What is a stepped-care approach to weight management?

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What is a stepped-care approach to weight management?

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Over the past five years, there have been literally five expert groups that have come together and looked at the science behind weight loss and for children and for teenagers and offered some opinions. The opinions that make the most sense to me focus on what's called a step care approach to this problem. That means you start with something simple, like education and medical management. Then you add some elements when it's not producing the desired results. Look at an athlete. Look at what an athlete does. If he's not improving, doing better, strong, faster, more skilled. They add stuff. Weight control is the same deal. You are trying to get your body to do something it doesn't want to do and you have to add elements or additional intensities of interventions in order to produce the desired changes. You can start with medical management and educational, but then you look at the environmental changes like adding a piece of equipment at home or move some place that will get you to be more active. Then you look at professional interventions. That would include cognitive behavior therapy, maybe in an outpatient clinic or cognitive behavior therapy in an immersion program like the one we provide in Well Spring. Finally, if you have a child that has a significant weight problem, and hasn't been helped with immersion programs, cognitive therapy, or all the other programs that make sense and are justified by science, look at bariatric surgery. The thing you don't do as an overweight or obese child, you don't accept that. You don't say, "Well, that's the way she was built. Everyone in my family has a weight problem." That I recommend strongly against doing. You look at a problem to be solved and you keep adding interventions in a stepped care approach until you solve the problem.

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Daniel S. Kirschenbaum, PhD

Weight Management Expert

Daniel S. Kirschenbaum, PhD, ABPP, is the President of Wellspring. He was Director of the Eating Disorders Program at Northwestern University Medical School, where he is Professor of Psychiatry & Behavioral Sciences. Dr. Kirschenbaum is a Fellow and Diplomate in Clinical Health Psychology in the American Psychological Association and former president of its Division of Exercise and Sport Psychology. Dr. Kirschenbaum has provided invited addresses at many professional conferences world-wide, received numerous grants for research, and published 10 books and 150 journal articles on weight loss, sport psychology, and related topics. His books include: the first book published for professionals on the treatment of pediatric obesity - Treatment of Childhood and Adolescent ObesityWeight Loss Through PersistenceThe Sierras Weight Loss Solution for Teens and Kids (2007); and, The Wellspring Weight Loss Plan. Dr. Kirschenbaum’s research on sport psychology won the top prize for research on the mental game of golf from the World Scientific Congress on Golf (St. Andrews, Scotland) and Golf Magazine; in 2000, the American Council on Exercise and its Board of Directors unanimously endorsed his book, The 9 Truths About Weight Loss, as "the best book ever written for the public on how to lose weight and keep it off."

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