Bolling Concert for Classical Guitar (Clasicalguitar.blogspot.com)
LessonsFromPractice Bolling
Transcript of LessonsFromPractice Bolling
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PRACTICAL OBESITY CARE:
LESSONS FROM PRACTICE
Christopher F. Bolling, MD
National Program Chair, AAP Provisional Section on Obesity
Obesity Chair, Kentucky Chapter, AAP
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There is no timelike the present
LESSON #1
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GUIDELINES EXIST
American Academy of Pediatrics 2007 recommendations
www.aap.org/obesity
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AND MORE
SUPPORT TOO
NICHQ and the Childhood Obesity Action Network
www.nichq.org/childhood_obesity
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THE PROVISIONAL
SECTION ON OBESITY
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ACKNOWLEDGMENT TO
DO THE RIGHT THING
HEDIS measure from NCQA
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AND NOT JUST
ACKNOWLEDGED, BUT
MANDATED
HEDIS measure from NCQA
Healthcare providers should document BMI percentile for ageand gender annually in every patients chart between the agesof two and seventeen years.
Healthcare providers should document evidence of counselingfor good nutrition and activity annually in every patients chart
between the ages of two and seventeen years.
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SOME POWERFUL
PARTNERS
The Clinton Foundation &The American Heart Association
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WITH GREAT
RESOURCESAlliance for a Healthier Generation
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SUPPORT AT THE
HIGHEST LEVELS
Lets Move!
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SOME GOOD
TEAMWORKPhysicians should screen
for BMI percentile
Physicians should give a
prescription for goodnutrition and increasedactivity
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MY STATE (KENTUCKY) IS
REPRESENTATIVE
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www.ncsl.org/.../programs/health/ObesityMap.jpgThe National Survey of Children's Health, Overweight and Physical Activity Among Children: A Portrait of States and the Nation 2005; HRSA,Health, United States, U.S. Department of
Health and Human Services,Centers for Disease Control and Prevention, National Center for Health Statistics, 2007.
THE NEED IS STILL
VERY HIGH
http://www.ncsl.org/.../programs/health/ObesityMap.jpghttp://www.ncsl.org/.../programs/health/ObesityMap.jpg -
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Take Credit forWhat You Are
Already Doing!
LESSON #2
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KEEP SCREENING
BMI PERCENTILE!
BMI Percentile for age and gender
And the less savory alternatives:Abdominal circumference
Body fat analysis
Fitness assessment
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PRACTICE BASIC
PREVENTION
Promote breastfeeding
Encourage on demand feeding
Limit juice starting early on
Talk about feeding cuesPrepare parents for neophobia
Some great programs (more to follow!)
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Know yourcommunity
LESSON #3
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LIVE THE SOCIO-
ECOLOGICAL MODEL
You are not alone!
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Boys and Girls Clubs
Weight Watchers
TOPS
YMCA JCC
Health Clubs
Physical Therapy sites
Dietitians
Personal trainers Health Clubs
Parks and Recreation
School systems
Libraries
Child care providers
Churches
Neighborhood groups
Hospitals
Community Centers Colleges
Culinary Schools
Professional schools
Nurse organizations
Chambers of Commerce Children and Nature
Dairy Council
Professional SportsTeams
City Council members
Military recruiters
State legislators
Members of congress
Interested parents United Way
Wellness committees
Media
Various non-profits
Boy Scouts Girl Scouts
Extension Services
4 H
And so many more
AND KNOW YOUR
LOCAL RESOURCES
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Obesity Care in
your office iscompletely
scalable
LESSON #4
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Severity
Timing
Complexity
AND SCALABLE IN
DIFFERENT WAYS
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Pay attention toreadiness
LESSON #5
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Our Internal Medicine/Family Medicine brethren getthis because of dealing with substance abuse
Our patients behavior is their behavior Pediatrics is very prescriptive
Cold turkey is never an option
We cant let challenges with behavior change causeus to blame our patients
IS READINESS THE KEY?
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Provides us with a great opportunity to bemore effective
Fits well into practice
Allows a lot (or a little) for you to do Increasing numbers of training opportunities
Helps you overcome the I dont have time forthat! hurdle
And lastly
Its fun!
MOTIVATIONAL INTERVIEWING
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Set a goodexample
LESSON #6
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Does not mean you need to beperfect, just trying your best
The value of advocacy
Office wellness
Let your patients and parents seeyou out there!
SO, WHAT DOES
THAT MEAN?
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THINKING GLOBALLY
AND ACTING LOCALLY
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EVERYBODY
INTO THE ACT
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SEEING YOU IN ACTION
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Make it your own
LESSON #7
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BASE YOUR LEVEL OF
INTERVENTION ON
Your motivation
Your level of comfortYour resources
Your community
Your patients need
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Basic Training 14 MDs, 3 NPs, 2 PAs
Open to other patients, but all have been our own
All providers trained in screening and basic adapted MI
Patients referred after screening and readiness addressed
Referring provider orders basic labs
I do the initial visits (at least currently)
Follow-up with either me, our NP Amber (Nutrition Guru) orPA Rachell (Activity Guru)
Use CBT basic goal setting with MI counseling techniques
Patients pick goals and follow-up schedule
Frequently use local resources
OUR PROGRAM
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Handed outto interestedfamilies
BASIC TRAINING
INFO SHEET
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OUR LAB
SHEET
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GOAL
SHEET
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SPECIALIZED BEHAVIOR SHEETS
FROM CDC, USDA ETC
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OR FROM OTHER PROGRAMS
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GET CREATIVE!
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Pick some goodworkhorses
LESSON #8
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A GOOD PREVENTION
STRATEGY
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KEEPING IT GOING
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Pay attention to
outcomes, butkeep them in
perspective
LESSON #9
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Very important for many reasonsKeep your improvement cycles goingWeight management programs are
notoriously difficult to gauge assuccessfulHard to move the BMI needle, so look
at proven intermediate steps
Measure absolutely, but dont let itparalyze you from acting
OUTCOMES
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Organize yourreferral strategy
LESSON #10
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Prevention &HealthyLifestylePromotion
Identi-fication PracticeIntervention MidlevelReferral HighLevelReferral
SurgicalIntervention TreatmentFailure
Various Medical Providers
Environment
Schools
Community Interventions
Hospital Based Programs
THE OBESITY SPECTRUM
KNOW YOUR
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KNOW YOUR
TERTIARY CENTER
Diverse and effective centers
Obesity is a chronic disease: think ADHD,asthma
Stay engaged
Know your other resources, especiallydietitians
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Co-morbidities may need more than youcan give, but address them as your
comfort level increases Severe obesity-these patients can really
derail you if you arent careful
The social services dilemma
Easy to forget that readiness is still afactor
A FEW OTHER THOUGHTS
ON REFERRALS
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1) No time like the present2)Take credit for what you are already doing
3)Know your community
4)Its scalable5)Pay attention to readiness
6)Set a good example
7)Make it your own8)Pick some good workhorses
9)Be practical about outcomes
10)Organize your referral strategy
TEN LESSONS
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Please feel free to contact me
Christopher F. Bolling, [email protected]
859-341-5400 office
859-630-8403 cell
859-578-3172 fax
QUESTIONS?
mailto:[email protected]:[email protected]