Update on Pediatric Obesity Lessons Learned Diane Dooley MD.
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Transcript of Update on Pediatric Obesity Lessons Learned Diane Dooley MD.
![Page 1: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/1.jpg)
Update on Pediatric Obesity
Lessons LearnedDiane Dooley MD
![Page 2: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/2.jpg)
Pediatric OverweightQuality Improvement Project – 2005-7
Phase 1 Measure and
Graph BMI for Age
Counseling rates of overweight children
Phase 2 Phase 3
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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
![Page 4: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/4.jpg)
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
![Page 5: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/5.jpg)
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
![Page 6: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/6.jpg)
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
![Page 7: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/7.jpg)
Program Tools
CDC growth charts/ BMI wheels
Treatment algorithm Negotiation Sheet Order sheet Educational
materials Community, health
system referrals
![Page 8: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/8.jpg)
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
![Page 9: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/9.jpg)
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
![Page 10: Update on Pediatric Obesity Lessons Learned Diane Dooley MD.](https://reader035.fdocuments.net/reader035/viewer/2022062718/56649e845503460f94b85ff0/html5/thumbnails/10.jpg)
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
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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
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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)
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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
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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