Goal setting needs to be specific and attainable. Instead of recommending that the child walk or bike to school, suggest walking or biking to school two or more days a week. Rather than recommending that a child watch less television, suggest watching no television on school days. It is important to keep it simple and set one or two short-term goals at a time. In addition, behavioral risk factors need to be identified, such as avoiding fast food when family life gets hectic. Helping the family think of healthy alternatives is important.
Families need to be counseled on age-appropriate and healthy eating patterns, beginning with the promotion of breastfeeding. For infants, transition to complementary and table foods and the importance of regularly scheduled meals and snacks, versus grazing behavior, should be emphasized. Age-appropriate portion sizes for meals and snacks should be encouraged. Children should be taught to recognize hunger and satiety cues, guided by reasonable portions and healthy food choices by parents. Smaller bowls should be used, and children should never eat directly from a bag or box. No juices or soda should be the rule. Children should never be forced
Limit screen time (television, computer games/Internet, video games) to <1–2 hours per day (no TV for child <2 yr of age)
Consume five or more servings of fruits and vegetables per day
Minimize consumption of sugar-sweetened beverages
FAMILY □ Eat at table, as a family, at least five to six times per week
Allow child to self-regulate his or her meals and avoid overly restrictive feeding behaviors
Do not reward children with food or drinks
Limit what is available in vending machines
Speak to patients about healthy weight and good nutrition
GOVERNMENT □ Increase access to healthy food and eliminate food deserts to eat when they are not willing, and overemphasis on food as a reward should be avoided. “Choose My Plate” by the U.S. Department of Agriculture can provide parents with a general guideline for the types of foods to be offered on a regular basis, including fruits, vegetables, grains, protein, and dairy.
The importance of physical activity should be emphasized. For some children, organized sports and school-based activities provide opportunities for vigorous activity and fun, whereas for others a focus on activities of daily living, such as increased walking, using stairs, and more active play may be better received. Time spent in sedentary behavior, such as television viewing and video/computer games, should be limited. Television in children’s rooms is associated with more television time and with higher rates of overweight, and the risks of this practice should be discussed with parents. Clinicians may need to help families identify alternatives to sedentary activities, especially for families with deterrents to activity, such as unsafe neighborhoods or lack of supervision after school.
More aggressive therapies are considered only for those who have not responded to other interventions. Treatment includes
Be able to count Decrease size of serving Small bowls (parent palm)
Aim to change behaviors
Avoid eating from the box
Don’t focus on consumption of Decrease to 20 g of fat Eat fish once a week carbohydrates, fat, protein
Eating fast food Eat less junk food Limit trips to McDonalds to once a week
Fruits Buy fewer juices Have no juices in the refrigerator Increase eating fruits Keep a bowl of fruits in the kitchen
Vegetables Increase eating veggies Have a bowl of veggies in the refrigerator
Cooperation, competition, and social interaction such as building a house of veggies a systematic approach that promotes multidisciplinary brief, office-based interventions for obese children as well as reducing weight. Before enrolling any patient in a weight-loss program, the clinician must have a clear idea of that individual’s expectations. Patients with unrealistic expectations should not be enrolled until these are changed to realistic and attainable goals. Using the pneumonic described, the clinician should guide the patient who seeks weight reduction to create SMART goals: Specific, Measurable, Attainable, Realistic, and Timely.