Handbook of Pediatric Obesity: Clinical Management

by Sothern; Melinda S.

• ISBN13: 9781574449136
• ISBN10: 1574449133
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-02-23
• Publisher: CRC Press

Summary

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.

Table of Contents

Clinical Management of Pediatric Obesity: An Overview	1	(8)
Dennis M. Styne
SECTION 1 Clinical Management
The Business of Weight Management	9	(22)
Melinda S. Sothern
Introduction	10	(1)
Economic Burden of Pediatric Obesity	10	(1)
Financial Aspects of Managing Pediatric Obesity in the Clinical Setting	10	(1)
Challenges of Providing Clinical Management of Pediatric Obesity	10	(1)
Models for Health Education, Health Promotion and Program Development	11	(1)
The Planning Process	11	(3)
Assessing the Needs of Your Target Population	12	(1)
Needs Assessment	12	(1)
Site Analysis	13	(1)
Learner Analysis	13	(1)
Establishing Goals and Objectives	13	(1)
Designing Health Promotion Interventions	14	(2)
Applying Health Promotion Models and Theories to Practice	14	(1)
Marketing	15	(1)
Program Promotion: Getting the Word Out	16	(1)
Implementing a Health Promotion Program	16	(8)
Concerns of Implementation	16	(1)
Identification and Allocation of Resources	17	(1)
Personnel	17	(1)
Space	18	(1)
Scheduling	18	(1)
Intervention Materials, Equipment, and Supplies	18	(1)
Financial Resources	19	(1)
Preparing a Budget	20	(1)
Pediatric Weight Management Program: Step-by-Step Instructions	20	(1)
Referral from Pediatrician, Family Physician, or Phone Inquiry	20	(1)
Parent Information Session and Registration	21	(1)
History and Physical	21	(1)
Patient Screening	21	(1)
Assign Participants to the Appropriate Treatment	22	(1)
Orientation	22	(1)
Baseline Evaluation	22	(1)
Initial Lesson	23	(1)
Intervention Classes	23	(1)
Quarterly Evaluation Follow-Up	23	(1)
Awards, Graduation, New Goals	23	(1)
Evaluating a Health Promotion Program	24	(1)
Evaluation Approaches	24	(1)
Results and Reporting	24	(1)
Summary	24	(1)
References	25	(6)
SECTION 2 Medical Aspects of Treatment
Medical Complications and Comorbidities of Pediatric Obesity	31	(10)
Marc S. Jacobson
Genetic Syndromes Associated with Childhood Obesity	32	(1)
Endocrine Disorders	32	(1)
Hypothyroidism	32	(1)
Growth Hormone Deficiency	32	(1)
Cardiovascular Complications	33	(2)
Lipid Disorders	33	(1)
Cardiac Structure and Function	34	(1)
Insulin Resistance Syndromes	35	(1)
Metabolic Syndrome or Syndrome X	35	(1)
Polycystic Ovarian Syndrome	35	(1)
Type 2 Diabetes Mellitus	36	(1)
Gastrointestinal System	36	(1)
Cholelithiasis (Gallstones)	36	(1)
Hepatic Steatosis (Fatty Liver)	36	(1)
Pulmonary Complications of Obesity	37	(1)
General Alterations in Pulmonary Function	37	(1)
Asthma	37	(1)
Obstructive Sleep Apnea Hypoventilation Syndrome	37	(1)
Neurological	37	(1)
Orthopedic	37	(1)
References	38	(3)
Medical Aspects of Treatment: The Role of the Physician	41	(14)
Stewart T. Gordon
Introduction	41	(1)
Role of the Primary Care Practitioners	42	(1)
The Role of the Physician in the Treatment of Overweight Youth	43	(6)
Performing the Initial Medical Evaluation	44	(1)
Ordering and Interpreting Laboratory Blood Work	44	(1)
Prescribing an Appropriate Diet in Coordination with the Program Dietician	44	(1)
Provide Ongoing Medical Supervision	44	(1)
Follow-Up	44	(1)
Height and Weight Measurement	45	(1)
BMI and CDC Percentiles	46	(1)
Circumference Measurements	46	(1)
Blood Pressure and Heart Rate	46	(1)
Laboratory Blood Work (Baseline, 3 Months and 1 Year)	46	(1)
Body Composition Analysis (Estimate of Percentage Body Fat)	47	(1)
Measurement of Physical Activity Level and Fitness	47	(1)
Psychological Testing	48	(1)
Tanner Staging	48	(1)
Conclusion	49	(1)
References	49	(6)
SECTION 3 Psychosocial and Physical Considerations
Psychosocial Considerations during Treatment	55	(12)
Jeffrey B. Schwimmer
Introduction	55	(1)
Underlying/Comorbid Psychopathology	56	(1)
Depression	56	(1)
Anxiety	56	(1)
Eating Disorders	56	(1)
Family Psychosocial Issues	57	(2)
Family Structure	58	(1)
Child-Parent Conflicts	58	(1)
Relationships between Child Abuse and Obesity	58	(1)
Culture as It Influences Body Type Images and Dietary Preferences	59	(1)
Psychosocial Consequences	59	(2)
Peer Teasing	59	(1)
School	60	(1)
Quality of Life	61	(1)
Psychosocial Tools	61	(2)
Cognitive Behavioral Therapy	61	(1)
Knowledge and Self-Efficacy	61	(1)
Behavioral Counseling	62	(1)
Motivational Interviewing	63	(1)
Conclusion	63	(1)
References	64	(3)
Weaknesses and Strengths in the Response of the Obese Child to Exercise	67	(12)
Connie VanVrancken-Tompkins
Melinda S. Sothern
Oded Bar-Or
Introduction	67	(1)
Responses of the Obese Child to Exercise	68	(3)
Aerobic Performance	68	(1)
Energy Cost of Locomotion	69	(1)
Muscle Strength	69	(1)
Motor Performance	70	(1)
Rating of Perceived Exertion	71	(1)
Implications of Exercise Prescription	71	(1)
Activities Suitable for the Obese Child	71	(1)
Activities Less Suitable for the Obese Child	72	(1)
Summary	72	(1)
References	73	(6)
SECTION 4 Clinical Evaluation
Clinical Evaluation: Diagnosis, Medical Testing, and Follow-up	79	(16)
Nancy F. Krebs
Melinda S. Sothern
Prevalence	80	(1)
Causes/Risk Factors	80	(1)
Comorbidities	81	(1)
Treatment Approaches	81	(1)
Diagnosis	82	(4)
Medical History	82	(1)
Family History	83	(1)
Social History	83	(1)
Review of Systems	84	(1)
Primary Risk Factors	84	(1)
Physical Exam	84	(1)
Body Mass Index	85	(1)
Background	85	(1)
Calculating Obesity Risk and Status with BMI Percentiles	85	(1)
Diagnosis	85	(1)
Anthropometries to Assess Fat Distribution	85	(1)
Skinfolds	85	(1)
Waist Circumference	85	(1)
Direct Measurements of Body Composition	86	(1)
Laboratory Testing --- Basic Panels	86	(1)
Measurements of Energy Expenditure	86	(1)
Referrals	86	(3)
Genetics	86	(1)
Endocrinology	86	(2)
Thyroid	88	(1)
Pancreas	88	(1)
Cardiology	88	(1)
Pulmonary	88	(1)
Orthopedics and Physical Therapy	89	(1)
Psychology	89	(1)
Social Services	89	(1)
Nutrition	89	(1)
Exercise	89	(1)
Education	89	(1)
Follow-Up	90	(1)
At Risk for Obesity	90	(1)
Overweight	91	(1)
Severe Overweight	91	(1)
Summary	91	(1)
References	92	(3)
Nutritional Assessment of the At-Risk for Overweight and Overweight Child and Adolescent	95	(10)
Nancy Copperman
Introduction	95	(1)
Home Environment Assessment	96	(1)
School Environment Assessment	97	(1)
Community Environment Assessment	97	(1)
Physical Activity Assessment	97	(1)
Psychosocial Assessment	98	(1)
Dietary Intake Assessment	98	(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