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

$1000/year increase in medical costs on average for people who are overweight/obese

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

What to do?

One Resource for Talking to Families

http://www.mcph.org/Major_Activities/KeepMEHealthy/Guide_to_Effective_Communication.pdf

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

What about serving sizes?

And they vary by age…

4 staged-approach

1.Prevention Plus

2.Structured Weight Management

3.Comprehensive Multidisciplinary Intervention

4.Tertiary Care Intervention

BMI ≥85th

PCP monthly for 6 months

Goal: weight maintenance

No improvement? Stage 2

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

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

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

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

Meal Replacement

Very low calorie diet

Medication

Surgery

Multidisciplinary Team

Age (in years)

Weight Maintenance

Weight Loss <1b/mo

Weight loss <2lb/wk

2-5 85th-94th

≥95th

BMI>21

6-11 85th-94th

95th-98th

BMI≥99th

12-18 85th-94th

95th-98th

BMI≥99th

This is why you should care…

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

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.