Team approach helps treat obesity in children

Healthcare teams at several Massachusetts community health centers are trying out a "third way" for treating obese children in the primary-care setting: A trained team consisting of a pediatric provider, a nutritionist, and a case manager working with children in dedicated weight-management visits.

Shikha Anand, MD, MPH, assistant professor of pediatrics at the Boston Medical Center, said that this way is necessary because most pediatric providers are not trained in obesity or health-behavior change and because pediatricians across the country vary in their approach to the problem. Additionally, lifestyle counseling with a family can take more time than a pediatrician can usually give in a patient visit.

Specialty care in hospital clinics is often expensive, inconvenient, and removed from the primary-care setting. Over the last 4 years, Healthy Weight Clinics have been established in 8 community health centers in different parts of the state, said Anand, who described the project at a recent Washington briefing for the journal Health Affairs.

Of the 174 children the clinics had seen more than once by August 2009, half had some decrease in body mass index (BMI), and 100% had set a goal for a lifestyle change such as increasing activity or decreasing sweetened beverage intake. Almost 80% said that they had carried through on the change, Anand said.

Although the project is still in early stages of data collection and analysis, Anand said that she believes the clinics will show an improved effectiveness over current obesity treatment in pediatric primary care. Having all 3 providers see a child during the same visit avoids problems like no-shows when a child is referred to a nutritionist. She also said that she believes the model will decrease costs compared to specialty care in hospital-based clinics.

Also at the Health Affairs briefing, William H Dietz, MD, PhD, director of the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention, said that since 2002, there has been "a suggestion" of a general plateau in the prevalence of childhood obesity.

However, Dietz said, "Among adolescent boys, ages 12 to 19, there seems to be a continuing increase in the prevalence of severe obesity, that is a BMI greater than the 97th percentile." He indicated that a medical solution is warranted for severe obesity and that there is not very good tertiary care for childhood obesity.

"The irony is that we don't have anything short of bariatric surgery," said Dietz. "My belief is if we spent the same amount of money on medical approaches to severe obesity that we spend on bariatric surgery, we would be a lot further along."

He also noted that the highest obesity prevalence is in Mexican American boys and African American girls, suggesting very significant cultural determinates.

Anand's article on the Massachusetts effort can be found on the Health Affairs Web site http://www.HealthAffairs.org/, along with the entire March 2010 issue of Health Affairs focusing on childhood obesity.