treating kids and family

American Board of Obesity Medicine board members are passionate about the field of obesity medicine. It is why they devote countless hours leading the organization, writing exam items, and lending their voices as thought leaders throughout the medical community. Periodically, we ask board members to share their views on an important topic within the field of obesity medicine. Below, Dr. Jenny Seger, a family physician and member of the ABOM item writing committee who will join the ABOM board of directors in 2016, turns her focus to pediatric obesity and family involvement:

The prevalence of pediatric obesity has increased at an alarming rate in our country, affecting 17% of children ages 2-18. Failure to adequately address obesity early can have long-lasting adverse psychosocial and health effects.

Every physician who works with pediatric patients recognizes the importance of engaging the family in the care of the patient, whether it’s to ensure the patient takes a prescribed medication, has a necessary diagnostic test or schedules an appointment with a specialist. Without the help of a responsible adult, these recommendations simply would not be followed and there is no doubt, the health of the patient would suffer. Now think about the challenge of tackling a complicated disease such as obesity and it’s easy to see that without the involvement of the parents, the likelihood of successful intervention and treatment is virtually zero. Treatment of obesity is not unlike that of other serious childhood diseases such as cancer in that it requires a multifaceted, comprehensive approach with long term follow-up care.

Irrespective of the patient’s age, having an engaged family is a critical factor in determining success. Obviously, with younger children, parents have nearly total control over what the child eats, drinks and activities he/she participates in. As patients get older (typically beginning in middle school), they begin to develop more autonomy. By high school, teenage patients are spending more time with friends and are often consuming more meals away from home than at home, thus there is even less oversight from parents. Less oversight does not have to equate to less influence.

The key to successful treatment of obesity in children and teens lies in empowering the family as a whole. In order to accomplish this seemingly insurmountable task, physicians often need to invest time into developing a deeper understanding of the family dynamics. Only by gaining insight into the patient’s home life in terms of family structure, financial and time constraints, cultural beliefs and traditions are we then able to develop a mindful approach to treating the patient’s obesity. Building a good rapport with the family will go a long way in helping the child reach his/her goals. As physicians, we can do a fantastic job teaching children and teens about healthy lifestyle habits, but if we do not also empower the parents through education and supportive resources, we are unlikely to make any meaningful progress.

Though the number of obesity medicine specialists is increasing, only a fraction are actively treating pediatric patients. Many obesity medicine specialists and primary care physicians cite a lack of education specific to pediatric obesity as the reason they are hesitant to treat this population of patients. It’s true that children are not simply ‘little adults’ and this fact necessitates our need to broaden our fund of knowledge in this unique area of medicine. Historically, there has been a scarcity of information available for physicians who wanted to learn more. Thankfully, there are organizations that are working hard to fill this knowledge gap. For physicians with the appropriate board certification, I encourage you to seek out additional education to build your confidence with this patient population. As physicians who treat obesity, we see firsthand how dramatically effective treatment can alter a person’s life in all aspects. Imagine the profound impact we can have in children and teens if we can effectively intervene and put that child on a different path in life.

A few tips to get you started:

  • Build your fund of knowledge
  • Develop an assortment of age appropriate handouts
  • Identify resources in your community…you do not have to do this alone
  • Ask permission to discuss the patient’s weight and begin the conversation
  • Provide validation to both the patient and family, address weight bias/stigma
  • Focus on health and quality of life rather than a number on the scale
  • Provide support to help move the patient and family further along in the readiness process
  • Be persistent about the importance of taking action while showing kindness and empathy
  • Focus on small changes which can have major beneficial effects, such as eliminating sugar sweetened beverages, juice and highly refined foods of low nutritional value
  • Identify the barriers to change (from both the child and parent’s perspective)