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UCLA Fit for Healthy Weight Program

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For Providers

Information for primary care providers regarding managing childhood obesity. UCLA Fit for Healthy Weight Program.What steps can I take in my clinic to help prevent and manage the overweight child?

  1. Calculate BMI.
  2. Show families where they fall on the CDC BMI Growth Chart (Boys/Girls; Niños/Niñas).
    • BMI 85th to 94th percentile = Overweight (previously considered "At Risk for Overweight")
    • BMI 95th to 99th percentile = Obese (previously considered "Overweight")
  3. Assess medical and behavioral risks.
  4. Assess readiness for change from the family and child.
  5. Empower your patients with motivational interviewing and target-goal setting.
    • On a scale from 0 to 10, with 10 being the highest, how important is it to change your  ______ (e.g. diet, activity, screen-time)?
    • On a scale from 0 to 10, with 10 being the highest, how confident are you that you could make this change?
    • What would it take to get you to a higher number?
  6. These questions can lead the physician to discuss what it would take to get to a higher number, therefore, leading the parent/patient to come up with solutions to the problem.

  7. Follow your patients with a lifestyle log (e.g. Venice Family Clinic Lifestyle Log) to quickly assess nutrition, activity and behavior and set SMART goals (Specific, Measurable, Achievable, Rewarding, and Trackable) that can be followed. |
  8. Reinforce the following principles for all families:
    • Eat less (avoid supersize and sweetened drinks)
    • Move more (>60 minutes per day)
    • Less TV (<2 hours per day)
    • Family meals
    • Healthy breakfast
    • Eat fruits, vegetables, and whole grains
    • Avoid junk food
  9. Consult Pediatrics Supplement (Assessment of Child and Adolescent Overweight and Obesity; December 2007) and take CME courses on motivational interviewing and childhood obesity (e.g. Discovery Health CME: Health Steps to Treating Childhood Obesity).    

Also, see our Fit for Residency Curriculum.

What do I do when patients/parents don't feel that their weight is a problem?

Patients/parents conception of overweight may vary based on cultural and community factors.  Showing patients/parents where they fall on the BMI curve is the first step.  Discussing potential health problems and quality-of-life issues that they encounter is the next step.

What do I do when parents insist there is a medical problem causing their weight problem? 

Hypothyroidism and endocrine problems are very unlikely to be the cause of obesity in children.  Laboratory tests can be ordered to exclude these causes or referral to a subspecialist can be helpful. 

What screening laboratory tests should be considered for overweight children?

>85%ile & no risk factors         Fasting lipid profile
         
85-94%ile, age >10 years, positive risk factors        Fasting lipid profile
        Fasting glucose
        AST/ALT
         
>95%ile, age >10 years, ± risk factors       Fasting lipid profile
        Fasting glucose
        AST/ALT

I have tried prevention and intervention, but have been unsuccessful or lack the resources.  What can I do?

The following stages of treatment are recommended by the American Academy of Pediatrics (AAP).  If Stage I and II have been unsuccessful, physicians should consider referring their patients to a high-intensity program or a tertiary-care center.  The UCLA FIT PROGRAM offers Stage III and IV treatment options.

Stage I: Prevention and motivational interviewing with goal setting
Stage II: Structured weight management program
Stage III: Multidisciplinary team with expertise in childhood obesity (including behavioral counselor, registered dietitian, and exercise specialist)
Stage IV: Referral to tertiary care and consideration for surgery

How do I refer my patient to the UCLA Fit for Health Weight Program?

In order to expedite a patient consultation, please: 1) have your office obtain insurance authorization , 2) fax a SIGNED REFERRAL FORM and LAB RESULTS to 310-301-5391, and 3) encourage the family and patient to promptly fill out and fax/mail a REGISTRATION FORM.

For Venice Family Clinic Providers wishing to refer a patient to the telemedicine Fit Clinic at Simms Mann Health and Wellness Center, please use this Referral Form. Have the patient complete the registration form (Spanish language registration form available here) and place it in the patient's chart. Call the Simms Mann Coordinator to set up appointment, and if you cannot reach the coordinator, fax the form to her at 310-829-4632. For questions about the Simms Mann Telemedicine Fit Clinic, call 310-825-6469.

LAUSD San Miguel Clinic providers, please use this referral form.

What steps can I take in my local community to promote healthy lifestyles for children?

There are many things you can do. Consider supporting local schools in setting up salad bars, so that kids have access to fresh fruit and vegetables. See our instructions and appendices to learn more about how you can start a school salad bar, and email us at fitprogram@mednet.ucla.edu if you have more questions. You can also visit the Salad Bars to Schools website for more information and to see if your school can obtain a grant for a salad bar.

Also, we have created a  Healthy Weight Resource Guide to help providers in Los Angeles county (focusing on LAUSD catchment area) find low cost referral options for patients who need more support with healthy lifestyle changes. See the map of resources here.

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