Kerri Wade, RN, MSN, PPCNP-BC Children s Mercy APRN Annual Conference October 7, The Children's Mercy Hospital, 2016

Transcription

1 12345 Fit-Tastic: A Tool for Combating Childhood Obesity Kerri Wade, RN, MSN, PPCNP-BC Children s Mercy APRN Annual Conference October 7, 2016 The Children's Mercy Hospital, 2016

2 Disclosure I am a nurse practitioner, wife and mother who specializes in childhood weight management and I LOVE FOOD! No financial disclosures.

3 Objectives Provide recent data on obesity rates. Discuss weight bias and how it effects the care of patients. Introduce Fit-Tastic and Healthy Lifestyles Initiative. Share tools used in clinical care of children with obesity.

4 Projection 2030

5 Children s Mercy Clinics Well Child Checks Prevalence of Overweight/Obesity in All CMH PCC Patients by Age Group vs % 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 2-5 years 6-11 years years % 38.0% 43.1% % 39.0% 43.3% 16,557 children ( ). 16,277 ( ).

6 Parents Weight Status Prevalence of children living with a parent who is overweight/or obese

7 Multitude of Causes Graphic courtesy of

8 Medical Complications of Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Gall bladder disease Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gout Obesity Idiopathic intracranial hypertension Stroke Cataracts Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis

9 BARRIER TO CARING FOR PATIENTS WITH OBESITY

10 Weight Bias Imagine. -Unfair and poor treatment -For a characteristic that is always visible -All of the time

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13 Weight Bias and Stigma Inclination to form negative and unreasonable judgments, attitudes, stereotypes, and assumptions about an individual s character, skills, and abilities based on his or her weight Often results in victimization and discrimination The last acceptable form of discrimination

14 QUIZ It is important to be aware of your own weight bias as you care for patients with overweight.

15 Weight Bias It is not uncommon to initially answer these questions quickly and in a socially desirable way, because it can be difficult to confront a possible personal bias and its potential implications.

16 Weight bias Development of obesity is often the result of many factors, several of which may be out of the control of not only the child, but the family. This may feel very overwhelming for them.

17 Weight Bias It is likely that the child s family, and perhaps also the child, has previously tried to lose weight, was unsuccessful, and may feel defeated about future attempts. Empathic acknowledgement of the difficulty of weight loss can provide support and promote meaningful patient-provider rapport.

18 Weight bias A patient s other presenting problems and co-morbidities may not definitively be weight-related, so all relevant causes must be ruled out before assuming that a problem is due to weight. This will in part require active listening to what is being reported by the patient and family.

19 Weight bias The patient s family may have experienced weight-based victimization with a previous provider, so attending a follow-up appointment with a new one may be challenging and intimidating. For some, this resiliency demonstrates motivation to change. Therefore, use this encounter as a new opportunity to reinforce this readiness, as opposed to encouraging negative beliefs about health care for a child and family who has significant medical necessity.

20 Weight bias Each of these statements encourages evaluating the experience of medically managed weight loss from the patient and family s perspective. Providers can deliver better care by striving to hear and understand each individual patient and family s experience of obesity development and processes of change. Developed from: Preventing weight bias: helping without harming in clinical practice. Toolkits for health care providers. (2008. Updated 2011). Retrieved June 30, 2013, from

21 Tools you can use! The Children's Mercy Hospital, 2016

22 MAPPS for Change ELEMENTS OF MAPPS M- Consistent message (12345 Fit-Tastic!). A- Consistent assessment of weight status and behaviors. P- Customized healthy weight plan for all. P- Policies & environments that enable healthy eating and active living. S- Statistics and healthy lifestyles reach.

23 Consistent messages provide: Quick way to remember what is important Consistent message utilized by all partners Clear call to action Reminder that healthy weight is contingent on multiple factors Alignment with evidence on behaviors that impact weight Proven community approach 23

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25 MESSAGE: MESSAGE Expert Committee Guidelines recommendation Obtain moderate to vigorous physical activity for at least 60 minutes each day. Limit television and other screen. (CE) Eat a diet rich in calcium. Limit consumption of sugarsweetened beverages. (CE) Encourage consumption of diets with recommended quantities of fruits and vegetables. (ME) Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. (Barlow 2007)

26 A: Healthy Lifestyles Assessment Weight Status: BMI in adults BMI %tile in children Behaviors: 1. Physical activity 2. Screen time 3. Low or nonfat milk or yogurt 4. Water (not Sugary Drinks) 5. Fruit & Vegetables

27 Assessment 1. Height 2. Weight 3. BMI/ BMI %ile 4. Healthy Lifestyles questions

28 P- Customized healthy Participant centered education Focused Goals Materials reinforce healthy lifestyles message lifestyle PLAN

29 Creating a Through Collaboration

30 Screening questions added to Children s Mercy s EMR-care assistant asks & records in patient s chart

31 View the Healthy Weight Screen 31

32 Order a HWP 32

33 Choose a HWP topic 33

34 Document giving a HWP 34

35 Results 35

36 It s as easy as 12345! Want to be Fit-Tastic?

37 How to Join and Stay Connected. Join by signing up at Make your MAPPS for Change. M- How will you share and incorporate the Fit-tastic! message in your setting? A- Do you have way to incorporate Healthy Lifestyle assessment into your standard protocols and EMR? P- Participant centered education (Fit-Tastic! Materials available) P- How will your agency implement policy or environmental change that supports healthy eating and active living? S- Share your stories online via feedback report.

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39 Join the Movement

40 Implementation MAPPS for Change framework and quality improvement methodology helps ensure the steps taken to implement this have the ability to be sustained as well as track progress.

41 Laboratory Test Patient s Level Normal Range Body System Health Habit Glucose blood sugar HbA1c 3 month average blood sugar AST (liver enzyme) ALT (liver enzyme) Triglycerides Fats in the blood related to sugars Normal: (fasting) <200 (non-fasting) Normal < 5.7 Pre-diabetes % Diabetes > 6.5% Normal <25 Borderline High >40units/L Normal <25 Borderline High >40units/L Pancreas/ sugar in the blood/ Diabetes Pancreas/ sugar in the blood/ Diabetes Liver/Fatty Liver Disease 0-9yrs Normal <75 Borderline High Heart & >100 circulation/blood yrs vessel disease Normal <90 Borderline High >130 Stop drinking sugary drinks (juice, soda, sports drinks). Choose water or skim/1% milk. Eat less foods high in sugar like candy, baked goods, sugar cereals, granola bars. Eat less pasta, bread, rice, and starchy side dishes. Choose cereals/ crackers/ granola bars with less than 9 grams of sugar and with at least 3 grams of fiber. Do more physical activity. Eat less calories by reducing portion size and following the plate model. Total Cholesterol LDL (Lousy Cholesterol) Normal <170 Borderline High>200 Normal<110 Borderline High > 130 Heart & circulation/blood vessel disease Eat less animal fats (including whole milk). Choose low fat options: skim/1% milk, 2% cheese, chicken/ turkey without skin, fish. Use very small amounts of olive oil or canola oil. Do more physical activity. Eat less trans fat: fat found in boxed or packaged foods and fast foods. HDL (Healthy Cholesterol) Normal >45 Borderline Heart & circulation/blood Do more physical activity

42 Motivational Interviewing Readiness ruler

43 Have kids help in the kitchen

44 Get active as a family

45 Have family meals

46 Grow your own veggies

47 Nature prescriptions

48 Encourage outdoor play

49 Spanish Rx

50 Pharmacological treatment Orlistat FDA approved for over 12 years Phentermine Not recommended for under age 16 years 50

51 Off label medications Metformin Diabetes 2 nd generation antipsychotic weight gain, PCOS, pre-diabetes Topiramate Seizures strong hunger, poor satiety Naltrexone Opioid antagonist - Hedonic eating Buproprion Depression weight loss side effect Lisdexamfetamine ADHD Binge eating 51

52 Local resources Parks and Recreation Departments YMCA Referrals to PHIT Kids Weight Management Clinic (CMH) Referrals to Healthy Hawks (KU)

53 Questions? If you would like further information or training, please see the Healthy Lifestyles Initiative Table