Families participating in the Shaping America's Youth (SAY) town meetings are asking pediatricians to provide consistent and accurate nutrition and physical activity information, deliver effective obesity-focused clinical care, and work in partnership with them to help in obesity prevention and treatment. With these requests from families, pediatricians and the health care community are presented with both a challenge and an opportunity. The challenge is to incorporate new knowledge, skills, and practice change into an already busy office. The opportunity is to partner with patients and families in new ways to achieve healthy nutrition and activity behaviors that support obesity prevention and treatment.
Obesity is a chronic disease1 and, as such, is informed by the chronic disease model.2 The American Academy of Pediatrics (AAP) is helping pediatricians incorporate new knowledge, skills, and practice change through a variety of educational opportunities and materials to provide “quick, convenient access to the latest and best practice recommendations on obesity prevention, intervention, and treatment.”3 The Expert Committee recommendations for pediatric obesity, published in 2007, directed primary care providers to “universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits.”1 The committee recommended that providers calculate and plot BMI at least annually and assess the child's obesity risk with screening for current medical conditions and for future risks, and that they offer diet and physical activity behavioral guidelines to promote maintenance of healthy weight.
For treatment, the recommendations propose 4 stages of obesity care; the first stage is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient's age and degree of excess weight. The committee recognized the importance of social and environmental change to reduce the obesity epidemic but also identified ways in which health care providers and health care systems can be part of broader efforts. It is important to note that the Expert Committee also placed emphasis on the interactions between the physician, patients, parents, and families and discussed the need to develop and integrate these interactions into clinical practice.
These interactions between pediatricians, families, and patients are supported by the concept of the pediatric medical home and access to medical care. The pediatric medical home has been endorsed by the AAP for the past 40 years4 and emphasizes the delivery of primary care that is continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.5 Originally seen as a paradigm for the provision of care for children with special health care needs, this model perfectly reflects what is needed to ensure that children at risk for obesity or who are obese receive optimal care. Principles of the pediatric medical home echo the expressed needs of parents in the SAY report. In particular the “provision of family-centered care through developing a trusting partnership with families, respecting their diversity, and recognizing that they are the constant in a child's life.”6 This gives families and patients the advantage of “cumulative prevention” that is developmentally appropriate and tailored to the individual needs and skills of the child and family.
The principle of “sharing clear and unbiased information with the family about the child's medical care and management and about the specialty and community services and organizations they can access”6 speaks to the integral link that the pediatrician provides between the individual patient and his or her community. This helps families assess and access appropriate resources to improve their nutrition and physical activity. Pediatricians are encouraged to interact “with early intervention programs, schools, early childhood education and child care programs, and other public and private community agencies to be certain that the special needs of the child and family are addressed.”6 This statement emphasizes the community advocacy that pediatricians, as child health experts, are called on to exercise on behalf of their overweight/obese patients. The AAP has designed resources for pediatricians to use in their community, state, and federal advocacy efforts (available at www.aap.org/obesity).
Today's epidemic of childhood obesity makes physician community collaboration imperative. The obesity epidemic has drawn the fields of pediatrics and public health even closer. We hear families acknowledging the continuum of care and support they need, which ranges from the family to the wider community and to the population in general. Many of the comments by the SAY participants reinforced a report on medicine and public health7 that called for collaboration between these fields. Collaboration would specifically improve health care by coordinating services for individuals, improving access by establishing frameworks to provide care for the uninsured and underinsured, and improve the quality and cost-effectiveness of care by applying a population perspective to medical practice. The report also encouraged the “use of clinical practice to identify and address community health problems and to strengthen health promotion and health protection by mobilizing community campaigns.”7
In the SAY findings, families clearly recognized the significance of the problem of childhood obesity and their role in implementing healthy nutrition and activity behavior change. Families also expressed a strong need for increased support from all segments of the community. They considered consistent and supportive local environments and policies critical to their efforts to practice healthier lifestyles. Recognizing that influences on a child's energy balance come from all areas of the child's environment, families believed their efforts to make healthier choices can succeed only if they are supported in all of these areas, including health care.
These findings are affirmed in the AAP policy on community pediatrics,8 in which the importance of supporting the child and family in the community was recognized. The AAP policy included in its definition of community pediatrics “recognition that family, educational, social, cultural, spiritual, economic, environmental, and political forces act favorably or unfavorably, but always significantly, on the health and functioning of children” and defined community pediatrics as an integral part of the professional role and duty of the pediatrician.
SAY, with support from participating communities and in partnership with the AAP, has assembled unique data about families and children directly from families and children. This information is important and should inform and assist pediatricians and community-based childhood obesity-prevention programs in becoming more effective and responsive to families' expressed needs. To fight obesity, families need the support of pediatricians, in the medical home, who will partner with them to provide the information and skills they need to achieve healthy lifestyles for their children and to advocate for the crucial changes in communities that are necessary to support healthy lifestyle behaviors.
Pediatricians and families have common goals: improving children's health and well-being. Pediatricians understand the complexity of obesity prevention and treatment and the fact that the entire trajectory of a child's journey from family through school, day care, and community is involved in either exacerbating or preventing obesity. The pediatrician can provide a perspective that takes into account the child's physical, mental, and social-emotional development and helps place in context family and community efforts to improve nutrition and physical activity.
- Accepted August 9, 2010.
- Address correspondence to Sandra G. Hassink, MD, FAAP, Nemours Obesity Initiative, Alfred I. DuPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19899. E-mail:
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
- SAY =
- Shaping America's Youth •
- AAP =
- American Academy of Pediatrics
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- Bonomi A
- Hassink S
- 5.↵American Academy of Pediatrics. Helping you implement the medical home into your practice. Available at: http://practice.aap.org/content.aspx?aid=1597&nodeID=8002. Accessed September 20, 2009
- Lasker RD
- Rushton FE Jr.
- Copyright © 2010 by the American Academy of Pediatrics