Running head: CHEAL PAPER

CHEAL Paper

Alyssa Matulich

University of Tennessee Chattanooga

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CHEAL Paper

The percentage of children who are considered obese has tripled since the 1970s. Because

obesity in childhood tends to persist into adulthood an increase in long-term morbidity and

mortality has been observe. Battling the childhood obesity epidemic is important because

childhood obesity and its negative effects have the potential to reverse the improvements in life-

expectancy that has occurred in the 20th century and can cause disability issues in people who

survive into old age (Yanovski, 2015). Childhood obesity can affect nearly every organ system

and cause serious health consequences like hypertension, dyslipidemia, insulin resistance,

hyperglycemia, fatty liver diseases and psychosocial. Establishing a comprehensive management

program that emphasizes the appropriate nutrition, exercise and behavioral modification is

crucial. It has been found that high consumption of sweetened drinks in childhood, low levels of

physical activity and greater hours of screen time and decreased sleep duration are all associated

with obesity (Gungor, 2014). Educating the child and the parent are extremely important

because parenting styles play a large role in the child’s eating habits. Obesity is caused by

genetic and environmental factors, so providers must work with families to determine the best

approach for each child (Brown, Halvorson, Cohen, Lazorick, & Skelton, 2015). The CHEAL

clinic in T.C. Thompson Children’s hospital works to educate their patients about the causes, the

affects, and how to combat childhood obesity.

The CHEAL clinic receives most of their patient through referral by a primary care

pediatric physician. The staff in the clinic put a great emphasis on the fact that battling

childhood obesity needs to be a teamwork approach with communication between physicians and

counselors being key. Before going into the CHEAL clinic, I honestly did not know what to

expect. I knew that the clinic was for childhood obesity, but I was not sure about the strategies
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the clinic staff would take in order to help the children battle obesity. The clinic’s

interdisciplinary approach uses the knowledge of a physician, nutrition counselor, and exercise

therapist. Doctor Jack does a wonderful job explaining to the children why the patient has found

themselves in the situation they are in. She makes sure the child understands that like any other

disease process, obesity has a large genetic component and that it is not the child’s fault. She

screens the children to determine the child’s willingness to make changes and determine the best

plan of action for each individual patient.

Most of the initial visit for a patient at the CHEAL clinic is focused on education. Once

doctor Jack has finished with her physical exam the nutrition counselor comes into play. I found

that most of the diet choices patients are making are poor choices, but they are not aware of it.

Most parents think that juices are a better option for children than sodas, but the truth is they

contain a lot of sugar and should be limited. The other main teaching point in this first visit

involves discussing portion size. Parents and children are not aware that protein portions should

be about the size of the child’s fist and more than half of the child’s plate should be fruits or

vegetables. The nutrition counselor also told me that most of their patients often skip breakfast

which is important because it jumps starts the patient’s metabolism for the day. I was surprised

by the number of patients the nutrition counselor saw that had food aversions and texture issues.

She spent a lot of time talking with parents on how to effectively include fruits and vegetables

for picky eaters and making achievable goals for each patient.

The exercise specialist also works with each patient to set a plan of small achievable

goals. He spoke with me about the important of making small goals so that the patient is more

likely to complete the goals and get a sense of encouragement. The goal for all patients is to be

active for at least sixty minutes each day. He educates the patients and their families about the
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importance of limiting screen time and doing activities that keep the children active after school

and on weekends. The exercise specialist tries to find activities the child enjoys like dancing or

playing soccer or basketball and encourage the child to do small intervals of those activities

throughout the day to reach the sixty-minute s each day.

The CHEAL clinic is playing a n important role in battling childhood obesity. The staff is

aware that it will be an ongoing process is works with patients up until the patients are twenty-

one years old or reach an optimal BMI. Dr. Jack is not against using medication in combination

with proper nutrition and exercise. I also found it interesting that they clinic is staring a pediatric

bariatric surgery program. They have not completed the first surgery yet because they send their

patients through several months of counseling and education before making the serious decision

that surgery is an option. Even though surgery can be complicated decreasing the child’s BMI

will hopefully reduce the long-term comorbidities that the child could face if they remain obese.

I thoroughly enjoyed my experience at the CHEAL clinic and learned a lot during my

visit that I can but into my practice. I hope future students will be able to continue visiting the

clinic so that as practitioners we can work together to battle this obesity epidemic.
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References

Brown, C. L., Halvorson, E. E., Cohen, G. M., Lazorick, S., & Skelton, J. A. (2015, October).

Addressing childhood obesity: Opportunities for prevention. Pediatric Clinic of North

America, 62(5), 1241-1261. http://dx.doi.org/10.1016/j.pcl.2015.05.013

Gungor, N. K. (2014, September). Overweight and obesity in children and adolescents. Journal

of Clinical Research in Pediatric Endocrinology, 9(3), 129-143.

http://dx.doi.org/10.4274/jcrpe.1471

Yanovski, J. A. (2015, October 1). Pediatric obesity. An introduction. Appetite, 93, 3-12.

http://dx.doi.org/10.1016/j.appet.2015.03.028