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HERE’S HOW TO TREAT OBESITY IN KIDS AND KEEP IT TASTY AT THE SAME TIME
In the early days of the pandemic, Becca Saul, MSN, ACNP, remembers the alarm she felt as obesity rates among children were climbing.
“With children confined to their homes, obesity rates are steadily increasing due to their sedentary lifestyles,” explained Saul, who specializes in adolescent primary care medicine at Prisma Health in Greenville, South Carolina.
While researching clinical resources for childhood obesity treatment, she discovered doctoryum.org, the website of the Dr. Yum Project nonprofit. Saul began incorporating the site’s recipes, nutritional videos, and menu planning tools into her patient education during appointments.
“Health should be more affordable than unhealthy options, and my patients can access these resources for free,” Saul noted. “The kids also find it very approachable and easy to use.”
Currently, obesity affects approximately 20% of American children and adolescents. The prevalence has increased over the past decade from 17.7% in the early 2010s to 21.5% by 2020, according to research published in JAMA Pediatrics.
Recognizing clinicians’ need for better treatment approaches, the American Academy of Pediatrics (AAP) released updated clinical guidelines for pediatric obesity in 2023. These recommendations include intensive behavioral and lifestyle interventions with at least 26 hours of nutrition, physical activity, and behavior change education over 3-12 months.
Many pediatricians welcomed this guidance but faced implementation challenges: How would they deliver these educational components?
In response, the creator of doctoryum.org stepped in later in 2023 to address this need.
IMPLEMENTING THE AAP GUIDELINES
Pediatrician Nimali Fernando, MD, MPH, spent most of the 2010s in private practice in Virginia, where she noticed the challenges her patients and caregivers had in eating healthfully. She eventually created a teaching kitchen and garden in her practice, Yum Pediatrics, where developed tools, ideas, and lessons for helping families.
During the pandemic, she recognized the potential to expand her website, doctoryum.org, into something more comprehensive. After retiring from her medical practice in 2023, she developed Touchpoints—a modular, multimedia program designed to help fellow physicians implement the AAP recommendations.
She devoted several months to reorganizing her content and developing detailed scripts that guide pediatricians through family conversations. The program covers various topics including mindful eating, addressing picky eaters, food insecurity, and eating disorders.
“The guideline left many pediatricians feeling overwhelmed,” Fernando explained. While the ideal scenario involves referring families to specialized multidisciplinary centers, “these clinics are often at capacity, and many regions lack access to such services, leaving the responsibility primarily with pediatricians.”
Dr. Sarah Hampl, who helped author the guidelines and teaches pediatrics at University of Missouri-Kansas City School of Medicine, noted that while the guidelines were generally well-received, practitioners faced two major challenges: incorporating intensive lifestyle intervention programs into busy practices and securing payment for these services.
“Insurance coverage has traditionally been limited because these were viewed as educational rather than behavioral health interventions,” Hampl explained.
This reimbursement issue inspired Fernando’s approach.
Saul suggests that when insurers don’t cover intensive lifestyle programs, clinicians can bill office visits for obesity-related conditions. Many patients experience issues like foot pain, constipation, sleep disturbances, elevated cholesterol, or prediabetes.
“It provides structured guidance for clinicians with limited nutrition training who may not feel confident giving dietitian-level advice,” Saul said. “You can follow the provided script exactly or customize it as needed.”
Dr. Santhi Nair, a pediatrician at ALL Pediatrics in Lorton, Virginia, and founding board member of the Dr. Yum Project, conducts the program exclusively through telehealth, often during evening hours from home, which better accommodates families’ schedules.
“You reconnect for subsequent modules, meeting monthly with families and building meaningful relationships,” Nair explained.
Fernando emphasizes that the program promotes telehealth visits to maintain focus on the entire family rather than singling out individual children.
“Eating disorders have increased significantly since the pandemic,” she noted, “so we strive to maintain a neutral approach toward both food and weight.”
The annual subscription-based program, priced at $49 monthly per practice, is regularly utilized by more than two dozen healthcare providers.
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