For Physicians: Working Together to Fight Childhood Obesity

Loyola’s Child and Adolescent Weight Management Clinic’s team of experts is committed to tackling the medical challenge of childhood obesity.

While our clinic program best serves pediatric patients who have a body mass index (BMI) greater than 99 percent, Type 2 diabetes mellitus, obesity-related hypertension or obesity-related liver disease, we have tools to help you help your patients even before their weight reaches such a critical state that they need our specialized weight management program. It is difficult to discuss a child’s weight, and parents can be very sensitive about the subject. But, by tackling this subject, you may be the one who helps the child avoid a lifetime of medical problems.

Loyola's Pocket Guide to Primary Care Pediatric Obesity Management, prepared by Garry Sigman, MD, assists primary care physicians in caring for overweight children of any stage.

Addressing this problem starts with talking to your patients and their families about their eating habits, activity levels and weight. To assess where to begin, we've set up this "decision tree" that starts with a child or teen's BMI, cardiovascular risks and other major health risks.

What does the child or teen need?

BMI < 85%

Primary care prevention strategies

BMI 85-94% without cardiovascular risk factors

Primary care plan

Lab work

  • Order Fasting Lipid Profile

Education and counseling

BMI 85-94% with cardiovascular risk factors

Primary care plan

Order lab work

  • Fasting Lipid Profile
  • ALT, AST (Alanine transaminase, aspartate aminotransferase)
  • Fasting Glucose

Manage care through primary care physician

  • Obesity assessment visit, including physical exam for obesity. 
  • Obesity specific patient and family history and risk assessment
  • Office visits every four weeks for three to six months. 
  • Use SHAPES message for healthy living
  • Use the healthy habits survey and readiness for change survey
  • Offer motivational interventions, behavioral counseling and handouts
  • Utilize available community-based wellness programs, such as Pro-Active Kids. (See details at right)
  • Use appropriate ICD-9 codes 

Goal: Prevent further weight gain

Next steps

If after three to six months, patients and families are making progress and wish to progress more rapidly, refer to Loyola’s Child and Adolescent Weight Management Clinic

Or if patients and families who have demonstrated their motivation, such as by coming to visits and doing homework, but are needing more treatment, refer to Loyola’s Child and Adolescent Weight Management Clinic

Summary of the Child and Adolescent Weight Management Clinic

  • Weekly visits for 12 weeks
  • Multi-disciplinary family-centered approach
  • Group activities
  • Strategies include medication, very low-calorie diet, weight-control surgery as necessary and appropriate

Goal: Decrease BMI

The clinic is described in the guide and on this website.

BMI 95-99%

Primary care plan

Order lab work

  • Fasting Lipid Profile
  • ALT, AST (Alanine transaminase, aspartate aminotransferase)
  • Fasting Glucose

Manage care through primary care physician

Goal: Prevent further weight gain

Next steps

If after three to six months, patients and families are making progress and wish to progress more rapidly, refer to Loyola’s Child and Adolescent Weight Management Clinic

Or if patients and families who have demonstrated their motivation, such as by coming to visits and doing homework, but are needing more treatment, refer to Loyola’s Child and Adolescent Weight Management Clinic

Summary of the Child and Adolescent Weight Management Clinic

  • Weekly visits for 12 weeks
  • Multi-disciplinary family-centered approach
  • Group activities
  • Strategies include medication, very low-calorie diet, weigh-control surgery as necessary and appropriate

Goal: Decrease BMI

The clinic is described in the guide and on this website.

BMI 99% or > or Type 2 diabetes, hypertension or other health conditions

For children and teens with these health conditions:

  • BMI of 99% or higher
  • Type 2 diabetes mellitus
  • Obesity-related hypertension
  • Obesity-related liver disease

The Child and Adolescent Weight Management Clinic offers comprehensive treatment.

Summary of the program

  • Weekly visits for 12 weeks
  • Multi-disciplinary family-centered approach
  • Group activities
  • Strategies include medication, very low-calorie diet, weigh-control surgery as necessary and appropriate

Goal: Decrease BMI

The clinic is described in the guide and on this website.

 

Loyola's Primary Care Guide to Pediatric Obesity Management is not intended to set an exact standard of care.

The approach to the overweight and obese child is based upon American Academy of Pediatrics recommendations for the prevention and treatment of obesity in children and adolescents.  The Prevention and Outpatient treatment core behavioral message is adapted from the University of California at San Diego Hope Program.