A Feasible and Effective Lifestyle Counseling Program for Obese Children and Adolescents

Childhood obesity is now an epidemic problem worldwide.A combination of decreased physical activity, increasedsedentary behavior, and consumption of excessive calories,has resulted in the increasing prevalence of childhoodobesity. In Taiwan, according to Nutrition and HealthSurvey in Taiwan Elementary School Children (NAHSITChildren, 2001e2002), 15.5% of boys and 14.4% of girlsbetween the ages of 6 and 12 years are overweight (
the85thpercentile value of body mass index), and 14.7% of boysand 9.1% of girls are obese (
the 95thpercentile value ofbody mass index).

As with adults, childhood obesity can cause seriouscomorbidities, such as type 2 diabetes,2cardiovascularcomplications,3nonalcoholic fatty liver disease,4etc. Ofparticular concern, obesity is associated with insulin resistance and increases the risk of metabolic syndrome inchildren and adolescents.5In view of the obesity epidemicand its related comorbidities, it is important for primarycare pediatricians to take action to prevent, assess andtreat childhood obesity.

According to the recommendations from the AmericanAcademy of Pediatrics (AAP), a staged approach to weightmanagement for children and adolescents is suggested. Thefour stages of treatment include: (1) Prevention Plus(healthy lifestyle changes); (2) structured weight management; (3) comprehensive multidisciplinary intervention;and (4) tertiary care intervention. The first two stages canbe implemented in the primary care office.6However, therequired staff, cost, and frequency of follow-up limit theapplicability of such obesity-related health services toprimary care settings.

Childhood obesity is now a prevailing issue in pediatricians’ offices. However, primary care pediatricians oftenfail to diagnose or treat childhood obesity, due to timeconstraint, lack of financial reimbursement, lack of accessto a nutritionist, as well as perceived low confidence andefficacy in managing obese children and adolescents.Furthermore, obese children and their parents are usuallynot motivated to change their diet or lifestyle.

benefit from lifestyle changes. Body mass index screeningshould become a standard practice at every clinic visit.Obesity related comorbidities should be identified early.Ideally, there are referral centers that provide comprehensive multidisciplinary weight management programs.However, without these, in practice, primary care pediatricians can support the family of obese children in theirefforts and encourage them to adopt healthy lifestylebehaviors.

In this issue of Pediatrics and Neonatology, Kelishadiet al7demonstrate the effectiveness and feasibility ofa simple office-based program for encouraging a healthylifestyle. The authors wanted to determine whethermotivational lifestyle counseling in the primary care environment can control excess weight and associated cardiometabolic risk factors. They studied 457 obese childrenand adolescents who were seen at the Isfahan Cardiovascular Research Center, Iran, between 2007 and 2008. Theresults suggested that motivational office-based counselingfor a period of 6 months can be effective in reducing bodymass index, waist circumference, and associated cardiometabolic risk factors. The prevalence of the metabolicsyndrome decreased from 20.8% to 1.8%. This reportpromisingly showed that obese children and adolescentscan achieve health benefits with a simple and feasibleprimary care-based clinical program.

Some limitations exist in this study. Firstly, it is a nonrandomized trial without a control. The differences ofcardio-metabolic risk factors before and after interventioncan be attributed by other confounding factors rather thanthe intervention itself. Secondly, the study subjects areheterogeneous, as the age varies widely from 2 to 18 years.The effectiveness of the intervention may depend on theage of the patients. In summary, this study may highlighta plausible office-based obesity management for generalpediatricians.