Handbook of Pediatric Obesity: Clinical Management

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ISBN: 9781574449136 | 1574449133
Cover: Hardcover
Copyright: 2/23/2006

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A compilation of management, medical, nutrition, psychological, and physical activity facts, models, theories, interventions, and evaluation techniques, the Handbook of Pediatric Obesity: Clinical Management is the most clinically appropriate and scientifically supported source of information available for pediatric health care and research professionals. This comprehensive, state-of-the-art, and easy-to-use reference can be used to develop programs that provide the best possible care to overweight children in clinical settings. Melinda Sothern is co-winnerof the 2009 Oded Bar-Or Award for Excellence in Pediatric Obesity Researchsponsored by the Obesity Society Pediatric Obesity Section Covering clinical evaluation, medical aspects of treatment, and psychosocial, behavioral, nutritional, and physical activity considerations, the book discusses approaches to weight management such as diet, behavioral counseling, exercise, pharmacology, and surgery. It presents coverage of applied techniques, information, and tools for developing, modifying, implementing, and evaluating weight-management programs for children and adolescents in clinical settings. Worksheets, menu plans, and sample exercise programs are just a few of the features that make this book practical as well as informative. It is clear that there is no single solution for every overweight child and the number of options can seem overwhelming. This text provides clinicians with the information and tools necessary to match or tailor the available treatment plans to the medical, physical, nutritional and emotional needs of their patients.

Clinical Management of Pediatric Obesity: An Overview

(8)

Dennis M. Styne

SECTION 1 Clinical Management

The Business of Weight Management

(22)

Melinda S. Sothern

Introduction

(1)

Economic Burden of Pediatric Obesity

(1)

Financial Aspects of Managing Pediatric Obesity in the Clinical Setting

(1)

Challenges of Providing Clinical Management of Pediatric Obesity

(1)

Models for Health Education, Health Promotion and Program Development

(1)

The Planning Process

(3)

Assessing the Needs of Your Target Population

(1)

Needs Assessment

(1)

Site Analysis

(1)

Learner Analysis

(1)

Establishing Goals and Objectives

(1)

Designing Health Promotion Interventions

(2)

Applying Health Promotion Models and Theories to Practice

(1)

Marketing

(1)

Program Promotion: Getting the Word Out

(1)

Implementing a Health Promotion Program

(8)

Concerns of Implementation

(1)

Identification and Allocation of Resources

(1)

Personnel

(1)

Space

(1)

Scheduling

(1)

Intervention Materials, Equipment, and Supplies

(1)

Financial Resources

(1)

Preparing a Budget

(1)

Pediatric Weight Management Program: Step-by-Step Instructions

(1)

Referral from Pediatrician, Family Physician, or Phone Inquiry

(1)

Parent Information Session and Registration

(1)

History and Physical

(1)

Patient Screening

(1)

Assign Participants to the Appropriate Treatment

(1)

Orientation

(1)

Baseline Evaluation

(1)

Initial Lesson

(1)

Intervention Classes

(1)

Quarterly Evaluation Follow-Up

(1)

Awards, Graduation, New Goals

(1)

Evaluating a Health Promotion Program

(1)

Evaluation Approaches

(1)

Results and Reporting

(1)

Summary

(1)

References

(6)

SECTION 2 Medical Aspects of Treatment

Medical Complications and Comorbidities of Pediatric Obesity

(10)

Marc S. Jacobson

Genetic Syndromes Associated with Childhood Obesity

(1)

Endocrine Disorders

(1)

Hypothyroidism

(1)

Growth Hormone Deficiency

(1)

Cardiovascular Complications

(2)

Lipid Disorders

(1)

Cardiac Structure and Function

(1)

Insulin Resistance Syndromes

(1)

Metabolic Syndrome or Syndrome X

(1)

Polycystic Ovarian Syndrome

(1)

Type 2 Diabetes Mellitus

(1)

Gastrointestinal System

(1)

Cholelithiasis (Gallstones)

(1)

Hepatic Steatosis (Fatty Liver)

(1)

Pulmonary Complications of Obesity

(1)

General Alterations in Pulmonary Function

(1)

Asthma

(1)

Obstructive Sleep Apnea Hypoventilation Syndrome

(1)

Neurological

(1)

Orthopedic

(1)

References

(3)

Medical Aspects of Treatment: The Role of the Physician

(14)

Stewart T. Gordon

Introduction

(1)

Role of the Primary Care Practitioners

(1)

The Role of the Physician in the Treatment of Overweight Youth

(6)

Performing the Initial Medical Evaluation

(1)

Ordering and Interpreting Laboratory Blood Work

(1)

Prescribing an Appropriate Diet in Coordination with the Program Dietician

(1)

Provide Ongoing Medical Supervision

(1)

Follow-Up

(1)

Height and Weight Measurement

(1)

BMI and CDC Percentiles

(1)

Circumference Measurements

(1)

Blood Pressure and Heart Rate

(1)

Laboratory Blood Work (Baseline, 3 Months and 1 Year)

(1)

Body Composition Analysis (Estimate of Percentage Body Fat)

(1)

Measurement of Physical Activity Level and Fitness

(1)

Psychological Testing

(1)

Tanner Staging

(1)

Conclusion

(1)

References

(6)

SECTION 3 Psychosocial and Physical Considerations

Psychosocial Considerations during Treatment

(12)

Jeffrey B. Schwimmer

Introduction

(1)

Underlying/Comorbid Psychopathology

(1)

Depression

(1)

Anxiety

(1)

Eating Disorders

(1)

Family Psychosocial Issues

(2)

Family Structure

(1)

Child-Parent Conflicts

(1)

Relationships between Child Abuse and Obesity

(1)

Culture as It Influences Body Type Images and Dietary Preferences

(1)

Psychosocial Consequences

(2)

Peer Teasing

(1)

School

(1)

Quality of Life

(1)

Psychosocial Tools

(2)

Cognitive Behavioral Therapy

(1)

Knowledge and Self-Efficacy

(1)

Behavioral Counseling

(1)

Motivational Interviewing

(1)

Conclusion

(1)

References

(3)

Weaknesses and Strengths in the Response of the Obese Child to Exercise

(12)

Connie VanVrancken-Tompkins

Melinda S. Sothern

Oded Bar-Or

Introduction

(1)

Responses of the Obese Child to Exercise

(3)

Aerobic Performance

(1)

Energy Cost of Locomotion

(1)

Muscle Strength

(1)

Motor Performance

(1)

Rating of Perceived Exertion

(1)

Implications of Exercise Prescription

(1)

Activities Suitable for the Obese Child

(1)

Activities Less Suitable for the Obese Child

(1)

Summary

(1)

References

(6)

SECTION 4 Clinical Evaluation

Clinical Evaluation: Diagnosis, Medical Testing, and Follow-up

(16)

Nancy F. Krebs

Melinda S. Sothern

Prevalence

(1)

Causes/Risk Factors

(1)

Comorbidities

(1)

Treatment Approaches

(1)

Diagnosis

(4)

Medical History

(1)

Family History

(1)

Social History

(1)

Review of Systems

(1)

Primary Risk Factors

(1)

Physical Exam

(1)

Body Mass Index

(1)

Background

(1)

Calculating Obesity Risk and Status with BMI Percentiles

(1)

Diagnosis

(1)

Anthropometries to Assess Fat Distribution

(1)

Skinfolds

(1)

Waist Circumference

(1)

Direct Measurements of Body Composition

(1)

Laboratory Testing --- Basic Panels

(1)

Measurements of Energy Expenditure

(1)

Referrals

(3)

Genetics

(1)

Endocrinology

(2)

Thyroid

(1)

Pancreas

(1)

Cardiology

(1)

Pulmonary

(1)

Orthopedics and Physical Therapy

(1)

Psychology

(1)

Social Services

(1)

Nutrition

(1)

Exercise

(1)

Education

(1)

Follow-Up

(1)

At Risk for Obesity

(1)

Overweight

(1)

Severe Overweight

(1)

Summary

(1)

References

(3)

Nutritional Assessment of the At-Risk for Overweight and Overweight Child and Adolescent

(10)

Nancy Copperman

Introduction

(1)

Home Environment Assessment

(1)

School Environment Assessment

(1)

Community Environment Assessment

(1)

Physical Activity Assessment

(1)

Psychosocial Assessment

(1)

Dietary Intake Assessment

(2)

Physical and Laboratory Assessments

100

(2)

Nutritional Care Plan and Case Management

102

(1)

References

102

(3)

Behavioral and Psychosocial Assessment Tools

105

(8)

T. Kristian von Almen

Behavioral Assessments

106

(1)

Achenbach Child Behavior Checklist

106

(1)

Social Skills Rating System

106

(1)

Psychosocial Assessments

107

(1)

Children's Depression Inventory

107

(1)

Reynolds Adolescent Depression Scale 2

107

(1)

Self-Esteem

107

(1)

Piers-Harris Children's Self Concept Scale, Second, Edition

107

(1)

Self-Perception Profile for Children

107

(1)

Anxiety

108

(1)

State-Trait Anxiety Inventory for Children

108

(1)

Measures of Eating Disorders

108

(1)

The Kid's Eating Disorder Survey

108

(1)

The Eating Disorder Inventory

108

(1)

The Eating Attitudes Test

108

(1)

The Diagnostic Survey for Eating Disorders

109

(1)

Family Measures

109

(1)

Family Adaptability and Cohesion Evaluation Scales

109

(1)

Family Environment Scale

109

(1)

Conclusion

110

(1)

References

110

(3)

Exercise Testing

113

(8)

Thomas Rowland

Mark Loftin

Physiological Considerations

113

(1)

Cardiovascular Fitness

113

(1)

Endurance Performance

113

(1)

Maximal Oxygen Uptake (VO2 max)

114

(1)

``True'' Cardiovascular Fitness

114

(1)

Autonomic Function

114

(1)

Blood Pressure

115

(1)

Ventilatory Anaerobic Threshold

115

(1)

Running/Walking Economy

115

(1)

Exercise Testing

116

(1)

References

116

(5)

SECTION 5 Dietary Approaches

Pediatric Obesity Dietary Approaches in Clinical Settings: A Survey of the Options and Recommendations

121

(12)

Melinda S. Southern

Connie VanVrancken-Tompkins

Lauren Keely Carlisle

Introduction

121

(1)

Individual- and Family-Based Dietary Interventions in Clinical Settings

122

(2)

Dietary Prevention and Treatment Recommendations for Children and Adolescents

124

(2)

Normal and Overweight Children 6 or Fewer Years of Age with Parental Obesity

124

(1)

At Risk for Overweight Children and Adolescents, 7 to 18 Years of Age

125

(1)

Overweight Children and Adolescents, 7 to 18 Years of Age

126

(1)

Severely Overweight Children and Adolescents, 7 to 18 Years of Age

126

(1)

Low-Glycemic Index Diet

126

(1)

Very Low Calorie Diets in the Clinical Setting

127

(1)

Summary

128

(1)

References

129

(4)

Nutrition Education

133

(14)

Heidi Schumacher

Connie VanVrancken-Tompkins

Melinda S. Southern

Introduction

133

(1)

Nutrition Education and Individual Counseling

133

(1)

Nutrition Education and Group Counseling

134

(1)

Nutrition Education in Multidisciplinary Settings

134

(2)

Nutrition Education and Alternative Dietary Approaches

136

(2)

A Sample Nutrition Education Curriculum in the Clinical Setting

138

(3)

Diet Instruction

138

(1)

Food Labs: The Meat and Protein Group

139

(1)

Cooking Demonstrations: Fun in the Kitchen --- Low-Calorie Pizza

139

(1)

Nutrition Games: Snack-Food Jeopardy

139

(1)

Class Discussion: Calcium: The Bone-Builder

140

(1)

Summary

141

(2)

References

143

(4)

SECTION 6 Behavioral Counseling

Behavioral Counseling: Family-Based Behavioral Counseling in Clinical Settings

147

(26)

Valerie H. Myers

Pamela Davis Martin

Behavioral Treatment Techniques

148

(2)

Goal Setting and Action Planning

148

(1)

Self-Monitoring

149

(1)

Stimulus Control and Cue Elimination

149

(1)

Modification of Eating and Activity Patterns

149

(1)

Contingency Management

149

(1)

Social Reinforcement and Modeling

149

(1)

Relapse Prevention and Problem Solving

149

(1)

Overview of Family-Based Studies

150

(15)

Literature Review

150

(1)

Family-Based Counseling Interventions

150

(1)

Group Treatment

150

(14)

Weight Maintenance

164

(1)

Adolescents

164

(1)

Component Analysis of Behavioral Techniques

165

(1)

Summary

165

(1)

Parent Training or Modeling Interventions

165

(1)

Weight Maintenance

166

(1)

Parents as the Focus of Treatment

166

(1)

Summary

166

(1)

Individual Treatment Approaches

166

(1)

Summary

167

(1)

Acknowledgment

167

(1)

References

167

(6)

SECTION 7 Exercise and Physical Activity

Increasing Physical Activity in Overweight Youth in Clinical Settings

173

(16)

Melinda S. Sothern

Connie VanVrancken-Tompkins

Courtney Brooks

Camille Thelin

Introduction

173

(2)

Determinants of Physical Activity

174

(1)

Motivational Theories and Models

175

(2)

The Theory of Planned Behavior

176

(1)

The Health Belief Model

176

(1)

Social Cognitive Theory

176

(1)

Motivational Techniques to Increase Physical Activity

177

(7)

Initial Evaluation

177

(1)

Music as a Motivational Tool

178

(1)

Team (Group) versus Individual Physical Activity

178

(1)

Individualizing Physical Activity Programs

178

(1)

Application of Social Cognition Theory to Promote Physical Activity in Multidisciplinary Settings

178

(1)

Increasing Daily Energy Expenditures: The Moderate Intensity Progressive Exercise Program Step

179

(1)

Muscular Strength & Endurance: The MPEP Pump! (Chapter 20: Appendice A3.1, A3.3)

179

(2)

Role Modeling

181

(3)

Summary

184

(1)

References

185

(4)

Exercise and Physical Activity: Exercise Training Programs and Metabolic Health

189

(12)

Scott Owens

Introduction

189

(1)

Components of Metabolic Health in the Pediatric Obesity/Exercise Literature

190

(1)

Effects of Exercise on Components of Metabolic Health

190

(6)

Exercise and Dyslipidemia

190

(1)

Exercise and Triglycerides

190

(4)

Exercise and HDL Cholesterol

194

(1)

Exercise and Hyperglycemia/Hyperinsulinemia

194

(1)

Exercise and Glucose

194

(1)

Exercise and Insulin

195

(1)

Exercise and Hypertension

195

(1)

Exercise and Abdominal Obesity

196

(1)

Exercise and Waist Circumference

196

(1)

Exercise and Visceral Adipose Tissue

196

(1)

Summary of Components of Successful Exercise Programs

196

(1)

Mode of Exercise

196

(1)

Intensity of Exercise

196

(1)

Duration of Exercise

197

(1)

Frequency of Exercise

197

(1)

Length of Exercise Training Program

197

(1)

References

197

(4)

SECTION 8 Internet-Based Approaches

Internet-Based Treatment for Pediatric Obesity

201

(10)

Donald A. Williamson

Heather Walden

Emily York-Crowe

Tiffany M. Stewart

Background

201

(1)

Using the Internet for Weight Management

202

(1)

HIPTeens

202

(4)

Program Description

202

(1)

Description of Internet Component

203

(1)

Measurement of Participation in the Internet-Based Interventions

203

(1)

Non-Internet Aspects of the Study

204

(1)

Computer Training and Counseling Sessions

204

(1)

Measurement of Body Weight at Home

204

(1)

Initial Findings from the First 6 Months

204

(2)

Summary and Conclusions

206

(1)

Pros and Cons for Using the Internet

206

(1)

Feasibility of Internet-Based Interventions

206

(1)

Future Directions

207

(1)

References

207

(4)

SECTION 9 Pharmacology

Pharmacologic Treatment of Adolescent Obesity

211

(12)

Canice E. Crerand

Thomas A. Wadden

Robert I. Berkowitz

Introduction

211

(1)

Pharmacological Agents for the Treatment of Obesity

212

(1)

Use of Orlistat with Adolescents and Children

212

(2)

Safety and Efficacy Trials

212

(1)

Open-Label Trials

213

(1)

Orlistat and Vitamin and Mineral Absorption

214

(1)

Orlistat's Use in Children

214

(1)

Use of Sibutramine with Adolescents

214

(2)

Safety and Efficacy Trials

215

(1)

Metformin

216

(1)

Clinical Implications and Conclusions

216

(1)

References

217

(6)

SECTION 10 Surgery

Surgical Management of Pediatric Obesity

223

(12)

Thomas Inge

Meg Zeller

Shelley Kirk

Stephen Daniels

Introduction

223

(1)

Primary Care Provider Considerations before Referral of Surgical Candidates

223

(3)

Comprehensive Team Assessment of the Patient Referred for Bariatric Surgery

226

(2)

Postoperative Management

228

(2)

Final Words of Caution

230

(1)

Summary

231

(1)

References

231

(4)

SECTION 11 Interdisciplinary, Interactive, Group Instruction

Interdisciplinary, Interactive Group Instruction: Orientation, Evaluation and Monitoring Progress

235

(8)

Lauren Keely Carlisle

Stewart T. Gordon

Introduction

235

(2)

Program Overview

235

(1)

Family Intervention

236

(1)

Four-Level Progression

236

(1)

Level I (Red)

236

(1)

Level II (Yellow)

236

(1)

Level III (Green)

236

(1)

Level IV (Blue)

236

(1)

Orientation

237

(1)

Evaluation

237

(1)

Monitoring Progress

238

(2)

Sample Activity Descriptions

239

(1)

Group Behavior --- Goal Setting

239

(1)

Group Exercise --- Aerobic Field Sports

239

(1)

Group Nutrition --- Portion Control

240

(1)

Procedures for Absentees

240

(1)

Summary

240

(1)

References

240

(3)

Interdisciplinary, Interactive, Group Instruction

243

(28)

T. Kristian von Almen

Melinda S. Sothern

Heidi Schumacher

Behavioral Therapy: Group Counseling Sessions, Follow-Up, and Relapse Prevention

244

(2)

Introduction

244

(2)

Setting Limits

246

(2)

Self-Monitoring of Food and Activity

248

(1)

Cue Elimination

248

(1)

Stimulus Control

248

(1)

Goal Setting: Short-Term, Long-Term, and Weekly

249

(1)

Goal Assessment

249

(1)

Behavioral Substitution or Replacement

249

(1)

Relapse Prevention

250

(1)

Applied Activities and Experiences

250

(1)

Family Physical Activity and Fitness Education Sessions

251

(1)

Introduction

251

(1)

Pediatric Obesity and Exercise Performance

251

(1)

Exercise Instruction in Interactive, Interdisciplinary Clinical Settings

252

(5)

Cardiorespiratory Endurance or Aerobic Exercises

256

(1)

Muscular Strength and Endurance Exercises

256

(1)

Muscular Flexibility Exercises

257

(1)

Summary

257

(1)

Lesson 1: Benefits of Exercise, Exercise Safety, Warming-Up, Exercise Prescription, and Increasing Your Daily Activity --- The MPEP-Step

257

(2)

Lesson 2: Exercise Intensity and Pacing Skills (Metabolic Systems), Cooling Down after Exercise

259

(1)

Lesson 3: Aerobic Exercise --- Modified Field Sports, the Homework Rule

259

(1)

Lesson 4: Muscular Strength and Endurance: MPEP Pump, Strength Training Circuit, Creating Indoor Play Areas

260

(1)

Lesson 5: Family Field Sports --- Aerobic Volleyball, Creating Outdoor Play Areas

261

(1)

Lesson 6: Flexibility, Flex Test I, and Flex and Stretch Class

261

(1)

Lesson 7: Aerobic Exercise and Cardiopulmonary Endurance, Steady State --- Monitoring Heart Rate and Aerobic Circuit

261

(1)

Lesson 8: Exercise Prescriptions: The Fit Kit Walking Program

262

(1)

Lesson 9: Review Muscular Strength and Endurance: Pull Your Own Weight Series

262

(1)

Lesson 10: Park Day --- Outdoor Play

262

(1)

Nutrition Education Sessions

262

(4)

Diet Instruction

263

(1)

Food Labs: Fruit and Vegetable Group

263

(1)

Cooking Demonstrations: Fun in the Kitchen --- Oven-Fried Chicken

264

(1)

Nutrition Games: Fast-Food Follies

264

(1)

Class Discussion: Understanding Fiber

265

(1)

Benefits of Fiber

265

(1)

Adding Fiber to Your Diet

265

(1)

References

266

(5)

Appendix 1 Clinical Management Forms

271

(38)

Appendix 2 Testing/Measurement Protocols

309

(14)

Appendix 3 Sample Intervention Materials

323

(70)

Index

393

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