Chris Reinold August 9, 2007

1. Expert Committee RecommendationsAssessment, Prevention and Treatment of Child and Adolescent Obesity Chris Reinold August 9, 2007

2. Objectives By the end of this discussion you will be able to: 1) Describe the expert committee development, representatives and goals 2) Understand CDC's role in the process 3) Explain how to access the childhood obesity action network created by NICHQ to develop to share this information among colleagues

3. Expert Committee Background • Rationale • Inclusion • Work group assignments • Partnerships

4. CDC Role and Future Plans • CDC and HRSA provided funding to AMA to host the expert committee • CDC, HRSA and AMA were involved in decisions about which professional organizations should be invited • All three were at the expert committee meetings but were not voting members of the expert committee

5. CDC Plans • Individual authors publishing CDC articles are citing the recommendations and using the terminology • In presentations such as this we will begin using the term “obese” to define the population with BMI above the 95th percentile for age • Discussions are ongoing about whether we will adopt the full recommendations

6. NICHQ and their role • National Initiative for Children’s Healthcare Quality • Joint effort with RWJ to launch the Childhood Obesity Action Network • The Childhood Obesity Action Network is a web-based national network aimed at rapidly sharing knowledge, successful practices and innovation

7. Childhood Obesity Action Network • COAN has created an Implementation Guide to accompany the newly released Obesity Recommendations. • These recommendations come from the Expert Committee on the Assessment, Prevention and Management of Child and Adolescent Overweight and Obesity, convened by AMA, CDC and HRSA. • The Implementation Guide is now available and will support providers with the tools and resources necessary to put the new recommendations into practice. • To join the network go to the website: www.nichq.org/obesityactionnetwork

8. Recommendations -- Assessment Key Points: • Assess weight status at least annually on all children via BMI-for-age • Prevention and anticipatory guidance for all patients regardless of presenting weight, at least annually • Add 99th percentile • Recommended against routine skinfold assessment • Not able to include recommendation on waist circumference due to lack of specific standard

9. Recommendation Three Key Clinical Steps Step 1 – Prevention Plus Protocol. Obesity prevention at Well Care Visits including assessment and prevention Step 2 – Structured Weight Management Protocol. Prevention Plus Visits including treatment Steps 3-4 – Comprehensive Multidisciplinary and Tertiary Care Protocol. Going Beyond the Practice including prevention and treatment

10. Recommendation Three Key Clinical Steps Step 1 – Prevention Plus Protocol. Obesity prevention at Well Care Visits including assessment and prevention Key Points: • Accurate measurement is critical. Calculation of BMI dependent on accurate measurement • Assess readiness of family and qualitative assessment of diet and activity patterns • Use behavioral counseling / anticipatory guidance to engage parents/adolescents

11. Recommendation Three Key Clinical Steps cont. Step 2 – Structured Weight Management Protocol. Prevention Plus Visits including treatment Key Points: • Implemented in primary care physician’s office or allied healthcare provider • Alter diet and physical activity behaviors via behavior counseling (e.g., motivational interviewing). • Involve family, consider group visits, arrange f/up • Establish guidelines for moving patients to step 3

12. Recommendation Three Key Clinical Steps cont. Steps 3-4 – Comprehensive Multidisciplinary and Tertiary Care Protocol. Going Beyond the Practice including prevention and treatment Key Points: • Structured behavior modification • Optimally at this stage, patient would be referred to multidisciplinary obesity care team with experience in childhood obesity • Step 4 should be referral to pediatric tertiary weight management center • All steps are age and BMI-for-age dependent

13. Additional Tools • NICHQ implementation guide has additional tools that are derived from the recommendations. • Full expert committee papers will be released in a Pediatrics Journal supplement in the late fall of 2007.

14. Description of Additional Tools • BMI 99th percentile cut points • NHLBI blood pressure table • Symptoms and Signs of Conditions Associated with Obesity • Staged Approach to Obesity based on age and BMI category • Weight loss targets

15. Questions / Next Steps • Chris Reinold contact info: CReinold@cdc.gov Join NICHQ Childhood obesity action network via web link provided earlier Questions about recommendations