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Childhood Obesity Screening and Surveillance

Childhood Obesity Screening and Surveillance. Barbara J. Moore, PhD* Rachel Pahut, RN‡ and Mary McCourt, BSW £ * Montana Nutrition and Physical Activity Program ‡Marias Medical Center, Shelby, MT £ Missoula City-County Health Department February 11, 2010 9:00 – 10:30 AM

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Childhood Obesity Screening and Surveillance

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  1. Childhood Obesity Screening and Surveillance Barbara J. Moore, PhD* Rachel Pahut, RN‡ and Mary McCourt, BSW£ *Montana Nutrition and Physical Activity Program ‡Marias Medical Center, Shelby, MT £Missoula City-County Health Department February 11, 2010 9:00 – 10:30 AM barbara.moore@att.net

  2. Topics • Planning, Safety and Confidentiality • Engaging parents and health care professionals in the community • What to consider and how to proceed • Measurement protocols • Calculating BMI and plotting age- and sex-specific BMI percentile

  3. Montana’s Health Ranking • Since 1990, Montana’s health ranking has steadily declined • Source: The Future Costs of Obesity (by Thorpe); United Health Foundation, APHA and Partnership for Prevention

  4. Montana’s Health Ranking • A major factor contributing to our declining overall ranking is Montana’s increase in obesity prevalence

  5. Trends in Obesity Prevalence in U.S. Children % DATA SOURCE: Ogden JAMA 2002 and Ogden JAMA 2006

  6. Growing % of Pediatric Diabetes is now Type 2 (Obesity-related) < 1990 2000

  7. Mortality in lean children (BMI quartile 1)vs. heaviest children (BMI quartile 4)Source: Franks et al. NEJM 362(6) Feb. 11, 2010

  8. E. Frongillo, Cornell University and B. J. Moore, Shape Up America!

  9. Adult Obesity is typically defined by BMI • BMI is “Body Mass Index” • BMI = weight (kg)/height (m)2 • BMI = [weight (lbs)/height (in)2] X 703 • Overweight  BMI 25.0 – 29.9 • Obesity  BMI 30.0 or higher

  10. Pediatric Assessment –BMI Percentile History • BMI = weight (kg)/height (m)2 • Requiresmeasuredheight and weight • Plot age-specific and sex-specific BMI Percentile on CDC growth chart (2000) • ≥85th - <95th percentile = “overweight” • ≥95th percentile = “obese”

  11. Reference Population of 5 year old females 50th Percentile 85th 5th 95th

  12. CDC Growth Charts - BMI 95th 95th 85th 85th 50th 50th 5th 5th

  13. Reference Population of 5 year old females 50th Percentile 85th 5th 95th

  14. For Children, BMI Differs by Age and Sex BMI BMI 95th BMI declines until age 3 – 5; then BMI increases thereafter Age BMI 2 yrs 19.3 4 yrs 17.8 9 yrs 21.0 13 yrs 25.1 Boys: 2 to 20 years 85th 50th 5th BMI BMI

  15. For this 10 year old girl with a BMI of 19.3, her BMI Percentile falls between the 75th and 85th percentile lines (normal weight) 85th 75th

  16. 95th 90th But 2 ½ years later, her BMI Percentile is above the 90th percentile so she is now categorized as “overweight” AND Her BMI trajectory is clearly upward (i.e. NOT tracking close to the 75th percentile) 85th 75th

  17. Is this boy obese? BMI BMI Example: 95th Percentile Tracking Age BMI 2 yrs 19.3 4 yrs 17.8 9 yrs 21.0 13 yrs 25.1 Boys: 2 to 20 years BMI BMI

  18. Growth Charts • “Children's Growth Charts Don't Measure Up With Parents” • Many don't understand how to read or interpret them, survey shows • You can help!

  19. In a normal population of 300 children … How many would you expect to meet the definition of “obese”?

  20. 5% 15 children Obesity is defined by the 95th percentile so only 5% would be expected to be obese.

  21. Childhood Obesity in Preschoolers, by Ethnicity % Anderson & Whitaker Arch PediatrAdolesc Med 2009;163(4):344-348

  22. Costs of Childhood Obesity –$15 billion (2004) “Children treated for obesity are roughly three times more expensive for the health system than the average insured child” Much higher rates of comorbidities >3X higher hospitalization rates 2X physician visit rates

  23. Risk of Childhood Obesity Increases if One or Both Parents Obese

  24. Vicious Cycle More obese children aregrowing up to be obese adults and obese parents. Their children are more likely to be obese What can be done to break the cycle ?

  25. Preventing Childhood Obesity: Health in the BalanceInstitute of Medicine2005

  26. School-based BMI programs • Screening programsmeasure children to identify those at risk • Send confidential letters home to parents on BMI status of child • Encourage referral to local professionals if appropriate for more thorough evaluation • Expensive but good for prevention

  27. U.S. Preventive Services Task Force (USPSTF) January 2010 Recommendation Statement on Screening for Obesity in Children and Adolescents The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status.Grade: B recommendation. See also: Pediatrics in January 2010 (Pediatrics 2010;125:361-367. http://www.pediatrics.org).

  28. School-based BMI programs • Surveillance programs measure children and calculate percentages of overweight and obesity at each grade level (and by sex) to assess health, inform policy and track progress • Can be limited to a single grade level or to two or more grade levels • Provide a “snapshot” on health status

  29. Planning • Funding for equipment and staff • School Nurse(s) • Orientation and Training of Staff • Wellness Committee • Parents involved/supportive • Local Health Care Professionals alerted • Data handling and storage

  30. Safety • Respect for students (↓trauma ↓stigma) • Accurate data • Clean, private setting for measurements • Discourage comparing numbers • Be alert to anxiety (heaviest girls and boys small-for-age) • Permit opt-out (?) • Parent • Student

  31. Confidentiality • Think of how you will use and analyze the data, store it and maintain it in a safe place • Store for years if screening; matching • Disclose only to parent(s) or legal guardian(s) • Special circumstances (teen) ?

  32. What to consider? • Screening vs. Surveillance • What do you want the data for? • Budget constraints • Alerting parents they may opt out • Passive vs. Active • Alerting and engaging local health providers (prepare for referrals)

  33. School Wellness Committee • Can help garner support for screening and/or surveillance of children • Committee members: school nurse, food service personnel, administrators, teachers, parents, students and local health care professionals

  34. How to Proceed • Train staff • Choose and calibrate equipment • Adopt protocols for height and weight measures (test and re-test) • Agree on dates, place and time(s) • Establish process for data collection, analysis and storage • Prepare reports and communicate results

  35. Height Protocol

  36. Height Protocol • Errors in height measures are squared • Consult the CDC website and training resources • Research various stadiometers and select the best equipment your budget permits • If student body is large, this is essential

  37. Height Protocol • Think about straight lines and right angles • Use ONLY a clinical quality stadiometer to measure height • (QuickMedical.com; model 31-420)

  38. Height Protocol • Measure to nearest 0.1 cm (or 1/8 inch) and record value • Repeat measurement, having the child line up again, and record appropriate value immediately on data form. • Repeat measurements should agree within ½ cm or ¼ inch, if they do not, repeat measurement a third time.

  39. Weight Protocol • Consult the CDC website and training resources • Research various scales and select the best equipment your budget permits • Select scale that is durable • Detachable readout is recommended • Measure in metric units (confidentiality)

  40. Weight Protocol(Tanita.com)

  41. Recording Data • Do you need a recorder? • Date of birth? • Record sex/gender • Screening data year to year ? • Matching up student’s data next year? • ID numbers for students? • Record directly into Excel?

  42. Calculations • Use the CDC Excel Spreadsheet • Checks for error messages/bad data • Calculates data AND summarizes the data automatically • Graphs your data by grade level if you use a separate spreadsheet for each grade

  43. The Link to the CDC Spreadsheets(English and Metric) http://www.cdc.gov/healthyweight/assessing/bmi/childrens_BMI/tool_for_schools.html

  44. Measurements (Metric vs. English)

  45. Measurements

  46. Group Summary

  47. Group Summary

  48. Resources – Missoulawww.co.missoula.mt.us/measures/PDF/BMIReport08.pdf Contact Mary McCourt at McCourtM@ho.missoula.mt.us

  49. Resources - Massachusetts Includes guidelines for measuring non-ambulatory students To be revised in 2010

  50. Resources - Arkansas • www.ACHI.net • Arkansas measured all children in the state (now alternate grades) • Procedures well established

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