Multidisciplinary evaluation
Doernbecher clinic addresses childhood obesity

According to the most recent report, obesity is epidemic in America. Fifteen years ago, all 50 states had obesity rates below 20 percent. Now in only one state does the obesity rate fall below 20 percent.

And it’s not Oregon. One of every four Oregon resident is obese, and just under 61 percent are considered overweight or obese, as are about about a third of our children.

But statistics and generalities can only go so far. When it comes to addressing the problem for a specific patient, a tailored course of action is often the best approach.

That’s why Doernbecher Children’s Hospital has launched a special clinic for overweight and obese children. The Doernbecher Healthy Lifestyles Clinic, located at Doernbecher’s Westside Clinic, opened its doors in February 2007.

Beau Weill, MD, is the clinic’s medical director.

“We are primarily an evaluation clinic,” he says. “We follow our patients’ progress every three months while they follow a path towards creating healthy lifestyles and managing their obesity-related co-morbidities. We are not currently structured to function as a weight-loss clinic.”

To fully understand the complex issues that may be contributing to a patient’s weight problem, the clinic team is multidisciplinary and includes: Dr. Weill; Karrie Stuhlsatz, a pediatric dietitian; Katie Laubscher, a pediatric physical therapist; and a number of child psychologists who rotate from Doernbecher’s Child Psychology Department.

“There are a number of ways that a child may be referred to our clinic,” Dr. Weill says. “Most are referred by their primarily care providers. Some are self-referred, and others are sent by the subspecialists that are treating their obesity-related co-morbidities.

“We provide a thorough evaluation that focuses on risk factors for their state of being overweight or obese. These could include: genetic factors; environmental factors, such as diet and exercise; and medications that might be contributing to the patients’ issues.”

Treatment will depend on the risk factors identified, and can include assistance in making changes with family behaviors and habits, preventing injury while improving physical activity habits, making a change in diet, or taking medication.

“We do focus on weight, but our primary emphasis is on creating healthy lifestyles,” Dr Weill says.

The clinic’s providers can start the changes or make referrals to one of the variety of weight management programs in the area. Most often, the clinic will give their recommendation to the referring physician.

“My primary responsibility within the clinic is to help identify both the risk factors leading towards the patient’s state of being overweight or obese, as well as to identify the obesity-related co-morbidities that they may possess,” Dr. Weill says. “I will often make suggestions for screening labs and/or consults to various subspecialists in order to better identify and treat these co-morbidities.

“Most of the children in the clinic, if you’re looking at their Body Mass Indexes, are over the 99th percentile, which would put them in the morbidly obese category,” he says. According to the Centers for Disease Control and Prevention (CDC), that puts them at risk for nearly 20 other conditions, from diabetes and heart disease to psychological problems such as depression and low self esteem.

That makes childhood obesity a national concern, which is especially worrying when the trends are considered.

“I can certainly say that when I first became interested in childhood obesity, five years ago, this wasn’t something we addressed on a regular basis,” says Dr. Weill. “We now know that the prevalence of childhood obesity has increased over threefold in the last 30 years.”

The response to the holistic, multidisciplinary approach to evaluation at Doernbecher Healthy Lifestyles Clinic has been positive, from parents, patients and providers.

“Initially, when the patients meet us, they are often apprehensive,” Dr. Weill says. “But when they leave, they usually have smiles on their faces.”

Providers feel it is a great service because although most patients have already been seen by their primary care providers for their weight, most physicians don’t have access to the ancillary staff that Doernbecher has.

“Certainly we get a lot of parents who are positive because they feel that we are able to provide an all-inclusive approach, which is a luxury that most other providers don’t have,” Dr. Weill says. “They’re pleased we’re here, but are unfortunately exasperated because they’ve had to wait so long. Right now there is a six-month waiting list.”

The clinic’s next milestone is to expand its operation so patients can be seen sooner. Right now it’s entirely funded by OHSU, but other grants are being sought.

“We’re also creating a web site for more information on the clinic, and about childhood obesity, lifestyle choices and community resources,” Dr. Weill says.

There are a lot of motivated people in this area working to address the childhood obesity issue. These include groups ranging from the local parks and recreation departments, to well-recognized groups like the American Heart Association and American Cancer Society, to local grass-roots organizations and to other major local health systems.

“We are already seeing some great progress with our patients and their families ,” Dr. Weill says. “And as long as we can work together, both within families and within our immediate environment. I think we have a great shot at making some progress in the battle against childhood obesity.”

Obesity within children is defined as the child having a Body Mass Index equal to or greater than the 95th percentile for age and gender.

Overweight within children is defined as the child having a Body Mass Index equal to or greater than the 85th percentile for age and gender, but less than the 95th percentile.

Here are a few co-morbidities and their prevalence within obese children cited by Dr. Beau Weill, medical director of Doernbecher Healthy Lifestyles Clinic:

About 60 percent of obese children have at least one risk factor for heart disease, such as high insulin, dyslipidemias or elevated blood pressure.

About 30 percent of obese children have hypertension.

Approximately 20 percent of obese children have sleep apnea.

An estimated 4 percent of obese children have diabetes.

About 22 percent of obese children have Nonalcoholic Fatty Liver Disease (NAFLD).

For more information, see the CDC ‘s web site on overweight children.

Referrals can be made by calling 503-418-2000. A web site about the clinic is planned soon. When it is online, we will post a link here.