new the role of dental professionals in addressing childhood obesity · 2018. 2. 5. · actions and...
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Calories, Cavities and Kids:The Role of Dental Professionals in Addressing
Childhood Obesity
Robin Wright, PhD
Director, Pediatric Oral Health Research and Policy Center
American Academy of Pediatric Dentistry
Childhood Obesity
In 1980, 6 percent of
children ages 6 to 17
were obese; rose to 18
percent in 2010.
Childhood Obesity
In 2011–2012, 17
percent of children
ages 2–18 were obese
32 percent were either
overweight or obese
8 percent of infants
and toddlers had high
weight for recumbent
length
Childhood Obesity
Obesity is Body Mass
Index (BMI) at or above
the 95th percentile for
children and teens of
the same age and sex
Overweight is BMI at or
above the 85th
percentile
Childhood Obesity
22 percent of Hispanic
children
20 percent of non-
Hispanic black children
17 percent of white,
non-Hispanic children
were found to be obese
Childhood Obesity
Psychological and
social impact
Health risk factors as
high blood pressure,
high cholesterol, and
pre-diabetes
Childhood Obesity
About 6 in 10 children
who are overweight
develop into
overweight or obese
adults
Childhood Obesity
About 6 in 10 children
who are overweight
develop into
overweight or obese
adults
Children ages 3-5 who
are overweight or
obese are 5 times
more likely to be
obese as an adult
Learning Objectives
1. Explain the association between sugar-containing beverages, caries and childhood obesity.
2. Describe the attitudes of both parents and oral health professionals toward nutritional and weight counseling in a dental setting.
3. Identify the barriers that prevent oral health professionals from providing interventions related to childhood obesity.
4. Recognize effective strategies for oral health professionals to address childhood obesity in collaboration with other health professionals.
Sugar-Sweetened Beverages
SSBs are the single
largest category of
caloric intake in
children ages 2-18
Sugar-Sweetened Beverages
SSBs are the single
largest category of
caloric intake in
children ages 2-18
Teens ages 14-18 drink
an average of 260
calories of added
sugars from SSBs a day
Caries and Sugar-Containing Beverages
Caries SCBs
Obesity and Sugar-Containing Beverages
Obesity SCBs
Obesity and Sugar-Containing
Beverages
A positive association between
SCB consumption among
children under 12 and both
total and central adiposity
Mixed results with only fruit
juice and total adiposity
The association with total
adiposity strongest among
children under 5
Frantsve-Hawley, et al., 2017
Caries and Obesity
Caries Obesity
Kantovitza, et al., 2006
Obesity, Caries and Sugar-Containing
Beverages
Caries Nutrition Obesity
Recommendations
American Academy of Pediatric Dentistry
Breast-feeding up to age 12 months
Breast-feeding more than 12 months
Academy of Pediatrics
No juice before one year of age
4 ounces a day for children ages 1–3
4–6 ounces for children ages 4–6
8 ounces for children ages 7–18
Recommendations
USDA 2015-2020 Dietary Guidelines
Sugar less than 10 percent of daily calorie intake
World Health Organization
Sugar less than 5 percent of total energy intake
Learning Objectives
1. Explain the association between sugar-containing beverages, caries and childhood obesity.
2. Describe the attitudes of both parents and oral health professionals toward nutritional and weight counseling in a dental setting.
3. Identify the barriers that prevent oral health professionals from providing interventions related to childhood obesity.
4. Recognize effective strategies for oral health professionals to address childhood obesity in collaboration with other health professionals.
2016 Survey on Attitudes/Actions
Toward Childhood Obesity and SSBs
Pediatric Dentist Survey
1,615 responses or 22
percent of the sample
Dental Hygienist Survey
2,361 responses or 7
percent of the sample
Actions and Intentions: Obesity
17 percent currently
offer childhood obesity
interventions
67 percent interested
in establishing a plan
Actions and Intentions: Obesity
17 percent of pediatric dentists currently offer childhood
obesity interventions
Curran, et al., 2010: 3 percent of GPs and 6 percent of PDs
provide obesity interventions
67 percent of pediatric dentists interested in establishing a
plan
Curran, et al., 2010: 50 percent interested
Actions and Intentions: Obesity
Obesity intervention methods currently performed.
(Rating Average for Always 5, Sometimes 3, Never 1)
Answer Options Rating
Average
Note signs of being overweight or obese in the
child’s chart
4.10
Weigh children and measure their height 3.71
Talk to parents about observations if a child shows
signs of being overweight or obese
3.64
Provide educational materials on childhood obesity 2.92
Actions and Intentions: Obesity
Answer Options Rating
Average
Offer a referral for children identified as
overweight or obese
2.85
Calculate and interpret a Body Mass Index (BMI)
score for children ages 2 and older
2.75
Offer weight-related motivational interviewing or
other behavior-modification programs in my
practice
2.72
Follow up on interventions with additional contact 1.81
Provide parents with a self-administered screening
tool for childhood obesity
1.61
Actions and Intentions: SSBs
94 percent of pediatric
dentists currently offer
interventions on SSBs
93 percent interested
in establishing a plan
86 percent of dental
hygienists currently
offer interventions on
SSBs
Actions and Intentions: SSBs
Intervention methods for SSBs
(Rating Average for Always 5, Sometimes 3, Never 1)
Answer Options Rating
Average
Talk to parents about my observations if a child shows
signs of high risk for caries
4.86
Note signs of high caries risk in the child’s chart 4.80
Provide educational materials on sugar-sweetened
beverages
3.78
Offer motivational interviewing or other behavior-
modification programs about the consumption of
sugar-sweetened beverages
3.59
Actions and Intentions: SSBs
Intervention methods for SSBs
(Rating Average for Always 5, Sometimes 3, Never 1)
Answer Options Rating
Average
Provide parents with a self-administered screening
tool for consumption of sugar-sweetened beverages
2.09
Offer a referral to a dietitian or nutritionist for
children who have high consumption of sugar-
sweetened beverages
1.55
Follow up on interventions with additional contact 1.42
Perceived Parent Expectations
14 percent agreed that
parents are receptive to
obesity counseling in the
dental office
7 percent agreed that
parents think it is important
for dentists to screen
children for obesity
21 percent thought
screening for obesity would
make them appear more
professional/knowledgeable
Perceived Parent Expectations
14 percent agreed that parents are receptive to obesity counseling in the dental office
81 percent think parents are receptive to advice about consumption of SSBs
7 percent agreed that parents think it is important for dentists to screen children for obesity
84 percent agreed that parents think it is important for dentists to provide counseling about SSBs
21 percent thought screening for obesity would make them appear more professional/knowledgeable
72 percent agreed that SSB advice would make them appear more professional/knowledgeable
Perceived Parent Expectations
9 percent had been
asked for advice from
parents about obesity
85 percent had been
asked for advice about
SSBs
Perceived Parent Attitudes
Barriers to providing healthy weight
interventions (Rating average for Major Barrier
5, Minor barrier 3, Not a barrier 1)
Rating
Average
Lack of parental acceptance of advice about weight
management from a dentist4.15
Fear of appearing judgmental of parents and/or child
patients4.14
Fear of offending the parent 4.10
May create parent dissatisfaction with my practice 3.62
Perceived Parent Attitudes/Provider
Response
Barriers to providing healthy weight
interventions and provider action
Chi-
Square
Lack of parental acceptance of advice about weight
management from a dentist.0004
Fear of appearing judgmental of parents and/or child
patients>.0001
Fear of offending the parent >.0001
May create parent dissatisfaction with my practice >.0001
Actual Parent Attitudes
Scarcity of research
Primarily qualitative
with small groups
Generally positive
Some negatives
Learning Objectives
1. Explain the association between sugar-containing beverages, caries and childhood obesity.
2. Describe the attitudes of both parents and oral health professionals toward nutritional and weight counseling in a dental setting.
3. Identify the barriers that prevent oral health professionals from providing interventions related to childhood obesity.
4. Recognize effective strategies for oral health professionals to address childhood obesity in collaboration with other health professionals.
Perceived Barrier/Provider Response
Lack of time in the daily clinical schedule
Lack of trained personnel in my office to perform this
service
Lack of personal knowledge or training about
childhood obesity
Lack of knowledge about how to start the
conversation
Lack of reimbursement from 3rd-party payers
Lack of appropriate referral options
Perceived Barriers
No additional fees charged to parents for the services
Lack of available patient education materials on childhood
obesity
Dietary recommendations about childhood obesity are
ambiguous and/or confusing
Concern over legal risks
Lack of training in communication skills
Learning Objectives
1. Explain the association between sugar-containing beverages, caries and childhood obesity.
2. Describe the attitudes of both parents and oral health professionals toward nutritional and weight counseling in a dental setting.
3. Identify the barriers that prevent oral health professionals from providing interventions related to childhood obesity.
4. Recognize effective strategies for oral health professionals to address childhood obesity in collaboration with other health professionals.
Incentives
More approaches that add little time to a dental visit
More parents asking about obesity and weight counseling
More continuing education courses on childhood obesity
Clearer clinical guidelines on nutrition and obesity
Stronger clinical evidence of a link between childhood
obesity and dental disease
Increased availability of patient education materials
Increased credibility and satisfaction from parents
Strategies: Provide Interventions
Weigh children and measure their height
Calculate and interpret a BMI score for children ages
2 and older
Provide educational materials on childhood obesity
Provide parents with a self-administered screening
tool for childhood obesity
Note signs of being overweight or obese in the
child’s chart
Strategies: Provide Interventions
Weigh children and measure their height
Calculate and interpret a BMI score for children ages
2 and older
Provide educational materials on childhood obesity
Provide parents with a self-administered screening
tool for childhood obesity
Note signs of being overweight or obese in the
child’s chart
Strategies: Provide Interventions
Talk to parents about observations if a child shows signs
of being overweight or obese
Offer weight-related dietary counseling in my practice
Refer children identified as overweight or obese to a
specialist
Offer weight-related motivational interviewing or other
behavior-modification programs in my practice
Follow up weight maintenance counseling and other
interventions with additional communication, such as
phone calls, text messages, or emails
Strategies: Provide Interventions
Talk to parents about observations if a child shows signs
of being overweight or obese
Offer weight-related dietary counseling in my practice
Refer children identified as overweight or obese to a
specialist
Offer weight-related motivational interviewing or other
behavior-modification programs in my practice
Follow up weight maintenance counseling and other
interventions with additional communication, such as
phone calls, text messages, or emails
Strategies: Provide Interventions
Talk to parents about observations if a child shows signs
of being overweight or obese
Offer weight-related dietary counseling in my practice
Refer children identified as overweight or obese to a
specialist
Offer weight-related motivational interviewing or
other behavior-modification programs in my practice
Follow up weight maintenance counseling and other
interventions with additional communication, such as
phone calls, text messages, or emails
Resources
National Maternal and Child Oral Health Resource Center
http://www.oralhealth4healthyfutures.org/
Centers for Disease Control and Prevention
https://www.cdc.gov/healthyweight/children/index.html
American Academy of Pediatrics
https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/provisional-section-on-obesity/Pages/Additional-Resources.aspx
Motivational Interviewing Network of Trainers
http://www.motivationalinterviewing.org/
Robert Wood Johnson Foundation
https://www.rwjf.org/en/our-focus-areas/focus-areas/healthy-children-healthy-weight.html
Resources
AAPD
http://www.aapd.org/media/Policies_Guidelines/P_RecDietary.pdf
http://mouthmonsters.mychildrensteeth.org/
Calories, Cavities and Kids:The Role of Dental Professionals in Addressing
Childhood Obesity
Robin Wright, PhD
Director, Pediatric Oral Health Research and Policy Center
American Academy of Pediatric Dentistry
References
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systematic review of the association between consumption of sugar-
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Kantovitza, K. Pascona, F. Rontania, R. Gavião, M. Obesity and Dental Caries –
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Curran AE, Caplan DJ, Lee JY, Paynter L, Gizlice Z, Champagne C, et al.
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