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Research has shown that successful treatment of overweight children and teens requires a multi-specialty approach. A patient’s progress through the Great Moves! Program will be medically supervised with at least three visits with a physician from Children’s Hospital Boston.

Initial Medical Visit
The first consultation (during week 1) involves a 60 minute comprehensive medical evaluation during which a complete physical examination and review of systems, medical history, and family history will be reviewed.

The purpose of this evaluation is to identify underlying medical conditions, including endocrine conditions, such as hypothyroidism, or genetic problems, that may contribute to the development of obesity. The examination also focuses on identifying potential complications of obesity, including diabetes or prediabetes, dyslipidemia, hepatic steatosis, or sleep apnea, that may require further evaluation or management.

Each time a patient meets with an individual specialist in the Great Moves! program, height and weight are obtained in order to evaluate body mass index. At each medical visit, a waist circumference and blood pressure measurement are also obtained.

As measurement of body composition is an important means of monitoring clinical progress, bioelectrical impedance (BIA) is also used to measure fat mass, fat free mass, and total body water at the beginning and the end of the program. BIA is a simple technique in which two electrodes are placed on the patient’s right hand and right foot. It works on the principle that electric current flows more quickly through tissue with a higher water and electrolyte content, such as fat free mass. Thus the impedance to the electric current relates directly to the amount of fat free mass, which can then be calculated. The testing takes about five minutes and the current is very small and not clinically appreciated by the patient (similar to a dead AA battery). The weight of the different body compartments can be monitored over time.

At the baseline assessment, all patients have fasting laboratory tests including glucose, insulin, a lipid profile, ALT, and a TSH. Additional screening or diagnostic testing may be ordered based on the findings of the medical evaluation.

A summary letter of the patient’s assessment, plan and specific recommendations will be sent to the referring provider and, if necessary, recommendations would be made for additional evaluations that might be required. If additional specialty consultation is felt to be needed to evaluate or treat a condition diagnosed during the assessment (e.g., type 2 diabetes, severe dyslipidemia etc.), recommendations would be provided to the referring provider for appropriate specialists.

Help us prepare for your patient’s first visit!
To prepare for the initial visit, we will need the following information faxed to us from your office before your patient’s appointment:

• Growth chart
• Copy of notes from the most recent physical exam and any visits related to overweight/obesity assessment or treatment
• Any laboratory tests or other procedures (e.g., overnight sleep study) related to overweight/obesity or one of its complications

Follow-up Medical Visits
Patients would be seen for at least two additional 30 minute follow up medical visits at the middle and at the end of the 6 month program. The primary purpose of these visits is to monitor the rate of change in the child’s weight and body mass index during the program and to ensure that the child is growing normally while participating in the program.

Waist circumference and blood pressure in addition to BMI are monitored at each medical visit. At the final medical visit, body composition by bioelectrical impedance is reassessed. If necessary based on the initial medical evaluation, laboratory tests may be repeated at a follow up medical visit.