Downstart Healthy Lifestyles Center: An Approach with Emphasis on the Psychology of Healthy Living

Transcription

1 Downstart Healthy Lifestyles Center: An Approach with Emphasis on the Psychology of Healthy Living Eugene Dinkevich, MD Downstart Healthy Lifestyles Center Downstate Medical Center Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 1

2 Founded in 1860, was the first medical school in the US to bring teaching to the patient s bedside 8 th in number of alumni on faculty in US medical school, and 1 st in graduating MD s who practice in NY State Children s hospital within a hospital accredited by NACHRI Has all major pediatric specialists available Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 2

3 Challenge Pediatric Obesity Downstart Healthy Lifestyles Program Developed in 2003 to treat obese children Expanded in 2006 address obesity in the primary care setting Training practicing PCPs Training residents Focus on nutrition and psychology of behavior change Obesity prevention in young children Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices

4 Challenge: How to lose weight? What s wrong with diet and exercise Diet Problem: Implies temporary change in eating habits Downstart Solution: Gradual improvement in eating habits to match caloric intake to typical expenditure Teach basic aspects of healthy eating from reading the labels to practical tips for children Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 4

5 Is exercise enough for children to lose weight? Problem: Can t make up with exercise what you overeat 8oz soda =100cal, need to strenuously exercise for 15 min to burn that off No one drinks 8 oz anymore Snapple=12 oz Arizona=16 oz Why exercise: Delays onset of cardiometabolic disease Decreases emotional eating and cravings Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 5

6 Downstart Healthy Lifestyles Program Approach for an individual family Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 6

7 Obesity treatment and prevention must be age-specific Age categories Before conception and during pregnancy Infancy Toddlers Preschoolers Children before mid-puberty Children past mid-puberty Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 7

8 Toddlers: Patient AH: DOB F Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 8

9 Preschool: 3 yr, 10 mo old male Weight 2-4 yrs Stature 2-4 yrs BHx: FT, NSVD, 6lb, 8 oz, FHx: mother 24, father 34, MGM--NIDDM BMI 2-4 yrs Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 9

10 Track BMI! Obesity screening primary prevention Plot BMI Follow BMI % change Severe risk-seen in 15% of kids 85% become obese by 7 y Moderate risk-seen in 48% of kids 52% become obese by 7 y Low risk-seen in36% of kids 5% become obese by 7 y Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 10

11 Patient A: 9 months later Weight Height BMI Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 11

12 BMI Patient: Healthy African-American girl BMI between 8 th and 18 th percentile from 2 to 4 years old Gained 71% in BMI over 1.5 years Weight gain discussed at the 4.5 yr old visit Lifestyle/nutritional counseling started Age (yr) Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 12

13 BMI change over two years Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 13

14 Effective counseling for preschool familes*: assess current practices Nutrition: Eating outside of home per week: Intake of juice and milk daily: Eating breakfast per week: Portion sizes (optional) and/or snacks Activity: TV/screen time per week: Regular exercise per week: *Based on the 15 min obesity prevention protocol from Davis M. Pediatrics. 2007:120:S245 Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 14

15 Intervention: Assessment motivation, develop a joint plan Assess concern (scale of 1-10): Importance to change Confidence in being successful Develop 3 targets for change 2 Dietary targets Family choose from eating habits discussion Try for 1 positive (start eating breakfast) and one negative (cut down to 1 glass of juice, Fast food 2 times per months), be specific 1 Physical activity issues (Screen time, walking to school, playing in park, sports) Provide positive feedback Agree on a follow-up time (2-3 months) Adapted from: Barlow S. Pediatrics. 2007;120 Suppl 4:S Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 15

16 Downstart Program Group Therapy Focus on psychology of behavioral change Individual evaluation Medical evaluation and follow up Psychological evaluation and follow up Nutritional consultation Ludwig D, NEJM. 2007;357: Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 16

17 Downstart Group Therapy Program Based on the Epstein Model Components 20 sessions for children and parents (twice weekly x 10 weeks) and Nutrition curriculum (RD) Behavioral Modification curriculum (PhD Psychologist) Exercise: Afro-Caribbean Dancing Dance Show Epstein L. Health Psychol Jul;26(4): Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 17

18 Effectiveness Individual evaluations 276 children in 12 months Group therapy 52 children completed 75% of the program 50% lost weight 25% repeating cycles improves likelihood of sustainable behavior change Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 18

19 Thank you. Contact Information: Ms. Shevonne Williams Program Coordinator Downstate Healthy Lifestyle Program Eugene Dinkevich, MD Director, Downstart Healthy Lifestyles Program Optimizing Health Outcomes for Children: Innovative Approaches and Best Practices 19