MIAMI — A regimented, no excuses approach to tackling childhood obesity at Miami Children's Hospital in South Florida could be a model of success for other programs, according to Dr. William I. Muiños.
However, he cautioned, “we cannot make a difference unless all the primary care providers get involved. There aren't enough soldiers in this battle. We need reinforcements.”
Childhood obesity is a worldwide problem, not just a major concern in the United States. “Children are more obese now than ever. We are seeing obesity in children as young as 2 years old,” Dr. Muiños said at a pediatric update sponsored by Miami Children's Hospital.
His message for primary care providers is to intervene: “Don't be afraid to jump in because they need your help. They cannot do it on their own.” Parents also need guidance and education.
Miami Children's Hospital employs a multidisciplinary approach that includes physicians, nurses, social service representatives, and psychologists, but “you don't need a lot of multidisciplinary help. You can do it on your own if you take the time,” said Dr. Muiños, a pediatric gastroenterologist and director of the hospital's weight management program.
The key is to involve the family in a consistent way. Participating family members, however, must be strong and not negotiate with the child. They must be “like a sergeant,” he said.
Treatment plans are individualized for each patient. Children and families are educated about the benefits of fruit, vegetables, and fiber. They are instructed to eat smaller portions, turn off the television, and walk instead of drive. Exercise is emphasized. Patients sign a contract that calls for at least 1 hour of exercise five times per week. They get graded on how well they follow the regimen. Weekly meetings are helpful for keeping participants on track, he said.
Unlike some programs for overweight and obese adults, the goal is weight management, not extensive weight reduction, Dr. Muiños said. “If you start a weight loss program in a child who is growing up … the issue of losing weight actually changes the metabolism of the child during the growing years. It actually starts them on stress modalities [that] are not good for the child because the child's physiology is trying to protect the body weight.
“We need to overcome that by stabilizing weight and allowing height and growth and development to take hold and be the driving force of diminution of body fat,” he said. “We can use this physiologic event to our benefit to diminish [body mass indices] over time.”
Dr. Muiños said that it can actually be helpful to show parents and patients photos of the potential comorbidities if obesity is left unchecked. “I started doing this years ago. I do a lot of hepatology in my practice. And I would see the liver engorged with fat. It is an ugly thing. The macronodular specimen of the liver gets totally distorted.”
He added that “it will impact you when you see that. It impacted me as a physician. So I try to use that impact on the parent so they can see we are not playing around here. This is very, very real.”
Dr. Muiños reported having no relevant conflicts.
To see an interview with Dr. Muiños, go to www.youtube.com/FamilyPracticeNews
Stabilizing weight can allow growth to reduce body fat over time, said Dr. William I. Muiños (right).
Source Damian McNamara/Elsevier Global Medical News