Sample Solution

• Monthly patient-provider contact
• Monitor eating & physical activities through logs
• Use positive reinforcement techniques (reward system)
• Strong parental involvement for school aged children
3. Comprehensive multidisciplinary intervention
• Same as stage 2, along with structured diet & physical activity designed for negative energy balance behavioral interventions like development of short-term diet & physical activity goals.
• Weekly patient-provider contact (and/or phone) for a minimum of 8-12 weeks. Subsequently, monthly visits can help maintain new behaviors.
• Parent training in behavioral techniques to improve home eating & activity environment

4. Tertiary care intervention
• Used for severely obese children who failed in comprehensive multidisciplinary intervention stage but are willing to maintain physical activity and healthy diet. Options include pharmacotherapy and bariatric surgery but children should be carefully selected for this intervention and only is absolutely required.

If there is no improvement after 3-6 months of stage1 adaptation, the patient can move on to stage 2. Similarly after 3-6 months in a structured weight management program, some patients who have not achieved goals can move to stage 3.
TABLE 10
Age Weight goals according to BMI percentiles
2-5y 85-94th: weight maintenance until BMI is <85th percentile, or slowing of weight gain as indicated by lowering of BMI
≥95th: weight maintenance until BMI is <85th percentile (weight loss of up to 0.5kg/month is acceptable)
6-11y 85-94th: weight maintenance until BMI is <85th percentile, or slowing of weight gain as indicated by lowering of BMI
95-99th: gradual weight loss (0.5kg/month)