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Pediatric Obesity The Epidemic is upon us!

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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!. - PowerPoint PPT Presentation

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Page 1: Pediatric Obesity The Epidemic is upon us!
Page 2: Pediatric Obesity The Epidemic is upon us!

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!

Page 3: Pediatric Obesity The Epidemic is upon us!
Page 4: Pediatric Obesity The Epidemic is upon us!
Page 5: Pediatric Obesity The Epidemic is upon us!

5

Rank States% Overweight & Obese

10-to 17- year-olds (95% CIs)1 Mississippi 44.4% (+/- 4.3)2 Arkansas 37.5% (+/- 4.2)3 Georgia 37.3% (+/- 5.6)4 Kentucky 37.1% (+/- 4.1)5 Tennessee 36.5% (+/- 4.3)6 Alabama 36.1% (+/- 4.6)7 Louisiana 35.9% (+/- 4.6)8 West Virginia 35.5% (+/- 3.9)9 D.C. 35.4% (+/- 4.8)10 Illinois 34.9% (+/- 4.1)

Page 6: Pediatric Obesity The Epidemic is upon us!

Source: CDC Behavioral Risk Factor Surveillance System.

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Page 7: Pediatric Obesity The Epidemic is upon us!

Source: CDC Behavioral Risk Factor Surveillance System.

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 8: Pediatric Obesity The Epidemic is upon us!

Source: CDC Behavioral Risk Factor Surveillance System.

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 9: Pediatric Obesity The Epidemic is upon us!

Source: CDC Behavioral Risk Factor Surveillance System.

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%

Page 10: Pediatric Obesity The Epidemic is upon us!

Source: CDC Behavioral Risk Factor Surveillance System.

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%

Page 11: Pediatric Obesity The Epidemic is upon us!

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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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.

Page 18: Pediatric Obesity The Epidemic is upon us!

Total obesity-attributable expenditures in 2003 were $75 Billion

Medical costs

Growth in real medical spending

Increased Medicare spendingStop Obesity Alliance, 2008

Page 19: Pediatric Obesity The Epidemic is upon us!
Page 20: Pediatric Obesity The Epidemic is upon us!

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

Eat breakfast daily

Limit eating at restaurants

Encouraging family meals

Limiting portion sizes

Page 21: Pediatric Obesity The Epidemic is upon us!

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

Page 22: Pediatric Obesity The Epidemic is upon us!

Plot BMI percentile in ALL children

Show BMI percentile to parents at EVERY visit

See those over the 85th monthly for 4-6 months

Page 23: Pediatric Obesity The Epidemic is upon us!

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.

Page 24: Pediatric Obesity The Epidemic is upon us!

Set agendaElicit 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 confidenceAssess 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.

Page 25: Pediatric Obesity The Epidemic is upon us!

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

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4 staged-approach

1. Prevention Plus

2. Structured Weight Management

3. Comprehensive Multidisciplinary Intervention

4. Tertiary Care Intervention

Page 29: Pediatric Obesity The Epidemic is upon us!

BMI ≥85th

PCP monthly for 6 months

Goal: weight maintenance

No improvement? Stage 2

Page 30: Pediatric Obesity The Epidemic is upon us!

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

Page 31: Pediatric Obesity The Epidemic is upon us!

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

Page 32: Pediatric Obesity The Epidemic is upon us!

Meal Replacement

Very low calorie diet

Medication

Surgery

Multidisciplinary Team

Page 33: Pediatric Obesity The Epidemic is upon us!

Age (in years)

Weight Maintenance

Weight Loss <1b/mo

Weight loss <2lb/wk

2-5 85th-94th

≥95th

BMI>21

6-11 85th-94th

95th-98th

BMI≥99th

12-18 85th-94th

95th-98th

BMI≥99th

Page 34: Pediatric Obesity The Epidemic is upon us!

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

Page 35: Pediatric Obesity The Epidemic is upon us!

-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

Page 36: Pediatric Obesity The Epidemic is upon us!

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

Page 37: Pediatric Obesity The Epidemic is upon us!

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

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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/

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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

Page 41: Pediatric Obesity The Epidemic is upon us!

Change existing policy

Propose new policy

Implement existing policy

Support/Oppose a proposed policy

Page 42: Pediatric Obesity The Epidemic is upon us!

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

Page 43: Pediatric Obesity The Epidemic is upon us!

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

Page 44: Pediatric Obesity The Epidemic is upon us!

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

Page 45: Pediatric Obesity The Epidemic is upon us!

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)?

Page 46: Pediatric Obesity The Epidemic is upon us!

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)

Page 47: Pediatric Obesity The Epidemic is upon us!

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 York New York-Presbyterian Hospital/Weill Cornell

Medical Center, New York Orlando Health – Department of Pediatrics Residency

Training Program Florida University of Florida-Gainesville, Florida

Page 48: Pediatric Obesity The Epidemic is upon us!

Core Elements Knowledge

Relationships

Leadership/Team Skills

Skills to Execute Strategies

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State Federal

Knowledge Current policy: Who

supports/opposes it?State data on current

practiceModels from other statesCost of implementationBenefits of implementation

Federal lawmaking processBackground data on the issue Federal and state level dataCost including health impact

Coalition partners

Relationships Supporting state organizations (eg, PTA)Legislators

Key constituents

Key contacts in CongressPotential sponsors

Other stakeholders

Page 50: Pediatric Obesity The Epidemic is upon us!

State Federal

Team Skills Ability to take issue to scaleAbility to connect multiple stakeholdersAbility to negotiate with

opposition

Ability to speak in sound bytesHandle controversyWork with opponentsWork with lobbyist to manage issue

Know of stakeholders

Skills to Execute Lobbying skillsLiaisons with stakeholder organizationsUnderstanding of and relationship with oppositionAbility to articulate the opposition’s concernsAbility to create win-win scenarios

Connect to local legislatorsStay on messageAct when neededMedia skills

Persistence

Page 51: Pediatric Obesity The Epidemic is upon us!

Example: Sugar-sweetened Beverages in Schools

Knowledge: Use policy tool to get strategies and

evidence School board decision making Issue knowledge (eg, finances of school,

history of contract) Local data Other programs that have worked

Page 52: Pediatric Obesity The Epidemic is upon us!

Relationships

School board members

Wellness Committee

Influential families

PTA

School staff

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Leadership Team Skills: Ability to champion issue Raise awareness Gather core support Articulate goals Assemble team Have passion

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Skills to Execute: Relationship building Speaking skills Media skills Writing skills Informal networking skills

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Monthly

Multidisciplinary Physician Psychologist Dietitian

Family based

Billed through insurance

Page 57: Pediatric Obesity The Epidemic is upon us!

Weekly for 12 weeks Includes entire family (siblings, aunts,

etc.) Spanish & English parent groups 3-4 child groups divided by age Manualized treatment

Page 58: Pediatric Obesity The Epidemic is upon us!

Free to families

Families are welcome to continue exercising with us for 1 year or they can request a free family membership to the YMCA

Page 59: Pediatric Obesity The Epidemic is upon us!

At KUMCs exercise facility, Kirmayer fitness center Whole family participates Supervised by exercise physiologist Taught exercises they can do at home Fun, fun, fun!

Page 60: Pediatric Obesity The Epidemic is upon us!

25

26

27

28

29

30

BMI

Baseline12 Weeks

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1520

1540

1560

1580

1600

1620

Caloric Intake

Baseline12 Weeks

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620

640

660

680

700

720

740

760

780

Activity Counts

Baseline12 Weeks

Page 63: Pediatric Obesity The Epidemic is upon us!

• 100% = "Excellent" Rating (1 on scale of 1 to 4)

• What did you like best about Healthy Hawks?– "Exercise"

– "That everyone was not looking down on the next person and was very positive and helpful and open to suggestions."

• Do you think that you have made healthy life-long behavior changes?– "Yes I do because we're learning more and more to read labels and

watch our portion sizes and even healthier recipes for our entire family. And we actually have changed our concept of our entire eating habits and exercise completely."

• How do you think the program could be improved?– "If we could do it again."

Page 64: Pediatric Obesity The Epidemic is upon us!
Page 65: Pediatric Obesity The Epidemic is upon us!

Pediatric obesity – Why should you care?

Simple Changes in your Clinic-What can you do?

Community Advocacy- How do you get everyone involved?

Legislative Advocacy-How can you get help nationally?

Success Story-Make your own and tell us about it!

Page 66: Pediatric Obesity The Epidemic is upon us!

Kate Roberts Marissa DiGiovine Tyler Smith Lase Ajayi Ashley Lucke David Tayloe Jennifer Yu Kristina Betters Julio Bracero Hava Haischer-Rollo Pattie Quigley Jennifer Concepcion

Medical Student Members:

Ruth Chiang Lisa Costello Julie Hui