A boy, aged 7 years, is of normal height and well over the top of the developmental chart for weight. He is happy, active and does well in school. His father is large, and his siblings are of normal weight.

I did a lipid profile and do not know how to follow up. His parents cannot afford a pediatrician, and driving all the way to the nearest pediatric endocrinologist would be a hardship. A consult with a dietitian does not seem worthwhile because the family seems to have a healthy diet. — Marylou Potts, ARNP, Ocala, Fla.

Based on the information presented, there seems to be no reason to suspect an endocrine disorder. Most overweight children can be cared for within the context of primary care. A lipid profile was in order; however, even if it is abnormal, the first-line recommendations for this child are lifestyle modifications (Daniels SR et al. Pediatrics. 2008;122:198-208, accessed July 24, 2012).

Principles for motivational interviewing may help you determine if the family members perceive the boy’s weight as a problem and if they are interested in and feel like they are capable of making changes in diet and behaviors to impact this unhealthy weight. At this child’s age, the family must be committed, or change will not occur. The American Academy of Pediatrics has guidelines for management of elevated lipids that you can follow as a primary-care provider (Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, N.Y.: Guilford Press; 2008). These guidelines include the use of the American Heart Association dietary recommendations. — Julee B. Waldrop, DNP (165-2)

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