In effective lifestyle interventions, parents and children work with a behavioral specialist and attend regular treatment sessions, with options for phone sessions and email check-ins interspersed throughout the intervention. Families participate in group (45 minutes) and individual (30 minutes) sessions during each appointment; this format provides families with peer support through the group setting and a tailored intervention via the individual sessions. To optimize support in the home, additional family members are encouraged to attend as well.
Though these effective interventions have been established, recommended practices have not been implemented into routine practice. Thus, it is critical to extend beyond traditional settings and have providers work in concert with behavioral interventionists to provide integrated care and reinforce messaging across contexts. For instance, providers are in a prime position to identify at-risk families and make referrals for specialized weight loss intervention. Providers can then follow up with families once every three months to regularly track children’s health outcomes. Finally, providers can support the behavioral interventionists in establishing a unified treatment program for families by facilitating parents’ use of community resources and encouraging children’s development of positive social ties. Such collaborative effort is necessary to most effectively promote healthy behaviors, address families’ weight trajectories, and eliminate obesity.
Optimally, office policies and practices will ensure that staff members are equipped to confront weight-related problems. It is important for staff to be educated in behavior change principles so that they gain an understanding of how to help families to implement healthy strategies in their homes and communities. Office-based trainings can include the importance of early intervention, with instruction on how to appropriately and effectively intervene with parents and children and provide referrals.23
In addition, it is advantageous for staff to be educated in diversity awareness, as cultural differences may impact families’ values regarding weight status, body ideals, and parenting behaviors, and socioeconomic barriers (e.g., family finances and spending practices; access to community resources) may affect the intervention strategies that families are willing or able to implement. Ideally, providers will learn families’ stances on these issues to tailor their recommendations appropriately. Ongoing training and supervision in stigma awareness and reduction may be of benefit, as well.
Concerted efforts to 1) reduce providers’ skepticism regarding the efficacy of weight loss interventions; and 2) increase reimbursement for the provision of obesity-related services, will increase the likelihood that providers will engage families in weight loss interventions.23
Offering CME training opportunities, making accessible medical journals (e.g., Pediatrics)
, and increasing access to medically-relevant websites (e.g., AAP, CDC) are useful avenues for increasing providers’ knowledge of AAP recommendations.21
When addressing weight-related problems with families, it is imperative for staff to remain empathetic and utilize reflective listening. Ideally, staff will be trained to engage in open discussion with families about making healthy eating and activity changes, particularly as discomfort surrounding these conversations is a reported barrier for providers to address this issue.23
These conversations typically focus on understanding a family’s health behaviors, as well as their social network, with the goal of identifying sources of support for making healthy changes. Skills clinicians will teach to families include: how to engage in healthy eating; meal planning; and self-monitoring; and the tools for implementing these changes across the socioenvironmental contexts.
As mentioned above, the regularity of doctor’s appointments places PCPs in an ideal position to track and monitor children’s progress over time. Structuring appointments to allow time to calculate children’s BMI, review their weight trajectory, and discuss families’ progress in implementing healthy strategies will optimize intervention. Routine assessment of metabolic profiles and tracking risk for obesity-related health consequences is also imperative; this recommendation is line with the AAP guidelines for addressing pediatric obesity.5,19
It is crucial for staff to engage families about their weight goals and help families to problem-solve potential barriers. Discussing ways to maintain social support or seek avenues for developing healthy social ties is encouraged, as well. Overall, it is important that sessions focus on increasing families’ skills for at-home implementation of behavior change strategies.
Finally, it is recommended for obesity prevention that providers calculate BMI and address weight status with all families. Providers are encouraged to talk with parents of children who are normal weight to confirm whether they are currently engaging in healthy eating and activity behaviors; PCPs can promote the implementation or maintenance of these practices as needed and address any areas of concern to prevent the development of obesity. Noting family histories of overweight or obesity, obesity-related health problems, or gestational diabetes mellitus will help providers to screen for children at elevated risk for obesity. By using a universal approach, providers encourage healthy eating and activity practices and reduce risk for excessive weight gain among all families.
Promoting healthy lifestyles does not need to be limited to conversations between health professionals and patients; the office environment itself provides substantial opportunities to promote healthy lifestyle behaviors by making healthy resources and relevant prompts accessible and visible. First, offices can promote healthy lifestyle activities, such as emphasizing the use of stairs, increasing office walkability, and making breastfeeding rooms accessible. Second, healthy eating can be encouraged by removing vending machines, providing water fountains, and enforcing healthy standards for office meals (e.g., healthy staff lunches). Third, prompts for healthy local events and resources, such as farmers markets and community events for running, walking, or biking, can be made available in waiting rooms and hallways. It would be ideal for take-home materials with strategies for implementing behavior change to be made accessible. Finally, staff can set a positive example by modeling healthy behaviors (e.g., by not making unhealthy food visible, drinking water, walking during lunch breaks). In doing so, families receive consistent, healthful messaging that extends beyond the appointment session, in that the office environment models the infusion of healthy prompts across contexts.