Transcript Examining the reach of Smoking Cessation Treatment for

OBESIT Y
MODULE 6
Pediatric
Obesity
KAMU
Kansas
Association for
the Medically
Underserved
https://www.flickr.com/photos/joe_13/188297063/
GOALS: WEIGHT MANAGEMENT TRAINING
COMMUNIT Y HEALTH CLINICS
 Module 1: Why is it so Hard to Lose Weight?
 Module 2: Assessing and Documenting BMI
 Module 3: Brief Treatment:
Ann M. Davis, PhD, MPH, ABPP
►Assess, Advise and Agree (AAA p )
 Module 4: Intensive Treatment and Follow -up
 Module 5: Resources and the Office Environment
 Module 6: Pediatric Obesity
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PEDIATRIC OBESITY
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What is it?
How do we measure it?
Who is most at risk?
How should you treat it?
What else can you do?
http://pixabay.com/en/child-kid-boy-snacklollypops-164454/
WHAT IS PEDIATRIC OBESIT Y?
http://www.letsmove.gov/obesity
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WHY USE BMI PERCENTILE?
http://www.letsmove.gov/obesity
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1 out of every 3 children is
overweight or obese
Ann M. Davis, PhD, MPH, ABPP
Children
are
struggling
with their
weight
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PREVALENCE AMONG CHILDREN IN KANSAS
30
25.7
% over 95th
25
20
20
15
10
5
0
Urban
Rural
Davis AM, Boles RE, James RL, Sullivan DK, Donnelly JE, Swirczynski DL, Goetz J. Health behaviors and weight status among urban and rural
children. Rural and Remote Health 8 (online), 2008: 810. Available from: http://www.rrh.org.au.
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HIGH RISK POPULATIONS
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WON’T THEY OUTGROW IT?
NO!
A child who is overweight
or obese at age 11 has
already “taxed” their body
to such an extent that they
are significantly more likely
to suffer these health
consequences, even if they
lose the weight as a teen.
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TREATING PEDIATRIC OBESIT Y
Prevention
Treatment
Stage 1 = Prevention Plus
Stage 2 = Structured Weight Management
Stage 3 = Comprehensive
Multidisciplinary Intervention
Stage 4 = Tertiary Care Intervention
Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity:
Summary Report; Sarah E. Barlow and the Expert Committee; Pediatrics 2007;120;S164-S192; DOI: 10.1542/peds.2007-2329C
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IDENTIFY/DOCUMENT THE PROBLEM
1.
2.
3.
4.
Get accurate height and weight at EVERY visit
Measure height with recumbent or wall stadiometer
Calculate BMI percentile on EVERY child
If appropriate, make the weight diagnosis
“Weight”
“Excess weight”
Stadiometer:
“Body mass index”
http://en.wikipedia.org/wiki/Height_gauge
“BMI”
“Risk for diabetes & heart disease”
►Use the term “overweight” or “obese” as a medical diagnosis,
and put the diagnosis in their medical chart.
►Show them their growth chart.
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STAGE 1 - PREVENTION PLUS
ADVICE FOR EVERYONE:
THE “9 HEALTHY BEHAVIORS”
1. Limit sugar sweetened
beverages
5. No TV in bedrooms**
2. 5 or more of fruits and
vegetables a day
7. Limit eating out
3. 60 minutes of activity
per day
4. 2 or fewer hours of
screen time per day
6. Eat breakfast daily
8. Encourage family meals
9. Appropriate portion
sizes
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ORDER TESTING
Order labs
 BMI 85-94 th %ile with NO risk factors
Fasting Lipid Profile
 BMI 85-94 th %ile WITH risk factors
Fasting Lipid Profile
ALT and AST
Fasting Glucose
 BMI ≥ 95 th %ile Age 10 years and older
Fasting Lipid Profile
ALT and AST
Fasting Glucose
Other tests as indicated by health risks
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Weight Recommendations
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STAGE 2 - COUNSEL THE PATIENT
Counsel the patient
Empathize
 Reflect
 “What is your understanding?”
 “What do you want to know?”
 “How ready are you to make a change (1-10 scale)?”
Provide
 Advice or information
 Choices or options
Elicit
 “What do you make of that?”
 “Where does that leave you?”
Commit
 “What goal are you ready to set?”
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STAGE 2 - GOALS OF YOUR WORK
Monthly family visits with health professional
(with training in pediatric weight management/behavioral counseling)
Health goal = Meet prevention goals
More focused attention to lifestyle changes
DO NOT tell them what changes to make
Instead elicit “change talk” from them
3-6 months
Goal = weight maintenance or a decrease in BMI velocity;
Long term goal = BMI < 85th %ile
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STAGE 2 - TOOLS
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INTERNET RESOURCES
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STAGES 3 AND 4
Sometimes Stages 1 and 2 Don’t Work
 Stage 3: Family -Based Behavioral Groups
 Healthy Hawks at KU Med
 Lasts 12 weeks
 Free
 Available in English and Spanish
 Telemedicine-based, available throughout the state
 Call: (913) 588-6300
 Stage 4: Bariatric Surgery and Very Low Calorie Die ts
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WHAT ELSE CAN YOU DO?
As a healthcare team member…. people listen when you talk!
 Join the local school wellness
committee
 Bring healthier foods to
potlucks that you attend
 Encourage that group outings
focus on an activity rather
than food
 Start a healthy recipe
exchange at work
 Start a wellness effort at
your local place of worship
 Put together a healthy
families resources packet for
your area – increase
awareness of
programs/supports in your
community
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RECAP:
PEDIATRIC OBESIT Y IS A PROBLEM AND YOU CAN HELP
1. Pediatric obesity is a significant problem
2. It needs to be treated in childhood
3. Measuring/reporting/diagnosing using BMI
percentile at every pediatric visit is key
4. Recommend the 9 healthy behaviors for everyone
(Slide 12)
5. Increase efforts for those over the 85 th %ile
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PLEASE TAKE THE QUIZ TO COMPLETE THE MODULE
Please click on the link below to take the quiz for this module
Ann M. Davis, PhD, MPH, ABPP
Thank you!
Yo u m ay o p e n t h e s u r v ey i n yo ur w e b b r o w s e r b y c l i c k i n g t h e l i n k b e l ow :
K A M U O b e s i t y M o d ul e 6 Q u i z
I f t h e l i n k a b o v e d o e s n o t w o r k , t r y c o py in g t h e l i n k b e l o w i n to yo u r w e b b r o w s e r :
h t t p s :/ / r e d ca p . kum c. e d u/ s ur v ey s / ? s = S s 9 XL S Ta r S
If you have questions, please feel free to contact Leslie Sullivan, MS,
Department of Preventive Medicine and Public Health, KU Medical Center
[email protected] or 913-588-2791
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