CCE Cardiometabolic disorders: University of Minnesota

Providers from each clinic that makes up the program-lipids, weight management, and type 2 diabetes-share the goal of modifying each patient's risk profile using a behavioral approach that often incorporates the parents, and sometimes medication, to prevent progression to heart disease and diabetes. This overarching approach allows children and their families to work with more than one provider, she says, including dietitians, psychologists, and those who provide physical activity counseling-and all at one facility.

Some children treated in the lipid clinic have genetically high cholesterol, but the majority suffer as a result of unhealthy lifestyles, says Steinberger, director of the lipid clinic.

Themes for type 2 diabetes prevention and treatment are universal, but each child and family must be seen as an individual unit to identify practical solutions. "Parents who also participate in lifestyle changes not only improve their own health, but also make it more likely that their children will succeed," Nathan says.

"In the weight management clinic, we try to help each family develop daily habits, both in exercise and food choices, that promote their health," says Sarah Jane Schwarzenberg, MD, director of pediatric gastroenterology, hepatology, and nutrition. "Each family is different and needs a different plan."

For example, an obese child from an otherwise healthy and active family will be examined to rule out medical causes of obesity, then may undergo motivational interviewing and psychological evaluation to determine what barriers are preventing him from being active with his family members, says Steinberger. However, when all family members display cardiometabolic risk factors, the entire family will participate in group dietary and physical activity counseling and will receive extensive education on the long-term consequences of their unhealthy habits.

Clinic teams have also developed produce baskets for low-income members to pick up at specified local farmers' markets, to help them see the value of eating nutritious meals despite financial constraints.

"We work with children and their families monthly until they begin making progress, then gradually increase the interval between visits," says Schwarzenberg. "Weight management is a lifelong process, with ups and downs through the lifespan. None of us are ever finished."