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					                                                   Pharmacists’ Interventions to Decrease Child Obesity
                                                                 at a Community Hospital
                                                      Laura Erhardt, Pharm. D Candidate, Stacie Thoman, Pharm. D Candidate
                                                                     Kristin K. Johnson, B.S., Pharm. D., BCPS
                                                                     Abby A. Kahaleh, B.S. Pharm., MPH., PhD.
                                                  Lake Erie College of Osteopathic Medicine School of Pharmacy
                     INTRODUCTION                                                                                           RESULTS                                                                                                            CONCLUSIONS
                                                                                         Jones RA, Okely AD, Collins        Eisenmann JC, Gentile        Savoye M, Shaw M,                  Wilfley DE, Stein RI,        The results demonstrate a lack of consistency on how to
It was estimated in 2003-2004 that 17.1% of patients,                                               CE, et al.              DA, Welk GJ, et al.              Dziura, et al.                  Saelens BE, et al.          set up a child obesity clinic. These studies focused on a
ranging from 2 years old to 18 years old, have a BMI in the     Place of Study         Australia                            United States             United States                     United States                    more community based clinic and had some deficiencies,
95th percentile and are considered obese. This is up from       Length of Study        6 months                             9 months                  12 months                         6 years                          including a lack of long term follow up and a
13.9% in 1999-2000. It is also estimated that 33.6% of          Enrollment Number      205 families                         1359 families             174 participants                  204 children
                                                                Inclusion Criteria     Overweight and obese, pre-           Not reported              BMI >95%                          Children 20-100%
                                                                                                                                                                                                                         multidisciplinary healthcare team. The studies discussed
patients are at risk of being obese. At risk patients are                                                                                                                                                                involved parents, teachers, dieticians, an exercise
                                                                                       pubertal, generally healthy                                                                      overweight with at least 1
deemed to have a BMI in the 85th percentile. An                                                                                                                                         parent with BMI > 25             physiologist, and social workers, but not physicians or
imbalance in energy intake and expenditure causes obesity       Exclusion Criteria    Extreme obesity (BMI Z-score          Not reported              Diabetes, psychiatric, or         Child or parent were             pharmacists. Therefore, it may be beneficial to create a
which can lead to many complications. Some of these                                   >4), known syndromal cause of                                   serious medical condition,        involved in psychological or     clinic that is based out of a hospital so all disciplines
complications include asthma, metabolic syndrome,                                     obesity, long term steroid use,                                 medications that cause            weight loss treatment,
                                                                                      meds associated with weight                                     weight gain/weight loss           appetite or weight loss
                                                                                                                                                                                                                         participate in the care of the patient.
type 2 diabetes, and cardiovascular diseases.
                                                                                      gain, chronic illness, significant                                                                medications, or had a
                                                                                      dietary restrictions                                                                              psychiatric condition                                 DISCUSSIONS
                       OBJECTIVES                               Age group of children 5 to 9 years old                      8 to 10 years old         8 to 16 years old                 7 to 12 years old
                                                                                                                                                                                                                         A proposed way to set-up a clinic may be by having a
                                                                Involvement of others Trained physical education            Not reported              Registered dietician, social      Exercise physiologist,           three component obesity clinic. This would include an
The purpose of this review is to establish a way to                                   teacher and accredited practicing                               worker, exercise                  registered dietician             assessment survey, a counseling session, and a visit to
decrease the complications that can occur from childhood                              dieticians                                                      physiologist
                                                                Intervention          1. Parent centered dietary            1. Community component    1. Weight management              1. Behavioral skills             the clinic. Based on the a survey that will be given to
obesity. Establishing an outpatient obesity clinic associated                                                                                                                                                            the parent a counseling session with the parent and
                                                                                      modification                          2. School component       2. Control group                  management (BSM)
with a community hospital will allow an opportunity for                               2. Child centered physical activity   3. Family component                                         2. Social facilitation           child will be conducted by a dietician, pharmacist or
pharmacist interventions to help reduce childhood obesity.                            skill development program                                                                         management (SFM)                 physician. The caregiver will then have the option to
                                                                                      3. Combination of the two                                                                         3. Behavioral skills or social   enroll the child into the obesity clinic. At the clinic visit,
                                                                                                                                                                                        facilitation
                         METHODS                                Primary outcomes       BMI Z-score and waist            Increase amount of habitual   Changes in BMI (between           BMI z score and                  the patient will be provided with an active session
                                                                                       circumference                    physical activity, reduce     baseline and 6 months),           percentage overweight            involving a certified fitness trainer, a dietary consultant,
Data sources and searches                                                                                               amount of television time,    body composition, insulin                                          and a one-on-one session with a registered
                                                                                                                        increase fruits and           sensitivity, BP, lipid profiles                                    pharmacist. The fitness trainer will have the child
Pubmed was searched with the terms obesity, overweight,                                                                 vegetable intake
clinic, and program. Inclusion criteria were English, human                                                                                                                                                              actively involved in weekly activities and set
                                                                Secondary outcomes BP, fasting levels of total CHO,     Reduce the occurrence of      Nutritional components            None reported
trials published after 1989, children, randomized control                          HDL, LDL, TG, glucose, insulin       overweight/excessive                                                                             fitness goals. The dietitian will monitor the caloric
trial, programs that could be extrapolated to the United                           and C-reactive protein, dietary      weight gain and Increase                                                                         intake and type of calories the patient intakes
States and access to full text. Exclusion criteria were non                        intake, movement skill proficiency community awareness                                                                                weekly. The pharmacist will discuss medical options
peer reviewed journals, supplements, abstracts, and
                                                                                   and perceived competence,                                                                                                             and review the patients’ medications. Obese children
                                                                                   objective physical activity, time                                                                                                     may have already developed complications due to
specific ethnicity or gender. A total of 4 articles met this                       spent on sedentary activities,
criteria and were chosen to be reviewed.                                           proficiency in performing an                                                                                                          obesity and they may be on various medications
                                                                                   activity of daily living, and health                                                                                                  depending on their condition. Another benefit to having
Data extraction and analysis                                                       related QOL                                                                                                                           a pharmacist would be the ability to monitor the child’s
For each trial, a reviewer recorded details about the type of
                                                                Results            On-going                             On-going                      Statistical significance seen     BSM or SFM maintained            medications. It has been shown that pharmacist’s can
                                                                                                                                                      at 6 and 12 months in favor       relative weight significantly    have an important impact on monitoring patient
study, number of patients, where the study was conducted,                                                                                             of the weight management          better than children from
and the methods and results from each study. From this                                                                                                group in regards to BMI,          the control group (BMI z         medications.
information, information was grouped, and an assessment                                                                                               weight, body fat, fasting         score -0.04, -0.04, and 0.05
about the present programs that are available for                                                                                                     insulin, and insulin              and percentage overweight
                                                                                                                                                      resistance p <0.001)              p = 0.008, 0.05, and 0.86
overweight children was made.                                                                                                                                                           respectively).

				
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