OBESITY SEARCH Program Southwest Community Health Center Grace Hwang, RN, SPNP Yale University SON
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 1991 70-80% obese adolescents remain obese 26.7% of adults in U.S. considered obese Cost: $147 billion in medical costs in 2006
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
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
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
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
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
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
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
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!
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!
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
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 http://cme.medscape.com/viewarticle/481633. Randall, M. (July 2010). Ranking States By Obesity Rates. The Wall Street Journal. Retrieved from http://online.wsj.com/article/sb100014240527487 04499604575407480181932468.html?mod=dist_s martbrief
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