The Right Tool for the Job: Child & Adolescent Obesity 2015

The 2007 AAP guidelines form the basis for the algorithm and framework for obesity prevention and treatment tools.

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.

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.

Obesity is affected by multiple levels of the socio-ecological model: individual behavior, interpersonal networks, organizational structures (school, work), community, and public policy.

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.

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.

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.

Quality improvement collaboratives (national, state, regional, citywide) help practices hone obesity prevention strategies while earning maintenance of certification credit.

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.

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.

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.

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.

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.

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.

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.

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.

Pediatricians will need to act more like internists as children develop obesity-related comorbidities, requiring training in comorbidity management.

Obesity contacts at tertiary care centers may reside in multiple divisions including GI, endocrine, cardiology, psychology, not just one location.

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.

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.

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.

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.

The Children's Hospital Association website maintains a list of programs that conform to CHA recommendations for pediatric obesity care.