Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways
Abstract
:1. Introduction
2. Edmonton Obesity Staging System in Paediatrics
3. Levels of Care
3.1. Monodisciplinary Physicians
3.2. Paediatric Multidisciplinary Obesity Managements Centres (PMOCs)
3.3. Centres of Expertise for Paediatric Obesity Management (CEPOs)
4. Management Plan according to EOSS-P
4.1. Stage 0—Outpatient
Intensive Health Behavior and Lifestyle Treatment
- It is important to maintain energy deficits but at the same time meet nutritional requirements for growth [44].
- Energy-Dense, Nutrient-Poor foods (EDNP), like sweets, chocolates, and cookies, should not be prohibited, but consumption should be reduced. Totally avoiding these foods cannot be sustained in children [47].
- An age-appropriate approach regarding parental or family involvement is recommended [48].
- Apart from dietary interventions, focusing on weight bias and stigmatization can help improve the patient’s self-esteem [43].
4.2. Stage 1—Outpatient
4.2.1. Psychological Interventions
4.2.2. Management of Mechanical Limitations
4.3. Stage 2 and 3—Outpatient
4.3.1. Referral to PMOC
4.3.2. Pharmacotherapy
4.4. Stage 2 and 3—Inpatient
4.4.1. Referral to CEPO
4.4.2. Bariatric Surgery
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Stage | ||||
---|---|---|---|---|
Risk Factor | 0 | 1 | 2 | 3 |
Metabolic | No metabolic abnormalities | Acanthosis nigricans Impaired glucose tolerance Impaired fasting glucose | T2D without diabetes-related complications | T2D with diabetes-related complications, HbA1C ≥ 8% |
Prehypertension | Hypertension | Uncontrolled hypertension on pharmacotherapy | ||
Lipids at upper end of normal range LDL-C: 3.4–4.1 mmol/L HDL-C: 0.8–1.03 mmol/L TG: 1.5–4.0 mmol/L | Lipids modestly elevated LDL-C: >4.2 mmol/L HDL-C: <0.8 mmol/L TG: >4.0 mmol/L | Elevated lipids requiring pharmacotherapy | ||
ALT: 1.5–2.0× normal | ALT: 2–3× normal | ALT: >3× normal | ||
Ultrasound: mild to moderate fatty infiltration of the liver | Ultrasound: severe fatty infiltration of the liver | Liver dysfunction | ||
PCOS | Cardiomegaly | |||
Focal segmental glomerulosclerosis | ||||
Mechanical | No functional limitations | Mild OSA not requiring BiPAP or CPAP | OSA requiring BiPAP or CPAP | OSA requiring BiPAP or CPAP and supplementary oxygen |
Mild MSK pain that does not interfere with daily activities of daily living | MSK pain and/or complications limiting physical activity | Limited mobility; Blount’s disease; slipped capital femoral epiphysis; osteoarthritis | ||
Dyspnea with physical activity not interfering with activities of daily living | Dyspnea causing moderate limitations in activities of daily living | Dyspnea when sleeping or sitting | ||
Gastroesophageal reflux disease | Peripheral edema | |||
Mental health | No psychopathology | Mild depression or anxiety that does not interfere with functioning | Major depression or anxiety disorder | Uncontrolled psychopathology |
Mild body image preoccupation | Significant body image disturbance | Self/physical loathing | ||
Mild emotional/binge eating (occasional) | Moderate binge eating (frequent) | Severe binge eating (daily) | ||
Developmental delay with mild impact on weight management | Developmental delay with moderate impact on weight management | Developmental delay with severe impact on weight management | ||
ADHD or learning disability | ||||
Social milieu | No parental, familial, or social environment concerns | Occasional bullying at school or at home | Significant bullying at school or at home; poor school attendance | School refusal/absenteeism |
Minor problems in the relationships of the child with one or more family members | Moderate problems with parents, siblings or other family members, frequent arguing, difficulty maintaining positive relationships | Severe problems with parents, siblings or other family members, constant arguing or family violence | ||
Caregiver is generally knowledgeable of child’s needs/strengths but may require information or support in parenting skills | Need for information on parenting skills; current lack of information interfering with ability to parent effectively | Unable to monitor or discipline child | ||
Caregiver has minimal difficulty organizing household to support needs of child | Moderate difficulty organizing household to support needs of child | Unable to organize household to support needs of child; experienced recent periods of homelessness | ||
Caregiver is recovering from medical/physical, mental health and/or substance use problems | Medical/physical problems that interfere with parenting; has some mental health, substance use and/or developmental challenges that interfere with parenting | Medical/physical, mental health, substance use or developmental challenges that make it impossible for caregiver to parent effectively | ||
Mild financial limitations | Moderate financial limitations | Severe financial limitations | ||
Dangerous home environment; child protection involvement |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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De Wolf, A.; Nauwynck, E.; Vanbesien, J.; Staels, W.; De Schepper, J.; Gies, I. Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways. Life 2024, 14, 319. https://doi.org/10.3390/life14030319
De Wolf A, Nauwynck E, Vanbesien J, Staels W, De Schepper J, Gies I. Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways. Life. 2024; 14(3):319. https://doi.org/10.3390/life14030319
Chicago/Turabian StyleDe Wolf, Astrid, Elise Nauwynck, Jesse Vanbesien, Willem Staels, Jean De Schepper, and Inge Gies. 2024. "Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways" Life 14, no. 3: 319. https://doi.org/10.3390/life14030319