Table 2.

Four stages of treatment for child and adolescent obesity

Stage 1: prevention plus
Behaviors: 5+ Fruits and vegetables ≥2-h screen time ≤1-h of physical activity Etc.	Delivery: Office based Trained office support MD, PNP< PA, RN Scheduled follow-up visits
Stage 2: structured weight management
Behaviors: reduced calorie eating plan ≤1-h screen time >1-h physical activity Monitoring	Delivery: RD, MD, RN with training in assessment and counseling Office based Support from referrals Monthly visits
Stage 3: comprehensive multidisciplinary intervention
Behaviors: More frequent contact More structured monitoring, goal setting, feedback	Delivery: Dedicated weight management program or RD and behavior counsel and structured activity Weekly for 8–12 weeks
Stage 4: tertiary care
Consider: Medication Surgery Meal replacement Ongoing behavior change	Delivery: Pediatric weight management center Multidisciplinary team Clinical or research protocol

Abbreviations: MD, medical doctor; PA, physician’s assistant; PNP, pediatric nurse practitioner; RN, registered nurse; RD, registered dietician.