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Update on Pediatric Obesity

Update on Pediatric Obesity. Lessons Learned Diane Dooley MD. Pediatric Overweight Quality Improvement Project – 2005-7. Phase 1 Measure and Graph BMI for Age. Phase 2 Phase 3. Counseling rates of overweight children. Measurement and Feedback.

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Update on Pediatric Obesity

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  1. Update on Pediatric Obesity Lessons Learned Diane Dooley MD

  2. Pediatric OverweightQuality Improvement Project – 2005-7 Phase 1 • Measure and Graph BMI for Age Phase 2 Phase 3 • Counseling rates of overweight children

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

  4. Pediatric OverweightQuality Improvement Project Phase 1 • Measure and Graph BMI for Age Phase 2 Phase 3 • Counseling rates of overweight children • Counseling rates, diagnosis and follow-up of overweight children

  5. 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

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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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)

  12. 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

  13. 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

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