The Right Tool for the Job: Child & Adolescent Obesity 2015

The 2007 AAP guidelines form the framework for obesity treatment tools, organizing interventions by age and obesity severity (85th-94th percentile, 95th-98th percentile, 99th percentile, and above 99th percentile).

Obesity treatment exists on a spectrum from prevention and healthy lifestyle promotion through surgical intervention, with practice capacity, resources, and community needs determining where a practice operates on this spectrum.

The pyramid model of obesity intervention shows progressively fewer patients requiring increasingly intensive interventions as severity increases, with universal prevention at the base and severe obesity treatment at the apex.

Let's Go Maine (letsgo.org) is the origin of the 5-2-1-0 prevention messaging and provides toolkits, community interaction strategies, office materials including posters and logos for practices implementing prevention programs.

The AAP Pediatric e-Practice (PEP) at pep.aap.org is a virtual office tool jointly created by AAP and the Institute for Healthy Childhood Weight, organizing resources by office location (exam room, waiting room, billing office) and topic area.

Healthy Active Living for Families (HALF) on healthychildren.org provides age-organized nutrition guidance, physical activity recommendations, and parenting strategies for all families, with strong obesity prevention messaging.

Motivational interviewing training is the cornerstone counseling skill for pediatricians doing weight management, and can be obtained through schools of public health, nursing, health education, or motivationalinterviewing.org, regardless of whether the course is weight-specific.

Motivational interviewing addresses the 'why' of behavior change while cognitive behavioral therapy (CBT) strategies address the 'how,' and elements of both are helpful in weight management.

The Cognito Change Talk app and desktop site, developed with Bob Schwartz from the Section on Obesity, provides free pediatric obesity-specific motivational interviewing training.

Content for obesity prevention should be personalized to the practice, use local vernacular and logo, and reference locally available resources rather than generic national programs that may not exist in the community.

The Super Tracker tool on ChooseMyPlate.gov allows families to track physical activity and food intake, find recipes, and compare their eating patterns to age-appropriate recommendations.

ChopChop magazine (chopchopmag.org), created by the Institute for Healthy Childhood Weight and New Balance Foundation, promotes fruit and vegetable intake based on the principle that children are more likely to eat foods they help prepare.

Activity tracking devices (Fitbit, pedometers, accelerometers) and food tracking apps (MyFitnessPal, Lose It) are appropriate tools to recommend for certain families in obesity treatment.

For higher-level obesity care, pediatricians need to develop expertise in managing comorbidities including interpreting elevated hemoglobin A1C, blood glucose, and abnormal lipid profiles, functioning more like internists.

Obesity contacts at tertiary care centers may reside in multiple divisions including gastroenterology, endocrinology, GI, cardiology, and psychology, requiring providers to search across departments.

The Next Steps program uses 17 behavioral goals; Foley's adapted version focuses on 8 core goals including the 5-2-1-0 behaviors plus restricting eating out to 3 times weekly, portion control, healthy snacks, and eating breakfast.

Super Tracker resources allow families to obtain age-appropriate eating plans and perform self-monitoring by entering food intake to compare against recommendations, though not all families will use all available tools.

Starting with topics where the clinician feels comfortable (such as sugar-sweetened beverages, screen time, or sleep) and gradually expanding to other areas is an effective approach for implementing obesity care in practice.