Integrative Management of Childhood Obesity: Harnessing ... › ... › Session-1-Track-B-Obesity.pdfIntegrative Management of Childhood Obesity: Harnessing the Power of Community

Integrative Management of Childhood Obesity: Harnessing the Power of Community Partnerships

Presented By:

Deborah A. Hutcheon, DCN, RD, LD

Cara Reeves, PhD

Disclosures/Funding: None.

GHS New Impact: A Healthy Lifestyles Program Team

Erin Brackbill, MD

Laure Utecht, MD

Cara Reeves, PhD

Deborah Hutcheon, DCN, RD, LD

Bethany Suddreth, MS, RD, LD

Disclosures & Acknowledgements

Presentation Objectives

Define overweight and obesity in youth age 2 to 20 years

Understand national statistics on overweight/obesity

Summarize health and social consequences of obesity

Analyze causes and contributing factors of obesity

Apply current pediatric obesity guidelines to practice –review implementation by GHS New Impact Program

Generate positive approaches and messaging through community partnerships to address pediatric obesity

Defining Overweight & Obesity in Youth Age 2 to 20 Years Old

Body Mass Index (BMI) Equation

Weight in Pounds x 703(Height in Inches)2

1. Square Height in Inches (Inches x Inches)

2. Divide Weight by Product of Height

3. Multiple by 703

CDC BMI Calculator for Youthhttps://nccd.cdc.gov/dnpabmi/Calculator.aspx

National Survey of Children’s Health, 2016

Childhood Overweight & Obesity 31.2% Nationally, 2016

32.9% South Carolina, 2016 (Ranked 17th)

Obesity in Adults v. Youth (2-19)NHANES Data, 1999-2014

NCHS Data Brief, No. 219, November 2015

Obesity by Sex in Youth (2-19)NHANES Data, 2011-2014


Obesity by Race/Ethnicity in YouthNHANES Data, 2011-2014


Health Consequences of Obesity

George Washington University, National Public Health Week, 2013

Energy Balance: Energy Intake > Energy Output

BUT: Does not tell us why the obesity occurs.Also, Does not tell us how to prevent/treat obesity.

Is energy balance the cause or the outcome of obesity?

What Causes Obesity?The Conventional Response Is…

How Can We Treat Obesity?The Process is Complex!

Matarese L et al. Nutr Clin Pract. 2014;29(6):759-767.

AAP Guidelines (2007)

Barlow S. Pediatrics. 2007;120(4):S164-S192.











Chronic Care Model


Environment Medical System

Family

School

Worksite

Community

Information Systems

Decision Support

Delivery System Design

Self-Management Support

Family and Patient Self-Management

USPSTF Recommendation for Obesity Screening (2017)

USPSTF. JAMA. 2017;317(23):2417-2426.

AND Evidence Analysis Pediatric Weight Management

Henry BW. J Acad Nutr Diet. Article in Press.

New Impact: A Healthy Lifestyles Program

TreatmentLifestyle and Behavior ManagementDiet, Exercise, Sleep, Parenting

Approach

Multidisciplinary, Multicomponent ProgramFamily-Based Program with 1:1 SessionsTotal Diet (Food-Based) ApproachMotivational InterviewingPatient-Centered Goal Setting

Duration 6 Month Program

Visit Frequency Once a Month – Every 4 Weeks

PartnershipsRegional YMCAsCooking Demonstrations

Pediatrician Specializing in

Obesity

Primary Care Pediatrician

Registered Dietitian

Psychologist

Exercise Specialist

Sleep Medicine

Endocrinology

Nephrology

Feeding Therapy,PT, OT, SLP

Genetics


ComprehensiveMedical

Evaluation

Referrals to Sub-Specialists

Nutrition Assessment & Goal Setting

Referral to YMCA

MD 1 / RD 1Vitals

Review of Goals

Nutrition Education & Counseling

Review of Goals & Goal Setting

RD 2 – RD 5 MD 2 & 3Medical

Re-Evaluation

Follow-Up onSub-Specialist

Referrals

Review of Goals & Goal Setting

Return Care to PCP (MD3)


TreatmentPhysical Assessment at Beginning & End

Physical Activity / Exercise Goals

Approach5 Visits with YMCA Wellness Coach

Exercise at YMCA and at Home

Duration2-3 Month Reduced Rate Membership

Opportunities for Financial Scholarship

Visit Frequency Encourage Weekly Visits

Partnership with Regional YMCA Facilities


Encouraging Exercise at Homewww.ghs.org/movewell

GHS MoveWell Program

http://www.ghs.org/movewell

Focusing on Healthy Behaviors

• Eating a healthy breakfast (emphasis on protein)

• Increasing intake of vegetables and fruit (fresh, frozen, canned)

• Limiting sedentary (screen) time

• Incorporate regular physical activity – 1 hour per day

• Limiting consumption of sugary drinks (including fruit juice)


• Focusing on food quality rather than food quantity

• Learning proper portion sizes and food combinations

• Support consistent structure to meals and snacks (no skipping)

• Encouraging family meals away from electronics

• Limiting meals at restaurants (consider healthier options)

• Limit, not eliminate, “treat” foods

• Avoid rewarding and/or punishing with food (this includes candy)


• Substituting unhealthy snacks with healthy snacks

Protein Snack PLUS Carbohydrate Snack OR Vegetable Snack1 low-fat cheese stick ½ medium-large banana ½ cup cucumber slices2 slices low-fat cheese ½ medium-large apple 8 baby carrot sticks1 TBSP peanut butter ½ cup grapes 8 celery sticks2 TBSP roasted nuts ½ cup berries ½ cup bell pepper strips2 Tablespoons hummus 2 cup plain popcorn 3 mini bell peppers½ cup Greek Yogurt ½ cup unsalted pretzels ½ cup sugar snap peas½ cup cottage cheese 8 whole grain crackers ½ cup raw broccoli1-2 slices deli meat 1 granola bar ½ cup raw cauliflower1 hard cooked egg 2 graham cracker sheets ½ cup raw zucchini slices ¼ cup chicken salad 1 slice whole grain bread1 TBSP cream cheese 1 – 6 inch corn tortilla1 beef jerky stick ½ cup low sugar cereal


• Substituting unhealthy snacks with healthy snacks

Protein Snack PLUS Carbohydrate or Vegetable Snack = A Healthy Snack Station

Creation1 low-fat cheese stick 8 whole grain crackers cheese and crackers2 slices low-fat cheese 1 corn tortilla + 2 TBSP salsa cheese quesadilla1 TBSP peanut butter 2 graham cracker sheets peanut butter and crackers1 TBSP peanut butter 1 slice whole grain bread ½ peanut butter sandwich2 TBSP unsalted almonds 2 cups light popcorn “crunch and munch”2 Tablespoons hummus ½ cup unsalted pretzels pretzels and hummus2 Tablespoons hummus 8 baby carrot sticks carrot sticks and hummus½ cup plain Greek Yogurt ½ cup berries + ½ cup cereal fruit & cereal yogurt parfait½ cup cottage cheese ½ cup canned peaches cottage cheese and fruit1 slice turkey + cheese 1 slice whole grain bread ½ turkey+cheese sandwich¼ cup chicken salad 8 whole grain crackers chicken salad and crackers


• Encourage low-fat dairy intake (milk, yogurt, cheese)

• Encourage low sugar, high protein, high fiber intake

(Follow “10-5-5” Rule for foods such as cereal & granola bars)

o <10 grams of sugar

o 5+ grams of dietary fiber

o 5+ grams of protein

• Consider healthy sleep habits – at least 8 to 10 hours per night

Setting SMART Goals

Social Consequences of Obesity:Weight Stigma and Bias

What is Weight Stigma?

Social Devaluation Based on Weight

Views patient as lazy, unmotivated, lacking willpower or undisciplined

Who Contributes?

Parents and Other Family Members

Peers

Educators and Coaches

Healthcare Professionals

Community Partners

Society as a Whole – Social Media

Puhl RM et al. Am J Public Health. 2010;100:1019-1028.

Social Consequences of Obesity:Weight Stigma and Bias

• Focus on the child health, not weight

• Focus on behavior change, rather than weight loss

• Consider role of lifestyle as a whole, not diet alone

o Food / Home Environment

o Parenting Strategies

o Sleep Hygiene

o Emotional Intelligence / Psychosocial Aspects

o Physical Activity

Appropriately AddressingOverweight/Obesity in Children

• Involve the entire family, not single-out the child

• Consider age-appropriate, culturally-sensitive intervention

• Avoid the concept of “dieting” or “food restriction/elimination”

• Use “people-first” language



Volger S et al. Obesity (Silver Spring). 2012;20(1):147-150.

Words to Avoid Words to UseNormal Weight Healthy WeightBelly AbdomenChubbyFat/FatnessExcess FatHeavy/Large Size

Weight ProblemUnhealthy WeightOverweightHigh BMI

Weight Problem Unhealthy WeightUnhealthy BMI

Obese Obesity (A Disease)Obese Person Person with ObesityLose Weight Manage Weight

Improve Health


Approaches ExamplesNon-Directive Questions “Your child’s BMI is above the 95th

percentile. What concerns, if any, do you have about your child’s weight?”

Reflective Listening “Just so I understand, you eat 12 packets of ramen noodles and a 12-pack of regular Pepsi every day. What are your thoughts about how these foods are making you feel?”

Provide Positive Feedback

“That is great that you are choosing to drink chocolate milk only one time per day at school instead of two times a day at school.”


Approaches ExamplesExplore Motivation “Which goals would you like to work on

at this time?”

Explore Barriers “If I’m hearing you correctly, transportation is a challenge right now, so exercising at the YMCA may not be an option at this time.”

Explore Benefits “What are your thoughts on how limiting your intake of sugary drinks might make you feel at school? Do you think you would be more alert and less sleep?”


Approaches ExamplesCompare Values with Current Health Practices

“If I’m hearing you correctly, you are frustrated that Johnny is choosing chips, cookies, and soda for snacks. Where is he getting these foods?”

Discuss Solutions “How could your family work together to decrease snacking on chips, cookies, soda and increase snacking on fruits and vegetables?”

Establish a Specific Plan Aim to have 1 serving of vegetable at dinner at dinner at least 5 days a week


• AAP Bright Futures: https://brightfutures.aap.org

• AAP IHCW: https://ihcw.aap.org/

• Let’s GO! MaineHealth: https://mainehealth.org/lets-go

• USDA ChooseMyPlate: https://www.choosemyplate.gov/

• AND Kids EatRight: http://www.eatright.org/resources/for-kids

• Obesity Action Coalition: http://www.obesityaction.org/

Helpful Resources

https://brightfutures.aap.org/

https://ihcw.aap.org/

https://mainehealth.org/lets-go

https://www.choosemyplate.gov/

http://www.eatright.org/resources/for-kids

http://www.obesityaction.org/

Deborah Hutcheon, DCN, RD, LD

[email protected]

Cara Reeves, PhD

[email protected]

Questions?

mailto:[email protected]

mailto:[email protected]

Integrative Management of Childhood Obesity: Harnessing ... › ... › Session-1-Track-B-Obesity.pdfIntegrative Management of Childhood Obesity: Harnessing the Power of Community

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