1 / 36

Unhealthy life-style choices: The Elephant in the Room!

Unhealthy life-style choices: The Elephant in the Room!. Lynn Clark, MS, RN-BC, CPNP-PC Lynn.clark@childrens.com Britney Cox, MS, RN-BC, CPNP-PC Britney.cox@childens.com Pain Management Nurse Practitioners Children’s Medical Center Dallas Although the world is full of suffering,

theola
Download Presentation

Unhealthy life-style choices: The Elephant in the Room!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Unhealthy life-style choices: The Elephant in the Room! Lynn Clark, MS, RN-BC, CPNP-PC Lynn.clark@childrens.com Britney Cox, MS, RN-BC, CPNP-PC Britney.cox@childens.com Pain Management Nurse Practitioners Children’s Medical Center Dallas Although the world is full of suffering, It is also full of the overcoming of it. -Helen Keller

  2. Conflict of Interest Disclosure • Conflicts of Interest for ALL listed contributors. • Clark, L: None • Cox, B: None A conflict of interest is a particular financial or non-financial circumstance that might compromise, or appear to compromise, professional judgment. Anything that fits this should be included. Examples are owning stock in a company whose product is being evaluated, being a consultant or employee of a company whose product is being evaluated, etc. • Taken in part from “On Being a Scientist: Responsible Conduct in Research”. National Academies Press. 1995.

  3. Objectives Participants will be able to: • Describe consequences of obesity and sedentary life-style on the health of pediatric patients • Learn 3 challenges for pediatric patients that impact the ability to make healthy life-styles choices • List 3 pain conditions (co-morbidities) that are frequently related to obesity and sedentary life-style • Describe an intervention that is helpful to address the elephant in the room in relation to managing pain

  4. Background on Obesity • Center for Disease Control Comparing children of the same age and sex • Overweight: BMI >85th - 95th percentile • Obese: a BMI at or above the 95th percentile • 17% (12.5 M)of US Children are obese • 33% (72 M) of US Adults are obese

  5. Do you know your BMI? BMI= pounds/(inches2) * 703 160/(662) *703 160/4356*703= 25.82185

  6. Epidemiology

  7. Trends

  8. Rates

  9. Culture Crisis • Obese children are more likely to become obese adults. • Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, and some cancers. • If children are overweight, obesity in adulthood is likely to be more severe.

  10. Nutrition Culture/ Practices • School influence • Sugary drinks & less healthy food • Advertising • Day cares not regulated like public schools • Lack of daily, quality physical activity in school • < 4 % of elementary schools have PE • Increasing portion sizes • Lack of breastfeeding support • TV and media • 2-4 hours daily

  11. Culture/ Practices Perceptions: • 67% of obese children were perceived as overweight by their mothers • 14% of overweight boys and 29% of overweight girls perceived themselves as overweight • Ethnic minority women have a great acceptance of body image than white women. Education: • Mothers with HS or less education were less likely to identify children as overweight

  12. Times have changed Poor Role Modeling: • 9 out of 10 kids are driven to school (compared to 50% a generation ago) • Home cooked meals are rare and fast-food and eating out are the norm. • Foods are more dense in calories Lack of Limit setting: • Fewer hours of sleep = higher likelihood for obesity • Screen Time • Limited adult exercise

  13. Familial Influence Study by Whitaker et al. (4432 families with 7078 kids) Incidence of childhood obesity: • 2 normal weight parents = 2.3 % • 2 overweight (but not obese) = 4.9% • 2 obese parents = 21.7% • 2 severely obese parents= 35.3% Association of child BMI has a stronger link to maternal BMI

  14. Socioeconomical

  15. Sedentary Lifestyle

  16. Dietary Risk Factors • Skip breakfast or lower energy meal • Eat lunch at school • Ate supper while watching TV > 5 days/wk • Separated/ divorce parents • Eating alone • High energy meal at dinner • Clean plate club • Snacking and watching TV (sedentary)

  17. Physical consequences include: Cardiovascular disease (70 % had 1 symptom & 39% had 2 or>) • Hypertension • high cholesterol/ triglycerides Endocrine • Hyperinsulinism • type 2 diabetes Neurologic • pseudo tumor cerebrii • Migraine/ Headaches • MS Respiratory • Asthma • OSA GU • Polycystic ovarian syndrome Gastrointestinal • Fatty liver disease • Gallstones • Gastro-esophageal reflux • Encopresis • Constipation • IBS • FAP • Low Vitamin D Musculoskeletal • Tibia vara (Blount’s) • Slipped capital femoral epiphysis (SCFE) • Musculoskeletal problems • Back pain • Chronic pain

  18. Psychological Consequences • Children < 15 yo–Victim of Bullying • Overweight = 26% more likely • Obese = 85% more likely • Aggression, withdrawn friendships, rumors, lies, name calling, teasing, hitting and kicking • Children > 15 yo who are obese are more likely to be a perpetrator of bullying • School based friendship clusters

  19. Psychological Consequence • Psychological crisis • Depression • Lower Self-esteem • Appearance • Widespread bias • Anxiety • Stress • Socially withdrawn

  20. Psychological Consequence • Poor quality of life

  21. Why… Obesity and pain? • Stress on joints • Inflamatory process

  22. Chronic Pain • Affects 25-37% of children and adolescents • Combination of pain and obesity • decreased QOL and functioning • BMI should be a routine screen for patients with chronic pain

  23. Pain Amplification • Adults: • 30% were overweight • 47% were obese • Pain Amplification symptoms are increased with sedentary life-style • Treatment includes exercise • Kinesophobia • Obesity contributes to the continued presence and increase in severity of symptoms

  24. Headache • Increased BMI = increase frequency & disability related to HA • Patients who lost wt had decrease in headache frequency • Overweight females are 4x more likely to develop headaches than normal-weight girls

  25. Chronic Back Pain • BMI > 30 = increase risk of LBP • Mechanical stress • CVD which decrease blood flow to the lumbar spine • Wt loss may or may not address pain • Children > 95% BMI are more likely to have LBP and pain in at least 1 joint.

  26. Lower extremity pain (knees, ankles, hips) • Mechanical issues • Overweight patients are at 2.2x higher risk for development of osteoarthritis • 69% of knee replacement surgeries in adult women are related to obesity

  27. Why is there an elephant in the room? • Emotional • Political • Controversial • Perception is skewed / cultural barriers • Lack of community education and support • Fear by provider of an emotional reaction • Fear of promoting disordered eating behaviors

  28. Addressing the elephant… • Addressing the vital statistics • Discuss BMI with the patient and family • State why we assess the whole patient and their behaviors • Nutritional, dietary behavioral and activity assessment • Diagnose the patient appropriately • Build trust to achieve outcomes

  29. Promote positive change in your practice • Communication and building trust • Collaborative process SMART goals • Set 1-2 nutrition goals • Set 1 physical activity goals

  30. Education • Hot Cheetos • Creative BASIC Handouts • Engaging the family • Address negative behaviors • Giving permission • Limit setting

  31. CDC-Division of Nutrition, Physical Activity, and Obesity • http://www.cdc.gov/nccdphp/dnpao/index.html

  32. Follow up • Follow up phone call at one month • Follow up appt at 2 months • Reassess and reevaluate goals • Global impression of change • Affect on pain • New goals • Discuss as a life style change

  33. Outcomes • Compliance with set goals • Functionality • Perception of improvement • Global impression of change

  34. Acheivements Participants will be able to: • Describe consequences of obesity and sedentary life-style on the health of pediatric patients • Learn 3 challenges for pediatric patients that impact the ability to make healthy life-styles choices • List 3 pain conditions (co-morbidities) that are frequently related to obesity and sedentary life-style • Describe an intervention that is helpful to address the elephant in the room in relation to managing pain

  35. Take home points • Recognize the epidemic • Address the elephant in the room • Listen • Ask • Act • Be SMART • Praise and reassess • Multimodal treatment is the Key!

More Related