Introduction

The Problem Pediatric

overweight and pediatric obesity defined

Successful treatment strategies

Implement into your daily practice

The Scope of the Problem

In 30 years, obesity rates have DOUBLED for preschool age children and adolescents

TRIPLED for children aged 6 to 11 years Obese children under 10 have at least 1

cardiovascular risk factor already Overweight children have 70% chance of

being an overweight or obese adult Increases to 80% if one parent is

overweight

Goals of Treatment

Reduce energy intake while maintaining optimal nutrition to support growth and development

Increase energy expenditure while reducing sedentary behaviors

Facilitate a supportive family environment with ‘buy in’ from the adults

Sobering fact

Only 21% of 64 preventitive obesity programs for children reviewed resulted in even short-term weight loss

Those that do represent change often show small changes

Stice E, Shaw H, Marti N. A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventiosns that work. Psychol Bull 2006;132(5):667-91.

Definitions

Underweight: BMI <5th percentile Normal: 5th to <85th percentile Overweight: 85th to <95th percentile Obese: >95th percentile or BMI >30

American Medical Association. Expert Committee Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity. Jan 25, 2007.

Treatment Strategies

Therapeutic use of nutrition Motivational interviewing Mind-body connection Exercise counselling Close partnership between patient

and physician

Treatment StrategiesTherapeutic use of nutrition

Anti-inflammatory diet Phytochemicals found in foods lead to

reduced levels of inflammatory states in the body

Antioxidant properties are cardioprotective

Omega-3 fatty acids Most pediatric diets are insufficient May consider supplementing if high

number of cardiac risk factors

Treatment Strategies Therapeutic use of nutrition

5-2-1-0 project 5 or more servings of fruits and

vegetables 2 or fewer screen hours 1 or more hours of physical activity Zero sugar-sweetened beverages

Treatment Strategies Motivational interviewing

Directive style of counseling Focus is on patient’s own

perceptions and motivations Seeks to resolve ambivalence Strengthen’s patients reasons for

positive behavior change Triggers change in a way consistent

with patient’s goals and values

Treatment Strategies Motivational interviewing

Treatment of 7-12 year olds for childhood overweight using three treatment arms Behavioral skills maintenance (BSM) Social facilitation maintenance (SFM) Control

Each family was instructed on dietary recommendations, exercise goals, behavior change (ie. less screen time)

The first two groups received extended maintenance therapy for 2 years

Treatment Strategies The studies that WORKED

During management phase, more counseling resulted in higher weight loss

At 2 years, the BSM and SFM patients maintained their weight better but only modestly compared to controls

Bottom line: Regular monitoring with counseling

appears to help in the weight loss effort but effects tend to wane over time

Wilfley, et al. Efficacy of Maintenance Treatment Approaches for Childhood Overweight: A Randomized Controlled Trial. JAMA. 2007;298(14):1661-1673.

Treatment Strategies Mind-body connection

Engages power of thoughts and emotions to positively influence physical health

May help children feel a sense of control over their illness

Indirectly has been shown to help obesity by improving the co-morbidities: stress, depression, anxiety, low self-esteem, coping

Treatment Strategies Exercise counseling

The APPLE project School based initiative in New Zealand Intervention: school-based activity

coordinators acted to increase exercise before/during/after school, actively improve diets

Measurements of BMI annually x 4 years Intervention group: improvement in BMI

and sustained BMI change compared with control

Taylor RW, et al. Two-year follow-up of an obesity prevention initiative in children: the APPLE project. Am J Clin Nutr 2008;88:1371-7.

Treatment Strategies Exercise counseling

The APPLE project Very cool side effect: Intervention schools decided to

remove fried foods and sugary drink options from cafeteria

One school created an edible garden Parental involvement in sports

remained strong in follow-up phase

Taylor RW, et al. Two-year follow-up of an obesity prevention initiative in children: the APPLE project. Am J Clin Nutr 2008;88:1371-7.

Treatment Strategies Close partnership between patient and physician What is the ‘job’ of the physician? Beginning at age 3, yearly BMI

measurements should be taken Educate parents and patients about

BMI as a screening tool Identify cardiac risk factors if present Referral to nutritional counseling Get involved with local schools!

Implementation into Daily Practice Monitor BMI at least once annually

between 2-20 years of age Adopt motivational interviewing style Consider monitoring for

cardiovascular risk factors in obese children ‘

Get involved with local communities to help affect change