HJNO Jul/Aug 2023

CHILDHOOD OBESITY 30 JUL / AUG 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS   classifications of overweight and classes of obesity are highly predictive of increased risk for health complications. However, just like with any disease, BMI is only one indi- cator for obesity — a provider should do a systems review on the child to detect early signs of comorbidities and also reviewmed- ical history, home environment, and lifestyle behaviors in evaluating and treating obesity. The AAP CPG provides several additional clinical measures like blood pressure and lab values to monitor based on their comor- bid occurrence with elevated weight. As a practitioner, how do you initiate a conversation with an overweight or obese child and their family? Do the Clinical Practice Guidelines (CPG) provide language suggestions/ recommendations to use to gently guide patients and family into this introductory discussion about obesity without creating fear or stigma? Great question, and thank you for bring- ing it up as the CPG and other guidelines recognize the pervasive weight bias and weight stigma that children with obesity encounter every day, even from healthcare professionals. Discussions around weight and obesity with children and adults can be a sensitive subject, so we want to proceed with care and caution. Conveying bias, even if it’s implicit and unintended, is the quickest way to lose the trust of a patient. However, not talking about obesity and its health risks and treatment options is a disservice to our children in regard to both their current and future health. The CPG emphasize that to begin with, talking with children about overweight and obesity should be done in a nonjudgmen- tal and non-stigmatizing manner. Health- care professionals should be cognizant and mindful of the implicit biases we may have regarding childhood obesity. I encour- age clinicians to take the Harvard Implicit Associations Test (IAT) to check their own implicit biases and to consider this when speaking with patients. In clinic, a child’s BMI must be communi- cated to the patient and family, once calcu- lated based on the child’s height and weight, because this is what guides the next steps that you take — whether to do an evalua- tion and then develop and discuss a treat- ment plan for the child with the family. What we say matters — and how we say it mat- ters, too. Some of the tips the CPG includes for having a non-stigmatizing conversation about weight with patients and families include: • Ask permission first to discuss weight or BMI. • Use person-first language in the con- versation (not obese child but child with obesity). • Use neutral and non-offensive language. The AAP guidelines recommend 12 facilitators for successful health behavior lifestyle treatment. Could you walk us through these and discuss their effectiveness? Yes, I encourage readers to review the infographic on p. 51 of the CPG. I summa- rize these facilitators below: • Longitudinal : Obesity is a chronic disease. It will rebound and remit. A life course approach should begin as soon as possible and continue through childhood, adolescence, and young adulthood, with transition to adult care. • Interaction : Provide the family with a safe space to interact and understand obesity. • Family Based : Parent or family unit should be included in treatment, and family strengths and challenges should be considered. • Medical Home: PCP serves as the care coordinator to coordinate treatment with specialists and/or community resources. • Increased Frequency : Greater contact hours have greater treatment effects. Evidence indicates the strongest, most consistent effects among interventions “... there are over 14 million children and adolescents in the U.S. who already have obesity, and they need access to evidence-based treatment options.”