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What's the latest in treating childhood obesity?

The Canadian Taskforce on Preventive Health recently released recommendations about the identification and management of childhood obesity in primary care. What can we learn from their recommendations? Also, is medication ever a consideration for treating obesity for children?

Recently, the Canadian Taskforce on Preventive Health released recommendations about the identification and management of childhood obesity in primary care. Our friends in the North are not alone in this problem. Currently, one-third of children and adolescents in the United States are classified as either overweight or obese. Overall, the guidelines address three major issues that affect us here in the US:

  1. Dealing with children that are at a healthy weight.

  2. Dealing with children that are obese.

  3. In these obese children, is there any role medications or surgery?

Luckily, your child's primary care physician can be your first line resource for identifying and helping with weight management. The first group deals with children that are at a healthy weight (BMI≥5th to <85th percentile).  In dealing with children at a healthy weight, there is no structured intervention. This does not mean that you should not be aware of proper eating habits and exercise, but overall no set structure for management is needed.  I find it useful to still educate my patients on a few simple tips:

  1. Eat 5 to 9 fruits and vegetables (combined total) servings per day.

  2. Follow recommendations for juice and sweetened drinks

  3. Encourage exercise and outdoor play.

The second group deals with children that fall outside the healthy weight group.  This group involves the overweight and obese categories. These children can benefit from a structured weight management plan that involves dietary measures, physical activity interventions, and behavior changes.

I also always caution to be very careful about which words to use when speaking about obesity.  Words like heavy, overweight, and obese can carry some unintentional negative feelings and upset children and parents. Two approaches are needed when implementing a weight management plan.  First, we can deal with the behavior modifications. Here, physicians can discuss behavioral weight management techniques with both the child and the parents using motivational interviewing.

In this scenario, the physician will use positive language and motivational techniques to improve attitudes and outlooks for weight loss. The key in this type of management involves being positive.  If the child loses or stays stable with weight, we want to motivate and even reward at times. If no weight loss occurs, we want to look at positive aspects, never be negative, and motivate further so we can all achieve the goal.

The second component in weight management plan deals with improving diet and exercise.  Children that fall into the overweight and obese categories do benefit from a structured diet and exercise plan. These plans can be created with your primary care physician or the patient can be referred to other specialists to help with their needs. Here is a guide from the American Academy of Pediatrics on how to evaluate a weight loss program or plan for a child or teen.

In general, there are a few rules to live by when it comes to weight loss in obese children:

  1. You want to encourage healthy weight loss. This means setting attainable goals such as losing one pound a week or even just maintaining the weight in the some cases.

  2. Again, be positive, encouragement and positivity is key.

  3. Control portion sizes. Make these portion sizes something the children can understand.  For example, you can relate a cup to the size of a baseball.

  4. Avoid sugary drinks and you can decrease the fat content in milk.

  5. Eat meals together and at the table.  Distractions like television during meals increase the actual eating time and can add to extra eating.

  6. Encourage at least an hour of exercise a day. Make this something fun. It does not matter if it is dancing, jumping rope, walking, or playing baseball, just as long as you are actually exercising.

  7. Recognize accomplishments. Weight management shouldn't be a burden and it is OK to give rewards when goals are met. Just make them small and not junk food.

  8. Limit on-screen time. Too much television, video games, computer time can promote less exercise.

Last, but not least, in dealing with childhood obesity there are always questions about bariatric surgery and medications like Orlistat to help improve weight loss. Currently, these interventions are not recommended as routine treatment for children.

Dealing with childhood obesity has no easy answer and sadly there is no quick fix. It is always a good idea to consult with your physician before starting any diet or exercise plan especially in children. Most importantly, remember to stay positive and to support your children during these tough interventions. All the hard work will benefit everyone in the end.

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