# Overweight — GCMD Library living collection Everything in the library about overweight — built automatically from dossiers that name it. Updated: n/a · 5 episodes · 99 cited statements ## Episodes ### Diagnosis & Workup - [Making the Assessment, Management and Treatment of Obesity Come Alive in Your...](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865) — video · 46:57 · [machine version](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865.md) ### Nutritional Management - [Taking the Battle Out of Getting Kids to Eat Healthier and Move More: Child &...](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862) — video · 1:09:36 · [machine version](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862.md) ### Evidence & Research - [Exercise Journal Club: Pediatric Obesity 2017](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370) — video · 25:58 · [machine version](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370.md) - [Clinical Research Facilitators, Barriers, and Preferences of Parents of Children With Overweight...](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884) — video · 0:41 · [machine version](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884.md) ### In-Depth Reviews - [The Right Tool for the Job: Child & Adolescent Obesity 2015](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870) — video · 42:40 · [machine version](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870.md) ## Chapters - [0:00](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=0) Study presentation: Summer versus school-year obesity prevalence growth (Ep 1) - [12:37](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=757) Clinical approaches to summer activity planning and barriers (Ep 1) - [18:00](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1080) ADHD medications, sleep, and weight management considerations (Ep 1) - [0:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=0) Introduction and Parenting Styles Overview (Ep 2) - [3:57](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=237) The Three P's: Parent Responsibilities in Feeding and Activity (Ep 2) - [9:58](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=598) Counterproductive Parenting Behaviors to Avoid (Ep 2) - [13:57](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=837) The Three C's: Child Responsibilities in Eating and Activity (Ep 2) - [20:40](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1240) Developmental Stages and the Healthy Eater (Ep 2) - [28:22](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1702) Message Makeovers for Feeding (Ep 2) - [39:26](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2366) Discussion: Transitioning Older Children and Practical Challenges (Ep 2) - [47:55](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2875) Message Makeovers for Physical Activity (Ep 2) - [63:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3780) Case Studies: Applying the Framework (Ep 2) - [0:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=0) Introduction and Institute Mission (Ep 3) - [7:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=420) Algorithm Development and Rationale (Ep 3) - [13:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=780) Assessment Framework: Behaviors and Weight Classification (Ep 3) - [18:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1080) Healthy Weight Category Management (Ep 3) - [23:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1380) Overweight Category: Augmented Assessment (Ep 3) - [32:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1920) Obese Category and Laboratory Screening (Ep 3) - [36:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2160) Obesity-Related Comorbidities (Ep 3) - [40:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2400) Stage 1: Prevention Plus (Ep 3) - [42:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2520) Stage 2: Structured Weight Management (Ep 3) - [44:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2640) Stage 3: Comprehensive Multidisciplinary Intervention (Ep 3) - [46:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2760) Stage 4: Tertiary Care Intervention and Implementation Resources (Ep 3) - [0:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=0) Introduction and Framework: Tools Across the Obesity Care Spectrum (Ep 4) - [7:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=420) Prevention Tools: Community Programs and AAP Resources (Ep 4) - [15:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=900) Prevention-Plus Tools: Collaboratives, Counseling, and Content (Ep 4) - [25:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1500) Higher-Level and Tertiary Care: Comorbidity Management and Specialist Connections (Ep 4) - [36:13](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2173) Q&A and Faculty Discussion: Practical Implementation (Ep 4) - [0:00](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=0) Barriers to Childhood Obesity Research Enrollment (Ep 5) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - In clinical practice, calculating total weekly structured activity minutes from PE class, recess, and extracurriculars reveals that some kids have as little as 100 minutes per week while others have as much as 500 minutes per week — Jody Dimanta (clinical) [Ep 1 · 10:20](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=620) - Activity planning is very individual and requires constantly evaluating what works for each family at a particular time (opinion) [Ep 1 · 13:10](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=790) - In the Choosing Healthy and Active Lifestyles for Kids program, schools can control kids during the school year and most kids eat breakfast and lunch at school, but there is not great control during summer — John (clinical) [Ep 1 · 15:34](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=934) - In Maine, physical activity is the behavior that isn't changing as much as desired over the last 10 years of tracking — Tory (epidemiological) [Ep 1 · 16:44](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1004) - There is a significant correlation between obesity and ADHD, with decreased dopamine activity proposed as a common underlying pathway contributing to both conditions (clinical) [Ep 1 · 22:31](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1351) - Stimulants act to increase dopamine activity, and taking a break from stimulant medication puts patients in a position where they are seeking more input, which might be from food or other environmental stimuli (clinical) [Ep 1 · 22:31](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1351) - For weight management, the recommendation is to take stimulant medication every day with no breaks, including weekends and summer, because it helps with functioning in every realm of life (opinion) [Ep 1 · 22:31](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1351) - Beta blockers and antihistamines are medications known to aggravate obesity — Alan (clinical) [Ep 1 · 23:24](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1404) - Some children on ADHD medications struggle to maintain weight and may need medication breaks, particularly when side effects include blood pressure issues or personality changes — John (clinical) [Ep 1 · 23:38](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1418) - For children with obesity whose main ADHD manifestation is impulsivity, which can affect eating habits, staying on medication regularly is more likely to be recommended — John (opinion) [Ep 1 · 23:38](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1418) - Weight is not a behavior; weight loss is not something a child can go home and do. Providers should focus on healthy habits instead. (clinical) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=0) - All children need a healthy habit goal regardless of whether they are underweight, average size, overweight, or obese. (clinical) [Ep 2 · 1:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=60) - Authoritarian parents (controlling, strict) may hand-feed their child to control intake long after it is developmentally appropriate or restrict food intake. (clinical) [Ep 2 · 1:30](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=90) - Indulgent parents (permissive) may use food as comfort or reward to control behavior, with the child in control much of the time. (clinical) [Ep 2 · 2:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=120) - Uninvolved parents are neglectful, with children responsible for choosing their own food and deciding how much to eat even at a young age. (clinical) [Ep 2 · 2:30](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=150) - Authoritative parenting (responsive, with structure and limits) is the ideal style where children learn to self-regulate food intake, self-feed, enjoy mealtime, and enjoy being active. (clinical) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=180) - Parents should not dictate intake or neatness; it is developmentally appropriate for young children to make a mess while eating. (clinical) [Ep 2 · 10:30](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=630) - When parents force, pressure, restrict, or forbid foods, they override the child's internal hunger and fullness cues. (clinical) [Ep 2 · 11:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=660) - When parents indulge or bribe with food, it teaches the child they can get their favorite food by whining or crying. (clinical) [Ep 2 · 11:30](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=690) - Breastfeeding is the first introduction to the family table; breastfed babies get used to different flavor profiles from what the mother eats, which helps prevent picky eating tendencies later. (clinical) [Ep 2 · 20:40](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1240) - Formula-fed babies have the same flavor profile repeatedly, which may contribute to picky eating later. (clinical) [Ep 2 · 21:20](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1280) - Parents should read baby cues accurately; crying can mean many things (wet diaper, discomfort), not just hunger. Automatically feeding in response to crying can lead to inappropriate soothing with food. (clinical) [Ep 2 · 21:40](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1300) - When a toddler starts throwing food on the floor, that is a cue that mealtime is over. (clinical) [Ep 2 · 22:20](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1340) - It is harder to establish rules and limits around eating when children are older (teens) than when they are very young. (clinical) [Ep 2 · 23:20](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1400) - The 60 minutes of daily physical activity for children can be broken up throughout the day (e.g., 20 minutes before school, 20 minutes after school, 20 minutes after dinner). (clinical) [Ep 2 · 31:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1860) - Moderate to vigorous activity means the body is working: increased heart rate, sweating, muscle fatigue, and shortness of breath are normal signs that the body is working. (clinical) [Ep 2 · 31:40](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1900) - Using words like 'play' or 'be active' is more motivating to children than 'exercise' or 'workout,' which sound like work. (clinical) [Ep 2 · 5:50](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=350) - When parents praise children for finishing all their food, it overrides the child's hunger and fullness cues and sets them up to want to finish all meals to get praise again. (clinical) [Ep 2 · 38:20](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2300) - Parents should praise children for listening to their tummy and knowing when they are full, not for cleaning their plate. (clinical) [Ep 2 · 39:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2340) - Using food as a reward (e.g., 'if you are good, we can get ice cream') teaches children that good behavior is contingent on food rewards. (clinical) [Ep 2 · 40:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2400) - Food should not be part of a reward system; good behavior should be an expectation with or without rewards. (clinical) [Ep 2 · 40:40](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2440) - When parents use physical activity as punishment (e.g., 'run 3 laps around the house'), children associate physical activity with something to avoid and will not be motivated to participate. (clinical) [Ep 2 · 55:50](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3350) - Taking away physical activity as discipline is counterproductive; being active could be what helps a misbehaving child get their behavior back in order, especially after sitting all day at school. (clinical) [Ep 2 · 54:33](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3273) - There is not enough chips to fill a child up; snacks lacking protein will not satisfy hunger and lead to grazing behavior. (clinical) [Ep 2 · 65:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3900) - Protein is a crucial component in snacks to help keep a child feeling full until the next meal. (clinical) [Ep 2 · 65:40](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3940) - Children should not go more than 4 hours without eating to maintain normalized hunger and fullness cues. (clinical) [Ep 2 · 16:38](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=998) - Brain breaks (short periods of physical activity) before homework help children refocus their brains and can make them more efficient with homework. (clinical) [Ep 2 · 60:01](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3601) - Encouraging children to take breaks while working on homework can make them more efficient, not less, by helping them refocus. (clinical) [Ep 2 · 60:50](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3650) - The 2007 AAP guidelines form the basis for the algorithm and framework for obesity prevention and treatment tools. — Chris Foley (guideline) [Ep 4 · 7:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=420) - Obesity treatment exists on a spectrum from prevention and healthy lifestyle promotion on one end to surgical intervention and treatment failure on the other, with practice interventions and community interventions in between. — Chris Foley (clinical) [Ep 4 · 9:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=540) - The obesity care pyramid has progressively fewer patients at each higher level but requires increasingly detailed interventions: base (at-risk only), then higher risk, overweight, obese, and severely obese at the top. — Chris Foley (clinical) [Ep 4 · 11:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=660) - Obesity is affected by multiple levels of the socio-ecological model: individual behavior, interpersonal networks, organizational structures (school, work), community, and public policy. — Chris Foley (clinical) [Ep 4 · 13:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=780) - Let's Go (letsgo.org) from Maine, created by Tory Rogers and John Fanberg with community partners, is where 5-2-1-0 messaging originated and provides toolkits, posters, logos, and handouts for office-based prevention. — Chris Foley (clinical) [Ep 4 · 15:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=900) - The AAP's Pediatric e-Practice (PEP) at pep.aap.org is a joint product with the Institute for Healthy Childhood Weight that organizes resources by virtual office rooms (exam room, waiting room, billing office) with patient education materials, coding information, and work-site wellness resources. — Chris Foley (clinical) [Ep 4 · 17:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1020) - Healthy Active Living for Families (HALF) on healthychildren.org provides nutrition guidance for all families with a strong obesity prevention message, organized by age with sections on food/feeding, physical activity, and parenting tips. — Chris Foley (clinical) [Ep 4 · 19:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1140) - Quality improvement collaboratives (national, state, regional, citywide) help practices hone obesity prevention strategies while earning maintenance of certification credit. — Chris Foley (clinical) [Ep 4 · 21:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1260) - Motivational interviewing is the foundational counseling approach for pediatric weight management; training can be obtained through schools of public health, nursing, health education, or motivationalinterviewing.org, and does not need to be weight-specific. — Chris Foley (clinical) [Ep 4 · 23:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1380) - Cognito's Change Talk is a free app and desktop resource for pediatric obesity-specific motivational interviewing training, developed with Bob Schwartz from the Section on Obesity executive committee. — Chris Foley (clinical) [Ep 4 · 25:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1500) - Motivational interviewing addresses the 'why' of behavior change while cognitive behavioral therapy (CBT) strategies address the 'how'; elements of CBT are helpful when doing weight management. — Chris Foley (clinical) [Ep 4 · 27:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1620) - Content should be personalized with your own office logo and vernacular, and should make sense locally for your patients rather than referencing resources that don't exist in your community. — Chris Foley (opinion) [Ep 4 · 29:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1740) - ChooseMyPlate.gov provides tear-off sheets of the MyPlate graphic and the SuperTracker tool, which allows families to track physical activity and food, and find recipes. — Chris Foley (clinical) [Ep 4 · 31:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1860) - ChopChop magazine (chopChopmag.org), created by the Institute for Healthy Childhood Weight and New Balance Foundation, promotes fruit and vegetable intake based on the message that kids are more likely to eat if they are active participants in food preparation. — Chris Foley (clinical) [Ep 4 · 33:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1980) - Fitness trackers (Fitbit, pedometers, accelerometers) and apps (MyFitnessPal, Lose It) are appropriate tools to encourage for certain families; wearing one visibly as a provider opens the door to discuss 10,000 steps and daily physical activity. — Chris Foley (opinion) [Ep 4 · 35:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2100) - For severely obese patients with significant comorbidities, primary care providers need to expand care to include comorbidity management and may need to interpret elevated hemoglobin A1C, blood sugar, or abnormal lipid profiles themselves. — Chris Foley (clinical) [Ep 4 · 37:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2220) - Pediatricians will need to act more like internists as children develop obesity-related comorbidities, requiring training in comorbidity management. — Chris Foley (opinion) [Ep 4 · 39:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2340) - Obesity contacts at tertiary care centers may reside in multiple divisions including GI, endocrine, cardiology, psychology, not just one location. — Chris Foley (clinical) [Ep 4 · 41:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2460) - The Children's Hospital Association website maintains a list of programs that conform to CHA recommendations for pediatric obesity care. — Chris Foley (clinical) [Ep 4 · 43:00](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2580) - Dr. Foley's practice uses a 'Basic Training' program for families interested in obesity treatment, delivered by physicians, nurse practitioners, and physician assistants, using materials like the 5-2-1-0 clinical decision support flip chart. — Chris Foley (clinical) [Ep 4 · 42:40](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2560) - Maine's Next Steps program has 17 behavioral goals; Dr. Foley uses an adapted version focusing on 8 core goals including the 5-2-1-0 behaviors plus restricting eating out to 3 times per week, portion control, healthy snacks, and eating a healthy breakfast. — Chris Foley (clinical) [Ep 4 · 42:40](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2560) - SuperTracker on ChooseMyPlate.gov or supertracker.usda.gov provides age-appropriate eating plans and allows families to self-monitor food intake and compare it to recommendations. (clinical) [Ep 4 · 42:40](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2560) - Strong for Life (StrongForLife.com) from Children's Healthcare of Atlanta provides resources for parents on healthy eating and activity, plus a Provider Tab with clinical resources including developmental handouts on using the P's and C's for eating and activity. (clinical) [Ep 4 · 42:40](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2560) - Children with overweight and obesity may be sick and are often not being appropriately screened for comorbidities. — Corey (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=180) - The algorithm was developed using 2007 Expert Committee recommendations, US Department of Health and Human Services cardiovascular guidelines, and American Diabetes Association guidelines. — Corey (guideline) [Ep 3 · 8:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=480) - The algorithm starts at the well child visit and continues with planned follow-up visits as determined by the patient, family, and provider. — Corey (guideline) [Ep 3 · 11:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=660) - The algorithm is not a protocol but a suggested course of action to be used with clinical judgment. — Corey (guideline) [Ep 3 · 11:30](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=690) - The algorithm applies to patients 2 years and older, not addressing the birth to 2 years age group. — Corey (guideline) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=780) - For healthy weight children (BMI 5th-84th percentile), providers should screen for genetic dyslipidemia with non-fasting lipid profile at ages 9-11 and 18-21, independent of weight status. — Corey (guideline) [Ep 3 · 19:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1140) - Screening for genetic dyslipidemia is part of cardiovascular guidelines from approximately 3 years ago and should be done on all patients irrespective of weight. — Corey (guideline) [Ep 3 · 20:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1200) - An augmented review of systems for children ≥85th percentile should assess for snoring, sleep disturbances, abdominal pain, menstrual irregularities, hip/knee/leg pain, polyuria, polydipsia, and depression as indicators of potential comorbidities. — Corey (clinical) [Ep 3 · 25:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1500) - Snoring in children with elevated BMI may indicate obstructive sleep apnea. — Corey (clinical) [Ep 3 · 26:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1560) - Abdominal pain in children with elevated BMI may indicate gastroesophageal reflux, constipation, gallbladder disease, or non-alcoholic fatty liver disease. — Corey (clinical) [Ep 3 · 26:30](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1590) - Polyuria and polydipsia in children with elevated BMI may indicate type 2 diabetes. — Corey (clinical) [Ep 3 · 27:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1620) - Physical exam findings requiring attention in children with elevated BMI include blood pressure (with correct cuff size), acanthosis nigricans, tonsillar hypertrophy, goiter, abdominal tenderness, hepatomegaly, bowing of legs (Blount disease), limited hip range of motion (slipped capital femoral epiphysis), fuzzy optic discs (pseudotumor cerebri), acne, and skin inflammation. — Corey (clinical) [Ep 3 · 28:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1680) - Correct blood pressure cuff size is critically important for children with obesity. — Corey (clinical) [Ep 3 · 29:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1740) - Family history assessment for children with elevated BMI should include obesity, type 2 diabetes, hypertension, lipid abnormalities, and heart disease in first and second-degree relatives. — Corey (clinical) [Ep 3 · 31:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1860) - Children in the overweight category (85th-94th percentile) with positive family history, review of systems, or physical exam findings should receive laboratory screening for comorbidities. — Corey (guideline) [Ep 3 · 33:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1980) - All children with BMI ≥95th percentile should have additional screening and workup for underlying comorbidities regardless of symptoms. — Corey (guideline) [Ep 3 · 34:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2040) - Some providers obtain non-fasting labs for patient convenience, though fasting labs are preferred; this is particularly relevant in rural areas where return visits are unlikely. — Corey (clinical) [Ep 3 · 37:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2220) - Some subspecialty clinics screen for vitamin D deficiency and insulin resistance with vitamin D and fasting insulin levels, but the clinical utility and cost-effectiveness of these tests is yet to be determined. — Corey (clinical) [Ep 3 · 38:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2280) - There are no current guidelines on when to start laboratory testing for patients with obesity; based on health risks, some experts may start screening as early as 2 years of age. — Corey (guideline) [Ep 3 · 39:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2340) - Constipation is a very common comorbidity in children with obesity that is easily treated and improves patients' ability to eat more and be more physically active. — Corey (clinical) [Ep 3 · 40:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2400) - Not every patient is ready for obesity treatment; when patients and families are not ready, providers should avoid using fear tactics and instead keep the door open for future engagement. — Corey (clinical) [Ep 3 · 42:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2520) - There are no quick fixes for childhood obesity; surgical treatment for eligible older children requires many months of behavior modification before surgery. — Corey (clinical) [Ep 3 · 43:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2580) - Motivational interviewing works for behavior change and has been shown to work for obesity management and treatment. — Corey (clinical) [Ep 3 · 44:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2640) - Small behavior changes can have profound effects on health and are usually more sustainable than large changes. — Corey (clinical) [Ep 3 · 45:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2700) - In pediatrics, children will continue to grow taller until growth plates fuse, which is an advantage in obesity management. — Corey (clinical) [Ep 3 · 46:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2760) - Patients should start at the least intensive treatment stage and advance based on response to treatment, age, BMI, health risks, and most importantly patient/family motivation. — Corey (guideline) [Ep 3 · 47:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2820) - An empathetic, empowering counseling style such as motivational interviewing should be employed to empower patients and families in behavior change, avoiding fear tactics. — Corey (guideline) [Ep 3 · 48:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2880) - Stage 1 (Prevention Plus) consists of 15-20 minute themed follow-up visits in primary care focusing on behaviors chosen by patient/family, with possible partnerships with dietitian, social worker, athletic trainer, or physical therapist. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - For Stage 1, children ages 2-5 with obesity should not lose more than 1 pound per month, and older children/adolescents should not lose more than an average of 2 pounds per week. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Monthly follow-up visits are recommended for Stage 1, though follow-up should be tailored to patient/family motivation and can include text, email, or social media contact. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - After 3-6 months in Stage 1, if BMI and weight status do not improve, consider advancing to Stage 2. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 2 (Structured Weight Management) is delivered by primary care providers with appropriate training, particularly in motivational interviewing, with more intensive support than Stage 1. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 2 follow-up should occur every 2-4 weeks as determined by patient, family, and physician. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 3 (Comprehensive Multidisciplinary Intervention) is delivered by pediatric weight management clinics with multidisciplinary teams that may include endocrinologists, pulmonologists, gastroenterologists, social workers, and dietitians. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 3 includes structured behavior modification with food and activity monitoring and development of short-term diet and physical activity goals. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 4 (Tertiary Care Intervention) is for patients >95th percentile with significant comorbidities, delivered at pediatric weight management centers with obesity expertise. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 4 includes intensive diet and activity counseling with consideration of medications and age-appropriate surgery. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - The goal of Stage 4 is BMI decrease because these children are sick and need to reduce BMI, though behavior change remains the initial focus. — Corey (guideline) [Ep 3 · 46:57](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - Researchers surveyed more than 100 parents of children with overweight or obesity to understand what influences their decision to participate in research — Lizzy Lee summarizing a resource [Ep 5 · 0:07](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=7) - Parents reported more reasons to participate in childhood obesity research than reasons not to participate — Lizzy Lee summarizing a resource [Ep 5 · 0:15](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=15) - Mistrust, time demands, and social pressure are barriers that make it harder for parents to participate in childhood obesity research — Lizzy Lee summarizing a resource [Ep 5 · 0:15](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=15) - Research perceptions varied by family characteristics — Lizzy Lee summarizing a resource [Ep 5 · 0:26](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=26) - To improve childhood obesity research, studies need to be easier to join, reduce participation burden, and build trust with families from the beginning — Lizzy Lee summarizing a resource [Ep 5 · 0:30](https://qa.library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=30) - The study sample consisted of 13,006 children from 846 schools after excluding children with missing covariates and children from year-round schools — Jody Dimanta summarizing the discussion [Ep 1 · 3:20](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=200) - Children's height and weights were measured each fall and spring for a total of 6 occasions, with fall measurements taken 5-7 weeks after the first day of school and spring measurements taken 8 weeks before the last day of school — Jody Dimanta summarizing the discussion [Ep 1 · 3:50](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=230) - Obesity prevalence increased from 8.9% to 11.5% and overweight prevalence increased from 23.3% to 28.7% over the study period — Jody Dimanta summarizing the discussion [Ep 1 · 5:10](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=310) - All increases in obesity and overweight prevalences occurred during the two summer vacations with no increases during any of the three school years — Jody Dimanta summarizing the discussion [Ep 1 · 5:40](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=340) - During summer 1 and summer 2, both overweight and obesity prevalences increased by approximately 1% point per month — Jody Dimanta summarizing the discussion [Ep 1 · 6:10](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=370) - Over the average summer vacation of 2.6 to 2.7 months, there was a 2-3% rise in overweight and obesity points — Jody Dimanta summarizing the discussion [Ep 1 · 6:40](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=400) - During the school year, there was a decrease in obesity prevalence during kindergarten and second grade years — Jody Dimanta summarizing the discussion [Ep 1 · 7:10](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=430) - The standard deviation of BMI growth is approximately 3 times greater during the 2 summers than during the 3 school years — Jody Dimanta summarizing the discussion [Ep 1 · 7:40](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=460) - Children tend to sleep less and watch more screen time during summer — Jody Dimanta summarizing the discussion [Ep 1 · 8:40](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=520) - School-based interventions that tried to carry things over into the summer for families did not show any positive effect — Jody Dimanta summarizing the discussion [Ep 1 · 9:20](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=560) - In Minnesota, the requirement for gym class is 1 year out of 4 years of high school, with only half of that year being gym and the other half being health — Em Gootee summarizing the discussion [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/exercise-journal-club-pediatric-obesity-2017-370?t=1080) - Research shows it can take 10, 15, or more times of offering a previously refused food before a child will try it. — The host summarizing a resource [Ep 2 · 9:58](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=598) - The AAP recommends no screen time for infants and children under 2 years old. — The host summarizing a resource [Ep 2 · 28:22](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1702) - The AAP recommends no more than 2 hours of screen time daily for children 2 years and older. — The host summarizing a resource [Ep 2 · 28:50](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1730) - Toddlers need at least 30 minutes of structured physical activity daily and at least 60 minutes (up to several hours) of unstructured physical activity. — The host summarizing a resource [Ep 2 · 29:20](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1760) - Toddlers should not be sedentary for more than 60 minutes at a time except when sleeping. — The host summarizing a resource [Ep 2 · 30:00](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1800) - School-age children need to be active 60 minutes a day, with most activity being aerobic at moderate to vigorous intensity, plus muscle and bone strengthening activities. — The host summarizing a resource [Ep 2 · 30:20](https://qa.library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1820) - Starting with topics that are comfortable for the individual clinician (such as sugar-sweetened beverages, screen time, or sleep) and then expanding to other areas is an effective approach to building obesity counseling skills. — The host summarizes what Dr. Chris Foley said [Ep 4 · 42:40](https://qa.library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2560) - For patients with BMI over the 85th percentile, the 2007 Expert Committee recommendations state providers should have a 'pausing moment' because these children could be sick. — Corey summarizing the discussion [Ep 3 · 23:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1380) - The 2007 Expert Committee recommendations state that fasting glucose, fasting lipid profile, ALT, and AST should be obtained in patients with BMI ≥85th percentile with risk factors and all patients with BMI ≥95th percentile. — Corey summarizing the discussion [Ep 3 · 35:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2100) - ADA and Endocrine Society guidelines recommend hemoglobin A1c, fasting glucose, or oral glucose tolerance test to screen for diabetes or prediabetes in children with obesity. — Corey summarizing the discussion [Ep 3 · 36:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2160) - The Children's Hospital Association consensus statements on comorbidity management may help keep children in their medical home and provide guidance to sites without subspecialists. — Corey summarizing the discussion [Ep 3 · 41:00](https://qa.library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2460) --- Educational content from recorded physician discussions — not medical advice. 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