Doctors Not Stressing Follow-Up Plans With Obese Kids

Less Than Half of Overweight or Obese Kids Get Long-Term Follow-up

By Denise Mann
WebMD Health News

Reviewed by Laura J. Martin, MD

Oct. 14, 2011 -- More than half of all overweight and obese children are not getting proper follow-up advice from their pediatricians on how they can lose weight and keep it off.

The rates of childhood obesity have more than tripled in the past 30 years. Today, one in three American kids and teens are overweight or obese. Diseases and conditions normally only seen in adults like high cholesterol, high blood pressure, and diabetes are now increasingly being seen in children.

Most pediatricians weigh children and talk about nutrition and exercise during office visits, but some drop the ball when it comes to developing and helping to implement a long-term follow-up plan.

A new study included information about 1,193 overweight and obese children aged 2 to 12 who were seen for well visits in 2010. These findings will be presented at the annual meeting of the American Academy of Pediatrics National Conference and Exhibition in Boston.

"Parents should ask, 'When should we see you again' and 'What can I do between now and then to help my child reach a healthier weight,'" suggests study researcher Kerri Wade. She is a nurse practitioner at the Children's Mercy Promoting Health in Teens and Kids Weight Management Clinics in Kansas City, Mo.

Parents should also ask about their child's weight status: Are they normal, overweight, or obese?

"Ask the doctor to explain where they are on the growth chart and what they need to do to reach a healthier weight," she says. "You do have to treat obesity like a chronic illness; you can't see kids once and cure them."

Exactly why some pediatricians aren't doing this routinely is not fully understood. Wade says that doctors have told her in conversation that they don't want to tell parents to make a follow-up visit in a month when they know that they will not be able to get an appointment anyway due to overscheduling.

In the new study, older kids were more likely to have a follow-up plan outlined by their doctor as were those children who are considered obese, when compared to children who are overweight.

"We still are trying to overcome that 'chubby babies are healthy babies' mentality, so it may be that doctors still see chubby toddlers as cute, but when kids are overweight as they get older, we start think about the health problems," Wade tells WebMD. "When a child is overweight, but not obese, maybe there is not as much urgency."

Follow the 5-2-1-0 Rule

Yolandra Hancock, MD, says that sometimes parents have to take things into their own hands. She is a primary care pediatrician at Children's National Medical Center.

"Ask how your children are doing on weight, height, and body mass index, and based on this feedback, ask about what the follow-up plan should be" she says.

Children who are overweight or obese and have other conditions associated with obesity should be seen again in three to six months, Hancock says.

In the meantime, they should follow the 5-2-1-0 rule, she tells WebMD. "This means five fruits and vegetables a day, two hours or less of screen time such as TV or video games a day, one hour of physical activity a day, and zero or very little sugar-sweetened beverages per day."

"If there is no improvement, the next stage is participation in a structured weight management program," she says. These programs bring together a team of experts who help the child and their family lose weight, keep it off, and improve their health.

This allows more time to address the issues and helps to bring the entire family on board.

"The family is very, very crucial," Hancock says. "If we can find out from parents what their challenges are, we can certainly increase the level of success for the whole family."

Unfortunately, such comprehensive weight management programs for children are not available everywhere.

Preventing Obesity Is Easier Than Treating It

Ron Feinstein, MD, the director of the Weight Management Program at Steven and Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y., says the key is to prevent children from becoming overweight or obese in the first place.

"The average pediatrician spends six to 10 minutes in the office with a child, and this new epidemic has challenged the pediatric community," he says.

The focus needs to shift toward prevention. "Medical schools need to include nutritional education in pediatric residency programs," Feinstein tells WebMD.

Also, he says, insurers need to start covering the costs of counseling for obesity. As it stands, they are more likely to pay for the treatment complications associated with obesity rather than the root cause of these problems.

This study will be presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.



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SOURCES: Kerri Wade, nurse practitioner, Children's Mercy Promoting Health in Teens and Kids Weight Management Clinics, Kansas City, Mo.Ron Feinstein, MD, director, Weight Management Program, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, N.Y.Yolandra Hancock, MD, primary care pediatrician, Children's National Medical Center; member, Children's National Obesity Institute, Washington, D.C.The American Academy of Pediatrics National Conference and Exhibition, Boston, Oct. 15-18, 2011. ©2011 WebMD, LLC. All Rights Reserved.