2. Pediatric Obesity KAMU Kansas Association for the Medically Underserved OBESITY MODULE 6 https://www.flickr.com/photos/joe_13/188297063/

3.  Module 1: Why is it so Hard to Lose Weight?  Module 2: Assessing and Documenting BMI  Module 3: Brief Treatment: ►Assess, Advise and Agree (AAA p )  Module 4: Intensive Treatment and Follow-up  Module 5: Resources and the Office Environment  Module 6: Pediatric Obesity 2 GOALS: WEIGHT MANAGEMENT TRAINING COMMUNITY HEALTH CLINICS Ann M. Davis, PhD, MPH, ABPP

4. What is it? How do we measure it? Who is most at risk? How should you treat it? What else can you do? PEDIATRIC OBESITY http://pixabay.com/en/child-kid-boy-snack- lollypops-164454/

5. 4 WHAT IS PEDIATRIC OBESITY? http://www.letsmove.gov/obesity

6. 5 WHY USE BMI PERCENTILE? http://www.letsmove.gov/obesity

7. Children are struggling with their weight 6 1 out of every 3 children is overweight or obese Ann M. Davis, PhD, MPH, ABPP

8. 7 PREVALENCE AMONG CHILDREN IN KANSAS Davis AM, Boles RE, James RL, Sullivan DK, Donnelly JE, Swirczynski DL, Goetz J. Health behaviors and weight status among urban and rural children. Rural and Remote Health 8 (online), 2008: 810. Available from: http://www.rrh.org.au.http://www.rrh.org.au

9. 8 HIGH RISK POPULATIONS

10. 9 WON’T THEY OUTGROW IT? NO ! A child who is overweight or obese at age 11 has already “taxed” their body to such an extent that they are significantly more likely to suffer these health consequences, even if they lose the weight as a teen.

11. 10 TREATING PEDIATRIC OBESITY Prevention Stage 1 = Prevention Plus Stage 2 = Structured Weight Management Stage 3 = Comprehensive Multidisciplinary Intervention Stage 4 = Tertiary Care Intervention Treatment Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity: Summary Report; Sarah E. Barlow and the Expert Committee; Pediatrics 2007;120;S164-S192; DOI: 10.1542/peds.2007-2329C

12. 11 IDENTIFY/DOCUMENT THE PROBLEM 1.Get accurate height and weight at EVERY visit 2.Measure height with recumbent or wall stadiometer 3.Calculate BMI percentile on EVERY child 4.If appropriate, make the weight diagnosis “Weight” “Excess weight” “Body mass index” “BMI” “Risk for diabetes & heart disease” ►Use the term “overweight” or “obese” as a medical diagnosis, and put the diagnosis in their medical chart. ►Show them their growth chart. Stadiometer: http://en.wikipedia.org/wiki/Height_gauge

13. 1.Limit sugar sweetened beverages 2.5 or more of fruits and vegetables a day 3.60 minutes of activity per day 4.2 or fewer hours of screen time per day 5.No TV in bedrooms** 6.Eat breakfast daily 7.Limit eating out 8.Encourage family meals 9.Appropriate portion sizes 12 STAGE 1 - PREVENTION PLUS ADVICE FOR EVERYONE: THE “9 HEALTHY BEHAVIORS”

14. 13 ORDER TESTING Order labs  BMI 85-94 th %ile with NO risk factors Fasting Lipid Profile  BMI 85-94 th %ile WITH risk factors Fasting Lipid Profile ALT and AST Fasting Glucose  BMI ≥ 95 th %ile Age 10 years and older Fasting Lipid Profile ALT and AST Fasting Glucose Other tests as indicated by health risks

15. 14 Weight Recommendations

16. 15 STAGE 2 - COUNSEL THE PATIENT Counsel the patient  Empathize  Reflect  “What is your understanding?”  “What do you want to know?”  “How ready are you to make a change (1-10 scale)?”  Provide  Advice or information  Choices or options  Elicit  “What do you make of that?”  “Where does that leave you?”  Commit  “What goal are you ready to set?”

17. 16 STAGE 2 - GOALS OF YOUR WORK Monthly family visits with health professional (with training in pediatric weight management/behavioral counseling) Health goal = Meet prevention goals More focused attention to lifestyle changes DO NOT tell them what changes to make Instead elicit “change talk” from them 3-6 months Goal = weight maintenance or a decrease in BMI velocity; Long term goal = BMI < 85th %ile

18. 17 STAGE 2 - TOOLS

19. 18 INTERNET RESOURCES

20. 19 STAGES 3 AND 4  Stage 3: Family-Based Behavioral Groups  Healthy Hawks at KU Med  Lasts 12 weeks  Free  Available in English and Spanish  Telemedicine-based, available throughout the state  Call: (913) 588-6300  Stage 4: Bariatric Surgery and Very Low Calorie Diets Sometimes Stages 1 and 2 Don’t Work

21. As a healthcare team member…. people listen when you talk!  Join the local school wellness committee  Bring healthier foods to potlucks that you attend  Encourage that group outings focus on an activity rather than food  Start a healthy recipe exchange at work  Start a wellness effort at your local place of worship  Put together a healthy families resources packet for your area – increase awareness of programs/supports in your community 20 WHAT ELSE CAN YOU DO?

22. RECAP: PEDIATRIC OBESITY IS A PROBLEM AND YOU CAN HELP 1.Pediatric obesity is a significant problem 2.It needs to be treated in childhood 3.Measuring/reporting/diagnosing using BMI percentile at every pediatric visit is key 4.Recommend the 9 healthy behaviors for everyone (Slide 12) 5.Increase efforts for those over the 85 th %ile 21

23. Please click on the link below to take the quiz for this module Ann M. Davis, PhD, MPH, ABPP Thank you! You may open the survey in your web browser by clicking the link below: KAMU Obesity Module 6 Quiz If the link above does not work, try copying the link below into your web browser: https://redcap.kumc.edu/surveys/?s=Ss9XLSTarS KAMU Obesity Module 6 Quiz https://redcap.kumc.edu/surveys/?s=Ss9XLSTarS If you have questions, please feel free to contact Leslie Sullivan, MS, Department of Preventive Medicine and Public Health, KU Medical Center lsulliv1@kumc.edulsulliv1@kumc.edu or 913-588-2791 22 PLEASE TAKE THE QUIZ TO COMPLETE THE MODULE