What is the best way to tactfully discuss a child’s excess weight with his or her parent? No matter how compassionate I think I am being, someone in the room always ends up being offended.—RICHARD WAYNE, PA-C, Cashiers, N.C.

This is one of the most difficult tasks for anyone who treats children. I recommend “motivational interviewing,” a concept pioneered by William Miller and Stephen Rollnick and outlined in their book, Motivational Interviewing in Health Care: Helping Patients Change Behavior. The first step is asking permission to discuss a concern you have identified regarding the patient. This puts the family in control of the discussion. Permission will usually be given. The next steps involve determining whether your concern is the family’s concern and how important a concern it is. If it is deemed important to the family, you can more confidently begin discussion. If the family desires to change behaviors or remove barriers that contribute to the problem and believe they can be successful, you are ready to start counseling; if not, make a brief remark that you stand ready to assist them when they are ready. So much time is wasted every day giving advice and making recommendations to patients and families who are not ready to change their behavior.—Julee B. Waldrop, DNP (148-1)

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