1. Faculty Disclosure Karla K. Lester, MD Dr. Lester has listed no financial interest/arrangement that would be considered a conflict of interest.

3. Developed in Collaboration:

4. Nebraska’s Clinical Childhood Obesity Model Healthcare Provider Toolkit Pocket Reference Algorithm Youth PA-N Assessment Form Training Video Office Posters Patient Education Brochures

5. Healthcare Provider Toolkit Complete reference Etiology/Epidemiology Role of the Provider Clinical Algorithm Assessment Prevention Treatment Resources

6. Training Video 1 Hour Training Video Reviewed and approved for AMA category 1 credit Summary of the Clinical Model Infused with Nebraska Physician Champion Interviews

7. Pocket Reference Algorithm Convenient Clinical Algorithm

8. Steps 1, 2, 3: Assess BMI % for Age Clinical History and Physical Exam Health Behaviors and Attitudes (Readiness to Change) Using the Youth Physical Activity and Nutrition Assessment Form

9. BMI: Body Mass Index Wt (kg) Ht (m ) 2 Wt (lbs) x 703 Ht (in ) 2 Centers for Disease Control, Division of Nutrition and Physical Activity, http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_BMI/about_childrens_BMI.htm

10. BMI PERCENTILE

11. Weight Status Category % Range Underweight: < 5% Healthy weight: 5 > 85% Overweight:85 > 95% Obese:> 95% Centers for Disease Control, Division of Nutrition and Physical Activity, http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_BMI/about_childrens_BMI.htm

12. Health Consequences or Comorbidities

14. Pulmonary Conditions Related to Obesity OSAS Obesity, snoring or apnea, hypertension, daytime sleepiness or hyperactivity, depression FI : OSAS, obesity Positive polysomnography study Wt reduction, ENT surgery, CPAP

16. Slipped Capital Femoral Epiphysis Tibia Vara

17. Pseudotumor cerebri Normal Retina

19. acanthosis nigricans

20. Laboratory Evaluation BMI Percentile 85 th to 94 th > 95th Laboratory Study Fasting Lipid Profile If other risk factors*- fasting Glucose, ALT, AST every 2 years Fasting lipid profile, fasting glucose, ALT, AST every 2 years Other tests indicated by history and physical *Risk factors: positive family history or patient with hypertension, hyperlipidemia, tobacco use. Obesity 360 Pediatrics

21. Assessing Health Behaviors and Attitudes

22. Youth Physical Activity and Nutrition Assessment Form To be used with ALL pediatric patients: ages 2-18 years old regardless of BMI status

23. Nebraska Youth Physical Activity and Nutrition Assessment (PA-N) Form

24. Assess Key Health Behaviors Prevention and Treatment Tool Patient-Driven Goal Setting Consistent Messages

25. Quick Reference: Back Circle age-appropriate column for patient and parents

26. Assess Attitudes for change

27. Setting Goals Number of Goals to Set: Zero if resistant to change (ambivalent) 1-2 if ready for change Degree of Change: Suggest: 20-50% change Is it realistic?

28. Counseling and Motivating Children and Families Open-Ended Questions Affirmation Reflective of patient/parent comments Summarizations that include patient/parent comments

29. Counseling and Motivating Children and Families Under 12, work with the parent or guardian: They control foods in the home and access to PA, TV and other screen time. Junior High (12 -14 yr.): Work with the motivated person(s), be sure to interview teen individually and ask about goals separately as well. High school age, work with the teen.

30. Office Posters Size: 11 x 17 Series of 12

31. Patient Brochures Front: Main Message Back: Education and Tips Size: 5 ½ x 8 ½ Series of 9

32. Poster & Brochure Topics Breakfast Daily Physical Activity Screen Time Fruits and Veggies Sugar-Sweetened Beverages Family Meal Time Portion Distortion Breastfeeding Role Modeling BMI

33. Nebraska’s Clinical Childhood Obesity Model FREE To Pre-Order: Email: Holly.dingman@nebraska.govHolly.dingman@nebraska.gov

35. Why Prevention? Prevention works when put into practice. Prevention of overweight is critical because long-term outcome data for successful treatment approaches are limited. Pediatrics Vol. 112 No. 2 August 2003, pp. 424-430 The risk of persistence of obesity increases with age. Early physical activity and dietary patterns track into adolescence and correlate with adult obesity. – Pediatric Nutrition Handbook

36. Without a systematic effort, the health care system response to childhood obesity is likely to be slow, poorly coordinated, and insufficiently effective. The Childhood Obesity Action Network

37. Mission and Vision The mission of the Childhood Obesity Prevention Project is to mobilize and engage physicians as advocates in their practice, communities and for statewide policies to reduce overweight and obesity in Nebraska children. “We envision physicians mobilized as leaders in our communities across Nebraska finding solutions to the growing epidemic of childhood obesity.”

38. To carry out its mission, the Childhood Obesity Prevention Project will provide: Education and Clinical Resources Community Outreach Policy Advocacy