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Pediatric Obesity The Epidemic is upon us!

Pediatric Obesity The Epidemic is upon us!. Overview. Pediatric obesity – Why should you care? Simple Changes in your Clinic-What can you do? Community Advocacy- How do I get everyone involved? Legislative Advocacy-How can we help nationally? Success Story-Just one of many QI projects!.

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Pediatric Obesity The Epidemic is upon us!

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  1. Pediatric ObesityThe Epidemic is upon us!

  2. Overview • Pediatric obesity – Why should you care? • Simple Changes in your Clinic-What can you do? • Community Advocacy- How do I get everyone involved? • Legislative Advocacy-How can we help nationally? • Success Story-Just one of many QI projects!

  3. Terminology • “Obesity” was not used with children • 2007 - new • BMI for age/gender = 85th – 94th percentile = At risk for overweightOverweight • BMI for age/gender = 95th -98th percentile = Overweight Obese • ≥99th percentile

  4. Why Should You Care?

  5. State Rankings

  6. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  7. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  8. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  9. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  10. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  11. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

  12. Prevalence

  13. Prevalence – Teen Boys by Race/Ethnicity

  14. Prevalence – Teen Girls by Race/Ethnicity

  15. So….

  16. Health Consequences • High concentration of liver enzymes • Gall Stones (Cholelithiasis) • Hyperlipidemia • Glucose Intolerance • Learning • Social, Psychological, Behavioral Dietz, W.H. (1998). Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease. Pediatrics, 101, 518-525.

  17. Financial Issues • Total obesity-attributable expenditures in 2003 were $75 Billion • Medical costs • Growth in real medical spending • Increased Medicare spending Stop Obesity Alliance, 2008

  18. What Can You Do?Simple Changes in your Clinic…

  19. Prevention- Anticipatory guidance. Limit consumption of sugar sweetened beverages (6 oz) 5 fruits and vegetables per day Limit TV to 2 hours pre day or less No TV in bedroom Limiting portion sizes Encouraging family meals Limit eating at restaurants Eat breakfast daily

  20. Reach out and….JUMP! • The Reach out and Read program has done a fantastic job of promoting childhood literacy by handing out free books to children at their well child checks. • Consider handing out Jump Ropes at well child checks to promote exercise and fun

  21. Then What? • Plot BMI percentile in ALL children • Show BMI percentile to parents at EVERY visit • See those over the 85th monthly for 4-6 months

  22. 15 minute obesity prevention office visit • Take weight/height and plot BMI. Elicit parent and child reactions. • Assess intake of fruits and vegetables, sweetened beverages, and fast food. • Assess sedentary/screen time and daily activity. • Consider assessing breakfast consumption, portion sizes and family meals. • Provide positive feedback for behaviors in optimal range. • Provide constructive feedback for behaviors NOT in the optimal range.

  23. 15 minute obesity prevention office visit • Set agenda • Elicit from child/parents which of their behaviors they are interested in changing, willing to change, or would be easiest to change. Agree on possible targets. • Assess motivation and confidence • Assess importance of change on scale of 0-10. • Assess confidence to change on scale of 0-10. • Probe importance and confidence ratings. • Summarize and probe possible changes • Agree on possible first steps – patient leads (or not). Schedule follow-up visits as appropriate.

  24. Assessment • Plot Body Mass Index • Medical History/PMHX/FMHX • Dietary Assessment • Restaurant Food Consumption • Sweetened Beverage/Juice Consumption • Portion Sizes • Energy Dense Foods • Fruit and Vegetable Consumption • Breakfast Consumption • Meal Frequency and Snacking

  25. Assessment

  26. Assessment- Screening

  27. Treatment • 4 staged-approach • Prevention Plus • Structured Weight Management • Comprehensive Multidisciplinary Intervention • Tertiary Care Intervention

  28. Stage 1 - Prevention Plus • BMI ≥85th • PCP monthly for 6 months • Goal: weight maintenance • No improvement? Stage 2

  29. Stage 2 – Structured Weight Management • Calorie restriction • Structured daily meals/snacks • Over 60 minutes of active play per day • < 1 hour of screen time per day • Increased behavioral monitoring • Reinforcement for meeting behavioral goals • No improvement for 6 months? Stage 3

  30. Stage 3 – Comprehensive Multidisciplinary Intervention • Increased intensity of behavioral change strategies • Greater frequency of patient/provider contact • Inclusion of team members • Psychologist • Registered Dietitian • Exercise Specialist • Physician • Weekly visits for 8-12 weeks, followed by monthly visits • Individual or group

  31. Stage 4 – Tertiary Care Intervention • Meal Replacement • Very low calorie diet • Medication • Surgery • Multidisciplinary Team

  32. Weight Goals

  33. Community Advocacy: Getting involved!!! Find community activities or set up your own Contact local YMCA or Boys and Girls Clubs Set up time to talk to local school children in the classroom

  34. Community Advocacy Example: Girls on the Run • -Not for profit organization • -For girls 8-13 • Train for a 5K • 12 week curriculum focusing on self esteem and positive body • image while having fun with exercise

  35. Girls on the Run- Whose involved? Girls on the Run program: girls in 3rd-5th grade and their families Girls on Track program: girls in 6th-8th grade and their families Program Facilitators: coaches, volunteers, people of all ages and their families

  36. Girls on the Run-Results Academic evaluations of the program show a statistically significant improvement in body image, eating attitudes and self-esteem Evidence also indicates an improved sense of identity and an increasingly active lifestyle for program participants

  37. Locations Austin, Tx Phoenix, Az Santa Fe, NM Salt Lake, UT Denver, CO Portland, OR Ontario Canada And more… You can join one of these or set up your own in your community http://www.girlsontherun.org/

  38. Legislative Advocacy

  39. Policy Opportunities: How To Take Action Centers for Disease Control & Prevention, Institute of Medicine, Robert Wood Johnson Foundation and AAP have identified some specific strategies that fall into the following categories: Improving access to healthy foods and beverages Limit access to unhealthy foods and beverages Improve opportunities for safe and affordable physical activity Increase active transportation through community design Improve school and childcare environments Support breastfeeding

  40. Kinds of Policy Changes • Change existing policy • Propose new policy • Implement existing policy • Support/Oppose a proposed policy

  41. What you need to move policy? • Recognition that a problem exists • Evidence, data, stories • Strategies which address the problem • Evidence, information • Policy window of opportunity • Timing • Policy champion • Personal connections • Stories • Focusing event

  42. Mapping Policy to Your Practice Introducing a new tool that helps • Connect clinical guidance with policy change at the practice, community, school, state, and federal level • Allows you to transition from your patient story to policy

  43. Policy Opportunities Tool The AAP created a tool that looks at the different opportunities in terms of: Existing clinical anticipatory guidance and messaging The various sectors where changes can occur (practice, community, school, state, and federal) The tool also highlights which strategies are recommended by AAP, CDC, IOM, RWJF, and/or the National Governors Association www.aap.org/obesity/matrix_1.html

  44. Using Information and Data How many children in your community/state have what needs? How do needs vary across community states and why? How does data support your assumptions or what you re hearing from the field (providers, families, other agencies)?

  45. Additional Resources • AAP Websites and Tools (Federal Affairs, State and Government Affairs, Obesity, Community Pediatrics) • Let’s Move (http://www.letsmove.gov/) • Be Our Voice (www.nichq.org/advocacy) • Alliance for Healthier Generation (www.healthiergeneration.org) • Robert Wood Johnson Center to Prevent Obesity (www.reversechidlhoodobesity.org)

  46. Community Resources • AAP funded obesity projects: • Alabama, Arkansas, Kentucky, Mississippi (BOV) • Kansas, New York 1, New Jersey, Oregon, Maine (HAL) • Community Pediatrics Training Initiative: • Duke University, North Carolina • Mount Sinai School of Medicine • New YorkNew York-Presbyterian Hospital/Weill Cornell Medical Center, New York • Orlando Health – Department of Pediatrics Residency Training Program • FloridaUniversity of Florida-Gainesville, Florida

  47. Policy Implementation and StrategyWhat do you need? Core Elements • Knowledge • Relationships • Leadership/Team Skills • Skills to Execute Strategies

  48. State versus Federal

  49. State versus Federal

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