How do I approach treatment for an adolescent with a body mass index (BMI) greater than 95% for age and gender?
What specific lifestyle changes are likely to be most effective?
How would I address lifestyle change in terms of family and patient strengths and barriers?
How do the principles of the Chronic Care Model (CCM) apply to treatment of obesity?
How do I know when to “step-up or step-down” treatment?
This chapter will address the following American College of Graduate Medical Education competencies: patient care, interpersonal and communication skills, and systems-based practice.
Patient Care: In order to effectively care for a child with obesity the pediatric health care provider must be proficient in using the CCM (www.improvingchroniccare.org) applied to weight management. This chapter will review the salient points of this model.
Interpersonal and Communication Skills: This chapter will help the pediatric health care provider incorporate motivational interviewing into their practice as a core competency essential for caring for a child with obesity and their family.
Systems-Based Practice: This chapter will help the health care provider use systems-based practice to coordinate the care of children with obesity among the many practitioners and programs outside the physician office which are needed for successful treatment.
Obesity is a chronic disease, similar to asthma and diabetes, which responds best to regular, ongoing care over a prolonged period of time in an office prepared to offer effective treatment. Once a child is diagnosed with overweight or obesity, shifting the care model from acute disease treatment to chronic disease management offers potential for improving health outcomes. Some children will experience improvement in their obesity and potentially go into remission. Others may experience worsening over time and develop complications, such as hypertension, diabetes, dyslipidemia, sleep apnea, or depression. These children will need more intensive services over time to support them and their families in learning how to manage their obesity and its complications
TEAM APPROACH USING THE OBESITY CARE MODEL
Care of the child with overweight or obesity in the primary care setting can seem daunting, leading to frustration for both the pediatric health care provider and the family. While it is true that most evidence for interventions in the primary care setting show only small improvements in BMI1, 2, 3, 4, 5 except in very intensive interventions,6, 7, 8 improvements in healthy behaviors are possible over time. Further, an office setting and staff, using a systematic approach that begins with the promotion of healthy weight for all children and then offers targeted care for those who develop obesity, may have the best opportunity to produce significant improvements in the population of families they serve. The CCM9 offers an integrated structure to improve patient care and medical outcomes.