Primary care interventions for pediatric obesity: need for an integrated approach.

Recommendations for preventing and treating pediatric obesity suggest a staged approach with escalating intensity of care. Stage 1 is Prevention Plus, requiring sufficient capacity in a primary care setting to provide basic messages pertaining to healthful dietary and physical activity behaviors. Stages 2 and 3 are Structured Weight Management and Comprehensive Multidisciplinary Intervention, respectively, requiring more frequent clinical encounters and involving a registered dietitian (RD) and a behavioral medicine provider. Stage 2 may be appropriate in a primary care setting, although inadequate training and financial support for structured intervention often are limiting factors. Stage 3 requires primary care providers (PCPs) to coordinate patient care with a pediatric weight management clinic and, in some cases, community partners that provide opportunities for physical activity. Stage 4 is Tertiary Care Intervention and may include a very low-calorie diet, medication, and surgery.