| Stage | Staff and skills | Nutrition goals | Activity goals | Behavior intervention |
| 1: Prevention plus | Primary care provider | - Encourage consumption of 5 or more servings of vegetables or fruit daily
- Minimize sugared beverages
- Eat breakfast every day
- Eat most meals at home and as a family
| - Less than 2 hours of television or other screen time per day
- More than 1 hour of physical activity daily
| - Reinforce goals at each health care visit, additional visits as tolerated
- Allow child to self-regulate, avoid overly strict eating regimens
|
| 2: Structured weight management | Primary care clinician or provider with additional training in nutrition or behavioral counseling (eg, dietitian) | Stage 1 plus: | Stage 1 plus: | - Monthly patient-provider contact
- Monitor eating and physical activities through logs
- Use positive reinforcement techniques (reward system)
- Strong parental involvement for school-aged children
|
- Daily eating plan, with scheduled meals and snacks
- Emphasize foods with low energy density
- Reduce frequency and quantity of foods with high energy density (eg, fried foods, baked goods, fats)
- Limit portion size
- Set explicit behavior goals
| - Less than 1 hour of television or other screen time daily
- More than 1 hour of physical activity daily, supervised and structured
|
| 3: Comprehensive multidisciplinary intervention | Multidisciplinary team with childhood obesity expertise OR primary care-based program with counselor, dietitian, and use of structured outside activity program | Stage 2 plus: | Similar to stage 2, supported by behavioral interventions | - Weekly patient-provider contact (and/or phone)
- Similar, but with increased structure and accountability
- Parent training in behavioral techniques to improve home eating and activity environment
|
- Structured diet and physical activity designed for negative energy balance
|
| 4: Tertiary care intervention | Multidisciplinary team with childhood obesity expertise, including obesity medicine clinician to rigorously assess comorbidities | As guided by established protocols. Various modalities are available, including highly structured diets, medications, or bariatric surgery. |
