Wednesday, December 03, 2008

Is This the Future of Childhood Obesity Treatment?

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Lord I hope not.

Last week I attended a talk at the Family Medicine Forum in Toronto (the largest Canadian family medicine conference of the year). The talk was entitled,

"Childhood obesity in 2008: A growing challenge for family physicians"
and according to the conference program the learning objectives for this talk included,
"1. to increase awareness of the importance of childhood obesity,
2. to improve participants’ clinical skills towards children and adolescents,
3. to introduce a multimodal, integrative treatment strategy including practical instruction on exercise, nutrition, family
recruitment, medications, and more invasive options, and
4. to work to improve advocacy and prevention strategies at the patient as well as community levels
To help frame their talk the speakers used a hypothetical case of a 16 year old, obese, socially withdrawn, depressed female and then highlighted what they thought treatment should include.

Want to know their proposed treatment plan?

  • One hour of exercise daily.
  • No TV.
  • No Internet.
  • No going out to eat.
  • No junk food.
  • Plate regular portions and then take away 10% weekly

    What was not included? Any strategy to reduce hunger (ie. eating every 2-3 hours, including protein with every meal and snack, having sufficient numbers of calories per meal and snack, improving the quality of her carbohydrates by switching to whole grain versions, fueling properly for her hour of exercise etc), any discussion regarding calories and tracking food with a food diary (despite the recent study showing those who keep them lose twice as much as those who don't), any discussion regarding her depression (important given that an active depression is a contraindication to initiating an effort of intentional weight loss).

    Basically they took this socially withdrawn, depressed obese teen and told her that all the things she actually enjoys doing in her life she can't do, that she's got to go from not enjoying exercise to plodding through an hour of it a day (without ascertaining whether or not she's got time), that she's simply going to have to learn to eat less calories than before without any adjustments to how she uses food to minimize hunger and that she's now no longer able to access the only social venue she's got where she doesn't have to be the obese girl (the anonymous internet). There was also no mention of family counselling to determine family habits and lifestyles, no mention of exploring her social history to look for things like physical or sexual abuse, no mention of teaching her how to read a nutrition facts panel, etc.

    This girl needs guidance, not guilt. There was no mention of treating her like a living, breathing, complicated human being and instead the message being given to her was the classic and useless - eat less and exercise more.

    Perhaps the only thing worse than the messages these physicians were providing was the room full of family doctors nodding their heads in agreement.

    If this is the future of childhood obesity treatment in Canada we're all in big trouble.