ESTES PARK, COLO. — Family physicians can make a difference in the childhood obesity epidemic by using a simple, family-centered program that is created with their busy office practice schedules in mind.
The 8-week family fitness plan is an intervention that encourages families to choose from evidence-based activity and nutritional options, Dr. Walter L. Larimore said at the annual conference of the Colorado Academy of Family Physicians. The emphasis is on self-guided, small-step behavioral changes toward a healthier lifestyle, rather than on weight or body mass index. Nevertheless, clinical trials evaluating the plan have documented improvements in BMI, waist circumference, and blood pressure in obese and at-risk children, said Dr. Larimore, a Monument, Colo., family physician and medical journalist.
The family fitness plan suggests 8 weeks' worth of options in six categories: family projects, activities, mealtimes at home, nutrition, rest, and media. Families are encouraged to select one option to work on from each category every week. For example, under the media heading in week 1, a family might choose to limit the child's total television, computer, video game, and cell phone time to less than 4 hours a day. The media options in week 2 include having the family try one TV-free night a week.
The family fitness assessment tool is a quick quiz consisting of three sections—the nutrition and activity sections, each with 10 questions, and a BMI section, with 4 questions. Each of the three sections receives a score of A, B, C, D, or F. If any family member scores anything other than an A in any of the sections and the family is interested in reducing the risks for obesity, Dr. Larimore suggests trying the 8-week plan.
“We do not mind giving kids and families an F. We do not mind labeling this disease. In this we go against the American Academy of Pediatrics' recommendation that kids not be labeled as obese, that it's pejorative. We say it's potentially lifesaving to label that disorder,” he explained.
Typically, Dr. Larimore has an assistant explain the assessment tool, give it to the parent to fill out at home, and schedule a follow-up visit to discuss the results and introduce the 8-week plan.
A second follow-up visit is set up after the 8-week program is completed. If the child's BMI and blood pressure percentiles are not improved, then the slightly more intensive level-2 8-week plan is assigned. If the child's BMI and blood pressure percentiles are not normalized at the third follow-up visit, upon completion of the level-2 plan, Dr. Larimore will consider referral to a pediatric endocrine clinic or registered dietician.
The family fitness plan components are consistent with recently published recommendations of an American Medical Association expert committee on childhood obesity (Am. Fam. Physician 2008;78:56-63), he noted.
In an uncontrolled pilot study of the 8-week fitness plan supported by a grant from Florida Hospital in Orlando, the preintervention prevalence of borderline or high blood pressure in 60 children aged 4–12 years was 30%. After the 8-week program, the rate dropped to 13%, a reduction of 57%. At the same time, the proportion of children falling within the 6th-74th BMI percentile, defined as normal, rose from 27% to 37%, for a 37% improvement, according to Dr. Larimore.
Two simple steps that all family physicians can take to tackle the childhood obesity epidemic are to routinely record a BMI percentile as well as systolic and diastolic blood pressure for height percentiles on each child at every office visit, he said.
“If a child is in the 85th-94th BMI percentile, label it. Don't be scared to say, 'This is overweight, it's a vital sign about which I have concern,' “ he continued. Similarly, if a child is in the 90th-94th blood pressure percentile, label it pre-high blood pressure if based on one measurement and prehypertension if based on three.
And then react: Recommend the 8-week fitness plan or another intervention, Dr. Larimore urged.
The 8-week fitness plan and the accompanying fitness assessment tools are available as appendices to the book “SuperSized Kids,” which Dr. Larimore coauthored. The tools and the level-2 8-week plan are also available on the Web sites, www.drwalt.comwww.supersizedkids.com
The emphasis is on self-guided, small-step behavioral changes toward a healthier lifestyle. DR. LARIMORE