All children benefit from weight screening at all health care
visits. Table 32-4 outlines some of the important
aspects of such screening. In those with a high BMI, counseling
to achieve lifestyle modifications is recommended. Informing the
family of the child’s weight-associated risks is generally
helpful. Using more neutral terms to describe weight, such as excess
weight, body mass index, or risk for diabetes and
heart disease can reduce the risk of stigmatization or
harm to self-esteem in the child and may allow the family to engage
in therapeutic changes. A focused family history is important to
identify additional risk factors. A child with 1 obese parent has
a 3-fold increased risk, and with 2 obese parents, a 13-fold increased
risk of becoming obese. A family history of type 2 diabetes, hypertension,
hypercholesterolemia, and early deaths from heart disease or stroke
increases risk in the child. Assessment of risk behaviors and attitudes
allows intervention. The family’s perception or concern
about weight, readiness to change, successes, and barriers to change should
be evaluated. Primary care providers can access a useful toolkit
at http://www.chw.org/3210family that
includes a health habit screening form, educational handouts for
families, tips on how to implement the program in the pediatric
office, and tips on using motivational interviewing with patient families.
Increased activity, decreased sedentary time (especially screen
time), improved sleep habits, and reduced intake of sweetened beverages
and fatty foods are initial steps to promote weight
loss. In children with a BMI higher than the 95th percentile, formal
programs that focus on lifestyle change should be considered if
the family can be motivated to participate. Interdisciplinary teams,
including dietitians, physical therapists, psychologists, social workers,
and physicians, can provide effective care for select patients,
but community efforts are required to address the needs of most
children. Weight loss targets appropriate for specific age and BMI
are shown in eTable 32.1.