Table 2.

Proposed Stage 3: Structured Weight Management Care

Services	BMI
	85th–94th Percentile	≥95th Percentile
Medical: MD/DO/nurse practitioners with a special interest in childhood obesity who works closely with primary care physicians and follow the chronic care model of care delivery	With comorbidities	With or without comorbidities
	1/mo for 6 mo, then as needed or minimum 4/y	1/mo for 6 mo, then as needed or minimum 4/y
	During visits monitor progress to sustain health improvements or to escalate care as needed and to screen for comorbidities
Registered dietician visits	1/wk for 16 wk with follow-up at 3, 6, 9, and 12 mo	1/wk for 16 wk with follow-up at 3, 6, 9, and 12 mo
Mental health services (mental health: PhD, MFT, LCMSW, MA) if indicated during initial assessment	1/wk for 16 wk with follow-up at 3, 6, 9, and 12 mo	1/wk for 16 wk with follow-up at 3, 6, 9, and 12 mo
	If indicated on the basis of initial assessment	If indicated on the basis of initial assessment
Physical activity: physical therapist, exercise physiologist	Initial assessment	Physical activity with incremental increases with the goal of 1 h/d supervised by a professional in physical activity at least 1/wk for 16 wk with follow-up at 3, 6, 9, and 12 mo; other support services as needed
Laboratory tests: screening for comorbidities, continued follow-up of comorbid conditions	If risk factors present in history or physical exam: AST/ALT, fasting glucose and lipid levels, beginning at 2 y of age (every 2 y for screening)	AST/ALT, BUN/Cr, fasting glucose and lipid levels (with or without risk factors); consider insulin levels
Subspecialists involved as needed (eg, endocrinologist, gastroenterologist, orthopedist, cardiologist, pulmonologist)	As needed	As needed
Care coordination: RN, MSW, or health educator	As needed	As needed

AST indicates aspartate aminotransferase; ALT, alanine aminotransferase; SUN, serum urea nitrogen; Cr, creatinine.