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