When I work with kids regarding obesity, I truly never even have the goal of “reducing their obesity” enter my mind. As a clinician, my “goal” is always to start by understanding the family context, assess family dynamics and see where we can kick-start the engagement piece for the child and family. If we can get the family unit functioning in a healthier way, then we have a fighting shot at making a difference for them in the long term, thus, it never even crosses my mind to view the encounter as a way of “reducing obesity.”
As a clinician/BHC, it’s an absolute "win" in my mind if we can have a grasp on the why of a kiddo’s behavior (in other words, figure out the function of the behavior). When we can approach it from that angle, there are multiple ways we can come up with a collaborative plan versus trying to badger families into change. Additionally, we can share this feedback with the whole medical team, so that all of us can join with them on their journey and encourage candor versus attempting to mandate compliance.
So, please BHCs, let's do ourselves a favor. Embrace what we know about context, family dynamics, health behavior change and enter on a journey with our patients. It’s okay if/when self-critical thoughts show up in our mind regarding not being able to “get your patients to do x, y or z” – as it was never our job in the first place to (as motivational interviewing has long pointed out) “wrestle them into submission.”