Family Medicine

I saw a 5yo today whose mother had brought him in with an URTI. No problem, I dealt with that. What was an issue was this child’s BMI which was 18.9 (52 lbs, 44 inches). That puts him in the 97th percentile and firmly into the obese category. They’re new to the clinic so I’ve not had the opportunity to bring this up with them before. The boy spent most of the appointment playing on an iPad so I spoke to the mother (also overweight) who didn't seem to appreciate that there was a problem with his weight. She wasn’t especially forthcoming on details about his diet or level of physical activity, but I learned that he doesn’t do any sport outside of school. He snacks and drinks juice, but it was hard to get a handle on just how much from her answers. As this wasn’t the primary purpose of the visit, I’ve invited them back in a couple of weeks for review. Assuming this isn’t down to a medical cause, any suggestions on how to handle the discussion on their next visit? Any positive experiences to share?