1. A Tool Kit for Battling Childhood Obesity:
Implementing the ABCD Program for Childhood Obesity in Pediatric Primary Care
James Scibilia, MD
Kathleen Sweeney, CPNP

2. Background
Prevalence of obesity increased significantly from 1980 to 2004 (NHANES, 2004)
2-5 years 5.0% %
6-11 years 6.5%-18.8%
12-19 years 5.0% %
More than 9 million children and youth over 6 years of age are obese (Miller, 2007)
1 in 7 children in the United States are overweight (Harbaugh, 2006)
The probability of childhood obesity persisting into adulthood is estimated to increase from 20% at 4 years of age to approximately 80% by adolescence. (Caprio & Myron, 2005)

3. Implications for Children and Society
Physical Health
Type 2 Diabetes
Hypertension
Dyslipidemia
Glucose Intolerance/ Insulin Resistance
Hepatic Steatosis
Sleep Apnea
Orthopedic Complications
Emotional Health
Low self-esteem
Negative body image
Depression
Social Health
Stigma
Discrimination
Negative stereotyping
Bullying

4. AAP Recommendations Stage 2 - Structured Weight Management Protocol
Implemented by primary care provider highly trained in weight management
Development of a plan including specifics related to diet and macronutrients, physical activity, screen time
Increased monitoring and follow-up (AAP,2008)

5. Why ABCD Program?
Gap in primary care based programs for pediatric obesity
Lack of access to tertiary care based programs
Established relationships with primary care providers
Development of specific provider guidelines for ease and time constraints of implementation
Importance of program portability

6. Purpose of Program
Does a structured intervention program using a “tool kit” to deliver information regarding dietary modifications, nutrition education and activity recommendations in a pediatric primary care center influence the Body Mass Index (BMI) of children identified as being obese?

7. ABCD Program The “ABCD” acronym describes the intervention strategies:
A= “Activity Goals”
B= “Behavior modification”
C=“Close contact and counseling”
D= “Dietary Modifications”

8. Pilot Study
Twelve week program implemented by PCP based on diet and activity modifications(Unpublished data, manuscript in process)
ABCD Program for weight management in pediatric primary care appears to be associated with improvement and/or stabilization of BMI’s across all age groups (p=o.oo8)

9. Pilot Study Implications
Need for program revision – improved retention at 5 visits versus 6
Structured provider guidelines and parent/child educational binders
Recruitment based on family and child motivation and readiness to change
Portability assessed through multi-site implementation

10. ABCD Program Specifics
Cognitive Behavioral Theory/Motivational Interviewing
10 week program – 30 minute visits bi-weekly with same provider
Assessment of motivation, perceptions, co morbidities, family history
Assessment of current diet and activity patterns
Intake lab work –Lipid Panel, Liver Panel, FBS, Insulin
Individual binders consisting of educational materials/take home assignments
Pedometers and food/activity logs

11. ABCD Program Specifics
Individualized based on developmental level and specific issues
Health vs. Weight
Lifestyle Changes vs. Diet
Concrete & attainable goals set biweekly
Activity – Increase pedometer steps X 2000/day
Behavior – Identify triggers for “boredom eating”
Diet – Add fruit to breakfast 4x/week
Take home assignments
Compare 3 cereal box labels
Find 2 healthy fast food choices

12. Phase II Multi-Site Implementation BMI Changes
Tri-State Pediatrics
N=14, Retention 88%
Pediatrics South
N=17, Retention 92%
BMI Changes
Reimbursement Issues – Varies by carrier, Importance of appropriate coding

13. Future Implications School-Based ABCD programs
Partner with community resources
Web-based programs
Early identification and intervention by PCP
Follow-Up - Maintain lifestyle changes?

14. References
American Academy of Pediatrics. (2003). Committee on Nutrition Policy Statement: prevention of pediatric overweight and obesity. Pediatrics, 112(2),
Caprio, S., & Myron, G. (2005). Confronting the epidemic of childhood obesity. Pediatrics, 115(10),

15. References
Kaufmann, J. (2008). Developmental Differences in Adherence to the ABCD Program for Pediatric Weight Management. Unpublished manuscript, University of Pittsburgh Center for Research and Development.
Harbaugh, B.L. (2007). Nurses and families rising to the challenge of overweight children. Nurse Practitioner 32(3), 30-55, 42-43
Miller, J.L., Silverstein, J.H. (2007). Management approaches for pediatric obesity. Nature Clinical Practice Endocrinology and Metabolism, 3(12),