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Lynn Clark, MS, RN - BC, CPNP - PC Lynn. ns. com Britney Cox, MS, RN - BC, CPNP - PC Britney. ns. com Pain Management Nurse Practitioners.

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Presentation on theme: "Lynn Clark, MS, RN - BC, CPNP - PC Lynn. ns. com Britney Cox, MS, RN - BC, CPNP - PC Britney. ns. com Pain Management Nurse Practitioners."— Presentation transcript:

1 Lynn Clark, MS, RN - BC, CPNP - PC Lynn. ns. com Britney Cox, MS, RN - BC, CPNP - PC Britney. ns. 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 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

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

5 BMI = pounds /( inches 2 ) * /(66 2 ) * /4356*703=

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9 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 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 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 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 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

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16 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 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 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 Psychologic al crisis Depression Lower Self - esteem Appearance Widespread bias Anxiety Stress Socially withdrawn

20 Poor quality of life

21 Stress on joints Inflamatory process

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

25 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 Mechanical issues Overweight patients are at 2.2 x higher risk for development of osteoarthritis 69% of knee replacement surgeries in adult women are related to obesity

27 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 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

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30 Communication and building trust Collaborative process SMART goals Set 1-2 nutrition goals Set 1 physical activity goals

31 Hot Cheetos Creative BASIC Handouts Engaging the family Address negative behaviors Giving permission Limit setting

32 http :// www. cdc. gov / n ccdphp / dn pao / index. html

33 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

34 Compliance with set goals Functionality Perception of improvement Global impression of change

35 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

36 Recognize the epidemic Address the elephant in the room Listen Ask Act Be SMART Praise and reassess Multimodal treatment is the Key !


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