Transcript Slide 1

Faculty Disclosure
Karla K. Lester, MD
Dr. Lester has listed no financial
interest/arrangement that would be
considered a conflict of interest.
Developed in Collaboration:
Nebraska’s Clinical Childhood Obesity Model
 Healthcare Provider Toolkit
 Pocket Reference Algorithm
 Youth PA-N Assessment Form
 Training Video
 Office Posters
 Patient Education Brochures
Healthcare Provider Toolkit
 Complete reference
 Etiology/Epidemiology
 Role of the Provider
 Clinical Algorithm
 Assessment
 Prevention
 Treatment
 Resources
Training Video
 1 Hour Training Video
 Reviewed and approved for AMA category 1 credit
 Summary of the Clinical Model
 Infused with Nebraska Physician Champion Interviews
Pocket Reference Algorithm
 Convenient Clinical Algorithm
Steps 1, 2, 3: Assess
 BMI % for Age
 Clinical History and Physical Exam
 Health Behaviors and Attitudes (Readiness to Change)
 Using the Youth Physical Activity and Nutrition Assessment Form
BMI: Body Mass Index
Wt (kg)
Ht (m )2
Wt (lbs) x 703
Ht (in )2
Centers for Disease Control, Division of Nutrition and Physical Activity,
http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_BMI/about_childrens_BMI.htm
BMI PERCENTILE
Weight Status Category % Range
 Underweight:
< 5%
 Healthy weight: 5 > 85%
 Overweight:
85 > 95%
 Obese:
> 95%
Centers for Disease Control, Division of Nutrition and Physical Activity,
http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_BMI/about_childrens_BMI.htm
Health Consequences or
Comorbidities
Pulmonary Conditions Related to
Obesity
OSAS
 Obesity, snoring or apnea, hypertension, daytime sleepiness
or hyperactivity, depression
 FI : OSAS, obesity
Positive polysomnography study
 Wt reduction, ENT surgery, CPAP
Tibia Vara
Slipped Capital Femoral Epiphysis
Normal Retina
Pseudotumor cerebri
acanthosis nigricans
Laboratory Evaluation
BMI Percentile
 85th to 94th
 >95th
Laboratory Study
 Fasting Lipid Profile
If other risk factors*- fasting
Glucose, ALT, AST every 2 years
Fasting lipid profile, fasting glucose,
ALT, AST every 2 years
Other tests indicated by history and physical
*Risk factors: positive family history or patient
with hypertension, hyperlipidemia, tobacco
use.
Obesity 360 Pediatrics
Assessing
Health Behaviors and Attitudes
Youth Physical Activity and Nutrition Assessment Form
To be used with ALL pediatric patients:
 ages 2-18 years old
 regardless of BMI status
Nebraska Youth Physical Activity and Nutrition
Assessment (PA-N) Form
Nebraska Youth Physical Activity and Nutrition
Assessment (PA-N) Form
 Assess Key Health Behaviors
 Prevention and Treatment Tool
 Patient-Driven Goal Setting
 Consistent Messages
Quick Reference: Back
Circle age-appropriate column for patient and parents
Assess Attitudes for change
Setting Goals
 Number of Goals to Set:
 Zero if resistant to change (ambivalent)
 1-2 if ready for change
 Degree of Change:
 Suggest: 20-50% change
 Is it realistic?
Counseling and Motivating Children and
Families
 Open-Ended Questions
 Affirmation
 Reflective of patient/parent comments
 Summarizations that include patient/parent
comments
Counseling and Motivating Children
and Families
 Under 12, work with the parent or guardian:
 They control foods in the home and access to PA, TV and other
screen time.
 Junior High (12 -14 yr.):
 Work with the motivated person(s), be sure to interview teen
individually and ask about goals separately as well.
 High school age, work with the teen.
Office Posters
 Size: 11 x 17
 Series of 12
Patient Brochures
Front: Main Message
Back: Education and Tips
 Size: 5 ½ x 8 ½
 Series of 9
Poster & Brochure Topics
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Breakfast
Daily Physical Activity
Screen Time
Fruits and Veggies
Sugar-Sweetened Beverages
Family Meal Time
Portion Distortion
Breastfeeding
Role Modeling
BMI
Nebraska’s Clinical Childhood Obesity Model
 FREE
 To Pre-Order:
 Email: [email protected]
Why Prevention?
 Prevention works when put into practice.
 Prevention of overweight is critical because long-term
outcome data for successful treatment approaches are
limited. PediatricsVol. 112 No. 2 August 2003, pp. 424-430
 The risk of persistence of obesity increases with age.
 Early physical activity and dietary patterns track into
adolescence and correlate with adult obesity. –Pediatric
Nutrition Handbook
Without a systematic effort, the health care system
response to childhood obesity is likely to be slow, poorly
coordinated, and insufficiently effective.
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The Childhood Obesity Action Network
Mission and Vision
 The mission of the Childhood Obesity Prevention
Project is to mobilize and engage physicians as advocates
in their practice, communities and for statewide policies
to reduce overweight and obesity in Nebraska children.
“We envision physicians mobilized as leaders in our communities across
Nebraska finding solutions to the growing epidemic of childhood obesity.”
To carry out its mission, the Childhood Obesity Prevention
Project will provide:
 Education and Clinical Resources
 Community Outreach
 Policy Advocacy