Seven steps to success: a handout for parents of overweight children and adolescents.

© Mary Ann Liebert, Inc. February 2009 Obesity Management 29 The Expert Panel recommended four stages of treatment for overweight children (and their families).1 They used the principle of least intervention, starting slowly with a basic educational approach and then adding stages (steps) if necessary to achieve substantial improvement. That step-wise method is sensible and clear. However, we believe an expanded set of steps, from four to seven, will prove more useful, making it even clearer to parents of overweight children and teens what they can do to help their children. The seven steps defined below all make one very important assumption: pediatric obesity is a family affair. Parents who want their children to succeed must become fully involved, knowledgeable, and participate very actively in major lifestyle changes for themselves as well as their children. The illustration, “Seven Steps to Success,” can serve as a useful handout for the families with whom you work, summarizing seven levels of intensity of intervention. As shown in the illustration, each step could lead to favorable outcomes (notice the directional arrow pointing to “Health and Wellness” from each step), for some families some of the time. For example, by providing explicit feedback about BMI percentile and category (e.g., 97%–obese), clear suggestions for changing diet and activities, and appropriate parent guidebooks, some highly motivated families may be able to make substantial lifestyle changes and produce significant weight loss in their overweight children. However, most families with obese children or teens will find it necessary to go from the first step up to the second and often higher, adding levels of intensity to get the knowledge, skills, and support necessary to master this challenging problem. You will help your families with overweight children tremendously by doing what you can to promote an attitude of persistence. One, two, or even five steps may not produce healthier weights (and modified lifestyles), but you can make the following points: