Stephanie Cook, MSc., RD and Roseann Nasser, MSc., RD, CNSD

1. An Ounce of Prevention is Worth a Pound of Cure:Implementation of a Pediatric Weight Management Program in the Regina Qu’Appelle Health Region Stephanie Cook, MSc., RD and Roseann Nasser, MSc., RD, CNSD Healthy People, Families and Communities

2. Pediatric Obesity in Canada Healthy People, Families and Communities

3. “Causes” of Childhood Obesity Genetics Environmental Factors Behavioural Factors Childhood Obesity • within the home • within child care • within schools • within the community • energy intake • physical activity • sedentary behaviours Socio - Demographic • ethnicity • income status Healthy People, Families and Communities

4. Purpose To create an interdisciplinary team of health care professionals specializing in pediatric obesity. To implement a successful pediatric weight management program based on an existing model. To collect the outcomes data to lend strength to a proposal for a fully funded and permanent pediatric obesity program. Healthy People, Families and Communities

5. RQHR Project Team • Stephanie Cook, Manager, Clinical Nutrition Services • Roseann Nasser, Research Dietitian, Clinical Nutrition Services • Lorie Kinneberg, Manager, Pediatrics • Lisa Cooper, Pediatric Dietitian, Clinical Nutrition Services • Tania Soutar, Dietitian, Clinical Nutrition Services • Dr. Heather Switzer, Psychologist, Children's Program (CP) • Delee Farrow, Social Worker, CP • Greg Stopanski, Exercise Therapist, CP • Janet Sali, Rehabilitation Coordinator, CP Healthy People, Families and Communities

6. The Program - KidShapeTM • Established program – KidShapeTM • Eat Healthy, Move more, Feel good about yourself • Proven track record of success in the treatment of pediatric obesity • Family approach • Multi-disciplinary team • Psychologist, social worker, exercise therapist, dietitian, nurse Healthy People, Families and Communities

7. Program Schematic • 9 weeks x 90 minutes classes (once class each week) • Different “theme” each week • Conducted in May and June 2010 Kids Physical Activity Kids Mental Health Adults & Kids Nutrition Goal Setting Adults Mental Health Adults Dietitian 15 mins 15 mins 30 mins 30 mins Healthy People, Families and Communities

8. Methods • Inclusion criteria: • Referral to the program by RD, GP or Paediatrician • Child between 6-11 years with BMI of ≥85th percentile • Baseline, 9 weeks and 28 weeks • Anthropometrics: weight, height and BMI • Physical activity (1 mile Rockport walk test, V02 max) • Dietary intake records • Child health profile, KidShapeTM program evaluation Healthy People, Families and Communities

9. Results Participation / Attrition n=15 families recruited @ baseline ↓ n =8 families @ 9 week program • Attended mean of 7.5 classes • mean age = 9 years (ranged 7-11 years) ↓ n=7 families @ 28 week follow-up Healthy People, Families and Communities

10. 31.4 31.3 31.6 31 35 30 25 20 15 10 5 0 baseline 5 weeks 9 weeks 28 weeks Body Mass Index Healthy People, Families and Communities

11. Dietary Intake Dietary Fat Intake 20 18 saturated fat 17 16 16 15 15 15 mononunsaturated fat polyunsaturated fat 11 11 10 Intake (grams) 8 5 0 baseline 9 weeks 28 weeks Time (weeks) Healthy People, Families and Communities

12. Child Health Profile 60 55 satisfaction 50 comfort Mean Score 45 resilience risk avoidance 40 achievement 35 30 baseline 9 weeks 28 weeks Time (weeks) Child Health Profile Healthy People, Families and Communities

13. Physical Activity Rockport 1 mile walk test Vo2 Max 17.9 17.3 15.6 20 44 15 40 50 Time (min) 37 40 10 30 5 20 0 10 baseline 9 weeks 28 weeks 0 baseline 9 weeks 28 weeks mL/Kg/ min Healthy People, Families and Communities

14. Other Self- Reported Behaviour Changes • Baseline to 9 weeks • Fruit and vegetable intake • ↑ 1/week → 1 /day • Soft drink consumption • ↓ 2/day → 0/day • TV time • ↓ 3 hours/day → ½ -1 hour/day Healthy People, Families and Communities

15. Challenges/Opportunities Attrition rate Started with 15 families → 8 families → 7 families Assess families readiness to change Time of year Spring/Summer → Fall/Winter Offered free program, babysitting, meals → Charge tuition Commitment was a barrier for some → Simplify! Follow-up sooner and often All team members involved Funding $50,000 annually to enroll 50 families Healthy People, Families and Communities

16. Conclusions • Observed modest improvements in some outcome measures • Greatest success is the lessons learned! • Future Plans: • Revise the programming to better meet our needs • Enrolment based on readiness of the family to change • Target a more narrow age range of children • Provide for long term active follow-up by the team • Charge for the program (even a nominal fee!) Healthy People, Families and Communities

17. Closing thoughts • "Our kids didn't do this to themselves. They don't decide the sugar content in soda or the advertising content of a television show. Kids don't choose what's served to them for lunch at school, and shouldn't be deciding what's served to them for dinner at home. And they don't decide whether there's time in the day or room in the budget to learn about healthy eating or to spend time playing outside." • "The physical and emotional health of an entire generation is at stake. Childhood obesity isn't the kind of problem that can be solved overnight, but with everyone working together, it can be solved. So, let's move." • Michelle Obama Healthy People, Families and Communities

18. Acknowledgments Interprofessional Health Collaborative of Saskatchewan KidShapeTM Families Research and Performance Support Dufton Lewis, Research Consultant Judith Robertson, Senior Research Associate Johns Hopkins Bloomberg School of Public Health Children’s Program Nutrition and Food Services Healthy People, Families and Communities

19. Questions?