Surgical Options for Obesity

Transcription

1 Surgical Options for Obesity W. Raleigh Thompson M.D., FACS Florida Hospital for Children The NEED Childhood obesity statistics At the start of FHFC Healthy100Kids / Weight and Wellnessand Mission:fit possible National Childhood obesity rate (ages 2-19) 17% (1) Since 1980, obesity prevalence among children and adolescents had almost tripled Childhood overweight andobesity % (2) estimated rate of childhood overweight and obesity Sources : Task Force Aims to Cut Obesity. Pediatric News June 2010 / Arch. Pediatr. Adolesc. Med May 3. 1

2 The NEED continues Childhood obesity is changing- Today Most recent NATIONALstatistics from CDC as published in JAMA (1, 2, 3) Preschoolshowed a 43% decline in obesity prevalence among children ages 2-5 years, decreasing from 13.9% in to 8.4% in Obesity and extreme obesity rates decline among low-income preschool children ( ) The 6-11 years age group experienced a slight declinein obesity from 18.8% in to 17.7% in The overall prevalence of obesity among youth in the U.S. was slightly down (16.9% from 17.1%) Teensobesity on the rise -Obesity increased in the year old group from 17.4% in to 20.5% in (3) Sources: 1.Center for Disease Control and Prevention 2. JAMA. 2014;311(8): doi: /jama th annual F as in Fat: How Obesity Threatens America's Future 2013 Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). Childhood Obesity Statistics Local, Central Florida Florida 34% Orange 32% Osceola 64% Estimated rate of childhood Overweight and Obesity in 5 Central Florida counties * Seminole 32% Brevard 27% Lake 36% *Florida Dept of Health Summary of School Health Services Picture by Bing Images 2

3 Statement by the CDC (1,2) Overall, there have been no significantchanges in obesity prevalence in youth or adults between and Obesity prevalence remains high and thus is important to continue surveillance. 1. Center for Disease Control and Prevention 2. JAMA. 2014;311(8): doi: /jama Referrals: PCP >320 Specialists Schools Prior patients School Outreach Launched Spring 2011 Edutainers Grant funding and Philanthropy Community Education Emeril Lagasse Foundation and ESY at OJA Childhood Obesity Weight and Wellness Program Launched June 2010 Child and Family National Partners Research / Publications Community Partners UCF 3 Satellite Locations 3

4 H100K Weight and Wellness Behavior Outcomes: 36 month Total enrollment to date (June 2010-April 2014) 1586 Retention rate 76% (goal >65%) Improved or Maintained 12Mos 24 Mos 36 Mos Count % Count % Count % Quality of Life (Pediatric Symptoms Checklist) % % % Depression (Childhood Depression Index 2) % % % Family Activity % % % Individual Activity % % % Fruit Consumption % % % Vegetable Consumption % % % BMI (measured in clinic) % % % Triglycerides (outside lab) % % % Increase in average patient acuity, mirroring national trend Teen morbid obesity The past year 94% of patients clinically obese Diagnosing medical conditions 22% had high triglycerides (349 kids) 20% had high LDL cholesterol (317 kids) 4% had high blood pressure (49 kids) 4

5 Practice/Program Progress Increased in-office efficiency Now 6 month program Staggered team schedules Orientation video Edutainers at workshops 2. Expanded programming Locations of workshops and Open Gym Wellness Workbook Master Manual Teen summer camp, support group Volunteers / Interns UCF and others More frequent touch points/health coaching Pictures by A. Fals, with permission Practice/Program Progress Practice integration Culture change FH Family Practice and Pediatrics Residencies PCP In-office support and education (Healthy Living Goals and Motivational Interviewing Checklist) Healthy Tips Flyers for FHMG practices 4. Focus on Teen morbid obesity 5. Continue to demedicalize Less blood draws Fun, Age-appropriate activities More motivation and inspiration Move practice to a health and wellness environment (CF YMCA) and increase visibility in community while offering a community-based program for families 5

6 Sustainability & Organic Expansion Partnership provides to Healthy100kids program Practice & Workshop locations expansion throughout CF Professional Physical Education and Trainers expansion of trained staff Discounted memberships to families / scholarships Partnership provides to YMCA Access to medical/clinical expertise regarding healthy living/ obesity - Healthy 100 Kids Certification Access to research regarding obesity Mission Similarity Christ centered business Promote healthy lifestyles Healthy100 and YMCA programming synergistic Grants, co-fundraising and future funding New Partnerships Emeril Lagasse Foundation Edible School Yard (ESY) at Community Give-back Garden hosts H100K / CCFW gardening workshops monthly H100K and FHFC Research team offers support and education for outcomes and potential future grant-funding / Mission:fit Dr. Fals and Team part of ESY Committee Board since Fall 2012 Projected ground-breaking of kitchen house: March 2015 Pictures by A. Fals, with permission 2014 Strategies New Web Launch May 1 st Continued community outreach and relevance Maintain and grow communicationwith primary care providers Identifying opportunities for expansionof reach and accessibility Consistently re-evaluating ways to improve the quality of programming Efforts to increase patient volumes while decreasing program expenses Research / publications partnership with UCF Research Sustainability 6

7 Future Plans 2014 and Beyond Address Teen obesity Integration of pediatric residency program Covering physician Adolescent Medicine Specialist receiving training from Dr. Falsin Obesity Medicine to run 1 day per week Teen Weight Management day from Aquatic Center at YMCA (projected start date Sept 2014) Expansion of YMCA locations from current 3 in 2014 to future 6 locations in Central FL in 2015 and beyond (see next slide) 2 nd team: Medical Provider (NP/ PA/ NP) Child psychologist Dietician Budget for remodeling, furnishing locations, EMR, etc Current locations for H100K / CCFW 2014 Possible future locations for H100K / CCFW 2015 and beyond 7

8 Potential Bariatric Candidates from CCFW BMI percentile Overweight 85-94%: 95, 6% Obese 95-98%: 730, 46% >99%: 761, 48% Criteria for Bariatric Surgery: Ages 13 with BMI /1586, 12% Insurance: 33% private, 58% government, 9% no insurance Ages 16 with BMI 40 49/1586, 3% Insurance: 24% private, 73% government, 4% no insurance Ages 13 with BMI 35 with co-morbidities (High BP, High insulin, High triglycerides) 249/1586, 16% Insurance: 28% private, 56% government, 16% no insurance Ages 16 with BMI 35 with co-morbidities (High BP, High insulin, High triglycerides) 257/1586, 16% Insurance: 13% private, 68% government, 19% no insurance 8

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10 What does BMI mean? 10

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17 Operative Approaches Gastric Sleeve Bypass and lap band 17