 2 hrs/day, and engaging in ≥ 1 hr of moderate to vigorous physical activity per day.
  • Stage 2: Structured Weight Management – Continue behavior change goals from Stage 1, but with closer monitoring by the health care provider.  Increased monitoring can be achieved by keeping logs of physical activity and foods eaten, creating a meal plan, and offering incentives to reinforce target behaviors.
  • Stage 3: Comprehensive Multidisciplinary Intervention – Focus on frequent behavior modification by setting short term goals, increasing monitoring/health care visit frequency/parental involvement, modifying the home environment, and making contingency plans for slips.  The goal of this stage is to achieve negative energy balance for weight loss.
  • Stage 4:  Tertiary Care Intervention – Medications, a very low calorie diet, or weight control surgery should be considered at this stage for severely obese children.
  • Involvement  of whole families – parents have the authority to modify the child’s environment and family-based group therapy is a cost-effective approach
  • Use motivational interviewing techniques to promote non-judgmental questioning and reflective listening from health care providers
  • Focus self-monitoring and goal setting related to food intake and energy expenditure
  • Weight change within the first 3 months of treatment is an important predictor of long-term weight outcomes, and follow-up assessment is necessary to ensure long-term weight reduction
  • Integrate technology –pedometers, accelerometers, and smartphone apps can assist in monitoring behaviors; text messaging, video conferencing, and the internet make communication with patients easy
  • Be aware of special considerations – treatment plans should take into account a patient’s socioeconomic capabilities, gender, and cultural preferences
  • SHAPEDOWN – School of Medicine at University of California, San Francisco – A family-based obesity intervention designed to meet the social, cognitive, and emotional needs of children and adolescents of different backgrounds and abilities.  This intervention has shown success in improving children and adolescents’ relative weight, weight-related behaviors, self-esteem, weight management knowledge, and depression.  http://www.shapedown.com/
  • Mind, Exercise, Nutrition, Do it! (MEND) – United Kingdom – A family-based program that focuses on education, skills training, and motivational enhancement for nutrition, behavior change, and physical activity.  Children in MEND have reduced waist circumference and z-BMI scores, and increased cardiovascular fitness, physical activity levels, and self-esteem.  http://mendcentral.org/
  • High Five for Kids – Harvard Medical School Department of Population Medicine and Harvard Vanguard Medical Associates – A primary care intervention for young children to modify behaviors, adopt healthier diets, and increase physical activity.  Participants achieved slightly lower BMI after one year of follow-up, with girls and lower-income children showing significant reductions in BMI.  Children in the program also reduced television viewing and intake of fast food and sugary beverages.  http://www.populationmedicine.org/research/OPP/high-five-kids-toolkit
  • Bright Bodies and Smart Moves – Yale University – A weight management program for overweight children especially geared towards the needs of minority youth in urban settings.  This program has weekly nutrition/behavior modification and bi-weekly physical activity sessions and has shown beneficial effects on body composition (decreased weight, BMI, body fat) and insulin resistance.  http://www.brightbodies.org/ and http://www.smartmovesforkids.com/