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Childhood Obesity: Small Changes in clinic to make a big impact

Childhood Obesity: Small Changes in clinic to make a big impact. Why should you care?. 30 states have pediatric populations in which at least 30% of children are overweight/obese. Significant short- and long-term morbidity associated with being overweight Physiological and psychological

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Childhood Obesity: Small Changes in clinic to make a big impact

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  1. Childhood Obesity:Small Changes in clinic to make a big impact

  2. Why should you care? • 30 states have pediatric populations in which at least 30% of children are overweight/obese. • Significant short- and long-term morbidity associated with being overweight • Physiological and psychological • $1000/year increase in medical costs on average for people who are overweight/obese

  3. What Can You Do?Simple Changes in your Clinic…

  4. What to do? • Plot BMI percentile in ALL children • Show BMI percentile to parents at and talk about healthy lifestyle choices at EVERY visit • See those over the 85th monthly for 4-6 months

  5. One Resource for Talking to Families http://www.mcph.org/Major_Activities/KeepMEHealthy/Guide_to_Effective_Communication.pdf

  6. Anticipatory Guidance5-2-1-0…per day • 5 fruits and veggies • 2 hours or less of screen time • 1 hour of physical activity • 0 (restrict) soda, juice and other sugar sweetened beverages

  7. What about serving sizes?

  8. And they vary by age…

  9. Treatment • 4 staged-approach • Prevention Plus • Structured Weight Management • Comprehensive Multidisciplinary Intervention • Tertiary Care Intervention

  10. Stage 1 - Prevention Plus • BMI ≥85th • PCP monthly for 6 months • Goal: weight maintenance • No improvement? Stage 2

  11. When you have a patient whose BMI is >85%ile • This warrants monthly 15 minute office visits for 4-6 months • Things to discuss • BMI, PMH, Family history • Food intake: Fruits/veggies, soda, juice, fast food, portions, breakfast • Screen time/ daily activity • Feedback on current behaviors • Positive/Constructive

  12. 15 minute Office Visit Set agenda Which behaviors is the patient/family interested in changing, or would be easiest to change. Agree on possible targets. Assess motivation and confidence Rate each on a scale of 0-10 Summarize and probe possible changes Schedule follow-up visits as appropriate

  13. Stage 2 – Structured Weight Management • Calorie restriction • Structured daily meals/snacks • Over 60 minutes of active play per day • Less than one hour of screen time per day • Increased behavioral monitoring • Reinforcement for meeting behavioral goals • No improvement for 6 months? Stage 3

  14. Stage 3 – Comprehensive Multidisciplinary Intervention • Increased intensity of behavioral change strategies • Greater frequency of patient/provider contact • Inclusion of team members • Psychologist • Registered Dietitian • Exercise Specialist • Physician • Weekly visits for 8-12 weeks, followed by monthly visits • Individual or group

  15. Stage 4 – Tertiary Care Intervention • Meal Replacement • Very low calorie diet • Medication • Surgery • Multidisciplinary Team

  16. Assessment- Screening

  17. Weight Goals

  18. This is why you should care…

  19. We must try to end this vicious cycle for the health of our patients

  20. Take home (or to clinic) points • Overweight/obesity affects many children in this country with significant physiological, psychological and financial sequelae. • Anticipatory guidance AT EVERY VISIT, even for appropriate weight children, is essential to fight this epidemic. • Treatment begins in your office.

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