Implementing a lifestyle medicine approach to pediatric obesity care

Key takeaways:

• A lifestyle medicine approach for pediatric obesity care can be empowering for patients and providers.
• It is important to establish a positive relationship with young patients before discussing their weight.

DENVER — A lifestyle medicine approach can address gaps in pediatric obesity care, according to presenters at the annual American College of Lifestyle Medicine’s annual meeting.

J. Blakely Amati, MD, FAAP, DipABLM, an assistant professor of pediatrics at the University of South Carolina (USC) School of Medicine Greenville, said that a lifestyle medicine framework “can empower children and families to lead healthier lives with a focus on those living with obesity.”

“We are finding that a lifestyle medicine approach is both empowering and freeing to providers and patients,” Amati said. “We find that a lifestyle medicine approach incorporates all of the qualities we were looking for to address a very complex issue.”

A lifestyle medicine approach to pediatric obesity is evidence based and comprehensive, Erin L. Brackbill, MD, FAAP, DipABLM, an adjunct assistant professor of pediatrics at USC, said. It includes the recognition of obesity as a complex chronic disease, the use of motivational interviewing to support behavior change and emphasis on the same healthy habit messaging regardless of the size of a patient’s body.

“The lifestyle medicine emphasis on the same healthy habits regardless of body size is a weight-neutral approach that discourages weight stigma and encourages a family to work together on habits, not on numbers,” Amati said. “We introduce these concepts early and often to help build a healthy lifestyle from the beginning.”

This approach also includes all six pillars of lifestyle medicine — plant-based nutrition, physical activity, stress management, avoidance of risky substances, restorative sleep and social connections — rather than focusing on just exercise and nutrition, according to Brackbilll and Amati, who are both affiliated with Prisma Health Center for Pediatric Medicine.

“It is critical to recognize and address the impact of social drivers of health and trauma on health and weight,” Brackbill said.

Speaking with young patients about BMI and obesity can be challenging. But because a lifestyle medicine approach is a step-by-step process, Amati said, “all you need to do is get the ball rolling today and then bring the patient back for a focus and comprehensive visit regarding their health habits when they're ready.”

If a patient or their family does not see weight as an issue, Amati emphasized the importance of building rapport over the course of several visits.

“When we are addressing BMI and obesity, the first thing we must remember is to do no harm,” Amati said. “Remember that most patients will not be ready at first, and these early stages of change are where motivational interviewing is most effective.”

Overall, Amati said this lifestyle medicine approach “can be freeing for providers because they are meeting people where they are and coaching the patient to lead their own change.”

“In the same way, this can be empowering for patients and families as they are squarely in the driver's seat,” she said.