1. “Growing Healthy Kids III” Weight-Related Assessment and Management Tools for Youth Maria G. Boosalis, Ph.D., MPH, R.D., L.D. University of Kentucky Division of Clinical Nutrition

2. In Today’s Presentation Provide Tools & Resources to Identify & Assess Weight and Weight-related Co-Morbidities Provide Resources for Clinical Treatment Recommendations and/or “Best Practice” Advice

3. Identification of Weight Issues in Youth CDC Body Mass Index (BMI) for Age and Gender Growth charts available at http://www.cdc.gov/nchs/about/major/nhanes/grow thcharts/clinical_charts.htm#Clin%201 http://www.cdc.gov/nchs/about/major/nhanes/grow thcharts/clinical_charts.htm#Clin%201 Modules re: Measurement Techniques and Proper use of these Growth Charts are available at http://www.cdc.gov/nccdphp/dnpa/growthcharts/tra ining/modules/module2/text/intro.htm and http://www.depts.washington.edu/growth/module5/ text/page1atext.htm http://www.cdc.gov/nccdphp/dnpa/growthcharts/tra ining/modules/module2/text/intro.htm http://www.depts.washington.edu/growth/module5/ text/page1atext.htm

4. Identification/Treatment of Overweight/‘Obesity’ in Youth CDC Module on “Overweight Children and Adolescents: Screen, Assess and Manage” at http://www.cdc.gov/nccdphp/dnpa/growthchar ts/training/modules/module3/text/intro.htm http://www.cdc.gov/nccdphp/dnpa/growthchar ts/training/modules/module3/text/intro.htm Barlow & Dietz “Obesity evaluation & treat- ment: Expert committee recommendations. Pediatrics 102(3):e29, 1998 at http://www.pediatrics.org/cgi/reprint/102/3/e2 9.pdf http://www.pediatrics.org/cgi/reprint/102/3/e2 9.pdf

7. Identification/Treatment of Overweight/‘Obesity’ in Youth Certificate of Training in Childhood and Adolescent Weight Management, Commission on Dietetic Registration, 2004@ http://www.cdrnet.org/wtmgmt/chi ldhood.htm http://www.cdrnet.org/wtmgmt/chi ldhood.htm

8. Identification/Treatment of Weight-Related Co-Morbidities Cardiovascular Disease Hypertension Type-2 Diabetes

9. Identification/Treatment Cardiovascular Disease in Youth AHA Scientific Statement: AHA Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease beginning in Childhood. Kavey et al., Circulation. 107:1562- 1566, 2003 @ http://circ.ahajournals.org/cgi/content/ full/107/11/1562http://circ.ahajournals.org/cgi/content/ full/107/11/1562

10. Cardiovascular Health Promotion Goals for Youth [ Circulation 107:1562-1566, 2003 ] Diet: –Maintain an Overall Healthy Eating Plan –Maintain an Appropriate Body Weight –Maintain Desirable Lipid Profile/Blood Pressure Smoking: –Don’t ever Start/Stop if have Started –Stay away from Second-hand Smoke Physical Activity: –Be Physically Active every day –Reduce Sedentary Time every day

11. Kavey et al AHA Scientific Statement Circulation 107:1562-1566, 2003 Provides Guidelines for Identification of Children and Adolescents at High Risk of Cardiovascular (CV) Disease Provides Guidelines for CV Risk Reduction: Intervention for Children and Adolescents with Identified Risk

12. Identification/Treatment Cardiovascular Disease in Youth AHA Scientific Statement: Cardiovascular Health in Childhood: A Statement for Health Professionals From the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young. American Heart Association. Williams et al., Circulation 106:143-160, 2002 @ http://circ.ahajournals.org/cgi/content/full/106/ 1/143http://circ.ahajournals.org/cgi/content/full/106/ 1/143

13. Methods MD’s/HCP’s Can Use to Promote Desirable Body Weight [ Williams et al, Circulation 160:143-160, 2002] Identify obese children/adolescents and those at high risk of becoming obese (plot H/W/BMI, assess obesity in family as risk factor) Encourage a healthful diet to maintain a desirable weight ( take diet history, discourage use of food as reward, educate on nutritious snacks and on appropriate portion sizes) Encourage a more active lifestyle

14. Methods MD’s/Health Care Providers Can Use to Promote Physical Activity [ Williams et al, Circulation 160:143-160, 2002] Incorporate physical activity counseling into your practice (ask about patterns, encourage parents to move, recommend age specific activities) Encourage universal participation in increased physical activity (life-long vs team only sports) Improve children’s access to physical activity programs (advocate for school/neighborhood, promote life-long participation in & benefits of active lifestyle)

15. Identification/Treatment of Hypertension in Youth The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents Pediatrics 114(2):555-576, 2004 @ http://pediatrics.aappublications.org/cgi/conten t/full/114/2/S2/555http://pediatrics.aappublications.org/cgi/conten t/full/114/2/S2/555

16. “Hypertension” Definitions Pediatrics 114(2):555-576, 2004 Average SBP and/or DBP that is ≥95th percentile for gender, age, and height on ≥3 occasions. Prehypertension in children is defined as average SBP or DBP levels that are ≥ 90th percentile but <95th percentile. As with adults, adolescents with BP levels ≥120/80 mm Hg should be considered prehypertensive.

17. Identification/Treatment of Type-2 Diabetes in Youth Standards of Medical Care in Diabetes Diabetes Care, 27(90001):s15–s35, 2004 @ http://care.diabetesjournals.org/cgi/content/ full/27/suppl_1/s15 http://care.diabetesjournals.org/cgi/content/ full/27/suppl_1/s15 American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 23:381–379, 2000 @ http://care.diabetesjournals.org/cgi/reprint/ 23/3/381?ijkey=d4c7bdd0eab2508d12569adf 79658a68cc8ce324&keytype2=tf_ipsecsha http://care.diabetesjournals.org/cgi/reprint/ 23/3/381?ijkey=d4c7bdd0eab2508d12569adf 79658a68cc8ce324&keytype2=tf_ipsecsha

18. Identification/Treatment of Type-2 Diabetes in Youth An Update on Type 2 Diabetes in Youth From the National Diabetes Education Program. Pediatrics 114(1):259-263, 2004 @ http://pediatrics.aappublications.org/cgi/conten t/full/114/1/259 http://pediatrics.aappublications.org/cgi/conten t/full/114/1/259 Management of Dyslipidemia in Children and Adolescents With Diabetes. American Diabetes Association in Diabetes Care 26: 2194-2197, 2003 @http://care.diabetesjournals.org/cgi/content/f ull/26/7/2194http://care.diabetesjournals.org/cgi/content/f ull/26/7/2194

19. Bright Futures National health promotion initiative dedicated to the principle that every child deserves to be healthy and that Optimal health involves a trusting relationship between the health professional, the child, the family, and the community as partners in health practice. www.brightfutures.org

20. Organizations That Support Bright Futures American Academy of Pediatrics American Academy of Pediatric Dentistry American Dietetic Association American Medical Association National Association of Pediatric Nurse Associates and Practitioners American Academy of Physician Assistants American School Health Association American Public Health Association and many more…

21. Bright Futures Materials for Health Professionals

22. Bright Futures in Practice Series

23. Bright Futures in Practice: Nutrition (2002) Guide that emphasizes prevention and early recognition of nutrition concerns and provides developmentally appropriate nutrition supervision guidelines for infancy through adolescence. Includes information on hyperlipidemia, hypertension, diabetes, obesity and eating disorders, to mention a few. Contains reproducible master copies of nutrition questionnaires appropriate for use in families with infants, children, & adolescents.

24. Bright Futures in Practice: Nutrition (2002) Guidelines at http://www.brightfutures.org/nutrit ion/index.html http://www.brightfutures.org/nutrit ion/index.html Nutrition Questionnaires at http://www.brightfutures.org/nutrit ion/pdf/pocket.pdf http://www.brightfutures.org/nutrit ion/pdf/pocket.pdf

25. Bright Futures in Practice: Physical Activity (2001) Provides developmental guidelines on physical activity for the periods of infancy through adolescence and current information on screening, assessment, and counseling to promote physical activity at http://www.brightfutures.org/physicalactivity/ pdf/index.html http://www.brightfutures.org/physicalactivity/ pdf/index.html http://www.brightfutures.org/physicalactivity/ pdf/Tools.pdfhttp://www.brightfutures.org/physicalactivity/ pdf/Tools.pdf

26. Consensus in Pediatrics: “Childhood Obesity” Vol 1(4), 2004 Feld LG & Hyams JS, Editors Mead Johnson & Company Monograph that covers –Overview of Childhood Obesity –Complications of Childhood Obesity –Interventions for its Prevention and Treatment Nancy Cooperman, M.D., R.D., C.D.N, and Marc Jacobson, M.D., Schneider Children’s Hospital, NY Includes “Obesity Prevention Checklist” which covers –Identification of child/adolescent at risk and gives –Age Appropriate Interventions

27. Institute of Medicine [IOM] Report, 2005 In 2002, Congress charged the IOM to develop a prevention-focused action plan to decrease # obese youth in U.S. Action plan in Preventing Childhood Obesity: Health in Balance, 2005 @ http://www.iom.edu/report.asp?id=22 596 http://www.iom.edu/report.asp?id=22 596

28. 2005 Dietary Guidelines Advisory Committee Report @ http://www.health.gov/dietaryguidelines/d ga2005/report/ http://www.health.gov/dietaryguidelines/d ga2005/report/ Dietary Reference Intakes, IOM @ http://www.iom.edu/project.asp?id=4574 http://www.iom.edu/project.asp?id=4574

29. Thank you Any Questions?