My interest in childhood obesity counseling was first inspired by my son, Michael Dansinger, M.D., after he had been granted a post doctoral fellowship at Tuffs University in 1998. He studied and treated medical problems resulting from obesity and conducted medical research on obese adults. From our discussions, we were astounded at the large percentage of obese children that existed. The numbers of obese children and their health problems were rising dramatically.

At the same time, there were few mental health resources available to provide counseling to obese children and their families. I learned from my son, from other psychologists and health professionals in this field and from professional publications. By 2005, I was able to share my knowledge at professional conferences such as the annual meeting of the Minnesota Association for Children’s Mental Health and the Park Nicollet Conference on Optimal Management of Type 1 and Type 2 Diabetes in Pediatrics. I have continued to provide counseling services for obese children and adults since 2005 and primarily use Cognitive Behavior Therapy (CBT) techniques with my clients.

Unfortunately, the current mental health care system reimbursement policies and managed care guidelines make it very difficult for obesity clients to receive treatment and insurance coverage.  Furthermore, obesity can have multiple physical and mental health causes but the health system usually does not allow for a holistic or collaborative approach.  Thus, families have to advocate to receive treatment.  I recommend the following strategies:

• Have a complete medical assessment.
• Have a complete assessment by a mental health practitioner.

–    It is well documented that obese children may also have problems with depression, anxiety, trauma, obsessive-compulsive, low self concept, etc.

• Pursue the recommended level of care.
• Ask your insurance provider what is covered.

–    Record date, time and name of all communication with the insurance company.

–     Put requests in writing and keep copies.

–    Continue to get the care recommended by arranging to self pay while you continue to pursue reimbursement.

• When you and your child are referred for counseling:

–    Look for a therapist who has a short wait time to be seen and will provide periodic feedback to your doctor or other health specialist.

–    Be assured that your counseling referral does not mean you or your child is mentally ill, that you would spend many sessions talking about issues not related to obesity, and that your doctor or health professional is abandoning you.

–    If you have any other reason to resist the referral please discuss them with your doctor.

Questions to Ask the Therapist

• How will the therapist assess the various factors in obesity?

–    How will that information be communicated?

• What is the diagnosis?
• What treatment plan is recommended?

–    Treatment plans often have basic elements that include defining goals and objectives based on needs of the client.

• What is the role of the therapist?
• What are the roles and responsibilities of the parents and child?
• What are the beneficial effects of obesity counseling?

–    What are the possible negative side effects?

• What are the measures of progress?

–    How will these measures be obtained?

• What is expected of the sessions?

–    Number of sessions?

–    Length of sessions?

–    Method and cost of payment?

–    Termination plan?

• Who will perform the counseling?
• Will that person conduct the treatment?

–    Yes – What are his/her qualifications?

–    No  – Does the person work for you?

• Yes – will you supervise the treatment?
• No  – who will you refer to?
• What are alternative treatments?
• What role will family members and friends play in the therapy?

–    Parents should ask how they can help support their child during treatment.  They should determine what to do if their child does not want to participate in counseling.