Spring 2017 Issue

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Child Development

Childhood Development

Simple First Step for Most Overweight Children

By Gretchen Inkumsah, DO

Gretchen Inkumsah, DO
Gretchen Inkumsah, DO

When tackling the overwhelming epidemic of obesity in children, there are some simple tactics that can keep the primary care pediatrician focused and will hopefully have some benefit.

As a primary care pediatrician, I find myself talking about weight management more than ever. It has become so routine that I find myself pleasantly surprised when I have several patients in a row whom I do not have to counsel on weight management. This counseling is time-consuming and often emotional. Parents of young children are often not prepared to consider their little one to be overweight or obese. Many still consider this age group to be ‘babies’, and therefore should still be toting around their “baby fat.” Behavioral challenges, such as picky eating and temper tantrums, can be distressing to parents. Adding on the extra stress of pointing out that the child is actually overweight or obese, especially when they do not appear to have any problem at all, can be quite a struggle.

I suggest a simple idea with which we are all already very familiar. Beverages. Beverage limitation can make a difference especially with younger age groups. This can be an easy first step to success. The American Academy of Pediatrics recommends water as an ideal beverage at all meals and during the day. Juice should be limited to no more than 4-6 oz per day for toddlers. Milk consumption is generally recommended to be 12-20 oz per day. My general go-to recommendation is specific and usually parents find it attainable:

  1. Main beverage should be water
  2. Juice: No more than 8 oz. per day
  3. Milk: No more than 20 oz. per day

Here is a case of a young African-American male who, at his 12-month well-child check, started to cross percentiles in his height for weight graph. When asked about beverage intake, the mother admitted he was drinking about 50 oz/day of milk and 15 oz/day of fruit juice. I could clearly see where this was headed and emphasized my simple aforementioned recommendations. The mother was surprised that the child was classified as overweight and implemented the changes suggested. This is precisely when the drop-in weight for height occurred (see Figure 1).

Figure 1

Figure 1


In my second case, a new three-year old Hispanic female patient was seen for her well child check. She had not been consistently seen by her previous pediatrician and her mother was not aware of beverage recommendations. Education was emphasized at this visit and, again, her mother was surprised to learn that she was obese. Her mother implemented these changes and the BMI change is dramatic (see Figure 2). Notably with this case, she was seen by a temporary locum pediatrician for her next well child check at four years old and it is unknown how much emphasis was put on these recommendations. Her BMI has started to climb since that visit, which reminds me the importance of re-evaluating the issue.

Figure 2

Figure 2


At a time when motivational interviewing is becoming widely used, I often become overwhelmed with the vast array of methods available to counsel parents on this growing problem. I find my patients’ caregivers seem to be at a loss, pointing out that they do not know how to put a young child on a diet. It is nice that there could be a possible answer, at least for those caregivers at the right stage in motivation, to make this simple change. I offer that we pediatricians should not underestimate the possible effectiveness of this simple recommendation.

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ACOP Pediatric Track at OMED 2017


ACOP Pediatric Track at OMED 2017

October 7-10, 2017
Philadelphia, PA