ArticleChildhood Obesity: A Transtheoretical Case Management Approach
Section snippets
The Problem of Childhood Obesity
Obesity is more prevalent than ever among American children and adolescents (Harvey et al., 2004). Few children have the knowledge necessary to make healthy nutritional or physical activity choices on their own; therefore, parents are key mediators of obesity prevention among their children. Parents play a large role in influencing the diet and physical activity of their young children by their own actions (Toschke, Beyerlein, & von Kries, 2005). In fact, parental obesity has been noted as one
Health Problems Related to Childhood Obesity
Childhood obesity is a strong risk factor for a number of common health conditions in children. Hyperlipidemia, hypertension, glucose intolerance, insulin insensitivity, mental health concerns (e.g., depression, low self-esteem, and impaired health-related quality of life; Ravens-Sieberer, Redegeld, & Bullinger, 2001), atherosclerosis, asthma (Patel, Welsh, & Foggs, 2004), and orthopedic problems in children are all linked to obesity (Krebs & Jacobson, 2003). Obesity is one of the most common
The Treatment of Obesity and the Barriers to Treatment
Weight loss is a simple equation of decreased caloric intake and increased caloric expenditure through increased physical activity. Interventions to decrease caloric intake and increase caloric expenditure need to concentrate on modifying eating and physical activity habits so that new behaviors are formed, resulting in lasting changes throughout one's life (O'Brien, Holubkov, & Reis, 2004). The goal of modifying diets has been to decrease and stabilize caloric and fat intakes. This is based on
Case Management
A case management approach to facilitating health behavior change has been shown to be an effective method in managing many chronic conditions. Case management is a collaborative process between the case manager, other interdisciplinary health care team members (including primary care physicians, nurse practitioners, dieticians, exercise physiologists, psychologists, social workers, and so on), and the client that involves assessment, planning, implementation, coordination, monitoring, and
The TTM
The TTM, developed by Prochaska and DiClemente (1992), consists of four behavioral stages of change: precontemplation, contemplation, action, and maintenance. The stages of change represent the progress that individuals undergo in an attempt to modify their behavior to change their health. Proper assessment of the stage of change in both the child and the parent is essential in providing effective individualized case management interventions to treat childhood obesity. The first stage,
Case Management for the Treatment of Childhood Obesity
The proposed intervention involves a case management approach administered through the TTM framework, with the goal of reducing BMI among obese children by modifying their eating habits and by increasing their physical activity. The case manager can provide the interventions during an office/clinic visit, with follow-up interactions in person, over the telephone, or through e-mail as intervention methodology. The case manager can individualize the interventions based upon the overweight/obese
Conclusion
Health care providers typically do not have the time, knowledge, or skills necessary to effectively address the emerging problem of childhood obesity during a typical outpatient clinic visit. Due to this emerging epidemic, and the significant comorbidities associated with this condition, practitioners need to develop effective interventions to address this problem. Interventions based on the TTM framework must first identify the stage that the child and the their parent are in and the
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