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    Treating obesity at ground zero



    Our philosophy includes:

    • Keep healthy, natural food at home. Offer 3 meals and 2 to 3 snacks a day.

    • Follow the Division of Responsibility in Feeding for children.

    • Avoid coaxing or bribing, or artificial comments such as “Mmm, this tastes so good,” when feeding children.

    • Talk about your day at mealtimes. Nourish each other with sincere compliments that are not food related, such as “You had such nice manners when I took you to the store today.”

    • Be active 60 minutes a day.

    In general, the goal is to treat families for 6 months over 9 visits; I want to follow my patients past that initial hump of weight loss in the first 6 weeks of treatment to see if these changes could actually be maintained. That being said, I seldom graduate anyone in October with Halloween, Thanksgiving, and Christmas break lurking ahead. On the other hand, I had 1 year in which 3 patients each lost about 20 lb between October and January, and so I graduated them immediately. I miss being their general pediatrician so I could witness the full extent of the loss or the long-term patterns of my patients, and I hope to find grants to help sustain my follow-up more extensively into the future.

    We collect our results annually to match the fiscal year of most of my grants. Over the years, we have evolved in how we evaluate our program. The BMI percentile for age seems to be the best tool when the goal is to normalize the velocity of growth. Because BMI fluctuates with age, you could be a fraud for saying that BMI was going down in children aged 2 to 5 years because it is supposed to go down. Or, you could be falsely thinking you are failing when a BMI is going up between ages 6 to 18 years when actually the child is getting slimmer.

    We have statistically significant results so far, but I know that although the data we have collected over the past 5 years look good (amazing, in fact, with 84.5% of our patients improving their BMI percentile in 2012–2013), the scientist in me wants to see how all this will pan out over the next 50 years. Are my patients going to maintain a healthy weight? Are their younger siblings healthier than they would have been? How about their children?

    What you can do

    As a practicing community pediatrician, I see on a regular basis that many things we do can’t be measured and don’t add up to neat statistics. However, my amazing team and I have narrowed down some basic premises that seem to be most effective for combating this very misunderstood yet very manageable disease. Yes, the scientist in me has to live with the fact that no, I don’t have 50 years of data, but neither does the rest of the scientific community. With pediatricians out there every day being told to do something for this problem for which we have not been formally trained, I feel that I must share these pearls garnered from my experience with my fabulous team and my forthright patients. My 5 most important recommendations include:

    1. Get sugary drinks and processed foods out of the house.

    2. Serve fruits and vegetables with all meals and snacks.

    3. Look for stressors in the house (including bullying, dieting, and nocturnal enuresis) and support and refer these patients.

    4. Teach families good psychology when feeding children.

    5. Never underestimate the power of a good night’s sleep (always rule out OSA).

    The plight of overweight children can be extremely heartbreaking and challenging for both providers and families, but it doesn’t have to be. There is an answer, and it doesn’t cost the earth—just a little dedication and a lot of love.


    Hear Dr. Riba discuss her program on national radio. >>



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