part 1: frustrated with obesity management? 5210 & motivational interviewing to the rescue!
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Part 1: Frustrated with Obesity Management? 5210 & Motivational Interviewing to the Rescue!. Jamie Jeffrey, MD, FAAP Medical Director, Children’s Medicine Center & HealthyKids Pediatric Weight Management Program Clinical Associate Professor, WVU-Charleston - PowerPoint PPT PresentationTRANSCRIPT
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Part 1: Frustrated with Obesity Management?5210 & Motivational Interviewing to the Rescue!
Jamie Jeffrey, MD, FAAPMedical Director, Children’s Medicine Center &
HealthyKids Pediatric Weight Management ProgramClinical Associate Professor, WVU-Charleston
Project Director, KEYS 4 HealthyKids
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Objectives
1. Pediatric Policy Guidelines and 5210 for Prevention and Treatment of Pediatric Overweight/Obesity
2. Implementation of 5210, MI and goal setting into workflow
3. Motivational Interviewing 101
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1998
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2006
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2006
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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NHANES DATA
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Age of Onset of Pediatric Overweight and Obesity in CMC
Age of Onset of Pediatric BMI Shifting
-5
0
5
10
15
20
25
2 3 4 5 6 7 8 9 10 11 12 13 14
Age
Normal to Overweight
Overweight to Obese
Normal to Obese
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EtiologiesNature Vs
Nuture
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0
1
2
3
4
5
6
7
1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06
Year
Perc
ent w
ith D
iabe
tes
0
2
4
6
8
10
12
14
16
18
20
Num
ber
with
Dia
bete
s (M
illio
ns)Percent with Diabetes
Number with Diabetes
Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2008
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
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2008
Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes
Obesity (BMI ≥30 kg/m2)
Diabetes
1994
1994
2000
2000
No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%
No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
2008
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American Feast's Sustainable Food Blog
Pediatric Obesity……
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….is a chronic health disease…..a DIAGNOSIS Diabetes Hypertension Dyslipidemia Coronary Heart Disease Stroke Sleep Apnea Gallbladder Disease Osteoarthritis
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Chronic Care Model
Wegner, 1998
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Shift in Treatment Paradigm Educate, Educate, Educate
Pick issues important to patient- Educate, Educate, Educate
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Shift in Treatment Paradigm COLLABORATE!!
Patients make agenda when ready to change
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Expert Committee Guidelines
Pediatrics 2007;120;S164-192
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Maine “Keep ME Healthy”
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5210 Flip Chart
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UNIVERSAL ASSESSMENT OF OBESITY RISK Identification: Calculate and
plot BMI at every well child visit
Assessment: Identify medical risk, problem behaviors, and attitudes about healthy lifestyle
Prevention: Make a plan based on patients motivation, BMI category and risk factors
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BMI
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Obese
Overweight
Healthy Weight
Preventing obesity
starts with a
calculator & growth chart
OREMR that
does it all!
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BASIC DEFINITIONS Body Mass Index (BMI)= Weight (kg)/Height (m)2
BMI <5th %ile - Underweight BMI 5-84th %ile - Healthy Weight BMI 85-95th %ile, Overweight BMI >95th %ile or older adolescents
with BMI > 30 kg/m2, Obese
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Overweight
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Obese
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Blood Pressure-4th Report Pre-HTN
Stage I
Stage II
90%-<95%
95%- 99%
>99% + 5
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Blood Pressure
Correct Cuff Size– Cuff width cover
¾ between acromion & olecranon
– Cuff bladder length 80-100% of arm circumference
Manual vs Dynamap
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Acanthosis Nigricans
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Acanthosis Nigricans
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Acanthosis Nigricans
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LABORATORY WORK-UP
1. FLP
2. CMP (FBS, ALT/AST)
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The 15 minute Obesity Prevention Protocol Step 1-Assessment Step 2-Agenda Setting Step 3-Assess motivation Step 4-Sumarize and clarify Goal
easy…………………………..