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

http://erlangerhealth.files.wordpress.com/2011/03/childrenslogo_cmyk.jpg

http://erlangerhealth.files.wordpress.com/2011/03/childrenslogo_cmyk.jpg

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