Transcript Adherence in Pediatrics: The Example of Diet

Childhood Obesity:
Small Changes in clinic to
make a big impact
Why should you care?
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30 states have pediatric populations in
which at least 30% of children are
overweight/obese.
Significant short- and long-term morbidity
associated with being overweight
 Physiological and psychological
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$1000/year increase in medical costs on
average for people who are
overweight/obese
What to do?
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Plot BMI percentile in ALL
children
Show BMI percentile to
parents at and talk about
healthy lifestyle choices at
EVERY visit
See those over the 85th
monthly for 4-6 months
One Resource for Talking to
Families
http://www.mcph.org/Major_Activities/KeepMEHealthy/Guide_to_Effective_Communication.pdf
Anticipatory Guidance
5-2-1-0…per day
5
fruits and veggies
 2 hours or less of screen time
 1 hour of physical activity
 0 (restrict) soda, juice and other
sugar sweetened beverages
What about serving sizes?
And they vary by age…
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4 staged-approach
1.Prevention Plus
2.Structured Weight Management
3.Comprehensive Multidisciplinary Intervention
4.Tertiary Care Intervention
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BMI ≥85th
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PCP monthly for 6 months
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Goal: weight maintenance
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No improvement? Stage 2
When you have a patient
whose BMI is >85%ile
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This warrants monthly 15 minute office visits for 4-6
months
Things to discuss
 BMI, PMH, Family history
 Food intake: Fruits/veggies, soda, juice, fast food, portions,
breakfast
 Screen time/ daily activity
 Feedback on current behaviors
 Positive/Constructive
15 minute
Office Visit
Set agenda
Which behaviors is the patient/family interested in changing, or
would be easiest to change. Agree on possible targets.
Assess motivation and confidence
Rate each on a scale of 0-10
Summarize and probe possible changes
Schedule follow-up visits as appropriate
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Calorie restriction
Structured daily meals/snacks
Over 60 minutes of active play per day
Less than one hour of screen time per day
Increased behavioral monitoring
Reinforcement for meeting behavioral goals
No improvement for 6 months? Stage 3
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Increased intensity of behavioral change strategies
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Greater frequency of patient/provider contact
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Inclusion of team members
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Psychologist
Registered Dietitian
Exercise Specialist
Physician
Weekly visits for 8-12 weeks, followed by monthly visits
Individual or group
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Meal Replacement
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Very low calorie diet
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Medication
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Surgery
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Multidisciplinary Team
Age (in
years)
2-5
Weight
Maintenance
85th-94th
≥95th
BMI>21
6-11
85th-94th
95th-98th
BMI≥99th
12-18
85th-94th
95th-98th
BMI≥99th
Weight Loss
<1b/mo
Weight loss
<2lb/wk
This is
why you
should
care…
We must
try to
end this
vicious
cycle for
the
health of
our
patients
Take home (or to clinic)
points
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Overweight/obesity affects many children
in this country with significant
physiological, psychological and financial
sequelae.
Anticipatory guidance AT EVERY VISIT,
even for appropriate weight children, is
essential to fight this epidemic.
Treatment begins in your office.