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Primary Prevention of Childhood Obesity. Thomas N. Robinson, MD, MPH Division of General Pediatrics and Stanford Prevention Research Center Stanford University Center for Healthy Weight Lucile Packard Children’s Hospital at Stanford. Childhood Overweight. Childhood Overweight.

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Primary Prevention of Childhood Obesity


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    1. Primary Prevention of Childhood Obesity Thomas N. Robinson, MD, MPH Division of General Pediatrics and Stanford Prevention Research Center Stanford University Center for Healthy Weight Lucile Packard Children’s Hospital at Stanford

    2. Childhood Overweight

    3. Childhood Overweight

    4. Population Risk Factor Distribution

    5. Population Risk Factor Distribution

    6. Body Mass Index and CVD Risk Factors(Bogalusa, 5-10 year olds) Freedman et al. Pediatrics 1999;103:1175-82

    7. Barriers to Preventive Counseling • Insufficient time (duration and frequency of visits) • Lack of assessment and counseling skills • Lack of provider/patient knowledge & interest • Inadequate reimbursement • Uncertainty or doubt about efficacy • Frustration from past experiences • Personal weight control/behavior change experiences • Lack of organizational/system support

    8. Rationale for Primary Care-Based Prevention • Credibility with children and parents • Knowledge of developmental processes • Opportunity • Parent/guardian participation • Some evidence for short-term efficacy

    9. Preventing Childhood ObesityInstitute of Medicine2004 www.iom.edu/obesity/

    10. Background • Congressional request (2002) • Sponsors: CDC, NIH, ODPHP, RWJF • 19-member multidisciplinary committee • Task: prevention-focused action plan • 24 months www.iom.edu/obesity/

    11. Energy Balance Energy intake = Energy expenditure For children, maintain energy balance at a healthy weight while protecting health, growth and development, and nutritional status www.iom.edu/obesity/

    12. Action Plan forObesity Prevention • National Public Health Priority • Healthy Marketplace and Media Environments • Healthy Communities • Healthy School Environment • Healthy Home Environment www.iom.edu/obesity/

    13. IOM ReportRecommendations for Health Care • Incorporate screening and obesity prevention services into routine clinical practices • Disseminate evidence-based clinical guidance • Enhance training programs • Provide incentives - health plans and insurers • Accrediting organizations www.iom.edu/obesity/

    14. IOM ReportRecommendations for Health Care Health care providers • Track children’s BMI • Provide counseling • Serve as role models www.iom.edu/obesity/

    15. http://www.cdc.gov/growthcharts/

    16. IOM ReportRecommendations for Health Care Health care providers • Track children’s BMI • Provide counseling • Serve as role models www.iom.edu/obesity/

    17. IOM Reportrecommended behavioral targets • Exclusive breastfeeding for first 4 to 6 months • Provide healthful foods • consider nutrient quality and energy density • Encourage healthful eating behaviors • how often and what to eat • portion size • Encourage and support regular physical activity • Outdoor play • Walking/biking to school • Participation in community programs • Limit TV and recreational screen time to < 2 hours per day • Parents as role models www.iom.edu/obesity/

    18. Primary Care Television Reduction in 7-12 year old African-American Children (n=28):Four Week Changes * * p<.06 p<.005 * Significant within-group baseline to post-test change * * Ford BS, et al, Am J Prev Med 2002;22:106-109

    19. PROS Healthy Lifestyle Pilot StudyCDC, AAP, ADA • 3-7 year olds, BMI 85th-95th %’ile for age and sex or less than 85th %’ile and at least one overweight parent • Primary Care Practices Randomized • Usual care • Pediatrician counseling 1 visit (motivational interviewing) • Pediatrician counseling (2 visits) plus 2 additional dietitian visits (motivational interviewing) • Parent/child responsibility around food/eating • Reducing TV viewing • Also: Sweetened beverages, high fat snacks, F&V

    20. IOM ReportRecommendations for Health Care Health care providers • Track children’s BMI • Provide counseling • Serve as role models www.iom.edu/obesity/

    21. Motivations for physical activity and eating behaviors Medical/Public Health Professionals • Health concerns • Obesity • Diabetes • Hyperlipidemia • Hypertension • Family History of CVD, Cancer, diabetes • Depressive symptoms Children (and Adults) • Fun / Taste • Challenge • Pride, sense of accomplishment • Peer/social pressure or anticipated approval • Personal appearance • Social interaction • To please parents or other adults

    22. Key Principles • Keep it simple -- target behaviors and goals need to be simple, explicit & measurable. • Try to identify target behaviors that are motivating in themselves. • consider behaviors that “indirectly” influence your target behavior (stealth interventions). • Think less of what motivates you and more of what will motivate your patients/families. • Maximize dose (intensity, frequency, duration)