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INTRODUCTION

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  • What constitutes a complete assessment of a child with obesity?

  • How do I ensure that a child with obesity receives the proper evaluation for obesity and obesity-related comorbidities?

  • How do I perform a proper assessment to help focus counseling so a patient and family can make lifestyle change?

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This chapter will address the following American College of Graduate Medical Education competencies: patient care, practice-based learning and improvement, and professionalism.

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Patient Care: This chapter will help the pediatric health care provider incorporate evidence-based guidelines for the assessment of obesity into an appropriate and effective treatment plan and set effective lifestyle goals with the patient and family.

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Practice-Based Learning and Improvement: Incorporating the “work” of obesity prevention and treatment into practice is new for many health care practitioners. This chapter will help address childhood obesity and obesity-related comorbidities systematically in practice using advances in medical knowledge, epidemiology, and psychosocial and behavioral health to engage in continuous practice-based learning and improvement.

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Professionalism: This chapter will review the commitment to ethical principles, sensitivity to diversity and values of respect, compassion and kindness to patients which are particularly important in addressing the sensitive issue of weight and lifestyle behaviors with children and families.

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Appropriate assessment is the first step in the treatment of obesity in children and encompasses determining the patient’s body mass index (BMI) classification, considering the differential diagnosis for the etiology of obesity including an evaluation of weight related-behaviors, screening for comorbidities associated with obesity (including risk for developing comorbidities in the future), and exploring readiness to engage in weight management efforts.1, 2, 3 A thorough assessment will provide guidance for treatment and may be facilitated by the use of widely available tools4, 5, 6 to streamline the process and to help ensure that all necessary components are addressed.

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This chapter will describe a detailed approach to assessing obesity in the pediatric primary care setting. BMI should be obtained and monitored annually on all patients and become a vital sign. A thorough medical evaluation should be conducted for all children with obesity, focused on identifying underlying causes of obesity and screening for comorbidities. When children with obesity are short, or 2 standard deviations below the mean,7 have learning disabilities or findings suggesting a syndrome, then endocrine and/or genetic causes should be suspected. A thoughtful dietary assessment should be performed that goes beyond the content and quantity of food consumed, but also addresses eating, and food-related behaviors and cultural norms. The assessment of activity should include the duration and intensity of physical activity and the physical activity environment along with the amount of time spent in sedentary (eg, screen time) activities and sleep. Understanding family motivation and readiness to change, perceptions regarding participation in weight management efforts, and specific nutrition and activity-related behaviors are essential prior to beginning efforts to intervene.

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