Post on 17-Dec-2015
HEALEDHealthy Eating and Living Education
Evaluation and Management of Childhood Obesity in the Primary Care Setting
Joani Jack, M.D.
Purpose of Training
To provide primary care physicians and staff with efficient, evidence-based
strategies for the assessment, prevention and treatment of
childhood obesity
Tennessee Chapter of the American Academy of Pediatrics
1999
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2009
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Tennessee Chapter of the American Academy of Pediatrics
Social-Ecological Model of Influences on Childhood Obesity
Tennessee Chapter of the American Academy of Pediatrics
● Widespread despair exists among physicians, parents, patients, educators, community leaders, and the public at large
● Despair leads to a tendency to “give up” on many levels, causing a worsening of the epidemic
Tennessee Chapter of the American Academy of Pediatrics
Lack of confidence
Failure to recognize and diagnose obesity
Lack of successful treatment options for the primary care setting
Uncertainty over next steps
Physician Barriers
Tennessee Chapter of the American Academy of Pediatrics
Perceived Physician Ability to Treat or Prevent Common Pediatric Conditions
Preventing and Treating Obesity: Pediatricians’ Self-Efficacy, Barriers, Resources and Advocacy, Ambul Pediatr 2005;5:150-156.
Tennessee Chapter of the American Academy of Pediatrics
What’s Wrong with this Picture?
Recommendations for Treatment of Child and Adolescent Overweight and Obesity, Pediatrics 2007, 120:S254-288
Tennessee Chapter of the American Academy of Pediatrics
Other Barriers
Parental perception of childhood obesity
The “What’s The Big Deal” phenomenon
Tennessee Chapter of the American Academy of Pediatrics
What’s the Big Deal?
The media: “America is getting larger... how can we capitalize on that?”
The parents: “Our whole family is overweight and we are doing just fine. It’s not like we can do anything about it, anyway…”
The doctor: “Fat parents have fat kids… I don’t have the time to keep beating my head against the wall.”
Tennessee Chapter of the American Academy of Pediatrics
What’s the Big Deal?
In a 2004 conference on obesity, the speaker asked the audience of healthcare professionals to answer on paper the following question:
People who are overweight
are ______________
Obesity Treatment and Prevention Conference, Seattle, WA, 2004Tennessee Chapter of the American Academy of Pediatrics
The Answers?
● Hopeless
● Lazy
● Pigs
● Impossible to help
● Unhappy
● Unmotivated
● Ugly
● Scary
Tennessee Chapter of the American Academy of Pediatrics
What’s the Big Deal?
A group of 10- and 11-year old children were asked to study pictures of children with varying disabilities and rank them according to acceptability.
The obese child was ranked below all the physical deformities, including missing an arm and facial disfigurement.Richardson, SA, et al, Cultural uniformity in reaction to physical disabilities,”
Amer Sociol Rev, 1961, 26:241-247.
Tennessee Chapter of the American Academy of Pediatrics
Childhood obesity IS a big deal, and it is our
responsibility, as the advocates of children,
to persevere in finding a solution.
Tennessee Chapter of the American Academy of Pediatrics
Glimmer of Hope
LESS… BETTER… MORE
LESS concern about things that we cannot control
BETTER preparation for the things that we can control
MORE success in the treatment of childhood obesity
Tennessee Chapter of the American Academy of Pediatrics
Implementation: What to do and how to do it
1.Risks and Target Behaviors
2.BMI Percentile and Weight Category
3.Readiness for change
4.History and Physical Examination
5.Intervention
6.Laboratory Evaluation
7.Referral
8.Follow-upTennessee Chapter of the American Academy of Pediatrics
Tennessee Chapter of the American Academy of Pediatrics
Tennessee Chapter of the American Academy of Pediatrics
Tennessee Chapter of the American Academy of Pediatrics
Tennessee Chapter of the American Academy of Pediatrics
Billing and coding
Office protocol
Map the workflow
Problem solving
Follow-up training
Implementation: What to do and how to do it
Tennessee Chapter of the American Academy of Pediatrics
Community pediatric offices◦ Comprehensive Medical Care◦ Hamilton Pediatrics◦ Pediatrics on Dodds◦ Soddy Daisy Pediatrics◦ Family Health Services
Academic Primary Care◦ University Pediatrics◦ UT Family Practice
Participants:10 Pilot Sites in Chattanooga, TN
Federally Qualified Health Centers◦ Dodson Avenue Health
Center◦ Southside Health
Center Community Family
Practice Office◦ Erlanger North Family
Medicine
Tennessee Chapter of the American Academy of Pediatrics
Outcomes
Tennessee Chapter of the American Academy of Pediatrics
What’s Next?
United Healthcare Community Plan has verbally committed to funding a statewide program for 2012-2013
Regional trainings in major cities
Train-the-trainer approach for office trainings in each city
Tennessee Chapter of the American Academy of Pediatrics
Primary Care◦ Academic general pediatric practice◦ Federally Qualified Healthcare Center pediatric
practice Public Health
◦ Chattanooga-Hamilton County Health Department◦ Women Infant Children’s program (WIC)◦ Headstart
Community◦ Community Health Worker◦ East Chattanooga Improvement, Inc◦ Educator/Parent of special needs child
Chattanooga Regional Healthy Weight Collaborative
◦ Action Plan and Team Development
◦ Healthy Weight Message
◦ Healthy Weight Assessment
◦ Healthy Weight Plan
◦ Sector Integration
◦ Policy Development and Implementation
Chattanooga Regional Healthy Weight Collaborative
Chattanooga Regional Healthy Weight Collaborative
Chattanooga Mobile Market
Chattanooga Food Desert
Chattanooga Food Desert
61,924 total population (2010 Census)
14, 546 children 0-17 (ACS)
18,019 people living below the poverty level (ACS)
6,728 children 0-17 living below the poverty level (ACS)
22 public schools
(Percent Population, Age 0 - 17, Below Poverty Level, 2006-10 ACS 5-yr Est.)
2 grocery stores
1 produce stand
64 corner stores and gas stations
324 Restaurants
23 fast food chain restaurants
(USDA, SNAP Retailers 2012)
Chattanooga Food Desert
Grocery Stores with One Mile Radius
Chattanooga Mobile Market Stops with One Mile Radius
Combined Radius Showing Improved Access To Healthy
Affordable Foods
Chattanooga Mobile Market