PEDIATRICS Vol. 116 No. 1 July 2005, pp. 292 (doi:10.1542/peds.2005-0727)
Childhood Obesity: Benefits of Lifestyle-Modification Therapy
Naomi D. Neufeld, MD, FACEPrivate Practice,
Los Angeles, CA 90048,
KidShape,
Los Angeles, CA 90048
To the Editor.
I agree with Quattrin et al1 that referral of obese children to pediatric endocrinologists often occurs too late to promote restoration of weight to normal. As a pediatric endocrinologist practicing for 25 years in Los Angeles, California, I believe that late referral of overweight children by primary care physicians results from lack of routine charting of weight and/or BMI as standard care. However, several other factors also come into play.
- Health and dietary attitudes are culturally influenced; as America becomes more of a cultural mosaic rather than a melting pot, discussing these issues becomes more complex for physicians.
- Meaningful discussion is time consuming and involves areas in which physicians rarely have a core competency: nutrition education, meal planning, psychosocial behavior modification, and physical activity.
- An office setting is not the ideal environment to keep children and their parents engaged, nor are the time-consuming discussions necessarily covered by insurance.
However, my experience is that significant progress can be made even when referral occurs later than desirable.
In 1986, alarmed by increasing referrals of obese and overweight children, I began a program at Cedars-Sinai Medical Center, KidShape, for children aged 6 to 14 years. KidShape is an 8-week, 2-hour-long program, designed to provide a family-based group environment in which registered dietitians, licensed family therapists, and exercise physiologists help families develop more healthful dietary and exercise habits. The curriculum is designed to be multiculturally relevant, and classes are offered in English or Spanish.
We have treated >12000 children at KidShape-run locations in Southern California, as well as through licenses to health care entities including Highmark Blue Cross of Pennsylvania and Kaiser Permanente. Analysis of data collected in 1996–1997 revealed that 85% of the children who were studied lost weight. The mean weight loss was 1.5 BMI units (P < .01). A separate group of obese adolescents, who were not treated, gained 0.5 BMI units during the same time frame. After completing the program, a subset of subjects was again contacted at follow-up 3 to 12 months later. More than 80% of KidShape participants maintained or continued their weight loss long-term, compared with historical controls that gained weight at >10% per year. Other data, reported in 1999, showed improvement in features associated with metabolic syndrome.2
Our findings suggest that family-based, culturally relevant behavioral intervention can produce meaningful results even when the patient has reached a BMI well above the 85th percentile.
REFERENCES
- Quattrin T, Liu E, Shaw N, Shine B, Chiang E. Obese children who are referred to the pediatric endocrinologist: characteristics and outcome. Pediatrics.2005; 115
:348
–351
[Abstract/Free Full Text] - Neufeld ND, Wert C. Reversing hyperinsulinemia (HI) and associated sequelae of childhood obesity (CO) through medical nutrition therapy [abstract]. Pediatr Res.1999; 45 :95A
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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