Childhood Obesity Problems, Causes & Solutions by ONG against childhood obesity.
Integrative Management of Childhood Obesity: Harnessing ... › ... ›...
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Integrative Management of Childhood Obesity: Harnessing the Power of Community Partnerships
Presented By:
Deborah A. Hutcheon, DCN, RD, LD
Cara Reeves, PhD
Disclosures/Funding: None.
GHS New Impact: A Healthy Lifestyles Program Team
Erin Brackbill, MD
Laure Utecht, MD
Cara Reeves, PhD
Deborah Hutcheon, DCN, RD, LD
Bethany Suddreth, MS, RD, LD
Disclosures & Acknowledgements
Presentation Objectives
Define overweight and obesity in youth age 2 to 20 years
Understand national statistics on overweight/obesity
Summarize health and social consequences of obesity
Analyze causes and contributing factors of obesity
Apply current pediatric obesity guidelines to practice –review implementation by GHS New Impact Program
Generate positive approaches and messaging through community partnerships to address pediatric obesity
Defining Overweight & Obesity in Youth Age 2 to 20 Years Old
Body Mass Index (BMI) Equation
Weight in Pounds x 703(Height in Inches)2
1. Square Height in Inches (Inches x Inches)
2. Divide Weight by Product of Height
3. Multiple by 703
CDC BMI Calculator for Youthhttps://nccd.cdc.gov/dnpabmi/Calculator.aspx
National Survey of Children’s Health, 2016
Childhood Overweight & Obesity 31.2% Nationally, 2016
32.9% South Carolina, 2016 (Ranked 17th)
Obesity in Adults v. Youth (2-19)NHANES Data, 1999-2014
NCHS Data Brief, No. 219, November 2015
Obesity by Sex in Youth (2-19)NHANES Data, 2011-2014
NCHS Data Brief, No. 219, November 2015
Obesity by Race/Ethnicity in YouthNHANES Data, 2011-2014
NCHS Data Brief, No. 219, November 2015
Health Consequences of Obesity
George Washington University, National Public Health Week, 2013
Energy Balance: Energy Intake > Energy Output
BUT: Does not tell us why the obesity occurs.Also, Does not tell us how to prevent/treat obesity.
Is energy balance the cause or the outcome of obesity?
What Causes Obesity?The Conventional Response Is…
How Can We Treat Obesity?The Process is Complex!
Matarese L et al. Nutr Clin Pract. 2014;29(6):759-767.
AAP Guidelines (2007)
Barlow S. Pediatrics. 2007;120(4):S164-S192.
AAP Guidelines (2007)
Barlow S. Pediatrics. 2007;120(4):S164-S192.
AAP Guidelines (2007)
Barlow S. Pediatrics. 2007;120(4):S164-S192.
AAP Guidelines (2007)
Barlow S. Pediatrics. 2007;120(4):S164-S192.
AAP Guidelines (2007)
Barlow S. Pediatrics. 2007;120(4):S164-S192.
AAP Guidelines (2007)
Barlow S. Pediatrics. 2007;120(4):S164-S192.
Chronic Care Model
Barlow S. Pediatrics. 2007;120(4):S164-S192.
Environment Medical System
Family
School
Worksite
Community
Information Systems
Decision Support
Delivery System Design
Self-Management Support
Family and Patient Self-Management
USPSTF Recommendation for Obesity Screening (2017)
USPSTF. JAMA. 2017;317(23):2417-2426.
AND Evidence Analysis Pediatric Weight Management
Henry BW. J Acad Nutr Diet. Article in Press.
New Impact: A Healthy Lifestyles Program
TreatmentLifestyle and Behavior ManagementDiet, Exercise, Sleep, Parenting
Approach
Multidisciplinary, Multicomponent ProgramFamily-Based Program with 1:1 SessionsTotal Diet (Food-Based) ApproachMotivational InterviewingPatient-Centered Goal Setting
Duration 6 Month Program
Visit Frequency Once a Month – Every 4 Weeks
PartnershipsRegional YMCAsCooking Demonstrations
Pediatrician Specializing in
Obesity
Primary Care Pediatrician
Registered Dietitian
Psychologist
Exercise Specialist
Sleep Medicine
Endocrinology
Nephrology
Feeding Therapy,PT, OT, SLP
Genetics
New Impact: A Healthy Lifestyles Program
ComprehensiveMedical
Evaluation
Referrals to Sub-Specialists
Nutrition Assessment & Goal Setting
Referral to YMCA
MD 1 / RD 1Vitals
Review of Goals
Nutrition Education & Counseling
Review of Goals & Goal Setting
RD 2 – RD 5 MD 2 & 3Medical
Re-Evaluation
Follow-Up onSub-Specialist
Referrals
Review of Goals & Goal Setting
Return Care to PCP (MD3)
New Impact: A Healthy Lifestyles Program
TreatmentPhysical Assessment at Beginning & End
Physical Activity / Exercise Goals
Approach5 Visits with YMCA Wellness Coach
Exercise at YMCA and at Home
Duration2-3 Month Reduced Rate Membership
Opportunities for Financial Scholarship
Visit Frequency Encourage Weekly Visits
Partnership with Regional YMCA Facilities
New Impact: A Healthy Lifestyles Program
Focusing on Healthy Behaviors
• Eating a healthy breakfast (emphasis on protein)
• Increasing intake of vegetables and fruit (fresh, frozen, canned)
• Limiting sedentary (screen) time
• Incorporate regular physical activity – 1 hour per day
• Limiting consumption of sugary drinks (including fruit juice)
Focusing on Healthy Behaviors
• Focusing on food quality rather than food quantity
• Learning proper portion sizes and food combinations
• Support consistent structure to meals and snacks (no skipping)
• Encouraging family meals away from electronics
• Limiting meals at restaurants (consider healthier options)
• Limit, not eliminate, “treat” foods
• Avoid rewarding and/or punishing with food (this includes candy)
Focusing on Healthy Behaviors
• Substituting unhealthy snacks with healthy snacks
Protein Snack PLUS Carbohydrate Snack OR Vegetable Snack1 low-fat cheese stick ½ medium-large banana ½ cup cucumber slices2 slices low-fat cheese ½ medium-large apple 8 baby carrot sticks1 TBSP peanut butter ½ cup grapes 8 celery sticks2 TBSP roasted nuts ½ cup berries ½ cup bell pepper strips2 Tablespoons hummus 2 cup plain popcorn 3 mini bell peppers½ cup Greek Yogurt ½ cup unsalted pretzels ½ cup sugar snap peas½ cup cottage cheese 8 whole grain crackers ½ cup raw broccoli1-2 slices deli meat 1 granola bar ½ cup raw cauliflower1 hard cooked egg 2 graham cracker sheets ½ cup raw zucchini slices ¼ cup chicken salad 1 slice whole grain bread1 TBSP cream cheese 1 – 6 inch corn tortilla1 beef jerky stick ½ cup low sugar cereal
Focusing on Healthy Behaviors
• Substituting unhealthy snacks with healthy snacks
Protein Snack PLUS Carbohydrate or Vegetable Snack = A Healthy Snack Station
Creation1 low-fat cheese stick 8 whole grain crackers cheese and crackers2 slices low-fat cheese 1 corn tortilla + 2 TBSP salsa cheese quesadilla1 TBSP peanut butter 2 graham cracker sheets peanut butter and crackers1 TBSP peanut butter 1 slice whole grain bread ½ peanut butter sandwich2 TBSP unsalted almonds 2 cups light popcorn “crunch and munch”2 Tablespoons hummus ½ cup unsalted pretzels pretzels and hummus2 Tablespoons hummus 8 baby carrot sticks carrot sticks and hummus½ cup plain Greek Yogurt ½ cup berries + ½ cup cereal fruit & cereal yogurt parfait½ cup cottage cheese ½ cup canned peaches cottage cheese and fruit1 slice turkey + cheese 1 slice whole grain bread ½ turkey+cheese sandwich¼ cup chicken salad 8 whole grain crackers chicken salad and crackers
Focusing on Healthy Behaviors
• Encourage low-fat dairy intake (milk, yogurt, cheese)
• Encourage low sugar, high protein, high fiber intake
(Follow “10-5-5” Rule for foods such as cereal & granola bars)
o <10 grams of sugar
o 5+ grams of dietary fiber
o 5+ grams of protein
• Consider healthy sleep habits – at least 8 to 10 hours per night
Setting SMART Goals
Social Consequences of Obesity:Weight Stigma and Bias
What is Weight Stigma?
Social Devaluation Based on Weight
Views patient as lazy, unmotivated, lacking willpower or undisciplined
Who Contributes?
Parents and Other Family Members
Peers
Educators and Coaches
Healthcare Professionals
Community Partners
Society as a Whole – Social Media
Puhl RM et al. Am J Public Health. 2010;100:1019-1028.
Social Consequences of Obesity:Weight Stigma and Bias
• Focus on the child health, not weight
• Focus on behavior change, rather than weight loss
• Consider role of lifestyle as a whole, not diet alone
o Food / Home Environment
o Parenting Strategies
o Sleep Hygiene
o Emotional Intelligence / Psychosocial Aspects
o Physical Activity
Appropriately AddressingOverweight/Obesity in Children
• Involve the entire family, not single-out the child
• Consider age-appropriate, culturally-sensitive intervention
• Avoid the concept of “dieting” or “food restriction/elimination”
• Use “people-first” language
Appropriately AddressingOverweight/Obesity in Children
Appropriately AddressingOverweight/Obesity in Children
Volger S et al. Obesity (Silver Spring). 2012;20(1):147-150.
Words to Avoid Words to UseNormal Weight Healthy WeightBelly AbdomenChubbyFat/FatnessExcess FatHeavy/Large Size
Weight ProblemUnhealthy WeightOverweightHigh BMI
Weight Problem Unhealthy WeightUnhealthy BMI
Obese Obesity (A Disease)Obese Person Person with ObesityLose Weight Manage Weight
Improve Health
Appropriately AddressingOverweight/Obesity in Children
Approaches ExamplesNon-Directive Questions “Your child’s BMI is above the 95th
percentile. What concerns, if any, do you have about your child’s weight?”
Reflective Listening “Just so I understand, you eat 12 packets of ramen noodles and a 12-pack of regular Pepsi every day. What are your thoughts about how these foods are making you feel?”
Provide Positive Feedback
“That is great that you are choosing to drink chocolate milk only one time per day at school instead of two times a day at school.”
Appropriately AddressingOverweight/Obesity in Children
Approaches ExamplesExplore Motivation “Which goals would you like to work on
at this time?”
Explore Barriers “If I’m hearing you correctly, transportation is a challenge right now, so exercising at the YMCA may not be an option at this time.”
Explore Benefits “What are your thoughts on how limiting your intake of sugary drinks might make you feel at school? Do you think you would be more alert and less sleep?”
Appropriately AddressingOverweight/Obesity in Children
Approaches ExamplesCompare Values with Current Health Practices
“If I’m hearing you correctly, you are frustrated that Johnny is choosing chips, cookies, and soda for snacks. Where is he getting these foods?”
Discuss Solutions “How could your family work together to decrease snacking on chips, cookies, soda and increase snacking on fruits and vegetables?”
Establish a Specific Plan Aim to have 1 serving of vegetable at dinner at dinner at least 5 days a week
Appropriately AddressingOverweight/Obesity in Children
• AAP Bright Futures: https://brightfutures.aap.org
• AAP IHCW: https://ihcw.aap.org/
• Let’s GO! MaineHealth: https://mainehealth.org/lets-go
• USDA ChooseMyPlate: https://www.choosemyplate.gov/
• AND Kids EatRight: http://www.eatright.org/resources/for-kids
• Obesity Action Coalition: http://www.obesityaction.org/
Helpful Resources
Deborah Hutcheon, DCN, RD, LD
Cara Reeves, PhD
Questions?