Post on 30-Dec-2015
Update on Pediatric Obesity
Lessons LearnedDiane Dooley MD
Pediatric OverweightQuality Improvement Project – 2005-7
Phase 1 Measure and
Graph BMI for Age
Counseling rates of overweight children
Phase 2 Phase 3
M e a s u re m e n t a n d F e e d b a c k
1 2 %
6 7 %
4 7 %
7 5 %6 8 %
8 8 %
0 %
1 0 %
2 0 %
3 0 %
4 0 %
5 0 %
6 0 %
7 0 %
8 0 %
9 0 %
1 0 0 %
%
H C # 1 H C # 2 H C # 3
2 0 0 4
2 0 0 5
2 0 0 6
C lin ic a l s ta f f d e m o n s tra te d s u b s ta n t ia l im p ro v e m e n t in th e ra te s o f c a lc u la t io n fo r B M I fo r a g e
Measurement and Feedback
0
10
20
30
40
50
60
70
Counseled
2004
2005
2006
2007
Chart reviews demonstrated 88% increase in rate of diagnosis and counseling
Pediatric OverweightQuality Improvement Project
Phase 1 Measure and
Graph BMI for Age
Counseling rates of overweight children
Counseling rates, diagnosis and follow-up of overweight children
Phase 2 Phase 3
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
Program Tools
CDC growth charts/ BMI wheels
Treatment algorithm Negotiation Sheet Order sheet Educational
materials Community, health
system referrals
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
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
NAFLD Non-alcoholic fatty liver disease
Vague recurrent abdominal pain Prevalence 10-20% of overweight childrenDue to hyperinsulinemia, hepatic insulin
resistanceMore common in Hispanics,
Asians, American IndiansSmall percent progress to
steatohepatitis, cirrhosis, hepatocarcinoma
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
Screening recommendations for childhood diabetes
10 years old or onset of pubertyOverweight (>85% BMI)+ 2 risk factors
Family history of T2DM in first or second degree relativeAmerican Indian, Black, Hispanic or Asian/Pacific IslanderSigns of insulin resistance (acanthosis, hypertension, dyslipidemia, PCOS)
Pediatric Dyslipidemia
Differential includes:Monogenic dyslipidemiaSecondary lipid disorders: nephrotic
syndrome, hypothyroidism, etc Idiopathic dyslipidemia
Screening recommended:Family history CAD < 55 years or elevated
cholesterolRisk of CAD: smoking, OW, sedentary
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