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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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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!
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)
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%
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%
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%
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%
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%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
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.
Total obesity-attributable expenditures in 2003 were $75 Billion
Medical costs
Growth in real medical spending
Increased Medicare spendingStop Obesity Alliance, 2008
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
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
Plot BMI percentile in ALL children
Show BMI percentile to parents at EVERY visit
See those over the 85th monthly for 4-6 months
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.
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.
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
4 staged-approach
1. Prevention Plus
2. Structured Weight Management
3. Comprehensive Multidisciplinary Intervention
4. Tertiary Care Intervention
BMI ≥85th
PCP monthly for 6 months
Goal: weight maintenance
No improvement? Stage 2
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
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
Meal Replacement
Very low calorie diet
Medication
Surgery
Multidisciplinary Team
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
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
-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
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
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
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/
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
Change existing policy
Propose new policy
Implement existing policy
Support/Oppose a proposed 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
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
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
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)?
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)
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
Core Elements Knowledge
Relationships
Leadership/Team Skills
Skills to Execute Strategies
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
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
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
Relationships
School board members
Wellness Committee
Influential families
PTA
School staff
Leadership Team Skills: Ability to champion issue Raise awareness Gather core support Articulate goals Assemble team Have passion
Skills to Execute: Relationship building Speaking skills Media skills Writing skills Informal networking skills
Monthly
Multidisciplinary Physician Psychologist Dietitian
Family based
Billed through insurance
Weekly for 12 weeks Includes entire family (siblings, aunts,
etc.) Spanish & English parent groups 3-4 child groups divided by age Manualized treatment
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
At KUMCs exercise facility, Kirmayer fitness center Whole family participates Supervised by exercise physiologist Taught exercises they can do at home Fun, fun, fun!
25
26
27
28
29
30
BMI
Baseline12 Weeks
1520
1540
1560
1580
1600
1620
Caloric Intake
Baseline12 Weeks
620
640
660
680
700
720
740
760
780
Activity Counts
Baseline12 Weeks
• 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."
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!
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