web viewmipct clinical pathway: pediatric obesity. standards of care. educational information; ......

SMA

MiPCT Clinical Pathway: Pediatric Obesity

Standards of Care

Educational Information Outcomes Teaching Handouts

Community Resources

Health Professional Resources & References

Impact of Obesity

Obesity now affects 17% of all children and adolescents in the United States - triple the rate from just one generation ago.http://www.cdc.gov/obesity/childhood/index.html

Since 1980, obesity prevalence among children and adolescents has almost tripled.

There are significant racial and ethnic disparities in obesity prevalence among U.S. children and adolescents. In 2007—2008, Hispanic boys, aged 2 to 19 years, were significantly more likely to be obese than non-Hispanic white boys, and non-Hispanic black girls were significantly more likely to be obese than non-Hispanic white girls.http://www.cdc.gov/obesity/data/childhood.html

Patient / caregiver will verbalize understanding of weight control and importance of proactive management.http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

Facts for Families:Obesity in Children and Teenshttp://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/79_obesity_in_children_and_teens.pdf

Centers for Disease Control and Prevention (CDC):http://www.cdc.gov/healthyyouth/obesity/facts.htm

American Heart Association (AHA):http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/Obesity/Childhood-Obesity_UCM_304347_Article.jsp

American Academy of Pediatricshttp://www2.aap.org/obesity/

American Academy of Child and Adolescent Psychiatry (AACAP)http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_

NICHQ Measuresfor Cultural Competency Considerations for cultural diversity when managing childhood obesity.http://www.nichq.org/childhood_obesity/tools/NICHQ_CulturalCompetencyFINAL.pdf

NICHQ - Creating a Healthy Pediatric / Family Practice Office Environmenthttp://www.nichq.org/childhood_obesity/tools/CreatingOfficeEnvironmentfinal.pdf

NICHQ - Physician Involvement in Community Activityhttp://www.nichq.org/childhood_obesity/tools/PhysicianInvolvementinCommunityActionfinal.pdf

Health Equity Toolkit:http://www.cdc.gov/Obesity/Health_Equity/pdf/toolkit.pdf

1

SMA

Standards of Care


Community Resources


“In this year’s seventh annual survey of top health concerns conducted by the C.S. Mott Children’s Hospital National Poll on Children’s Health, adults rate childhood obesity as the leading health concern for children in their communities.” (August 19, 2013 publication)http://umhsheadlines.org/20/child-health-concerns-vary-among-different-races-ethnicities/?utm_source=HSH&utm_medium=email&utm_campaign=TopStory-child-health-concerns-vary-among-different-races-ethnicities

“Obesity and overweight have a negative impact on almost every organ system in the body. In addition to taking a toll on the physical health of children, obesity influences children’s quality of life, impactingtheir physical, social and

Pages/Obesity_In_Children_And_Teens_79.aspx

Robert Wood Johnson Foundationhttp://www.rwjf.org/en/about-rwjf/program-areas/childhood-obesity.html

National Institutes of Healthhttp://www.nlm.nih.gov/medlineplus/obesityinchildren.html

State resources:

Michigan Department of Community Health (MDCH): Healthy Kids, Healthy Michigan http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2959_51482---,00.html

Beaumont Healthy Kids Program

2

SMA

Standards of Care


Community Resources


psychological functioning.

In fact, obesity is associated with more chronic medical conditionsthan smoking or excessive drinking.”http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

Historically, children were diagnosed with Type 1 diabetes, usually a genetic disorder. However, 45% of children with new diagnoses of diabetes are now Type 2. Type 2 diabetes can be largely prevented with proper diet and exercise.http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

Beaumont Weight Control Center4949 Coolidge Highway, Royal Oak, MI 48073Phone: 248-655-5900 / 888-899-4600http://www.beaumontchildrenshospital.com/weight-loss

Health Alliance Plan – Weight ManagementHAP HMO Clients (800) 422-4641 Alliance Clients (888) 999- 4347E-mail: [email protected]://www.hap.org/health/programs/weightmanagement.php

Helen DeVos Children's Hospital Healthy Weight Center330 Barclay NE Suite 303, Grand Rapids, MI 49503Phone: 616-391-7999http://

3

http://www.helendevoschildrens.org/healthyweightcenter

http://www.hap.org/health/programs/weightmanagement.php



http://www.beaumontchildrenshospital.com/weight-loss



SMA

Standards of Care


Community Resources


www.helendevoschildrens.org/healthyweightcenter

Henry Ford Health System Pediatrics Let's Get Healthy!Phone:(313) 874-6653http://www.henryford.com/letsgethealthy

Henry Ford Weight Management ProgramHenry Ford Health System13355 E. 10 Mile Rd, Warren, MI 48089Phone: 800-HENRYFORDhttp://www.henryford.com/body.cfm?id=46426

Medical Network One / Michigan Institute for Health Advancement Kids and Teens Program4986 N. Adams Rd, Rochester, MI 48306Phone: 866- 648-3265http://

4

http://www3.mednetone.net/HealthPrograms/KidsandTeensLifestyleProgram/tabid/63/Default.aspx

http://www.henryford.com/body.cfm?id=46426



http://www.henryford.com/letsgethealthy





SMA

Standards of Care


Community Resources


www3.mednetone.net/HealthPrograms/KidsandTeensLifestyleProgram/tabid/63/Default.aspx

St John Providence Outpatient Nutrition Management Services ProgramSt John Providence Health System16001 W. 9 Mile Rd., Southfield, Michigan 48075Phone: 248-849-3903http://www.stjohnprovidence.org/providence/specialties/nutrition/

St Joseph Mercy Health System Shapedown ProgramShapedown®St Joseph Mercy Health System Ann Arbor 734-712-5800 #2http://www.stjoesannarbor.org/shapedownSt Joseph Mercy Health System

5

http://www.stjoesannarbor.org/shapedown



http://www.stjohnprovidence.org/providence/specialties/nutrition/





SMA

Standards of Care


Community Resources


Oakland (248) 858-2556http://www.stjoesoakland.org/Weight-LossPrograms

University of Michigan Pediatric Comprehensive Weight Management CenterMPOWER Michigan Pediatric Outpatient Weight Evaluation and Reduction Programs1500 E. Medical Center Drive, 1924 Taubman Center, Ann Arbor, MI 48109-0318Phone: 734-615-3829Email: [email protected]://www.uofmhealth.org/medical-services/ped-weight-management

andhttp://www.med.umich.edu/mpower/clinical/

6

http://www.med.umich.edu/mpower/clinical/mpowerjr/index.shtml


http://www.uofmhealth.org/medical-services/ped-weight-management



http://www.stjoesoakland.org/Weight-LossPrograms



SMA

Standards of Care


Community Resources


mpowerjr/index.shtml

MHealthyUniversity of Michigan Health System Community Health Services2850 S. Industrial, Suite 600, Ann Arbor, MI 48104-6773Phone: 734-975-3024E-mail: [email protected]://hr.umich.edu/mhealthy/

LOCAL PROGRAMS:

Check with local schools for programs such as Girls on the Run.

Check with local parks and recreation departments for information on local exercise programs, local trail ways/parks, and also farmers markets.

Other community

7

http://hr.umich.edu/mhealthy/

http://hr.umich.edu/mhealthy/


SMA

Standards of Care


Community Resources


resources can be found at your local health department, YMCA, and hospital.

What is Obesity?

Childhood obesity is the result of eating too many calories and not getting enough physical activity.http://www.cdc.gov/obesity/childhood/problem.html

“Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for their height and body type. Obesity most commonly begins between the ages of 5 and 6, or during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.”

Causes of obesity are multifaceted and may include genetic, biological, behavioral and cultural factors. Less than 1% of medical conditions are attributed to obesity.

Patient / caregiver will verbalize understanding of causes, management options of obesity and the importance of instituting proactive life style changes and management to prevent co-morbid conditions.http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf


American Heart Association:Understanding Childhood Obesity 2011 Statistical Sourcebookhttp://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

8

SMA

Standards of Care


Community Resources


Contributing Factors to childhood obesity

The American environment promotes ease and accessibility of non-healthy food and beverage choices along with activities that decrease physical movement.http://www.cdc.gov/obesity/childhood/problem.html

Specifically stated are the following environmental elements contributing to childhood obesity:1. School campuses

offer sugary drinks and less healthy foods. Students have access to vending machines and school canteens throughout the day and at fundraising events, school parties, and sporting events.

2. Media advertising for non-healthy foods is disproportionate to promoting awareness and purchase of healthy food choices.

3. Lack of licensure regulation consistency

Patient / caregiver will verbalize understanding of causes of obesity and the importance of instituting proactive life style changes and management to prevent co-morbid conditions.http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf


Michigan Nutrition Standards:Michigan Department of EducationRecommendations for all Foods andBeverages Available in MichiganSchoolsas approved by the State Board of Education October 12, 2010http://www.michigan.gov/documents/mdch/Michigan_Nutrition_Standards_Approved_10.12.10_351359_7.pdf

Healthy Kids, Healthy Michigan:

American Heart Association:Understanding Childhood Obesity 2011 Statistical Sourcebookhttp://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

9

SMA

Standards of Care


Community Resources


from state to state to standardize foods served and activity levels for children in child care centers.

4. Activity recommendations include at least 60 minutes of aerobic physical activity each day. Daily, quality physical education in school can help students meet these guidelines.

5. There is a lack of safe and appealing places in many communities to play or be active.

6. Access to stores and supermarkets that sell healthy foods is a higher risk for individuals living in rural, minority, and lower-income neighborhoods. In these areas there is increased availability of convenience stores and fast food restaurants.

7. On a typical day, 80% of youth drink sugary drinks. Sugary drinks are the largest source

Fight Childhood Obesity: Increase Physical Activity with Complete Streets,Context Sensitive Solutions and Safe Routes to School.http://www.heart.org/idc/groups/heart-public/@wcm/@mwa/documents/downloadable/ucm_307009.pdf

10

SMA

Standards of Care


Community Resources


of added sugar and an important contributor of calories in the diets of children in the United States. Additionally, availability of high-energy-dense foods is readily accessible and contributes to an increase in body fat.

8. Portion sizes of less healthy foods and beverages have increased over time in restaurants, grocery stores, and vending machines.

9. Breastfeeding support is lacking overall from families, friends, communities, clinicians, health care leaders, employers, and policymakers for mothers wishing to breastfeed. Breastfeeding decreases childhood obesity. Only 13% of the 75% of mothers who begin to breastfeed their babies continue to exclusively breastfeed at the end of 6

11

SMA

Standards of Care


Community Resources


months.10. Increased hours of

exposure to television and media. While watching TV children are not active and they are subjected to numerous advertisements for unhealthy foods.

http://www.cdc.gov/obesity/childhood/problem.html

Further influences relating to obesity may include: poor eating habits overeating or binging lack of exercise (i.e.,

couch potato kids) family history of obesity medical illnesses

(endocrine, neurological problems)

medications (steroids, some psychiatric medications)

stressful life events or changes (separations, divorce, moves, deaths, abuse)

family and peer problems

low self-esteem depression or other

emotional problems

12

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/The_Depressed_Child_04.aspx

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Child_Abuse_The_Hidden_Bruises_05.aspx

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_And_Family_Moves_14.aspx

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_and_Divorce_01.aspx

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychiatric_Medication_For_Children_And_Adolescents_Part_II_Types_Of_Medications_29.aspx

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychiatric_Medication_For_Children_And_Adolescents_Part_II_Types_Of_Medications_29.aspx

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Teenagers_With_Eating_Disorders_02.aspx

SMA

Standards of Care


Community Resources


http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

Classifications of Obesity in children

Percentiles for Assessing Overweight and Obesity Percentile Status:

1. ≤4th = Underweight

2. 5th to 85th % = Healthy weight

3. 85th – 94th = Overweight

4. ≥95th = Obesehttp://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

Parents and children will have an awareness of the appropriate weight for their individual health status and age.

CDC Growth charts:http://www.cdc.gov/growthcharts/who_charts.htm

CDC Growth charts:http://www.cdc.gov/growthcharts/who_charts.htm

Weight categories for children:http://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

Prevention Programs and Initiatives and teaching Guides

Jump Up & Go is a Youth Wellness Program developed in Massachusetts in conjunction with NICHQ and BCBS of Massachusettshttp://www.nichq.org/childhood_obesity/toolkit_prevention_tools.html

5-4-3-2-1-GO!:

Parents, schools, and children will have increased awareness of supportive programs for weight management.

Jump Up & Go Parent Brochure: http://www.nichq.org/childhood_obesity/tools/ParentBrochure.pdf

Jump Up & Go Resource page with links to many sites especially for kidshttp://www.nichq.org/

The American Heart Association has provided numerous educational resources for parents to use to engage their children in understanding nutrition and the importance of activity.Activities for Kids : This site provides

Jump Up & Go is a Youth Wellness Program developed in Massachusetts in conjunction with NICHQ and BCBS of Massachusetts with educational brochures and tools for parents to use.http://www.nichq.org/childhood_obesity/toolkit_prevention_tools.html

13

SMA

Standards of Care


Community Resources


5 - Eat more than 5 servings of fruits and vegetables4 - Drink 4 glasses of water3 - Have 3 servings of low fat or fat free dairy2 - Spend less than 2 hours at a T.V. or computer1 - Take 1 full hour to get a runnin’ and a jumpin’

GO! – For a healthier you!http://www.healthykidshealthymich.com/5-4-3-2-1-goreg.html

The Portion plate is a visual guide for daily consumption of proper portions for various food groups.http://www.theportionplate.com/

School Programs:Jump Rope for Heart: Designed for elementary

childhood_obesity/tools/Resources.pdf

5-4-3-2-1-GO! Interactive site. Parents or kids may choose their age group to see appropriate amounts of “screen time vs lean time.”http://www.healthykidshealthymich.com/5-4-3-2-1-goreg.html

Pediatric Physical Activity and Nutrition Survey for Assessmenthttp://www.bluecrossma.com/common/en_US/pdfs/brochure/Physical_Activity_Survey_69417_10-11-07.pdf

The Portion Platehttp://www.theportionplate.com/

Jump Rope for

information linking genetics to weight, impact of what a child eats and drinks on their health,everyday activities to increase cardiovascular health and games to teach nutritional value in various foods.http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/ActivitiesforKids/Activities-for-Kids_UCM_304155_SubHomePage.jsp

Healthy Schools Program:Alliance for a Healthier Generation:

14

SMA

Standards of Care


Community Resources


students, participants learn jump rope skills as well as how their hearts work, and how to keep them beating healthy and strong.http://www.heart.org/HEARTORG/Giving/ForIndividuals/JoinanEvent/Jump-Rope-for-Heart-Event_UCM_315609_SubHomePage.jspHoops for Heart:Middle school students that participate in Hoops For Heart have learn basketball skills and the importance of heart health, while raising dollars to support lifesaving research and learning about the importance of community service.http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/OurPrograms/Our-Programs_UCM_001191_SubHomePage.jsp

Teaching Gardens:Aimed at first graders

Heart:http://www.heart.org/HEARTORG/Giving/ForIndividuals/JoinanEvent/Jump-Rope-for-Heart-Event_UCM_315609_SubHomePage.jsp

Hoops for Heart:http://www.heart.org/HEARTORG/Giving/ForIndividuals/JoinanEvent/Hoops-For-Heart-Event_UCM_315630_SubHomePage.jsp

https://www.healthiergeneration.org/

15

SMA

Standards of Care


Community Resources


through fifth, children are taught how to plant seeds, nurture growing plants, harvest produce and ultimately understand the value of good eating habits.

Garden-themed lessons teach nutrition, math, science and other subjects all while having fun in the fresh air and working with their hands.http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/TeachingGardens/About-Teaching-Gardens_UCM_436619_SubHomePage.jsp

empowerME Kids’ Movement:“empowerME is a “by kids, for kids” initiative, inspiring all kids to make healthy behavior changes and to become leaders and advocates for healthy eating and physical activity.”

Teaching Gardens:http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/TeachingGardens/Teaching-Gardens_UCM_436602_SubHomePage.jsp

16

SMA

Standards of Care


Community Resources


http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/OurPrograms/About-the-Alliance-for-a-Healthier-Generation_UCM_303633_Article.jsp

The National Football League and the American Heart Association work together to produce the NFL PLAY 60 Challenge.This program inspires kids to get the recommended 60 minutes of physical activity a day in school and at home. It also helps schools become places that encourage physically active lifestyles year-round.http://www.heart.org/HEARTORG/Educator/FortheClassroom/NFLPlay60Challenge/NFL-PLAY-60-Challenge-Page_UCM_304278_Article.jsp

NFL PLAY 60 Challenge downloadable Teacher Guide and online teacher resources.http://www.heart.org/HEARTORG/Educator/FortheClassroom/NFLPlay60Challenge/NFL-PLAY-60-Challenge-Page_UCM_304278_Article.jsp

Management of children in the “Healthy” weight category: BMI

The AAP recommends that all parents and children receive preventive messaging.1. “Limit consumption of

Parents / children will have guidelines to follow and tools to use to maintain a healthy weight and prevent

NICHQ Serving Portion by age handout:http://www.nichq.org/

Instructions for use of the Clinical Decision Support Tools: includes age specific surveys that may be sent to families prior to Well Child

17

SMA

Standards of Care


Community Resources


5th to 84th percentile.

sugar-sweetened beverages.2. Encourage consumption of diets with recommended quantities of fruits and vegetables.3. Limit television and other screen time (the AAP recommends no television viewing before 2 years of age andthereafter no more than 2 hours of television viewing per day)4. Eat breakfast daily.5. Limit eating out at restaurants, particularly fast food restaurants.6. Encourage family meals during which parents and children eat together.7. Allow child to self-regulate his or her food.

• Find ways to reward good behavior other than with food.• Parents say “what & when,” children say “how much.” (Page 9)

http://www.michigan.gov/documents/mdch/CDS_Tools_Complete_2012_379192_7.pdf

them from becoming overweight or obese.

childhood_obesity/tools/ServingPortionByAge.pdf


Parent resources for healthy snacks, tips for picky eaters, healthier fast food options, activities, activities with pets, portion sizes and communication tips with the physician.http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/HowtoMakeaHealthyHome/How-to-Make-a-Healthy-Home_UCM_304154_SubHomePage.jsp

American Heart Association Dietary Recommendations for ages 1-18 years. (Page 10)

visits to assess nutritional status, eating habits as well as inclusion of AAP management / treatment recommendations based on BMI percentile. (Page 6, 11)http://www.michigan.gov/documents/mdch/CDS_Tools_Complete_2012_379192_7.pdf

Surveys to evaluate eating and activity habits. May be given or mailed to parents prior to a Well-child visit:Survey – Ages 2-5 years old: (Page 10)Survey - Ages 6-11 Years Old: (Page 12)Survey - Ages 12-18 Years Old: (Page 14)http://www.michigan.gov/documents/mdch/CDS_Tools_Complete_2012_379192_7.pdf

American Heart Association Dietary Recommendations for ages 1-18 years. (Page 10)http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

NICHQ recommendation of

18

SMA

Standards of Care


Community Resources


http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

Drink comparison chart / handout (Printable):http://www.nichq.org/childhood_obesity/tools/DrinkComparisonChart.pdf

NICHQ Food Portion Exercise for children and parents. (Printable)http://www.nichq.org/childhood_obesity/tools/FoodPortionExercise.pdf

elements to include in the assessment of children in regards to weight management:http://www.nichq.org/childhood_obesity/tools/Encounterdocumentationtool.pdfNICHQ Obesity Registry:http://www.nichq.org/childhood_obesity/tools/NICHQObesityRegistry051109Final.xls

Management of children in the “Overweight” category: BMI 85th to 94th

percentile.

“Obese children need a thorough medical evaluation by a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the

Parents, children and teens will understand how excess weight impacts health and have tools to assist with weight loss or maintenance as the child continues to


Parent resources for healthy snacks, tips for picky eaters,

Clinical Decision Tools:Comprehensive Assessment Guide, recommended labs, review of systems related to obesity, behavior targets, readiness for change, goals and follow up plan of care:2-5 years of age: (Pages 17-

19

SMA

Standards of Care


Community Resources


only way to lose weight is to reduce the number of calories being eaten and to increase the level of physical activity.”http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

grow.http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

healthier fast food options, activities, activities with pets, portion sizes and communication tips with the physician.http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/HowtoMakeaHealthyHome/How-to-Make-a-Healthy-Home_UCM_304154_SubHomePage.jsp


Drink comparison chart / handout (Printable):http://www.nichq.org/

18)6-11 years of age: (Pages 21-22)12-18 year olds:(Pages 25-26)http://www.michigan.gov/documents/mdch/CDS_Tools_Complete_2012_379192_7.pdf

Surveys to evaluate eating and activity habits. May be given or mailed to parents prior to a Well-child visit:Survey - Ages 2-5 years old: (Page 19)Survey - Ages 6-11 Years Old: (Page 23)Survey - Ages 12-18 Years Old: (Page 27)http://www.michigan.gov/documents/mdch/CDS_Tools_Complete_2012_379192_7.pdf

Children / youth with BMI > 85th%tile should be identified for more focused counseling.http://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

American Heart Association Dietary Recommendations for ages 1-18 years. (Page 10)

20

SMA

Standards of Care


Community Resources


childhood_obesity/tools/DrinkComparisonChart.pdf


http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

NICHQ recommendation of elements to include in the assessment of children in regards to weight management:http://www.nichq.org/childhood_obesity/tools/Encounterdocumentationtool.pdf

NICHQ Obesity Registry:http://www.nichq.org/childhood_obesity/tools/NICHQObesityRegistry051109Final.xls

Coding and reimbursement for children with abnormal weight gain in primary care.http://www.nichq.org/childhood_obesity/tools/CLOCCLevelsofbilling.pdf

NICHQ Algorithm for Prevention & Management of Overweight Children 2-12 years:http://www.nichq.org/childhood_obesity/tools/REVISEDHealthyCareforHeal

21

SMA

Standards of Care


Community Resources


thyKidsAlgorithm03_2006.pdfManagement of children in the “Obese” category: BMI ≥ 95th percentile.

“Obese children need a thorough medical evaluation by a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten and to increase the level of physical activity.”http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

Parents / child will engage in behaviors to prevent progression,avoid development of co-morbid conditions, prevent negative psychological/emotional consequences, identify and treat co-morbid conditions, promote weight loss and promote healthy behaviors even if weight loss is not attainable.http://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

Survey - Ages 2-5 years old: (Page 33)The Portion Platehttp://www.theportionplate.com/

Parent resources for healthy snacks, tips for picky eaters, healthier fast food options, activities, activities with pets, portion sizes and communication tips with the physician.http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/HowtoMakeaHealthyHome/How-to-Make-a-Healthy-Home_UCM_304154_SubHomePage.jsp

American Heart Association Dietary Recommendations for ages 1-18 years. (Page 10)http://

Clinical Decision Tools:Comprehensive Assessment Guide, recommended labs, review of systems related to obesity, behavior targets, readiness for change, goals and follow up plan of care:2-5 years of age: (Pages 31-32)6-11 years of age: (Pages 35-36)12-18 year olds:(Pages 39-40)http://www.michigan.gov/documents/mdch/CDS_Tools_Complete_2012_379192_7.pdf

Surveys to evaluate eating and activity habits. May be given or mailed to parents prior to a Well-child visit:Survey - Ages 6-11 Years Old: (Page 37)Survey - Ages 12-18 Years Old: (Page 41)http://www.michigan.gov/documents/mdch/CDS_Tools_Complete_2012_379192_7.pdf

Use of a multipronged approach for children/youth with BMI > 95th%tile is essential.

22

SMA

Standards of Care


Community Resources


www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

Drink comparison chart / handout (Printable):http://www.nichq.org/childhood_obesity/tools/DrinkComparisonChart.pdf


http://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf


NICHQ recommendation of elements to include in the assessment of children in regards to weight management:http://www.nichq.org/childhood_obesity/tools/Encounterdocumentationtool.pdf

NICHQ Obesity Registry:http://www.nichq.org/childhood_obesity/tools/NICHQObesityRegistry051109Final.xls

Coding and reimbursement for children with abnormal weight gain in primary care.http://www.nichq.org/childhood_obesity/tools/CLOCCLevelsofbilling.pdf

23

SMA

Standards of Care


Community Resources


Growth charts for various Pediatric populations

CDC recommends that health care providers:• Use the WHO growth charts to monitor growth for infants and children ages 0 to 2 years of age in the U.S.• Use the CDC growth charts to monitor growth for children age 2 years and older in the U.S.WHO growth charts provide information only on children up to 5 years of age.http://www.cdc.gov/growthcharts/who_charts.htm

Many diagnoses/ conditions have specific growth charts to aid in understanding appropriate size of children with special needs.http://www.dhs.wisconsin.gov/wic/WICPRO/CYSHCN/08-charts.pdf

CDC Growth charts for children with special needs or prematurity:http://www.cdc.gov/growthcharts/growthchart_faq.htm

Parents with children with special conditions or diagnoses will understand how this impacts the appropriate weight for their child.http://www.cdc.gov/growthcharts/growthchart_faq.htm

Growth charts for children with special needs or prematurity:http://www.cdc.gov/growthcharts/growthchart_faq.htm

Web link for disease or condition specific growth charts:http://www.dhs.wisconsin.gov/wic/WICPRO/CYSHCN/08-charts.pdf

WHO Growth Charts:Birth to 24 months: Boys Weight-for-length percentiles and Head circumference-for-age percentileshttp://www.cdc.gov/growthcharts/data/who/grchrt_boys_24hdcirc-l4w_rev90910.pdf

Birth to 24 months: Boys Length-for-age percentiles and Weight-for-age percentileshttp://www.cdc.gov/growthcharts/data/who/grchrt_boys_24lw_100611.pdf

Birth to 24 months: Girls Weight-for-length percentiles and Head circumference-for-age percentileshttp://www.cdc.gov/growthcharts/data/who/grchrt_girls_24hdcirc-l4w_9210.pdf

Birth to 24 months: Girls Length-for-age percentiles and Weight-for-age percentileshttp://www.cdc.gov/growthcharts/data/who/grchrt_girls_24lw_9210.pdf

24

SMA

Standards of Care


Community Resources


CDC Growth Charts:The clinical charts for infants and older children were published in two sets. Set 1 contains 10 charts (5

for boys and 5 for girls), with the 5th, 10th, 25th, 50th, 75th, 90th, and 95th smoothed percentile lines for all charts, and the 85th percentile for BMI-for-age and weight-for-stature.

Set 2 contains 10 charts (5 for boys and 5 for girls), with the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th smoothed percentile lines for all charts, and the 85th percentile for BMI-for-age and weight-for-stature.

All found and printable from:http://www.cdc.gov/growthcharts/clinical_charts.htm

CDC - Clinical Growth Chartshttp://www.cdc.gov/growthcharts/clinical_charts.htm

Overview of CDC Growth Chartshttp://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module2/text/

25

http://www.cdc.gov/growthcharts/clinical_charts.htm#Set2

http://www.cdc.gov/growthcharts/clinical_charts.htm#Set1

SMA

Standards of Care


Community Resources


page5a.htm

NICHQ Body Mass Index Chart for Boys age 2-20:http://www.nichq.org/childhood_obesity/tools/BMIBoysColor.pdf

NICHQ Body Mass Index Chart for Girls age 2-20:http://www.nichq.org/childhood_obesity/tools/BMIGirlsColor.pdf

Body Mass Index: Considerations for Practitionershttp://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf

Web link for disease or condition specific growth charts:http://www.dhs.wisconsin.gov/wic/WICPRO/CYSHCN/08-charts.pdf

A health professional’s guide for using the new WHO growth chartshttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865941/

Blood Pressure Levels for the

26

SMA

Standards of Care


Community Resources


90th and 95th Percentiles of Blood Pressure for Boys and Girls Ages 1 to 17 Yearshttp://www.nichq.org/childhood_obesity/tools/BP_levels.pdf

Treat co-morbid conditions

“Obesity impacts every organ system in the body.It is now regarded as more damaging to the body than smoking or excessive drinking.

Obese and overweight children are at increased risk of developing heart disease.”http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

Associated conditions with overweight or obesity include diabetes; high blood pressure; asthma; liver problems; sleep apnea; lower life expectancy; stroke; breast, colon, and kidney cancers; musculoskeletal disorders; and gall bladder disease.

Teens who are obese and

Child / parent will verbalize understanding of development of co-morbidities associated with increased weight, participate in weight management goals and seek assessment and treatment for co-morbid conditions if suspected or noted to prevent further lifelong sequela. http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

Facts for Families:Teenagers with eating disordershttp://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Teenagers_With_Eating_Disorders_02.aspxThe Depressed Childhttp://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/The_Depressed_Child_04.aspxChildren and Watching TVhttp://www.aacap.org/

American Heart AssociationUnderstanding Childhood Obesity2011 Statistical Sourcebookhttp://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

American Academy of Child & Adolescent Psychiatry (AACAP)http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

27

SMA

Standards of Care


Community Resources


who have high triglyceride levels have arteries similar to those of 45-year-olds and may result in children being put on medications they will have to take for the rest of their lives as early as age 12.http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_428180.pdf

Obesity affects the emotional and mental stability of children and adolescents. Teens tend to have much lower self-esteem and decreased popularity amongst peers. Additionally, depression, anxiety, and obsessive compulsive disorder (OCD) may occur.http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

Additional co-morbid conditions include:

AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_And_Wat_54.aspxChildren and Sportshttp://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_And_Sports_61.aspxHelping Teenagers with Stresshttp://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Helping_Teenagers_With_Stress_66.aspx

28

SMA

Standards of Care


Community Resources


Snoring, Abnormal menses, Polycystic ovarian syndrome, Early Puberty, Orthotic problems, Eating Disorders, GERD and Joint painhttp://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

Management of psychosocial elements contributing to overweight condition or obesity.

Being overweight impacts a child’s self-perception and emotional well-being. Addressing this component along with the physical management of obesity has improved outcomes.http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychotherapies_For_Children_And_Adolescents_86.aspx

“Psychotherapy involves therapeutic conversations and interactions between a therapist and a child or family. It can help children and families understand

Children will receive emotional and psychiatric support as appropriate to maximize their ability to lose weight, keep it off, and improve mental and emotional stability.http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychotherapies_For_Children_And_Adolescents_86.aspx

Facts for Families:Psychotherapies for Children and Adolescents:http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/86_psychotherapies_for_children_and_adolescents.pdf

Facts for Families: Psychiatric Medication For Children And Adolescents Part III: Questions To Ask:http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/

Types of Psychotherapy: http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychotherapies_For_Children_And_Adolescents_86.aspx

29

SMA

Standards of Care


Community Resources


and resolve problems, modify behavior, and make positive changes in their lives.”http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/86_psychotherapies_for_children_and_adolescents.pdf

Types of Psychotherapy for children and adolescents may include Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), Family Therapy, Group Therapy, Interpersonal Therapy (IPT), Play Therapy, and Psychodynamic Psychotherapy. In some instances a combination of therapies may provide enhanced results or inclusion of treatment with medications may be warranted.http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychotherapies_For_Chi

51_psychiatric_medication_for_children_and_adolscents_part_three.pdf

Facts for Families:Psychiatric Medication For Children And Adolescents Part I-How Medications Are Used:http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/21_psychiatric_medication_for_children_and_adolescents_part_one.pdf

Facts for Families:Children And Adolescents: Part II - Types Of Medications:http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/29_psychiatric_medication_for_children_and_adolescents_part_two.pdf

Psychiatric Medication For Children And Adolescents Part I-How Medications Are Used:http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychiatric_Medication_For_Children_And_Adolescents_Part_I_How_Medications_Are_Used_21.aspx

Psychiatric Medication For Children And Adolescents: Part II - Types Of Medications:http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Psychiatric_Medication_For_Children_And_Adolescents_Part_II_Types_Of_Medications_29.aspx

30

SMA

Standards of Care


Community Resources


ldren_And_Adolescents_86.aspx

Self-Management Goal

Lasting weight loss can only occur when there is self-motivation. Since obesity often affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent.http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx

How fast should my child lose weight?Children 2 to 18 years of age:• BMI 85th to 94th percentile: GOAL = Weight maintenance, resulting in decreasing BMI as age increases• BMI >95th percentile with no comorbidity: GOAL = Weight maintenance, resulting in

Child will maintain or achieve a healthy weight and lifestyle with support from parents / caregivers.http://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

Parent / Child Nutrition and Activity Assessment and Log:http://www.nichq.org/childhood_obesity/tools/AreyouaHealthyKid.pdf

Weekly Log for recording Nutrition, Screen time, and Physical activity:http://www.nichq.org/childhood_obesity/tools/WeeklyLog.pdf


Jump Up & Go Parenting Tips:Nutrition Tips:http://www.nichq.org/childhood_obesity/tools/NutritionTips.pdfFamily Friendly

In NICHQ’s Care Model for Child Health (based on the Chronic Illness Care Model developed by Ed Wagner), the health care system can optimize self-management support by informed, activated patients through collaboration with community resources.http://www.nichq.org/childhood_obesity/tools/CommResourcesKeyTips.pdf

NICHQ - Healthy care for healthy kids Care Management Plan:http://www.nichq.org/childhood_obesity/tools/HCHK_ManagementPlanVersion1.pdf

Bright Futures / AAPPromoting Healthy Weighthttp://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

31

SMA

Standards of Care


Community Resources


decreasing BMI as age increases• BMI >95th percentile with comorbid conditions or severely obese: GOAL = Gradual weight loss that should not exceed 1 pound per month in children 2 to 11 years of age or 2 pounds per week in older obese children and adolescentshttp://brightfutures.aap.org/pdfs/Guidelines_PDF/5-Promoting_Healthy_Weight.pdf

Recipes:http://www.nichq.org/childhood_obesity/tools/FamilyFriendlyRecipies.pdfActivity Tips:http://www.nichq.org/childhood_obesity/tools/ActivityTips.pdfGo Walking Tips:http://www.nichq.org/childhood_obesity/tools/GoWalkingTips.pdfAdditional Parental Resources:http://www.nichq.org/childhood_obesity/tools/Resources.pdfWeekly Log:http://www.nichq.org/childhood_obesity/tools/WeeklyLog.pdf

32

web viewmipct clinical pathway: pediatric obesity. standards of care. educational information; ......

Documents