new the role of dental professionals in addressing childhood obesity · 2018. 2. 5. · actions and...

Calories, Cavities and Kids:The Role of Dental Professionals in Addressing

Childhood Obesity

Robin Wright, PhD

Director, Pediatric Oral Health Research and Policy Center

American Academy of Pediatric Dentistry

Childhood Obesity

In 1980, 6 percent of

children ages 6 to 17

were obese; rose to 18

percent in 2010.

Childhood Obesity

In 2011–2012, 17

percent of children

ages 2–18 were obese

32 percent were either

overweight or obese

8 percent of infants

and toddlers had high

weight for recumbent

length

Childhood Obesity

Obesity is Body Mass

Index (BMI) at or above

the 95th percentile for

children and teens of

the same age and sex

Overweight is BMI at or

above the 85th

percentile

Childhood Obesity

22 percent of Hispanic

children

20 percent of non-

Hispanic black children

17 percent of white,

non-Hispanic children

were found to be obese

Childhood Obesity

Psychological and

social impact

Health risk factors as

high blood pressure,

high cholesterol, and

pre-diabetes

Childhood Obesity

About 6 in 10 children

who are overweight

develop into

overweight or obese

adults

Childhood Obesity

About 6 in 10 children

who are overweight

develop into

overweight or obese

adults

Children ages 3-5 who

are overweight or

obese are 5 times

more likely to be

obese as an adult

Learning Objectives

1. Explain the association between sugar-containing beverages, caries and childhood obesity.

2. Describe the attitudes of both parents and oral health professionals toward nutritional and weight counseling in a dental setting.

3. Identify the barriers that prevent oral health professionals from providing interventions related to childhood obesity.

4. Recognize effective strategies for oral health professionals to address childhood obesity in collaboration with other health professionals.

Sugar-Sweetened Beverages

SSBs are the single

largest category of

caloric intake in

children ages 2-18

Sugar-Sweetened Beverages

SSBs are the single

largest category of

caloric intake in

children ages 2-18

Teens ages 14-18 drink

an average of 260

calories of added

sugars from SSBs a day

Caries and Sugar-Containing Beverages

Caries SCBs

Obesity and Sugar-Containing Beverages

Obesity SCBs

Obesity and Sugar-Containing

Beverages

A positive association between

SCB consumption among

children under 12 and both

total and central adiposity

Mixed results with only fruit

juice and total adiposity

The association with total

adiposity strongest among

children under 5

Frantsve-Hawley, et al., 2017

Caries and Obesity

Caries Obesity

Kantovitza, et al., 2006

Obesity, Caries and Sugar-Containing

Beverages

Caries Nutrition Obesity

Recommendations


Breast-feeding up to age 12 months

Breast-feeding more than 12 months

Academy of Pediatrics

No juice before one year of age

4 ounces a day for children ages 1–3

4–6 ounces for children ages 4–6

8 ounces for children ages 7–18

Recommendations

USDA 2015-2020 Dietary Guidelines

Sugar less than 10 percent of daily calorie intake

World Health Organization

Sugar less than 5 percent of total energy intake

Learning Objectives





2016 Survey on Attitudes/Actions

Toward Childhood Obesity and SSBs

Pediatric Dentist Survey

1,615 responses or 22

percent of the sample

Dental Hygienist Survey

2,361 responses or 7

percent of the sample

Actions and Intentions: Obesity

17 percent currently

offer childhood obesity

interventions

67 percent interested

in establishing a plan


17 percent of pediatric dentists currently offer childhood

obesity interventions

Curran, et al., 2010: 3 percent of GPs and 6 percent of PDs

provide obesity interventions

67 percent of pediatric dentists interested in establishing a

plan

Curran, et al., 2010: 50 percent interested


Obesity intervention methods currently performed.

(Rating Average for Always 5, Sometimes 3, Never 1)

Answer Options Rating

Average

Note signs of being overweight or obese in the

child’s chart

4.10

Weigh children and measure their height 3.71

Talk to parents about observations if a child shows

signs of being overweight or obese

3.64

Provide educational materials on childhood obesity 2.92



Average

Offer a referral for children identified as

overweight or obese

2.85

Calculate and interpret a Body Mass Index (BMI)

score for children ages 2 and older

2.75

Offer weight-related motivational interviewing or

other behavior-modification programs in my

practice

2.72

Follow up on interventions with additional contact 1.81

Provide parents with a self-administered screening

tool for childhood obesity

1.61

Actions and Intentions: SSBs

94 percent of pediatric

dentists currently offer

interventions on SSBs

93 percent interested

in establishing a plan

86 percent of dental

hygienists currently

offer interventions on

SSBs


Intervention methods for SSBs



Average

Talk to parents about my observations if a child shows

signs of high risk for caries

4.86

Note signs of high caries risk in the child’s chart 4.80

Provide educational materials on sugar-sweetened

beverages

3.78

Offer motivational interviewing or other behavior-

modification programs about the consumption of

sugar-sweetened beverages

3.59


Intervention methods for SSBs



Average


tool for consumption of sugar-sweetened beverages

2.09

Offer a referral to a dietitian or nutritionist for

children who have high consumption of sugar-

sweetened beverages

1.55

Follow up on interventions with additional contact 1.42

Perceived Parent Expectations

14 percent agreed that

parents are receptive to

obesity counseling in the

dental office

7 percent agreed that

parents think it is important

for dentists to screen

children for obesity

21 percent thought

screening for obesity would

make them appear more

professional/knowledgeable


14 percent agreed that parents are receptive to obesity counseling in the dental office

81 percent think parents are receptive to advice about consumption of SSBs

7 percent agreed that parents think it is important for dentists to screen children for obesity

84 percent agreed that parents think it is important for dentists to provide counseling about SSBs

21 percent thought screening for obesity would make them appear more professional/knowledgeable

72 percent agreed that SSB advice would make them appear more professional/knowledgeable


9 percent had been

asked for advice from

parents about obesity

85 percent had been

asked for advice about

SSBs

Perceived Parent Attitudes

Barriers to providing healthy weight

interventions (Rating average for Major Barrier

5, Minor barrier 3, Not a barrier 1)

Rating

Average

Lack of parental acceptance of advice about weight

management from a dentist4.15

Fear of appearing judgmental of parents and/or child

patients4.14

Fear of offending the parent 4.10

May create parent dissatisfaction with my practice 3.62

Perceived Parent Attitudes/Provider

Response

Barriers to providing healthy weight

interventions and provider action

Chi-

Square

Lack of parental acceptance of advice about weight

management from a dentist.0004

Fear of appearing judgmental of parents and/or child

patients>.0001

Fear of offending the parent >.0001

May create parent dissatisfaction with my practice >.0001

Actual Parent Attitudes

Scarcity of research

Primarily qualitative

with small groups

Generally positive

Some negatives

Learning Objectives





Perceived Barrier/Provider Response

Lack of time in the daily clinical schedule

Lack of trained personnel in my office to perform this

service

Lack of personal knowledge or training about

childhood obesity

Lack of knowledge about how to start the

conversation

Lack of reimbursement from 3rd-party payers

Lack of appropriate referral options

Perceived Barriers

No additional fees charged to parents for the services

Lack of available patient education materials on childhood

obesity

Dietary recommendations about childhood obesity are

ambiguous and/or confusing

Concern over legal risks

Lack of training in communication skills

Learning Objectives





Incentives

More approaches that add little time to a dental visit

More parents asking about obesity and weight counseling

More continuing education courses on childhood obesity

Clearer clinical guidelines on nutrition and obesity

Stronger clinical evidence of a link between childhood

obesity and dental disease

Increased availability of patient education materials

Increased credibility and satisfaction from parents

Strategies: Provide Interventions

Weigh children and measure their height

Calculate and interpret a BMI score for children ages

2 and older

Provide educational materials on childhood obesity


tool for childhood obesity

Note signs of being overweight or obese in the

child’s chart


Talk to parents about observations if a child shows signs

of being overweight or obese

Offer weight-related dietary counseling in my practice

Refer children identified as overweight or obese to a

specialist

Offer weight-related motivational interviewing or other

behavior-modification programs in my practice

Follow up weight maintenance counseling and other

interventions with additional communication, such as

phone calls, text messages, or emails


Talk to parents about observations if a child shows signs

of being overweight or obese

Offer weight-related dietary counseling in my practice

Refer children identified as overweight or obese to a

specialist

Offer weight-related motivational interviewing or

other behavior-modification programs in my practice

Follow up weight maintenance counseling and other

interventions with additional communication, such as

phone calls, text messages, or emails

Resources

National Maternal and Child Oral Health Resource Center

http://www.oralhealth4healthyfutures.org/

Centers for Disease Control and Prevention

https://www.cdc.gov/healthyweight/children/index.html

American Academy of Pediatrics

https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/provisional-section-on-obesity/Pages/Additional-Resources.aspx

Motivational Interviewing Network of Trainers

http://www.motivationalinterviewing.org/

Robert Wood Johnson Foundation

https://www.rwjf.org/en/our-focus-areas/focus-areas/healthy-children-healthy-weight.html

http://www.oralhealth4healthyfutures.org/

https://www.cdc.gov/healthyweight/children/index.html

https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/provisional-section-on-obesity/Pages/Additional-Resources.aspx

http://www.motivationalinterviewing.org/

https://www.rwjf.org/en/our-focus-areas/focus-areas/healthy-children-healthy-weight.html

Resources

AAPD

http://www.aapd.org/media/Policies_Guidelines/P_RecDietary.pdf

http://mouthmonsters.mychildrensteeth.org/

http://www.aapd.org/media/Policies_Guidelines/P_RecDietary.pdf

http://mouthmonsters.mychildrensteeth.org/

Calories, Cavities and Kids:The Role of Dental Professionals in Addressing

Childhood Obesity

Robin Wright, PhD

Director, Pediatric Oral Health Research and Policy Center


References

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new the role of dental professionals in addressing childhood obesity · 2018. 2. 5. · actions and...

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