Adelle M. Cadieux

Recommendations for psychologists in Stage III pediatric obesity program

ABSTRACT The Children’s Hospital Association formed a national interprofessional workgroup to develop recommendations for the assessment and treatment of pediatric obesity. A subcommittee of psychologists created practice recommendations defining the role of psychologists in Stage III interprofessional pediatric obesity treatment teams. The committee carefully defined key issues for a psychological diagnostic interview assessment and treatment strategies within a Stage III obesity treatment center. Psychologist’s assessment and treatment within the interprofessional specialty care setting addresses the psychosocial needs of the youth and provides the additional support for behavioral change to achieve the overall treatment team goals.

Pediatric Obesity in Early Childhood A Physician Screening Tool

Obesity is a public health crisis and continues to affect youth of increasingly younger ages. With significant medical and psychosocial comorbidities, it is critical that front-line providers feel confident in their abilities to assess, and appropriately refer, children and families to subspecialties to aid in weight management treatment. This article describes the development and utility of a 1-page screening tool for pediatricians and other providers. Utilizing research, clinical experience, and consensus opinion, a brief tool was developed that could be incorporated into medical visits to facilitate medical care decisions and management of pediatric obesity.

Medical neglect and pediatric obesity: Insights from tertiary care obesity treatment programs

ABSTRACT Interprofessional pediatric obesity treatment teams may consider filing a report for medical neglect with their state child protection agency when a child’s family is consistently non-adherent to treatment recommendations and the child is medically at risk. The multifactorial nature of the etiology and treatment of obesity makes this a challenging issue to navigate with families and child protection agencies. The aims of this article are to (a) highlight common challenges faced by teams when addressing medical neglect, and (b) offer insights on navigating the medical protection of children with obesity and associated medical conditions in a way that minimizes adverse outcomes.

Growth and Development

Youth with autism spectrum disorder or other neurodevelopmental disorders have the potential for delays or deficits in motor skills, cognitive development, and sensory processing as these are more common in autism spectrum disorder and neurodevelopmental disorders than same-aged peers without one of these diagnoses. This chapter will explore the impact these delays and deficits have on health behaviors and BMI. Healthcare providers will need to understand the level of delay and/or deficits the youth is experiencing and services that are in place to address the delay/deficit in order to develop treatment goals to increase health behaviors that will have a positive impact on BMI.

Medical Comorbidities, Medications, and Sleep

Though there are many potential comorbidities with OB and OV, youth with ASD or ND have specific medical considerations that impact their health and their weight status. Frequency of sleep disturbances and disorders is high in this population. Assessing and treating sleep issues have benefits that extend to multiple areas of a youth’s life including behavioral and emotional functioning and increasing health behaviors. ASD and ND youth also have the potential of being prescribed medications that can cause weight gain. Healthcare providers need to carefully analyze the best option for symptom reduction without negative health impacts. Though there is some promising data to support the use of metformin to offset the weight gain and metabolic changes of psychotropic medications (particularly SGAs), there is not adequate evidence to support this currently.

Emotional and Behavioral Functioning

Social, emotional, and behavioral functioning though not necessarily contributing to weight status of youth, can impact the implementation of healthier lifestyle habits. Even when caregivers are not identifying any significant emotional or behavioral issues, issues can arise when implementing changes in daily routine or habits especially in youth who are routinized as can be the case in autism spectrum disorder and some neurodevelopmental disorders. Prior to seeking weight management treatment, some caregivers do not experience behavioral concerns due to their frequent acquiescence to the youth as a way to avoid conflict. The process has become so habitual that caregivers may not even realize the level to which they acquiesce. Assessing and treating the comorbid emotional and behavioral issues that are reported and the ones that are anticipated can assist the youth and family in more effective and potentially successful implementation of health behaviors. Additionally, social development and the ability to interact with healthcare providers, family, and peers are important to asses as this will inform healthcare providers about treatment options (e.g., individual, family, group treatment).

Building Prevention into Healthcare Services and in the Community

Prevention efforts can reduce obesity risks for all youth not just youth with autism spectrum disorder or other neurodevelopmental disorders. Prevention includes a wide range of interventions from the caregivers, the primary care providers, school, community, and government (at all levels). Each has a role to play in preventing abnormal weight gain in youth, but many of the prevention efforts are aimed at youth without a disability placing youth with autism spectrum disorder or neurodevelopmental disorder at a higher risk for abnormal weight gain. Coordinated efforts need to be made in order to provide youth with a disability the same opportunities for health as youth without a disability.

Introduction: The Need to Understand Obesity Risks in Autism Spectrum Disorder and Neurodevelopmental Disorders

Pediatric obesity has been a public health concern with many initiatives and treatments developed to reduce obesity risks. Children with autism spectrum disorder or other neurodevelopmental disorders are at a higher risk for comorbid obesity. However, most treatments for pediatric obesity including the obesity treatment stages were developed for a general pediatric population. This chapter will provide the basis for the need to address obesity in children and adolescents with autism spectrum disorder and other neurodevelopmental disorders.

Developing a Comprehensive Treatment Approach

Many families that participate in weight management treatment have multiple health behavior changes they could be making, but making all the changes at once can be overwhelming, especially when the youth who has been referred for weight management also has a diagnosis of autism spectrum disorder or other neurodevelopmental disorder. A comprehensive treatment approach involves understanding the youth and the caregivers’ level of motivation and readiness to change with each goal, the potential barriers and the strengths and challenges of the family. Families and healthcare providers will need to work together in establishing the goals for treatment and which goal to begin addressing first. Taking small steps toward the ultimate goal will be necessary for many of the youths and their caregivers. Healthcare providers will need to utilize motivational interviewing, problem-solving strategies, and behavioral strategies to assist families in being successful in making health behavior changes.

Developing a Comprehensive Treatment Program

Developing a comprehensive treatment program can be challenging given the various needs that a child with autism spectrum disorder or neurodevelopmental disorder with comorbid obesity may experience and the resources that may or may not be available to the healthcare provider. There are some stage 3 weight management treatment programs that have been developed with specialized treatments for children with neurodevelopmental disorders or autism spectrum disorder. This chapter will review one such program, the Helen DeVos Children’s Hospital Healthy Weight Center and how this program developed and what can be learned for its development.