Update on Pediatric Obesity Lessons Learned Diane Dooley MD

Pediatric Overweight Quality Improvement Project – Phase 1 Measure and Graph BMI for Age Counseling rates of overweight children Phase 2Phase 3

Measurement and Feedback Chart reviews demonstrated 88% increase in rate of diagnosis and counseling

Pediatric Overweight Quality Improvement Project Phase 1 Measure and Graph BMI for Age Counseling rates of overweight children Counseling rates, diagnosis and follow-up of overweight children Phase 2Phase 3

CCRMC QIP Pediatric obesity Assess all children for obesity BMI Calculated, graphed – Percentile on well child form Diagnosis made by provider 85-94% Overweight, > 95% Obese Clinical Evaluation Assess for hypertension, acanthosis nigricans, hepatomegaly, slipped capital femoral epiphysis, asthma Family history of diabetes, early MI, hypertension, obesity

Program Tools CDC growth charts/ BMI wheels Treatment algorithm Negotiation Sheet Order sheet Educational materials Community, health system referrals

BMI-for-age For children, BMI changes with age Percentile correlates with body fat, secondary complications BMI-for-age definitions: 85-95% At risk for overweight >95% Overweight

Pediatric Hypertension Use appropriate cuff size Risks: Obesity, family history of hypertension, History of prematurity, low birth weight, congenital heart disease, renal disease Evaluate blood pressure results based upon age, gender and height BP above 90% - prehypertensive BP above 95% - hypertensive

NAFLD Non-alcoholic fatty liver disease Vague recurrent abdominal pain Prevalence 10-20% of overweight children Due to hyperinsulinemia, hepatic insulin resistance More common in Hispanics, Asians, American Indians Small percent progress to steatohepatitis, cirrhosis, hepatocarcinoma

CCRMC QIP Pediatric obesity Assess health behaviors and attitudes Consider screening questionaire Negotiate a behavioral change Order any appropriate lab tests Fasting lipids, Fasting glucose, AST, ALT

Screening recommendations for childhood diabetes 10 years old or onset of puberty Overweight (>85% BMI)+ 2 risk factors Family history of T2DM in first or second degree relative American Indian, Black, Hispanic or Asian/Pacific Islander Signs of insulin resistance (acanthosis, hypertension, dyslipidemia, PCOS)

Pediatric Dyslipidemia Differential includes: Monogenic dyslipidemia Secondary lipid disorders: nephrotic syndrome, hypothyroidism, etc Idiopathic dyslipidemia Screening recommended: Family history CAD < 55 years or elevated cholesterol Risk of CAD: smoking, OW, sedentary

Follow up and referrals Schedule a return visit Offer appropriate educational materials Consider referrals: Health educator, Registered dietician WIC, Food stamps School lunch program Headstart, preschool Obesity intervention program – e.g. WeCan, NEW Kids Pediatric specialty referral