Comprehensive Multidisciplinary Program Perspective

ment of child and adolescent overweight and obesity1,2 provide specific and detailed guidance for a staged approach to address childhood weight concerns in primary practice. During 6 years as the clinical director of the FitMatters Weight Control Program, a comprehensive multidisciplinary intervention (such as would be recommended in Stage 3 of the expert recommendations), in which the average child BMI was 45,3 it became evident that earlier interventions were needed to truly address the obesity epidemic. FitMatters implemented empirically supported behavioral approaches (problem solving, contingency management, environmental control),2 including child and parental self-monitoring.3,4 Many of the participants joined the program without prior basic interventions, and thus lacked basic knowledge about healthy habits and the risks of obesity. Because the program served primarily a low-income, minority population, additional barriers included numerous psychosocial stressors, which often impeded participation in the program and implementation of specific weight management strategies on a day-to-day basis. The combination of already being severely overweight for many years, the lack of a foundation of health knowledge, and numerous psychosocial barriers made it difficult for many participants to manage their weight successfully, despite the intensive intervention, although some were successful despite these barriers.3–6 Primary care settings are ideally poised to provide primary interventions for eliminating racial/ethnic and socioeconomic-associated health disparities7 (a goal of Healthy People 2010). Since obesity treatment is rarely reimbursed, economically disadvantaged families may not have access to expensive specialized treatment programs. A staged approach, which begins with assessment and education for all children and families, provides the opportunity to spread health messages to all families, regardless of weight status, at an early stage of the child’s life, hopefully before excessive weight is evident; provide basic education about health habits; and increase families’ awareness of the risks associated with excessive weight. Based on experience in a comprehensive, multidisciplinary program, the following is a perspective on the most and least valuable recommendations, as well as suggestions for improving the recommendations.