Article
Childhood Obesity: A Transtheoretical Case Management Approach

https://doi.org/10.1016/j.pedn.2008.01.080Get rights and content

Childhood obesity is an increasing health problem because of its strong associations with chronic health problems in children and adults. Obesity during childhood commonly persists into adulthood and is resistant to interventions that involve only recommendations to decrease caloric intake and to increase caloric expenditure through increased physical activity. The challenge with this approach to childhood obesity is that it is not theoretically based, nor does it consider the child's or the parent's perceptions of the health problem or their transition along the stages of behavioral change. Case management has been proven to be successful in managing various chronic health problems in both adults and children. This article will introduce a new intervention model based on the transtheoretical framework by utilizing case management in a primary care setting to treat childhood obesity.

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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