1. OBESITY PREVENTION & CONTROL IN THE PEDIATRIC SETTING Ariana Raufi Warren Alpert Medical School of Brown University Hasbro Children’s Hospital

2. Topics To Cover The Problem: childhood obesity epidemic The Problem: childhood obesity epidemic When/ how to intervene? When/ how to intervene? Challenges Challenges Intervention: Pediatric counseling Intervention: Pediatric counseling

3. Obesity among Children Entering Kindergarten, Rhode Island, 2001-2007

4. Do you see a problem here?

5. Obesity is a Problem. Where to intervene? Family behaviors/habits Family behaviors/habits School lunches School lunches Community resources: parks, safe activity centers Community resources: parks, safe activity centers Availability of healthy foods in local stores Availability of healthy foods in local stores Creation of obesity clinics Creation of obesity clinics After school programs After school programs Soda Tax, governmental influences Soda Tax, governmental influences Obesity treatment programs Obesity treatment programs Pediatrician influence  Pediatrician influence 

6. When to intervene? Promote healthy nutrition in early childhood Window of opportunity: infancy to early childhood Window of opportunity: infancy to early childhood Prevention! Prevention! Food preference development Food preference development Younger children: visit pediatrician more frequently Younger children: visit pediatrician more frequently Parents have more control over feeding /activity Parents have more control over feeding /activity Good parenting in the early years  positive impact later Good parenting in the early years  positive impact later Parents are a child’s first teachers Parents are a child’s first teachers Eating is LEARNED BEHAVIOR: Eating is LEARNED BEHAVIOR: Exposure & Repetition Exposure & Repetition

7. Role of Families Home food environment: essential Food preferences, habits, activity, family meals, TV Parental Modeling Parenting Style Children are unable to eat foods not available to them! Most parents  misperceive their child’s weight /level of physical activity Parents will NOT seek help if they do not recognize their child has a problem! Chiang, Evelyn. "Parent Perceptions of Children's Weight Status, Nutrition, and Activity Levels." ICAN: Infant, Child, and Adolescent Nutrition. 1.4 (2009): 220-224. Print.

8. Pediatricians Matter! Study by Hernandez et al. in Clinical Pediatrics Study by Hernandez et al. in Clinical Pediatrics Absence of pediatrician commentary on child weight was the strongest predictor of misclassifying child body image (8-fold increase) Absence of pediatrician commentary on child weight was the strongest predictor of misclassifying child body image (8-fold increase) Pediatricians = highly favored as the most valued weight advisors Pediatricians = highly favored as the most valued weight advisors Most valued methods for understanding child weight = Most valued methods for understanding child weight = Growth curves Growth curves Pediatrician comment Pediatrician comment

9. Improving Primary Care Counseling Intervention: maximize the role of pediatricians Intervention: maximize the role of pediatricians What to say? What to say? Sessions on evidence-based nutrition for every age Sessions on evidence-based nutrition for every age Clarify the “agent of change” – most often the parent, not the child Clarify the “agent of change” – most often the parent, not the child How to say it? How to say it? Sessions on motivational interviewing – techniques to facilitate behavior change Sessions on motivational interviewing – techniques to facilitate behavior change Identify the situation Identify the situation Assess readiness to change Assess readiness to change Assess confidence Assess confidence

10. General Principles An ounce of prevention… An ounce of prevention… Make healthy eating habits a focus of all well visits…prenatal to adolescence Make healthy eating habits a focus of all well visits…prenatal to adolescence Identify unhealthy habits before they lead to obesity Identify unhealthy habits before they lead to obesity Do not be afraid to talk about obesity Do not be afraid to talk about obesity Rome was not built in a day! Rome was not built in a day!