/ by UK HealthCare
Since the 1970s, the percentage of children and adolescents in the U.S. who are obese has more than tripled. Now, one in five school-age children is considered obese, which can lead to a slew of other health issues.
The Pediatric High BMI Clinic at UK HealthCare was started by Dr. Aurelia Radulescu and a registered nurse in 2008 to help children who fall into this category develop healthy lifestyle habits that will prevent and treat obesity-related medical complications.
Now, the clinic is staffed by Radulescu, who serves as its medical director, along with a dietitian, two physician assistants and a clinical medical assistant. Students training to become physicians, dietitians, health promotion specialists and social workers also come to the clinic to learn and to help treat patients.
Measuring obesity in children and adolescents
Obesity is a condition that is associated with excess body fat and can increase the risk for other conditions such as diabetes, hypertension, fatty liver disease and sleep apnea. Children with obesity are also more likely to be bullied by peers, which can lead to suffering from depression and low self-esteem.
One way to measure for obesity is by calculating the body mass index (BMI). Figuring out how a young person’s BMI compares to other children of the same demographics is more useful than other measures because it takes into account that children are still growing at different rates depending on age and sex. Children who have a BMI greater than 95 percent of other children of the same age and sex are considered obese.
The first appointment
Radulescu starts off an appointment with a first-time patient with this question: Do you know why your doctor sent you here? A patient’s answer will cue Radulescu into how ready the child is to talk about weight and how much she needs to teach the child and family about obesity as a disease.
Radulescu will then go over the patient’s daily routine with them to find the root causes of their excessive weight gain. She digs into the minutiae, including how much they sleep, their meals patterns, whether they buy their lunch or pack it, what they do when they come home from school, and how much time they spend playing video games or on their phones. She also looks at other potential causes for weight gain and obesity, such as medications or genetics.
Additionally, she screens for conditions often associated with obesity, including diabetes, hypertension, fatty liver disease, sleep apnea and polycystic ovarian syndrome (PCOS) as well as any mental health issues.
A child’s primary care doctor has to refer them to the Pediatric High BMI Clinic, but Radulescu has noticed an uptick in parents who request for a referral initially. She said that parents who suffer from obesity-associated medical complications often don’t want their children to develop the same problems as themselves or other family members.
It’s about the health, not just the weight
Then, it’s time to offer guidance on how to live a healthier life.
“I tailor the recommendations based on the available resources and what they are able to do,” said Radulescu.
This means if they’re on a budget, Radulescu adjusts her advice accordingly to make it more realistic for the patient and their family. For instance, she often recommends packing a healthy lunch and cooking dinner at home rather than eating out to better control portions and caloric intake.
“It’s important to individualize the care plan so that the child does not get discouraged,” said Radulescu.
The most crucial point that Radulescu tries to instill into her patients is that it’s about the health instead of the weight.
“It’s about being healthy” she said. “We focus on healthy changes, not just the weight.”
For example, if the patient has gained weight after their first visit to the clinic, but it turns out to be muscle mass because the patient is exercising more, then Radulescu considers that progress. If a child has medical complications of obesity but those are resolved as a result of eating healthier, then that is what counts more than the weight itself, Radulescu said.
For some patients, making one change at a time is the way to go. If they spend six hours a day playing video games, reducing that amount to four hours a day is a reasonable first step. Other patients are more ready to make sweeping changes, such as reducing the amount of screen time to the recommended two hours, right off the bat.
“Our goal is to empower them to make these changes,” said Radulescu.
Ultimately, the team at the UK Pediatric High BMI Clinic want to teach their patients about how to make healthy lifestyle changes that they can incorporate into their lives now and as they grow older.