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Update on Pediatric Obesity Lessons Learned Diane Dooley MD
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Pediatric Overweight Quality Improvement Project – 2005-7 Phase 1 Measure and Graph BMI for Age Counseling rates of overweight children Phase 2Phase 3
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Measurement and Feedback Chart reviews demonstrated 88% increase in rate of diagnosis and counseling
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Pediatric Overweight Quality Improvement Project Phase 1 Measure and Graph BMI for Age Counseling rates of overweight children Counseling rates, diagnosis and follow-up of overweight children Phase 2Phase 3
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CCRMC QIP Pediatric obesity Assess all children for obesity BMI Calculated, graphed – Percentile on well child form Diagnosis made by provider 85-94% Overweight, > 95% Obese Clinical Evaluation Assess for hypertension, acanthosis nigricans, hepatomegaly, slipped capital femoral epiphysis, asthma Family history of diabetes, early MI, hypertension, obesity
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Program Tools CDC growth charts/ BMI wheels Treatment algorithm Negotiation Sheet Order sheet Educational materials Community, health system referrals
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BMI-for-age For children, BMI changes with age Percentile correlates with body fat, secondary complications BMI-for-age definitions: 85-95% At risk for overweight >95% Overweight
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Pediatric Hypertension Use appropriate cuff size Risks: Obesity, family history of hypertension, History of prematurity, low birth weight, congenital heart disease, renal disease Evaluate blood pressure results based upon age, gender and height BP above 90% - prehypertensive BP above 95% - hypertensive
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NAFLD Non-alcoholic fatty liver disease Vague recurrent abdominal pain Prevalence 10-20% of overweight children Due to hyperinsulinemia, hepatic insulin resistance More common in Hispanics, Asians, American Indians Small percent progress to steatohepatitis, cirrhosis, hepatocarcinoma
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CCRMC QIP Pediatric obesity Assess health behaviors and attitudes Consider screening questionaire Negotiate a behavioral change Order any appropriate lab tests Fasting lipids, Fasting glucose, AST, ALT
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Screening recommendations for childhood diabetes 10 years old or onset of puberty Overweight (>85% BMI)+ 2 risk factors Family history of T2DM in first or second degree relative American Indian, Black, Hispanic or Asian/Pacific Islander Signs of insulin resistance (acanthosis, hypertension, dyslipidemia, PCOS)
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Pediatric Dyslipidemia Differential includes: Monogenic dyslipidemia Secondary lipid disorders: nephrotic syndrome, hypothyroidism, etc Idiopathic dyslipidemia Screening recommended: Family history CAD < 55 years or elevated cholesterol Risk of CAD: smoking, OW, sedentary
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Follow up and referrals Schedule a return visit Offer appropriate educational materials Consider referrals: Health educator, Registered dietician WIC, Food stamps School lunch program Headstart, preschool Obesity intervention program – e.g. WeCan, NEW Kids Pediatric specialty referral
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