Identifying Obesity and Obesity Complications in Pediatrics

1. Identifying Obesity and Obesity Complications in Pediatrics PI: Sandra Benavides, PharmD Co-I: Jessica M. DeLeon, PhD Co-I: Magdaline Exantus, BS

2. Background & Significance

3. From: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm, accessed 1/9/11

4. From: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm, accessed 1/9/11

5. Florida Overweight & Obesity Rates From: The Report of the Governor’s Task Force on the Obesity Epidemic.

6. Florida Overweight & Obesity Rates From: The Report of the Governor’s Task Force on the Obesity Epidemic.

7. Complications of Obesity From: http://mozartinshape.org/misvsobesity/whymis.php?id=ch02, accessed 1/9/11

8. Current Problem • High rates in south Florida • US Preventive Services Task Force recommends all children > 6 years be screened1 • In clinical practice, barriers exist in timely identification of obesity and complications • On study reports only 34% of obese patients were correctly identified2 • Only 8% of general pediatric visits have screening for complications3

9. Current Problem • Reasons for under-diagnosis may be4,5 • Time limitations • Limited knowledge of diagnostic criteria • Poor patient counseling techniques • Lack of effective interventions

10. Objective of Study

11. Develop a Center for Child and Adolescent Health (CCAH) • Pharmacist-managed clinic • Screen and identify children & adolescents with obesity or complications of obesity • Pharmacist will provide assessments of children & adolescents requiring further treatment/referral • CCAH will provide patient education on wellness and pharmacotherapy (when indicate)

12. Research Design & Methods

13. Specific Aims: • Specific Aim 1: • Development of the CCAH • Specific Aim 2: • Identify and assess children & adolescents at high risk for developing complications secondary to obesity • Specific Aim 3: • Assess the patient and parent/guardian satisfaction with the clinic and perform a needs assessment to determine future weight loss intervention strategies

14. SA 1: Development of the CCAH • Pharmacist managed • Two days per week (10-15 hours) • Located in proximity to Pediatricians • Referred by Pediatrician or self-referral • Detailed to all Pediatricians in area • Serve as a clerkship site to 4th year pharmacy students

15. SA 2: Assessment of Children • Assessments conducted • Complete medical history • Weight, height, body mass index • Waist circumference • Blood pressure measurement • Point-of-care testing • Blood glucose • Lipid profile (TC, HDL, LDL, triglycerides) • High sensitivity C-reactive protein • Quality of life assessment

18. SA 2: Assessment of Children • Detailed analysis provided to referring physician with recommendations • Further testing • Treatment • When indicated, referral to dietician and/or fitness program • Pharmacist will educate the child/adolescent and parent/guardian one healthy lifestyle • Exercise • Disease prevention • Medication (when appropriate)

19. SA 3: Patient satisfaction/needs assessment • Survey provided to child/adolescent • Satisfaction with the CCAH • Determine what activities the child/adolescent would be interested in participating in • Survey provided to parent/guardian • Satisfaction with the CCAH

20. Study Participants • Available for all children & adolescents ages 6-18 • Will exclude pregnant females • No cost to the child/adolescent • Will not bill insurance

21. Data Analysis & Measurement Instruments

22. SA 1: Development of CCAH • Primary outcome: • Utilization (referrals) of the CCAH • Number (%) of physicians referring patients • Number (%) of children & adolescents attending • Secondary outcome: • Viability of the CCAH as a 4th year pharmacy clerkship site • Ability to meet learning outcomes required

23. SA 2: Assessment of Children • Primary outcome: • Improvements in the following parameters • Weight and BMI • Waist circumference • Diastolic and systolic blood pressure • Blood glucose • Total cholesterol, HDL, LDL, triglycerides • hs-CRP • Quality of life assessment • Descriptive, 2-tailed paired t-test (QOL—Mann Whitney t-test), p<0.05

24. SA 3: Patient satisfaction/needs assessment • Primary outcome • Satisfaction and acceptance of CCAH by children/adolescents and parents • Data collected from surveys

25. Current status…

26. Obstacles • Community partner is no longer involved • Explored other community partners • FLIPANY • Potential future partners being considered • Memorial Regional Hospital • Pediatric Associates

27. References • US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics 2010;361-7. • Benson L, et al. Trends in the diagnosis of overweight and obesity in children and adolescents: 1999-2007. Pediatrics 2009;123:e153-8. • Riley MR, et al. Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatricians and pediatric subspecialties. J Pediatr 2005;147:839-42. • Dorsey KB, et al. Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice. Arch PediatrAdolesc Med 2005;159:632-8. • Spivack JG, et al. Primary care providers’ knowledge, practices and perceived barriers to the treatment and prevention of childhood obesity. Obesity 2009;1-7 (advanced online publication) DOI: 10.1038/oby.2009.410

28. Stature-for-age & Weight-for-age Percentiles Available at: http://www.cdc.gov/growthcharts/

29. BMI-for-age Percentile Available at: http://www.cdc.gov/growthcharts/

30. Blood Pressure in Pediatrics

31. Lipid and Lipoprotein Distribution in Ages 5-19 years From: Pediatrics 2008;122:198-208