faculty disclosure karla k. lester, md dr. lester has listed no financial interest/arrangement that...

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 ModelHealthcare Provider ToolkitPocket Reference AlgorithmYouth PA-N Assessment FormTraining VideoOffice PostersPatient Education Brochures

Healthcare Provider ToolkitComplete reference

Etiology/EpidemiologyRole of the ProviderClinical Algorithm

Assessment PreventionTreatment

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 AlgorithmConvenient 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 703Ht (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

OSASObesity, snoring or apnea, hypertension,

daytime sleepiness or hyperactivity, depression

FI : OSAS, obesityPositive polysomnography study

Wt reduction, ENT surgery, CPAP

Slipped Capital Femoral Epiphysis

Tibia Vara

Pseudotumor cerebri

Normal Retina

acanthosis nigricans

Laboratory Evaluation

BMI Percentile85th to 94th

>95th

Laboratory Study Fasting Lipid ProfileIf 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

AssessingHealth 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 GoalsNumber of Goals to Set:

Zero if resistant to change (ambivalent)1-2 if ready for change

Degree of Change:Suggest: 20-50% changeIs it realistic?

Counseling and Motivating Children and FamiliesOpen-Ended QuestionsAffirmationReflective of patient/parent commentsSummarizations that include patient/parent

comments

Counseling and Motivating Children and FamiliesUnder 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 17Series of 12

Patient Brochures

Front: Main Message Back: Education and Tips Size: 5 ½ x 8 ½ Series of 9

Poster & Brochure Topics

BreakfastDaily Physical ActivityScreen TimeFruits and VeggiesSugar-Sweetened BeveragesFamily Meal TimePortion DistortionBreastfeedingRole ModelingBMI

Nebraska’s Clinical Childhood Obesity Model

FREETo Pre-Order:

Email: Holly.dingman@nebraska.gov

Why Prevention?Prevention works when put into practice.Prevention of overweight is critical because

long-term outcome data for successful treatment approaches are limited. Pediatrics Vol. 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. 

The Childhood Obesity Action Network

Mission and VisionThe 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 ResourcesCommunity OutreachPolicy Advocacy