AAP Four Stage Process
The 2007 Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report, adopted by the American Academy of Pediatrics recommends a four stage approach to treatment of obesity.
Stage 1 calls for primary care practices to provide comprehensive medical assessment of the patient's lifestyle and provide modification of dietary and physical activity behaviors and more frequent monitoring to motivated families over 3-6 months.
Stage 2 of treatment provides additional support and structure around healthy behaviors, usually with monthly follow-up visits, nutrition and activity logs from trained staff, with the potential for group sessions for families.
AAP recommendations call for medical centers that provide Stage 3 and 4 obesity treatment. Stage 3 is defined as a comprehensive multidisciplinary intervention that increases the intensity of behavior changes, the frequency of visits and the specialists involved to maximize support for behavior changes. Stage 3 treatment involves a physician, dietician, exercise specialist and a behavior counselor (social worker and/or psychologist). The program provides systematic evaluation of diet and activity at baseline and follow-up, with 8-12 weekly visits being the minimum.
Stage 4 is defined as a tertiary care intervention that may include medications, very low-calorie diets, and/or bariatric surgery to some severely obese youths age 12 to 18.