Building Effective Partnerships to End Childhood Obesity

1. Building Effective Partnerships to End Childhood Obesity Stephen Cook, MD, MPH, Golisano Children’s Hospital at URMC

2. Disclosures • Grant funding: • NYS Dept of Health, • Children’s Institute, • NIH CBPR project • Boards: ABOM, AAP IHCW ..…and I used to work at a TJ’s Big Boy

3. Host a Community Screening

4. Declining childhood obesity rates — where are we seeing the most progress? DISPARITIES PERSIST To date, only Philadelphia has reported major progress in closing the disparities gap.

5. Stigma of Childhood Obesity • “The lot of fat children is a sad one. They are bashful and ashamed of their shapeless figures, yet unable to conceal them. Wherever they go they attract attention…..Obesity is a serious handicap in the social life of a child, even more so of a teenager. Obesity does not have the dignity of other diseases…” Bruch H. Pediatric Annals: 1975

6. Adolescents’ Perceptions of Peers Being Teased or Bullied: The Reason Why Perceptions of weight-based victimization among N=1555 high school students in Connecticut

7. Percentage of teen girls who report frequent weight teasing • Neumark-Sztainer. J Adolesc Health. 2009;44:206-213.

8. ObesityAlgorithm Example – medical risk or behavioral risk 10 years and older every 2 years Progress to next stage if no improvement in BMI/weight after 3-6 months and family willing Age 6-11yr = 1 lb/month, Age 12-18yr = 2 lbs/week average Age 2-5yr = 1 lb/month, Age 6-18yr = 2 lbs/week average

10. Children and Adolescents age 2 to 18 years of age

11. In Our Backyard

12. Health Foundation Healthy Weight Strategy GOAL: Reduce the prevalence of overweight and obesity from 15% to 5% of Monroe County children ages 2-10 by 2017 [from 12,144 kids to 4,081 kids] GOAL: Reduce the prevalence of overweight and obesity from 15% to 5% of Monroe County children ages 2-10 by 2017 [from 12,144 kids to 4,081 kids] Execute a community communications campaign Increase physical activity and improve nutrition Engage the clinical community Advance policy and practice solutions

13. Evidence-based Behavioral Strategies • Breastfeed • Limit sugar-sweetened beverages • Consume the recommended fruits and vegetables • Eat daily breakfast • Limit fast food • Use appropriate portion size • Eat meals together as a family • Limit television and screen time and keep televisions out of children’s bedrooms • Encourage moderately vigorous physical activity of 60 min/day or more • Ensure adequate sleep; 1-3yr: 12hr, 3-5yr: 11hr, 5-12: 10hr and try to get teens after 8.5 hrs of sleep at night

14. Parents estimation of child’s weight status vs. measured weight, 2-9yo Estimation of weight 193 parent/child dyads from Strong Pediatrics Tschamler, et al, ClinPeds, 2010;49:470

15. GROC Breakthrough Series (12 Months) How well do successful teams “hold the gains” after LS3? Participants Select Topic Pre-work Expert Meeting P P A D A D Develop Framework & Changes S S Beyond LS 3 LS 1 LS 2 LS 3 Planning Group • Supports • Emails • Office Visits • Phone Conferences • -Monthly Team Reports • -Assessments • Stages of Improvement • -test • -implement • -hold the gain • -spread Borrowed from IHI

19. Some Results from Our Practices

21. Overweight BMI 85 - 95%ile Healthy Weight Obese BMI >=99%ile BMI 5 - 84%ile BMI 95 - 98%ile Primary Care Setting ?

22. 3yr old WCC w/ pt Not Mykid 22

23. Pt NW, first seen at 3yrs and noted to be obese PNP informed pt in ‘Red zone’ as unhealthy. Can we discuss? 23

24. Pt MN 24

25. Dr. Colpoys at Genesee Pediatrics

26. Penfield Pediatrics

27. Unity Pediatrics

28. More Unity Pediatric Pics

29. Extent of Community Reach Monroe County, NY – Estimated Birth Cohort = 1,015 Cycle 3 56.0% n= 26 Cycle 2 46.3% (n = 17) Cycle 1 24.8% n=9

31. Results 5.0% - 10.0% 10.1% - 15.0% 15.1% - 20.0% 20.1% - 24.0% Monroe County, NY RFEI = Unhealthy Food Source Healthy Food Source Obesity by Neighborhood

32. Maps of Parks and Recreation Centers

33. Rec on the Move

34. “Rec on the Move” comes to the Doc Office

35. Foodlink Curbside Market

37. Additional Partners / Tools

38. Pediatric e-Practice: Optimizing Your Obesity Care

39. Healthy Active Living for Families

40. Structured Weight Management • AAP & Academy of Nutrition and Dietetics (former ADA): • Set of visits with PCP and RD • Based on motivation at start • Self monitoring and uses tracking forms

41. One City’s “Communities of Solution” Note: Political boundaries, shown in solid lines, often bear little relation to a community’s problem-sheds or its medical trade area. Adopted from Folsom M. Health is a Community Affair: Report of the National Commission on Community Health Service, 1967

42. Next steps • Pediatric Primary Care Practices and using EMR • Writing reports for data collection • CDC piloting EMR templates for surveillance • Linking Resources in Community with Patient Centered Medical Home • STRONG Pediatrics has medical home designation • RGH completing pediatric medical home • Highland FM and Anthony Jordan • Create Linkage and Test Stage 2: Structured Weight Managment • STOP Obesity Alliance: Community Health Benefit • Children’s Hospital Association: Focus on a Fitter Future / Stage 3:CMWM

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45. Thank you Department of Pediatrics, GCH@URMC