Download
improving obesity prevention and treatment in gps clinic n.
Skip this Video
Loading SlideShow in 5 Seconds..
Improving obesity prevention and treatment in GPS clinic PowerPoint Presentation
Download Presentation
Improving obesity prevention and treatment in GPS clinic

Improving obesity prevention and treatment in GPS clinic

95 Views Download Presentation
Download Presentation

Improving obesity prevention and treatment in GPS clinic

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Improving obesity prevention and treatment in GPS clinic H Sonali Magdo, DO PGY 2 CHLA

  2. Background:Prevalence of obesity in American children1

  3. Health consequences of obesity in childhood5,6 • Type II DM • Hypertension • OSA • Depression/low self esteem • Nonalcoholic fatty liver disease • SCFE • Pseudotumor cerebri

  4. Objectives 1. Review existing literature on childhood obesity 2. Identify the obstacles faced by physicians in a general pediatrics clinic in assessing and treating children who are overweight through use of survey 3. Provide physicians in GPS clinic with resources to improve prevention/ management of overweight and obesity

  5. Assessment of PCP management of obesity4 • Of all children who met criteria for obesity, only 53% of visits documented obesity • 69% documented an adequate dietary history • 15% documented activity level

  6. Medical history and PE

  7. Survey Results:Barriers to treatment of obesity/overweight

  8. Survey results clinic resources Survey Results: 1. Lack of time to counsel patients 2. Lack of clinic guidelines for disease management 3. Lack of knowledge of community programs Intervention: 1. Nutritional intake form 2a. Creation of chart (adapted from Pediatric Annals article) for reference in clinic b. Weight check form 3. Creation of booklet compiling community programs for overweight/obese children in LA

  9. Clinic flow chart Adapted fromAriza AJ, RS Greenberg, R Unger. Childhood overweight: management approaches in young children. Pediatric Annals. January 2004; 33(1): 33-38.

  10. Clinic weight check form ALTA MED WEIGHT CLINIC VISIT Place sticker here Date: Vital signs: Temp BP / (___%) HR RR ___ Weight (___%) Height____ (____%) BMI____ (_____%) Previous BMI ____ (____%) on __/__ Allergies: Medications:_____________________________ Do you see your child as ___ overweight ____ normal weight ____ underweight? Diet History: 1. How many meals a day do you eat? At the table, with whole family present? ______ 2. What is the largest meal of the day? How many snacks do you eat per day? ______ 3. How much juice do you drink? How much soda? ______ Activity History: 1. How many hrs of TV do you watch? How many hours of video games/computer time? ______ 2. How much exercise do you get? Exercise enough to sweat: how many times/week? ______ Medical History Questions: 1.Obstructive sleep apnea: Snoring? Gasping for breath at night/long pauses in breathing? _____ 2. Shortness of breath with exertion? _____ 3. Irregular/scant periods? Known history of PCOS? _______ 4. Headaches? (pseudotumor cerebri) ______ 5. Depression: Increased or decreased sleep? _______ Loss of interest in favorite activities? _______ Feelings of guilt, hopelessness, regret? ______ Low energy? ______ Difficulty concentrating? _______ Increased or decreased appetite? _______ Psychomotor retardation/agitation? _______ Suicidality? _______ (Depression= 4 of the above + feelings of depression or anhedonia for at least 2 weeks) 6. Binging/Purging? (children >8-9 yrs old) _______ Family History: 1. Race/Ethnicity: * African American *Hispanic *Asian/Pacific Islander *American Indian Caucasian 2. FHx of Type II DM in 1st or 2nd degree relative? ____ Yes No 3. FHx of obesity: Yes No One parent overweight? ______ Both parents overweight? ______ 4. FHx of cardiovascular disease: 1st or 2nd degree relative with MI, CVA, PVD, angina, sudden cardiac death before age 55? ______ Coronary arteriography + for atherosclerosis), coronary bypass, balloon angioplasty? _______ Parent with cholesterol >240? _______

  11. Clinic weight check form Focused physical exam: HEENT: Tonsillar hypertrophy ______ Dysmorphic features _______Papilledema_____ Neck: Palpable thyroid _______ Lungs: Heart: Abdomen: Hepatomegaly ______ Skin: Acne ____ Acanthosis nigricans ____ Hirsutism _____ Striae _____ Neuro: Developmental delay ______ Musculoskeletal: Buffalo hump ______ Digital anomalies ______ Spinal asymmetry ____ Genu varum ______ Genu valgum ______ GU: Abnormal genitalia ______ Labs: Fasting glucose** Lipid panel ________ Liver function panel______ Thyroid function tests (if linear growth is poor, family hx, palpable thyroid)_____ Referrals ____ ENT (OSA, disordered sleep breathing) ____ Overnight Sleep Study ____ Cardiology (Dyspnea on exertion, LDL > 110mg/dl, + FHx, BP > 95% for height and gender on 3 visits) ____ Endocrinology ____ Orthopedics/PT(Spinal asymmetry, genu varum/valgum) ____ Genetics (DD, dysmorphic, abnormal genitalia, digital anomalies) ____ Gastroenterology ____ Comprehensive Obesity Program (Powerplay, ENERGY, Fit Families, Happy Feet) ____ Nutrition referral **Screen for diabetes: Any child/adolescent who is overweight (BMI >85%) + 2 risk factors Screening should begin at age 10 or onset of puberty if puberty occurs at a younger age. Screen every two yrs Risk factors: 1st or 2nd degree relative Race (American Indian, African-American, Hispanic, Asian/Pacific Islander) Signs of insulin resistance/conditions associated with insulin resistance: acanthosis nigricans, hypertension, dyslipidemia, PCOS Current screening guidelines call for fasting glucose. (Random glucose, 2 hr post prandial glucose, HgAIc: not part of current guidelines) Follow up visit: 1 month 2 months Signature:

  12. Clinic recommendations

  13. Future projects • Evaluation of success of project • Survey of patients and their families • Creation of webpage linked to CHLA website to use for resources in the community • Creation of nutrition and activity handouts that are culturally sensitive

  14. Thank you! • Susan Wu, MD • Larry Yin, MD • Hope Wills, RD • Esther Berenhaut, RD • Yvonne Gutierrez, MD

  15. References: 1. Ogden, CL, Carroll MD, Curtin LR et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006 Apr 5 295; (13): 1549-1555. 2. Ariza AJ, RS Greenberg, R Unger. Childhood overweight: management approaches in young children. Pediatric Annals. January 2004; 33(1): 33-38. 3. Committee on Nutrition. Cholesterol in childhood. Pediatrics. Jan 1998; 101(1): 141-147. 4. Obrien SH, R Holubkov, EC Reis. Identification, evaluation and management of obesity in an academic primary care center. Pediatrics. Aug 2004; 114(2): e154-e159. 5. Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. Mar 1998; 101(3pt2): 518-525. 6. Hoppin, AG, ES Katz, LM Kaplan, GY Lauwers. Case 31-2006: A 15-year-Old girl with severe obesity. NEJM. Oct 2006; 355(15): 1593-1602.