HJNO Jul/Aug 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2023 31 delivering 26 or more hours, face to face, family based, and multicompo- nent treatment over a 3- to12-month period. • Aligned Expectations: Help patients and families set realistic expectations. We know there is wide heterogeneity in outcomes. • Prompt: Watchful waiting is not effective. • Intensity: In primary care settings, healthcare providers should deliver the best available intensive treatment. • Empathetic, Non-stigmatizing: Com- munication of support and empathy helps reduce weight bias; families will not continue treatments if they encounter weight stigma. • Motivational Interviewing : This coun- seling approach used by healthcare providers has been reported to pro- duce positive effects on weight status. • Self-Management: Effective treat- ments will help patients and families develop strategies for self-manage- ment. This helps to sustain weight loss after the treatment program ends or once it becomes less intensive. • Engagement and Participation: Higher patient engagement and par- ticipation is related to lower attrition rates. But families face many barriers to attending and engaging, so the pro- vider should be cognizant and work with the family to overcome these bar- riers. This might mean offering evening or weekend clinic hours or telehealth options. What is motivational interviewing and the benefits for pediatric patients? How can practitioners hone or develop this skill in their practice? Motivational Interviewing (also called MI) is a counseling style that is patient-cen- tered — it identifies and reinforces a patient’s own motivation for change. In other words, this is in contrast to the more traditional approach of counseling that focuses on a provider prescribing behavior change. With MI, providers will guide families to identify what behavior they would like to change, and this is based on what the parent(s) or child feels is important and can be accom- plished. There were several scientific studies included in the technical reports of the CPG that were exclusively or predominantly MI and achieved weight loss among pediatric patients, and many of the behavioral pro- grams included MI as the general counsel- ing approach. In the resources section of the AAP CPG, there are several self-paced training modules for providers, and one module that has been around for a while introduces providers toMotivational Interviewing. The module is called “Change Talk: Childhood Obesity” and is a simulation training program to teach providers how to use Motivational Interviewing in their practice. From the AAP website: “ChangeTalk: Childhood Obesity - Motivational Interviewing (MI) Skill-Building Module: Designed to help health professionals utilize MI techniques to navigate challenging family and patient conversations regarding childhood obesity. Change Talk is a virtual practice environment in which healthcare providers assume the role of a pediatrician and engage in a simulated conversation and the user learns to apply MI techniques to help the virtual humans identify motivation for change, supporting them to implement modifications to their diet, screen time habits, exercise routines, and more! Available as a mobile app for Apple and Android devices.” ( https://go.kognito.com/changetalk) The new guidelines recommend “immediate, intensive” treatment for children diagnosed with obesity. What are some intensive health behavior and lifestyle treatment (IHBLT) options in New Orleans? • Healthier Together Clinic offered by Children’s Hospital New Orleans, LCMC: https://www.chnola.org/ services/endocrinology/healthier- together-clinic/. • Trim Kids offered by LSU Health New Orleans School of Public Health https://sph.lsuhsc.edu/research/ studies/trim-kids/. Many YMCAs also offer the MEND (Mind, Exercise, Nutrition...Do It!) program, an evi- dence-based family weight management program. There are also more telehealth programs coming available across the country, but it is important to ensure they are evidence-based and to be aware of the fees families may pay. If IHBLT is a highly effective treatment for children with obesity, how can we, as healthcare leaders, help to improve access to this treatment for our community members? One point to the “highly effective” com- ment — IHBLT is effective for many children and adolescents (though not all according to the clinical trials), but families and provid- ers should understand the expected weight loss or attenuated weight gain from IHBLT (the “effect size”) versus the expected weight loss from combining IHBLTwith treatment options like medication and surgery. Peo- ple can still experience meaningful health improvements from a 5% weight loss, which is what many experience in IHBLT, but many patients are striving for a larger weight loss like 15-20%, which is where you can see resolution or relapse of diabetes and other serious comorbidities. This effect size is typically only shown, at least on a consis- tent basis across study samples, for behav- ioral lifestyle treatment along with medica- tion and surgery treatments. Your advocacy efforts are needed to bring evidence-based programs to every corner of the country. TheAAP is making great strides to support implementation (read more at www.aap.org/obesitycpg where you can access a list of recommended family weight management programs and complete a