How can pediatricians help prevent obesity?

The childhood obesity epidemic is showing no signs of slowing down. Though some data suggest trends may be leveling off within certain groups, overweight and obesity is still a massive public health issue. Between 1999 and 2012, the percentage of overweight 2-19 year-olds increased from 28.7% to 32.2%. Obesity also increased about 3 percentage points during the same time, from 14.5% to 17.3%.

The future health and economic implications are massive, and maybe even more than we previously thought. For example, on the economic side, did you ever consider obesity’s connection with gasoline consumption? This BloombergBusiness article outlines how they are connected, along with a few other areas.

So what’s being done?

If there’s one critical individual within the healthcare system that can make the greatest contribution, it’s a pediatrician. (I’m not saying the pediatrician is the single most important individual when it comes to childhood obesity prevention. I’m also not suggesting that interventions within the healthcare system have more or less influence on obesity outcomes. I’m only suggesting the healthcare system has a role to play and pediatricians are a pivotal player when it comes to addressing obesity.)

Earlier this month the American Academy of Pediatrics replaced outdated 2003 guidelines for how pediatricians can prevent obesity. Over the past 12 years, a lot has changed within childhood obesity. Some changes are pretty concerning (like the trends I already outlined above), but others are more promising, like the evidence base around interventions that have been developed.

It’s promising to see AAP reinvigorate the topic of obesity among pediatricians. For many providers, they aren’t quite sure how to address the issue with their patients. Few have had any formal training in nutrition or exercise science, both related areas when it comes to obesity. Not to mention the communication skills needed to introduce such a sensitive topic, and subsequently coach patients along aren’t a focus within current medical education. This new clinical guidance from AAP makes a helpful contribution to equip pediatricians with some of the tools they need when they interact with patients who are overweight or obese.

There’s a ton of good information in the full report, but there were a few things that really caught my eye. The first is simply the case for why pediatricians have a role to play in all of this.

“Pediatricians can and should play an important role in obesity prevention because they are in a unique position to partner with families and patients…[they] often follow children over a long period of time, sometimes from fetal life through college, giving them a unique long-term perspective in preventing chronic conditions such as obesity.”

Here are a few additional points of emphasis in the new guidelines:

  • Regularly asking a few simple screening questions related to healthy food choices, food label literacy, nutrients of concern, and the benefits of physical activity can help refer patients to more specific resources. The questions aren’t complex and they shouldn’t be. The point is to make this type of lifestyle screening a more regular part of clinical examinations.
  • Monitor and track growth through age 5 and encourage self-monitoring. A large percentage of pediatricians still don’t collect any information related to obesity, whether BMI, waist circumference, or waist-to-hip ratio. Each of these three metrics have their own unique strengths and limitations from a data perspective (the topic of another post), but establishing a reference point, and tracking over time is the only way to see changes, and therefore adapt interventions. Whether through a journal of log, research has found self-monitoring to be an effective tool for weight loss, especially since it provides day-to-day feedback.
  • Intervene early. We are still learning a lot in this area, but things that happen before pregnancy, during pregnancy, birth, and in the few years following birth all play a role. This all suggests the need for more collaboration across the continuum of care, such as between OBGYN’s and pediatricians.
  • Focus on family-based interventions. This might be the most profound of the recommendations, in my opinion. Lifestyle changes, like those needed to prevent and manage obesity, are not a simple matter of individual will power or individual choices. The entire environment the child is in, including his/her closest relationships (i.e. family) can hinder or increase the likelihood of a new behavior being sustained. Social networks matter when it comes to obesity and lifestyle choices. Why not maximize your chances for success by trying to create the most supportive and enabling network as possible?
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