Duke Health Referring Physicians

Practice Management

Preventing and Treating Childhood Obesity

Pediatricians play a key role in helping combat the childhood obesity epidemic

children splashing in a pool

Childhood obesity is a serious public health issue influenced by physiological, psychological, environmental, and genetic factors, which makes it a challenging condition to address. One in five children in the United States are obese, according to the CDC, and one-third of all children ages 6 to 19 are considered overweight. Furthermore, a child who is overweight or obese has a 50% chance of becoming an adult who is obese, regardless of a family history of obesity.

These children are also more likely to develop chronic diseases, such as diabetes and cardiovascular disease, at a younger age. The good news: Pediatricians can help combat the childhood obesity epidemic by educating families on positive eating, sleeping, and activity patterns.

“Childhood obesity is a common problem, and it’s important to prevent and treat it well,” says Eliana Perrin, MD, MPH, a pediatrician and the director of the Duke Center for Childhood Obesity Research. Perrin wants pediatricians to recognize the crucial role they play in preventing childhood obesity. “Pediatricians probably underestimate the extent to which families view them as trusted advisors, but they’re extremely important partners in behavioral health change,” she explains. Some providers may feel ineffective at times, but given the number of children they see each day who may be overweight or obese, even a small success rate can make a difference, Perrin adds.

Promote Healthy, Active Lifestyles

Discussing healthy lifestyle patterns can begin in infancy and help prevent the need for treatment later on. The American Academy of Pediatrics’ (AAP) Healthy Active Living for Families program offers several resources for providers and parents, including interactive web-based tools, age-specific recommendations, and tips for communicating with parents. The AAP also developed a website specifically for families and parents on improving the physical, mental, and social health of children (HealthyChildren.org).

“We’re learning every day about how hard it is to change a child’s weight trajectory after early childhood, so we’re really focused on those early years of life,” Perrin says. In research with parents, Perrin and her team hear that families wish they’d never started some of those unhealthy habits. “Once children expect juice with every meal, that’s hard to take away,” she adds. “It’s best to just not buy it or start it in the first place.”

The AAP recommends 15 well-child visits in the first five years of life. From a family’s first visit after a child’s birth, health care providers can begin advising parents on appropriate feeding techniques (no bottle propping, only breast milk or formula in bottle) and when to introduce complementary foods (around six months of age).

Engage Parents

Talking to families about a child’s weight typically starts at birth, as every family wants to know how much their child weighs, according to Charles Wood, MD, MPH, a Duke pediatrician. “Throughout the first year of life, parents are different in how they approach this, but many of them are focused on weight percentiles,” Wood says.

Currently, although AAP recommends screening for obesity at age two using body mass index (BMI) guidelines, these conversations can begin as early as parents want. “Letting parents drive that conversation in the early years is really important,” Wood adds.

In a child who has an elevated BMI or weight, Wood advises providers to begin the discussion by asking permission from the parent (and child, if appropriate) to discuss weight. Motivational interviewing can be a helpful technique for these discussions; research has shown that it is an effective method for facilitating behavior change. This patient-centered communication technique is focused on being empathetic, nonjudgmental, and supportive—which is crucial when discussing weight.

Pediatricians can also discuss healthy lifestyle habits and activities without directly talking about weight. Questions about screen time, physical activity, and structured meals are helpful for all families, as most children are at risk for weight gain to some degree, Wood explains. “Just like you would ask about wearing a bike helmet, a pediatrician might ask about fruits and vegetables,” he says.

Acknowledge Barriers

Obesity and weight gain are spurred by the many calorie-dense, nutrient-poor food options marketed to adults and children. “Pediatricians have to ‘immunize’ families against these toxic food environments,” Perrin explains. “Tell them they need to be extremely proactive about encouraging healthy habits for their children because every other societal message is encouraging them to do the reverse.”

Additionally, many families encounter barriers to providing healthier foods, including cost, availability, and time. There is a proven link between obesity and socioeconomic status, and children from low-income families are more likely to become overweight or obese than those from middle- or high-income households.

Consider Partnerships and Referrals

Pediatricians will likely need to counsel many of their patients about achieving a healthier weight trajectory. Partnerships and referrals to registered dietitians and behavioral health specialists are key in preventing a child who is overweight from becoming an adult who is obese.

Many medical schools don’t include nutrition courses as part of a physician’s medical training, but registered dietitians can provide children and parents with specific nutrition advice and weight loss plans as well as counsel adolescents with eating disorders. “It’s not just the food; there are so many things that play a part in why a child eats or doesn’t eat,” explains Angela Lemond, a registered dietitian, nutritionist, and co-owner of Lemond Nutrition, a private nutrition practice in Texas.

Children who are coping with behavioral, social, and psychological issues may also require a referral to a licensed counselor. “They can get the appropriate support and actually deal with emotional issues so they don’t use food as a coping mechanism,” Lemond adds.

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