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Dr Natsheh's tips for treating
bigger little people
- Inquire about diet and activity
in your anticipatory guidance counselling, and
measure and plot heights and weights at each
clinic visit.
- Identify realistic goals
for the child and family to attain. Don't set
them up for failure.
- Include other members of
the healthcare team, such as dieticians and
psychologists, in the management of these patients.
- When a child or family requests
assistance regarding weight management, don't
downplay their concerns, rather use this as
an opportunity for further education.
- Encourage children to increase
their activity by at least 30 min per day, with
at least 10 min of vigorous activity. Gradually
increase activity to up to 90 min/day of physical
activity.
- Encourage parents to be
positive role models for their children.
- Be an advocate for healthy
lifestyle opportunities in your community.
- In your office, provide
easy access to pamphlets, displays, posters,
etc, that promote healthy behaviours.
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In a recent, particularly timely,
episode of The Simpsons, Bart gorges on the junk
food in his school's new vending machines and ends up
having a heart attack. He can't kick his junk habit and
Marge and Homer are forced to send him to a maximum security
fat farm to slim down. Hilarity and social commentary
ensue. With close to 20% of Canadian children classed
as obese, and those numbers growing, this is definitely
a case of Bart imitating life.
Many doctors are discouraged by
the uphill battle to get their young patients to eschew
the chicken nuggets and video games (sorry BioWare)
and eat their broccoli and go out and play. A new crop
of obesity clinics specifically for little ones is dotting
the Canadian landscape and turning the 'fat farm' concept
squarely on its head. We checked in on one such clinic,
recently opened in Canada's third most corpulent city,
Saint John, NB, to find out how they're doing.
A
CLINIC IS BoRN
The problem's been getting a lot of attention, from
media, the medical community and government alike. Earlier
this month, for instance, Ottawa hosted the Pediatric
Obesity Conference; the brochure calls childhood obesity
"one of society's most devastating epidemics."
A similar and equally high profile forum also took place
in Vancouver on May 5, complete with an impassioned
speech by BC Health Minister Shirley Bond.
That's where Saint John Regional
Paediatric Obesity Clinic comes in. Helmed by pediatrician
Dr Susan Natsheh, the clinic is approaching the dilemma
with creativity and sensitivity, and their results are
encouraging.
Dr Natsheh recounts how several
years ago she and a group of her peers in Saint John
got inspired at a conference on childhood obesity similar
to the ones just held in Ottawa and Vancouver. After
a year of planning and research, the clinic opened its
doors in February 2004. "We have almost 80 patients
in the program, and are rapidly outgrowing our resources,"
says Dr Natsheh. The clinic is one of just seven clinics
of its kind in Canada, with others located in Calgary,
North York, Hamilton, Fredericton, Halifax, and St John's.
"We are not a weight loss program,"
insists Dr Natsheh, "rather a weight maintenance program,
promoting adoption of healthy lifestyle behaviours."
"As not to overburden the clinic,"
she adds, "we have limited entry to the program to those
who are 130% of ideal body weight, 120% of ideal body
weight with a diagnosed comorbidity of obesity, or for
children with a diagnosis known to predispose them to
obesity, such as Prader Willi Syndrome."
HOLISTIC
APPROACH
While they acknowledge it's important to be aware of
the three main physical causes of obesity (genetics,
overeating, and lack of exercise), the Saint John clinic
decided from the outset to take what they call a more
'holistic approach.' "Any intervention program that
evaluates the child as a whole person, incorporating
nutrition, exercise and self-esteem issues is ideal,"
says Dr Natsheh.
One of the key tenets of the program
is that it's voluntary for the child. "The issue is
more for the teens who don't appreciate the importance
of lifestyle modifications, particularly when their
friends enjoy sedentary activities," explains Dr Natsheh.
"Some have been brought to the clinic by their parents
under duress. In these cases, we thank them for coming
and explain the importance of healthy lifestyle choices.
We encourage them to return, if only to learn and we
hope they will apply the knowledge at a later date."
Once the child decides to take
part, specific and attainable goals are developed at
each visit and the clinic aims for frequent followup
in order "to reinforce lifestyle changes and encourage
progress," says Dr Natsheh.
"Our clinic differs in that we
are fortunate to have more disciplines involved than
some other sites," says Dr Natsheh. "Members of our
team include a pediatric nurse, a dietician, a physiotherapist,
a psychologist, pediatricians and a family therapist."
This formidable team is inclusive, and makes sure the
patient's family, school and community play a role in
promoting healthy lifestyles.
"The advantage to the team approach,"
she says, "is that we can identify the specific needs
of the patient and their family, and tailor their followup
to the professionals with expertise in that area."
HOW
DID WE GET HERE?
Dr Natsheh is pretty sure the increase in child obesity
has occurred too rapidly to blame on genetic factors
alone. She says in addition to the usual suspects —
video games, junk food, TV — learned behaviour
also plays a big role. "We like to see the chubby child,"
she notes, "... this is what society associates with
'good health'." She also thinks parents ignore their
kids' signals that they're full and thus teach them
to overeat.
If weight loss is not the primary
goal of the clinic, how do they measure success? "Success
is difficult to define," she says. "We have many children
lose weight, others have stopped gaining weight and
are growing into their bodies' height, many children
just feel better about themselves and we have parents
who have lost weight." In some cases, Dr Natsheh explains,
there are teens who ostensibly express little or no
interest in the program, but go on to adopt some of
her suggestions. "In my opinion these are all examples
of success."
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