{"id":1126,"date":"2017-09-01T13:02:31","date_gmt":"2017-09-01T13:02:31","guid":{"rendered":"http:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/?p=1126"},"modified":"2017-09-01T13:02:31","modified_gmt":"2017-09-01T13:02:31","slug":"obesity-counseling","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/2017\/09\/01\/obesity-counseling\/","title":{"rendered":"Obesity Counseling: Getting Real"},"content":{"rendered":"
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Emily F. Moore, RN, MSN, CPNP-PC, CCRN practices pediatric cardiovascular care across the Pacific Northwest.<\/p><\/div>\n

\u201cYour BMI puts you in the obese category. You need to limit weight gain to 10 pounds this pregnancy.\u201d<\/p>\n

As the obstetrician\u2019s words sunk in, I was overcome with embarrassment. Sure, I knew I was overweight, but I was pregnant. And according to my BMI, I have been \u201cobese\u201d for years. But this was the first time a provider had actually called it to my attention, at least in such a blunt manner.<\/p>\n

Sitting in the patient\u2019s seat made me think about the best way to counsel families of pediatric patients about obesity. I have had plenty of practice discussing diets with people, but now I wondered — was I being sensitive to people’s feelings while also making the necessary lasting impression? The first time I had to educate a family regarding obesity, it wasn\u2019t fun, but my preceptor broke the ice. Here\u2019s what happened:<\/p>\n

I had a patient in the 99th<\/sup> percentile for weight and BMI. He was only 7 and visibly obese. My preceptor counseled me before the appointment, educating me on why this was an important issue and how it would affect his life for years to come. He couldn\u2019t stress enough how the family needed a provider to be \u201creal\u201d with them. I walked into the patient room and politely started asking about diet and exercise. After about 5 to 10 minutes of dancing around the subject, my preceptor barged into the room and said, \u201cWhat she\u2019s trying to say is, your son is overweight.\u201d Though his approach was abrupt, it got the point across and got us all down to business. My preceptor asked me to show the family my patient\u2019s growth charts and really explain, without beating around the bush, how serious the subject was. So, there I sat, showing charts and talking about the importance of exercise as well as avoiding juice, candy, soda, and the like. My patient left with a plan to change his diet and follow up in a few months.<\/p>\n

\"\"<\/a>My clinical training took place in an area where not every neighborhood is safe, and many of my patients were of low socioeconomic status. This complicated things when counseling them about diet and exercise. How does one encourage physical activity when there is no safe place to play? Similarly, with money scarcity, buying fresh fruits and vegetables in lieu of fast food was not always possible or a priority, especially in families where parents were working two jobs just to make ends meet. In these situations, a parent would often tell me that time and money were pretty influential in guiding meal choices. A box of macaroni and cheese is not only much cheaper but can feed a lot more people than a head of lettuce.<\/p>\n

Hearing this story over and over again, I began to realize that although clinicians can do a lot to educate parents regarding childhood obesity and promote healthy eating, we must first understand the context of our patients\u2019 lives \u2014 neighborhood safety, access to healthy foods, income level \u2014 to be most effective. By validating these hardships prior to suggesting solutions, I found that families were much more receptive to change.<\/p>\n

\"\"<\/a>After being on the receiving end of obesity counseling, I started to suggest rules for my patients\u2019 families to follow. I picked up several of these from a physician I shadowed for a number of months, and now I use them all the time (in my home as well). Here they are:<\/p>\n