OBESITY. SEARCH Program Southwest Community Health Center Grace Hwang, RN, SPNP Yale University SON
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1 OBESITY SEARCH Program Southwest Community Health Center Grace Hwang, RN, SPNP Yale University SON
2 BACKGROUND: STATISTICS 1 in 4 children in U.S. <17 yrs old considered overweight or obese 155 million obese children worldwide Rates have tripled since 1960 in pediatrics 35% increase since % obese adolescents remain obese 26.7% of adults in U.S. considered obese Cost: $147 billion in medical costs in 2006
3 BACKGROUND: WHAT IS OBESITY? Determined by Body Mass Index (BMI) Weight (kg) divided by square of height (m) Estimates child s adiposity levels via BMI-for-age growth chart Plot percentage against reference standards: <5 th percentile: underweight 5 th 84 th percentile: healthy weight 85 th - 95 th percentile: overweight 95 th percentile: obese
4 BACKGROUND: SECONDARY COMPLICATIONS Cardiovascular: Dyslipidemia, HTN, L ventricle hypertrophy, atherosclerosis Pulmonary: Asthma, obstructive sleep apnea, hypoventilation syndrome Hepatic: Nonalcoholic steatohepatitis + fatty liver disease Endocrine: Metabolic syndrome, DM2, polycystic ovarian syndrome Nervous: Pseudotumor cerebri Reproductive: Oligomenorrhea, amenorrhea Orthopetic: Slipped capital femoral epiphysis, Blount s disease Cancer: Breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate Psychologic: Quality of life, depression, negative self-image
5 BACKGROUND: ETIOLOGY Genetic, Environmental, Developmental Environmental factors: Diet high in calories, high in processed foods, low in fiber, lowdensity foods Sedentary lifestyle + decreased media time Decreased physical activity Psychosocial factors
6 OBJECTIVES For the Southwest Community Center: 1) Create a provider manual of patient/parent educational material on nutrition, exercise and decreasing media time 2) Assess whether nutrition counseling had any effects on BMI and the secondary consequences of obesity
7 METHODS: PROVIDER MANUAL Collection of various resources (websites, journals, etc.) printed + kept in binder for providers to educate + manage obese children Nutrition (food + beverages) Food pyramids, colors of nutrition, healthy choices, breakfast importance, milk + calcium, fiber, healthy cooking methods, fast food, reading labels, portion sizes, controlling cholesterol + triglycerides, diabetes prevention, picky eater tips, using food as reward or punishment Exercise Media time Self-management tracking + goals
8 METHODS: NUTRITION COUNSELING REVIEW Chart reviews ICD9 codes for abnormal weight gain from 8/09 8/10 as primary diagnosis BMI changes Abnormal lipid levels LFTs Glucose + insulin Diabetes HTN GI problems Sleep apnea RAD Orthopedic problems PCOS Family history
9 METHODS: NUTRITION COUNSELING REVIEW 99 patient charts reviewed total seen in nutrition: 84 Ave # of nutrition visits: 1.2 Ave 1 st BMI: 26 Ave last BMI: 25.9 Total abnormal insulin: 7 Total abnormal glucose: 2 Total DM dx: 0 Total HTN: 24 Total abnormal cholesterol: 21 Total abnormal LFT: 10 Total abnormal triglycerides: 11 Total GI problems: 8 Total RAD: 23 Total sleep apnea: 2 Total orthopedic problems: 1 Total PCOS: 0 (but 1 female had SxS of PCOS, not dx) Total family hx: 32 HTN, DM, Cholesterol
10 CONCLUSIONS: NUTRITION COUNSELING REVIEW A lot of abnormal cholesterol, HTN, asthma at such a young age! Some had dx of fatty liver disease! Asthma due to obesity? GI problems (constipation) due to diet? Must control cholesterol + HTN via diet + exercise!
11 CONCLUSIONS: NUTRITION CHART REVIEW Need better BMI tracking Need more nutrition counseling throughout the year Need better lab f/u Need to do more chart reviews!
12 CONCLUSIONS: PROVIDER MANUAL Obesity has so many secondary complications (already seen in chart reviews) Need more comprehensive + systematic way to treat obesity as a PREVENTABLE disease Protocol step-by-step interventions needed! Need to prevent + fix NOW for healthier lives LATER Difficulty finding Spanish handouts Packet will be sent to satellite offices in Bridgeport
13 REFERENCES: CMA Foundation and CAHP. (April 2008). Child & Adolescent Obesity ProviderToolkit. Hoppin, A. (September 2006). Assessment and Management of Childhood and Adolescent Obesity. Medscape CME. Retrieved from Randall, M. (July 2010). Ranking States By Obesity Rates. The Wall Street Journal. Retrieved from html?mod=dist_s martbrief
14 QUESTIONS?
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