There is a fundamental difference between treating overweight or obese adolescents and treating pre-adolescents. In most situations, the teenager decides what particular food will be eaten and how much of it will be consumed. Parents are not the primary decision-makers in terms of what food and how much food a teenager eats. Parents may influence the teenager as role models and by the kinds of foods purchased for the house, but that is where their influence ends. Parents cannot plead, cajole, or threaten their teenager to eat certain foods. The adolescent's personal preferences, peers, school and work schedule, and extracurricular activities strongly influence the teenager's dietary habits. However, both parents and the physician can provide information on healthful eating and physical activity if the teenager asks; otherwise, they must stand by and let the adolescent make his or her own choices, whether good or bad.
Treating overweight adolescents is difficult. The physician can show both the patient and the parent where the adolescent's BMI falls on the pediatric BMI chart and express concern about possible future weight gain. However, this may have little meaning to the patient or parent, especially if the teenager is participating in sports or if the parents are waiting for the adolescent to experience a growth spurt. In this sense at best, the patient is in the contemplation stage of change.
Another issue regarding treatment of overweight adolescents is that there is no reimbursement. Unless the teenager meets the criteria for metabolic syndrome, third party payers do not cover clinic appointments for weight management, so payment is not provided for any treatment. Therefore, all the physician may be able to do to help the overweight adolescent is to encourage awareness of the weight trend and offer informational material and website addresses.
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