About This Blog

In working with an obese adult population for over 7 years, I observed that very few health care providers feel comfortable discussing a patient’s weight status. Some providers I’ve observed, tell patients to “lose weight” as they are exiting the exam room. Health care providers are in a unique position to counsel and guide patients in their weight loss journey, especially pediatric patients and their families. Families look to primary care providers for direction about weight management.

Under the new Affordable Health Care Act, counseling for obesity prevention and treatment is covered at 100% as a preventative service.

I created these modules as a resource for providers to use in their office in the prevention, management, and counseling of overweight and obese pediatric patients. Each module contains a guide for the provider, educational handouts for the patient, and scholarly articles that help the provider navigate the educational process.

These modules are in no way comprehensive of the information available about pediatric obesity, but they offer providers a place to start in combating the national epidemic of childhood obesity.

Friday, March 2, 2012

5-2-1-0 Guideline

Source: www.let'sgo.org
Source: www.letsgo.org
The 5-2-1-0 guideline was created by the American Academy of Pediatrics (AAP) in Partnership with First Lady, Michelle Obama's Let's Move! initiative. 

The 5-2-1-0 plan is an easy to remember guideline for promoting four healthy behaviors:
  • 5: Eat 5 or more fruits and vegetables every day.
  • 2: TV and computer play screen time to 2 hours or less every day. Under age 2, no screen time.
  • 1: Participate in at least 1 hour of  physical activity every day.
  • 0: Aim for 0 sugar-sweetened drinks every day, restrict soda pop, sports drinks, and fruit drinks. Instead, drink water and 3-4 servings a day of skim or 1% milk. 

Thursday, March 1, 2012


A project that was completed for an obesity interventions class. 
I envisioned teaching to a group audience. It may be useful in that setting

Module 1: Self Image

Being an overweight or obese kid is difficult. They struggle with self-esteem and are at higher risk for psychological disorders, such as depression, anxiety, and disordered eating. Addressing physical appearance is a difficult topic for even the most seasoned healthcare provider. Starting out with this module, which starts an open dialogue about self-image is helpful in navigating those difficult discussions ahead. Take time to listen. Each child and family will tell a different story.

This can be used with all of the modules in the series

From The Module:

For Providers:

Module 2: Portion Control and MyPlate.gov Guidelines

I imagine it would be overwhelming to try and make better food choices when you don't understand the difference between a carbohydrate and a protein. This module provides a basic understanding of food groups, portions, and myplate.gov. There is a lot of information and a variety of handouts in this module which could be used in more than one visit.

Fantastic patient education about each food group in detail.

Eat Right Nutrition Tips
Handouts written by the Academy of Nutrition and Dietetics

(some Spanish)

Module 3 Physical Activity Guidelines

What do you think of when you hear the word exercise? Most patients envision running on a treadmill or lifting weights, which in all honesty, does not sound fun.  Exercise when described in that context may be overwhelming to an obese child who already struggles with self esteem issues and lags behind their peers. I recently saw a young boy in clinic who was clearly excited about football, but was embarrassed when it came to conditioning because he had a difficult time doing situps. So he quit. How do we motivate youth to participate? Clearly there are some activities that can appeal to all. Some studies found that encouraging less screen time was more effective that encouraging more exercise. The trick is to make activity fun and parents are a big part of that. It may take some work finding physical activity that will fit into every one's schedule, but it is clearly an important part of setting up lifelong fitness habits.  Encouraging at least an hour a day of physical activity is the key component of this module. Additionally, a recent Utah survey of providers found that we are better at recommending exercise to our pediatric patients, when we are actually exercising ourselves.

CDC Toolkit
Includes Power Points About the Importance of Family Involvement in Physical Activity

For the Provider:

this link has a toolkit where you can order free educational materials in different languages

Module 4: The StopLight Diet


While most experts discourage the use of the word "diet" when addressing food related lifestyle changes, the Stoplight Diet or program is one of the most widely used "diets" used in pediatric obesity research. There are several programs available that are similar to and utilize the same principles of the Stoplight Diet, they are included below. Any diet modifications for children should be adopted and embraced by all family members and should be easy to use and follow.  The book is out of print but can be easily purchased at retailers like Amazon or Half.com. It is a bit outdated, but still easy to use and gives the parents and child an idea of what foods belong in the green, yellow, and red categories. 

If the family prefers online monitoring of food intake here are online resources

Motivational Interviewing

Motivational interviewing is an essential skill for the health care provider. Assessing patients readiness to change and guiding them through that process can be both challenging and rewarding. Motivational interviewing takes time, learning, and practice. The information presented here is brief in nature, but should help providers form a basic understanding of motivational interviewing components.

Billing for Providers

One of the most important components to implementing any program into practice is reimbursement. Even though it may be of benefit to the patient, providers can't spend valuable time counseling patients, only to have these services denied by insurance companies. Under the Affordable Health Care Act of 2010, insurances are required to cover obesity prevention and treatment as a preventative service, which generally means no out of pocket expense to the patient.  This overcomes barriers for provider reimbursement and patient payment.

Wednesday, February 22, 2012

Group Class 1: Mindless Eating

One of the greatest downfalls of weight loss is mindless eating. Extra calories add up over time and equal additional pounds. Researcher, Dr. Brian Wansink developed a lab at Cornell University to track eating habits over time. The lessons he learned were published in the book Mindless Eating. He found several strategies that if we become aware of them, can help us eat less. His research is fascinating and before teaching this class, I highly recommend a reading (or at least skimming) of his book Mindless Eating.

Mindless Eating Power Point Outline
Mindless Eating Handout
Mindless Eating Website

Group Class 2: Making Wise Food Choices

Very often, planning ahead is the key to making wise food choices. Parents can help children make healthy choices with some planning ahead and forethought. The purpose of this class is to help children and their parents identify healthy choices for snacking, eating out, and celebrations. These occasions can be difficult to navigate for the family that is trying to make healthy lifestyle changes. This class gives participants solutions and opportunities for success when the occasions arise.

The suggestion for this class is to involve parents, and is best done in a setting with 10-16 participants.

Class Outline and Handouts

Helpful Resources and Links