The Importance of Early Intervention in Weight Management in a Pediatric Setting

By: Skylar Sites

Last month, I had the honor of interning with the IDEAL Weight Management Clinic through Children’s National Medical Center. IDEAL stands for “Improving Diet, Energy and Activity for Life.” This is an outpatient program providing early intervention in children who, based on their BMI-for-age, require either lifestyle interventions, medication or bariatric surgery for weight management. However, surgery is only used as a last resort if lifestyle interventions and medication do not result in weight maintenance or, hopefully, weight loss. Additionally, the clinic sees a select few patients who have a normal BMI for their age but have other complications such as dyslipidemia or prediabetes. In this rotation, I was exposed to a wide range of reasons why a child may struggle with weight management. I believe that weight bias and stigma is such a problem in our healthcare system and country as a whole. I appreciated this experience where the providers emphasized that weight management is more complex than a child’s appetite and physical activity level. There are many physiological reasons that a child may struggle with weight management. Examples include hormonal imbalances involved in PCOS (polycystic ovarian syndrome) or hypothyroidism where an individual’s metabolism is slower than expected.

This was my first rotation after my main clinical rotation, where I saw all adult patients. Transitioning to pediatrics was an adjustment, but one that I really enjoyed. I originally fell in love with nutrition due to the role that it plays in preventative medicine. The nutrition choices we make everyday can impact such a wide range of outcomes whether it is our energy level or lab values and related health outcomes. With the IDEAL Clinic, I connected to that initial allure of nutrition while I got practical experience. I counseled children, along with their families, on how to make small, attainable changes in their daily lives. These small changes will help ensure they can be healthier now and into adulthood. In each appointment, the dietitian and I would discuss how the previous goals that the family set for themselves were going. We would then assess if they were ready for new goals to be set or if we should just “stay the course.” Commonly we set goals for drinking more water daily, eliminating sugar-sweetened beverages, increasing physical activity or including more fruits and vegetables daily.

I assisted the registered dietitian in all visits by filling out the sheet we used to help guide children and families in setting goals.

This rotation also helped to enhance my cultural competency. I talked to several families who did not speak English and required a call-in interpreter. At first, I was concerned that this would make education more difficult for these families. However, the clinic had all the patient handouts written in other languages and the interpreter was able to call in through a video so the translation process went very smoothly.

One of my projects during this rotation was to make a handout that would be beneficial for the clinic to provide to children and their families. Given the time of year, I decided that a predominant issue would be providing ideas on how children can remain active with the earlier sunset as well as cold weather approaching. Most families shared that it has been extremely difficult even in nice weather to encourage their children to remain active during quarantine. Many children are experiencing decreased physical activity due to lack of group sports or in-person gym classes. This combined with a normally decreased level of physical activity in the winter makes this a big concern. Exercise is important for all, but is especially crucial for children who are trying to manage their weight. In this handout, I provided suggestions on how kids can stay active and enjoy it in many different ways, such as trying a dancing video on YouTube or going outside and sledding with their siblings.

Overall, this rotation provided great exposure to working in a pediatric setting, practicing cultural competence and understanding the complexities behind weight management. This was a part of nutrition that I had not previously been exposed to, but I can see myself working in pediatric nutrition in the future.

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