Overweight Children
November 30, 2005
The Role of Health Care in Prevention & TreatmentFOR STATE OF CALIFORNIA
Erna Wong, MD Pediatrician
The Role of Health Care in Prevention & Treatment
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Today we will talk about...
The Epidemic of Overweight Children Medical Office Visit Interventions
Weight Management Interventions
Environmental Changes and Physician Advocacy
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By the end of this lecture participants will be able to…
Describe 3 overweight prevention strategies. Diagnose overweight and at risk for overweight using BMI % for age. Describe the weight goals for overweight children. Give Brief Focused Advice.
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About Kaiser Permanente (KP)
One of the nation’s oldest not-forprofit health care delivery systems and a leader in quality.
8.2 million members nationwide; 6.2 million in California. KP has made a deep and longstanding commitment to healthy eating and active living in our communities with intensive interventions since 2001.
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How serious is the problem of overweight children in California today?
No Opinion 1% Not Serious 7%
Very Serious
Very Serious 46% Somewhat Serious 46%
Somewhat Serious
Not Serious No Opinion
1,068 random sample CA residents, telephone survey 10-11/2003 http://calendow.org/caobesityattitudes/index.htm
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How many children are overweight?
18 16 14 12 10 8 6 4 2 0 1963-70 1971-74 6-11 Years 1976-80 1988-94 1999-02 12-19 Years
Percent
Since 1963, the number of overweight children in the U.S. has tripled!
6 4 7 5
15.8 16.1
11 11
4
5
SOURCE: CDC/NCHS, NHES and NHANES
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Some children are more likely to be overweight.
% Overweight Kids & Teens in 2000
25 20
19.5
23.7 23.6 23.4
Teenagers Black, Mexican American, American Indian, Alaskan Native
12.7
% Overweight
15 10 5 0 2-5 Yr
White Non-Hispanic 10.1 8.4 11.1 11.8
6-11 Yr
Black Non-Hispanic
12-19 Yr
Mexican American
Children of overweight parents
NHANES 1999-2000 JAMA 2002;288:1728-1732
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Do overweight children grow up to be overweight adults?
% Overweight Children who Become Obese Adults
100 90 80 70 60 50 40 30 20 10 0
80 50 35 10
Percentage
The older the overweight child is, the more likely he/she will continue to be overweight as an adult. 8 out of 10 overweight teens will continue to be overweight as adults.
Preventive Medicine 1993; Vol. 22:pp. 167-177 Arch Pediatr Adolesc Med Vol. 158 May 2004 pp. 449-452
Pr es ch oo Sc l ho ol A ge A do le sc en t
In fa
nt s
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How many adults are overweight?
Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003
(*BMI 30, or about 30 lbs overweight for 5’4” pe rson) 1991 1996
“the average weight gain among subjects (20-40 years old) in the population is 1.8 to 2.0 pounds/year.”
Science. 299:7;853-855 (2003)
No Data <10% 10%–14%
2003
15%–19%
20%–24%
¡ 25%
Source: Behavioral Risk Fac tor Surveillance System, CDC.
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What health problems are related to being overweight?
Type 2 diabetes
Heart disease Hypertension
Asthma
Slipped capital femoral epiphysis
Nonalcoholic steatohepatitis
Polycystic ovary syndrome Sleep apnea
Depression and low self-esteem
Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430
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How many overweight children have metabolic syndrome?
Metabolic Syndrome (1)
Criteria: TG>=110 mg/dL, HDL-C<=40 mg/dL, Waist Circ. >=90%, FBS>=110 mg/dL, BP>= 90% (3 of 5 criteria needed) A predictor of Type 2 diabetes and premature coronary artery disease. Prevalence = 28.7% among overweight adolescence.
The prevalence of metabolic syndrome increased with the severity of overweight and reached 50% in severely overweight children. (2)
1. Arch Pediatr Adolesc Med Vol. 157, Aug 2003 pp. 821-827 2. N Engl J Med Vol. 350, June 2004 pp. 2362-2374
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The Epidemic of Overweight Children
“I think we’re looking at a first generation of children who may live less long than their parents as a result of the consequences of overweight and type 2 diabetes.”
Francine Ratner Kaufman, MD
Head, Division of Endocrinology & Metabolism Children’s Hospital Los Angeles
www.discoveryhealthCME.com, N Engl J Med Vol. 352(11) March 2005, pp. 1138-1145
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What are the costs of overweight and obesity?
Obesity-Associated Annual Hospital Costs for Youths Aged 6 to 17 Years
140 120
127
Million Dollars
100 80 60 40 20 0
3 Fold Increase
Health care for obese adults costs 37% more than for people of normal weight, adding $732 to the annual medical bills of every American.
35
1979-81 1997-99
Treatment of illnesses related to obesity costs America $93 billion a year.
Health Affairs May 14, 2003; W3:219-226 NIHCM Obesity in Young Children: Impact and Intervention Aug 2004
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What are the causes of overweight and obesity?
GENES
METABOLISM
BEHAVIOR
ENVIRONMENT
CULTURE
SES
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What are the genetics of overweight and obesity?
Twin analysis indicates a heritability of fat mass of 40–70% Adopted children have BMIs that correlate to those of their biological parents
Genetic Risk for Overweight One obese parent (3X increase) Two obese parents (13X increase) Early puberty
Behavioral Genetics, 1997, 27:325–351
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What behaviors are related to children becoming overweight?
Not enough physical activity.
Too much TV & video games.
Not enough milk, dairy, fruits and vegetables.
Too many sweetened drinks (e.g., soda, juice drinks, sports drinks) and too much fast food. Skipping meals and breakfast.
Position Paper - Prevention of Childhood Overweight What Should Be Done? Center for Weight and Health - U.C. Berkeley 10/02
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Why is physical activity important?
Fitness and Academic Performance
2001 Grade 7 SAT 9 and Physical Fitness 70
SAT 9 Percentile
60 50 40 30 20 10 0 1 2 3 4 5 6 Number of Fitness Standards Achieved Reading Math
3 out of 4 children in California fail to meet the minimum fitness standards in 5th, 7th and 9th grade.
Being in good shape…
reduces
the risk of being overweight and heart disease is related to better school performance
California Department of Education 12/10/02 http://www.cde.ca.gov/news/releases2002/rel37.asp
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Why is TV harmful?
Children average 2-3 hours of TV viewing every day. 30-50% of children have a TV in their bedroom. TV viewing is associated with...
increased
risk for being overweight problems
school
aggressive
behavior & drug use
Pediatrics Vol. 107 No. 2 February 2001 pp. 423-426
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Are dairy products important?
Milk consumption in the U.S. has declined over the last 40 years. Milk and calcium consumption has declined significantly for adolescent girls. Drinking milk may reduce the risk of…
becoming
overweight osteoporosis
developing
J Am Diet Assoc. 2003;103:1626-1631.
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Are eating fruits and vegetables important?
In California, of 7th, 9th and 11th graders surveyed less than half reported eating fruits or vegetables at least once per day in the past week.
Eating 5 servings of fruits and vegetables every day can help reduce the risk of overweight.
Food Review. 2002;25:28-31.
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Why are sweetened drinks harmful?
Teenagers drink an average of 20 ounces of soda every day. Drinking more than 12 ounces a day of sweetened drinks is associated with…
an
increased risk of being overweight less milk
drinking an
increased risk of cavities
J PEDIATRICS Vol. 142 June 2003, pp. 604-610 BMJ. May 22, 2004;328:1237
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What about eating out and fast food?
Eating
out has increased from 16% to 27%. fast food portion sizes have tripled from 1960 to 2000.
food and eating out may be associated with an increased risk for overweight.
Some
Fast
Int J Obes Relat Metab Disord. 2004;28:282-289.
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What are the risks of skipping breakfast?
Eating breakfast by teens has declined by 20% over the last 20 years. 44% of teens said they skipped meals to lose weight. Skipping breakfast is associated with…
eating more later in the day and
the risk of becoming overweight.
J Am Diet Assoc. Vol. 101, 2001, pp. 798-802
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Small changes over time can make a big difference!
15 minutes of play instead of watching TV
can prevent some weight problems.
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A Longitudinal Approach to Preventing Overweight
Fetus
Preventing: • SGA
Infants
Promoting: • Breastfeeding
• LGA
Toddlers
Diagnosing:
• Early Adiposity Rebound
Children
Increasing:
• Physical Activity
Decreasing: • TV Viewing • Sweetened Beverage Consumption
Adults
Increasing: • Physical Activity
Decreasing: • Portion Size Encouraging: • Weight Maintenance
The Permanente Journal/ Summer 2003/ Volume 7 No. 3 pp. 6-7
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Can overweight among children be prevented?
Breastfeed for the first year. Wean from the bottle at 12 months of age. Limit juice and other sweetened drinks to 4-6 ounces per day max.
Limit TV - none before 2 years, 1 hour or less over 2 years of age. Avoid using food as a reward for good behavior.
J Pediatr Vol. 141 No. 6 December 2002 pp. 764-769 JAMA Vol. 285 No. 19 May 2001 pp. 2461-2467
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Primary Care
Interventions
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Kaiser Permanente’s Approach to Preventing Overweight
MEDICAL OFFICE VISIT INTERVENTIONS BMI Screening Physician Counseling Patient Education Materials Referral and Follow-Up WEIGHT MANAGEMENT INTERVENTIONS Individual Counseling Group Programs Intensive Programs Internet Resources
ENVIRONMENTAL CHANGES
School Programs Work Site Programs Community Programs Legislation & Partnerships
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First Steps. . .
Changing the Message Active bodies are healthy bodies Healthy bodies come in all shapes and sizes Anticipatory guidance Breastfeeding promotion Improved nutrition Increased physical activity Identification, Risk Stratification, and Early Intervention BMI Targeted evaluation and education
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A Practical Approach to Overweight Children
Well Child Care Visit
Calculate BMI and Plot BMI% for Age Perform In-Depth Medical Assessment Determine Weight Goals Order Screening Lab Tests (if indicated) Provide Brief Focused Advice Arrange for Follow-Up Visit or Phone Call 1-4 Weeks
Follow-Up Visit or Phone Call
Review Labs Discuss Treatment Options and Referrals Provide Brief Negotiation or Motivational Interviewing Arrange for Follow-Up as Necessary
Proposed Treatment Approach to Overweight Children, Kaiser Permanente, © 2004
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Primary Care Interventions
Diagnosis of overweight using body mass index (BMI)% for age at well child care visits 2 years and older In-depth medical assessment
Appropriate weight goals Counseling - motivational interviewing
Referral and follow-up
Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430
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How do you calculate body mass index (BMI)?
BMI (English): [ weight (lb) / height (in) / height (in) ] x 703
BMI (metric):
[ weight (kg) / height (cm) / height (cm) ] x 10,000
BMI Conversion Tables: http://www.cdc.gov/ Web Calculator: http://www.cdc.gov/ Palm Calculator and Growth Chart: http://www.pdacortex.com/ BMI Calculator Wheel: http://www.trowbridge-associates.com/ $5
BMI = 28
BMI Does Not Measure Body Fat Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430
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Why do we use BMI?
Consistent with adult standards and tracks childhood overweight into adulthood
10Y 8Y
BMI for age relates to health risks including cardiovascular disease, hypertension and type 2 diabetes BMI measurement is recommended by the AAP at all well child care visits 2 years and older.
Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430
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How is overweight diagnosed?
Indicators
of Nutritional Status
>= 95% for age At Risk of Overweight 85-94% for age Underweight < 5% for age
Overweight
Early
Adiposity Rebound
Definition:
8Y 10Y
Early Adiposity Rebound (4Y)
Adiposity rebound is the point when the BMI is the lowest for a child before it increases again Experiencing early adiposity rebound (rebound before 5-6 years old) is a risk factor for subsequent adiposity in adulthood (1) and is associated with parental obesity (2)
(1) Pediatrics Vol. 101 No. 3 March 1998 pp. 462 (2) Pediatrics Vol. 105 No. 5 May 2000 pp. 1115-1118
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Who should receive an in-depth medical assessment?
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In-Depth Medical Assessment History
Developmental delay (Genetic disorders) Poor linear growth (Hypothyroidism, Cushing’s, Prader-Willi syndrome) Headaches (Pseudotumor cerebri) Nighttime breathing difficulty (Sleep apnea, hypoventilation syndrome) Daytime somnolence (Sleep apnea, hypoventilation syndrome) Abdominal pain (Gall bladder disease) Hip or knee pain (Slipped capital femoral epiphysis) Oligomenorrhea or amenorrhea (Polycystic ovary syndrome)
Family History
Obesity NIDDM Cardiovascular disease Hypertension Dyslipidemia Gall bladder disease
Pediatrics 1998 102: e29 http://www.pediatrics.org/cgi/content/full/102/3/e29
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In-Depth Medical Assessment Physical examination
Height, weight, Blood pressure and BMI Truncal obesity (Risk of cardiovascular disease; Cushing’s syndrome) Dysmorphic features (Genetic disorders, including Prader–Willi syndrome) Acanthosis nigricans (NIDDM, insulin resistance) Hirsutism (Polycystic ovary syndrome; Cushing’s syndrome) Violaceous striae (Cushing’s syndrome) Optic disks (Pseudotumor cerebri) Tonsils (Sleep apnea) Abdominal tenderness (Gall bladder disease) Undescended testicle (Prader-Willi syndrome) Limited hip range of motion (Slipped capital femoral epiphysis) Lower leg bowing (Blount’s disease)
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In-Depth Medical Assessment - Laboratory Evaluation Fasting lipid profile and insulin? (1) Screening for diabetes if (2)…
Age 10 or older with BMI >= 95% with 2 of the following:
Family History: type 2 diabetes in a 1st or 2nd degree relative Ethnic Group: Native American, African American, Hispanic, Asian/Pacific Islander Signs of Insulin Resistance: acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome
Screening Tests for Diabetes and Diagnostic Criteria
Fasting (8 hour) plasma glucose = 126 mg/dl Oral glucose tolerance test: 2-hour plasma glucose = 200 mg/dl Casual (random) plasma glucose = 200 mg/dl WITH symptoms of diabetes
ALT (SGPT) (1) Other tests based on history and physical
(1) Circulation 2005;111:1999-2012 (2) Diabetes Care 2000a;23:381-9
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What are the recommended weight goals?
Older Adolescents and Adults: 10% weight loss from baseline over 6 months
Weight loss approx. 1 pound/month Weight goal: BMI< 85%
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What should my child weigh?
Tell the parent what the weight would be for the BMI 85%. Tell the parent that for children the focus is on making improvements in family lifestyles such as making better food choices and being more active not on weight or weight loss. Your health professional will follow your child’s height, weight and BMI and let you know how your family is doing.
Pediatrics 1998 102: e29 http://www.pediatrics.org/cgi/content/full/102/3/e29
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The Role of Nurses, Health Educators, Physicians, etc. ADVISE
All Children
Get up and play hard Cut back on TV and video games Eat 5 helpings of fruits and vegetables/day Cut down on sodas & juice drinks
IDENTIFY
MOTIVATE
Children at Risk or Overweight
Screen with BMI starting at age 2 for all children Focus on key intervention ages
Families at Risk to Make Changes
Ask permission to discuss weight Negotiate areas of improvement Assess readiness to change Explore ambivalence Offer health education materials, referral and follow-up
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Get More Energy! Poster
4 Key Messages
Readiness to Change Tool
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Health Education Materials
Physicians who had
written nutrition brochures in their exam rooms were more likely
to discuss nutrition.
Preventive Medicine Vol. 38 No. 2 February 2004 pp. 198-202
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Effective Communication With Families
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Solutions for childhood nutrition problems mentioned in CA newspaper articles, 7/98–8/00 (N=88) Personal behavior change No solution suggested 31% 17%
Make better options available for school lunch Improve counseling by pediatricians Extend PE requirements in schools
Improve nutrition education in schools Add a “fat tax” to foods based on nutrient value
9% 8% 7%
6% 5%
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What are more sensitive ways to address overweight?
Obesity
Ideal Weight Personal Improvement
Overweight
Healthier Weight Family Improvement
Focus on Weight
Diets or “Bad Foods” Exercise
Focus on Lifestyle
Healthier Food Choices Play or Activity
Effective Communication with Families, Kaiser Permanente, © 2004
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Family Changes-Acknowledge Parental Perceptions and Barriers
May not perceive their obese children as overweight May define overweight as limited physical activity or being teased, not by growth charts May attribute to being “big-boned” or “thick” May believe that nature not nurture determines weight May have trouble controlling children’s eating habits or use food to shape child’s behavior May feel lack of control over child’s diet May themselves be dealing with weight issue
Effective Communication with Families, Kaiser Permanente, © 2004
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Family Changes-Parental Sensitivity
Parents should explain that children come in different shapes and sizes and that they love them whatever their size. Parents should avoid saying “skinny,” “fat,” “obese” or teasing children about their weight.
Parents should address eating and activity as a family issue, not as the child’s “problem.”
Encouraging a Healthy Weight for Your Child, Kaiser Permanente, © 2003
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Family Changes-Positive family attitudes
Having extra weight is no one’s fault. There’s no such thing as good food or bad food. Any activity is helpful, it doesn’t have to be “exercise.” There is no ideal weight or body shape. Body size is just one part of who a person is.
Encouraging a Healthy Weight for Your Child, Kaiser Permanente, © 2003
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Family Changes-Parents Responsibilities
Purchase and offer healthy foods and portion sizes. Limit fast food and eating out. Set limits on TV and video games. Stick to them. Let child choose things to work on. Be a good role model with healthy eating and physical activity. Regularly show affection.
Encouraging a Healthy Weight for Your Child, Kaiser Permanente, © 2003
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Family Changes-Child’s Responsibilities
Eat as much or as little as they need among the food available. Eat 3 meals a day with breakfast. Be active every day and have fun.
Be responsible for TV and video game limits. Be proud of things they do. Choose things to work on to be healthier.
Encouraging a Healthy Weight for Your Child, Kaiser Permanente, © 2003
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Starting the Conversation: Let’s Talk About Weight
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What are the stages of change? Integrated Behavior
Action Preparation
Maintenance Relapse & Recycle
Contemplation
Pre-contemplation
Prochaska & Di Clemente: Transtheoretical Model of Behavior Change
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Change Talk Self-motivating statements made by the patient:
Recognition of an issue Hazards of not making a change Recent efforts to make a change Ideas and options for making a change Hope or confidence about making a change Specific intentions to make a change
Effective Communication with Families, Kaiser Permanente, © 2004
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Self Perception
People are more powerfully influenced by what they hear themselves say than by what someone else says to them
Encourage your patients to say the things that you usually tell them. Help your patients talk themselves into making a change.
Effective Communication with Families, Kaiser Permanente, © 2004
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Behavior Change Techniques
Lifestyle Advice – Well Child Visit < 1 minute Children not currently at risk for overweight
Brief Focused Advice – Well Child Visit < 3 minutes Children who are overweight or at risk for overweight
Brief Negotiation– Follow up Visit 10+ minutes: single or multiple sessions Children who are overweight or at risk for overweight
Effective Communication with Families, Kaiser Permanente, © 2004
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Lifestyle Advice
To stay healthy and energized:
Get up & play hard 30-60 minutes each day Limit TV/video games to <1 hour each day Eat five fruits and vegetables each day Limit juice and soda to < 1cup each day
Effective Communication with Families, Kaiser Permanente, © 2004
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Brief Focused Advice
Step #1: Engage the Patient / Parent
Can we take a few minutes to discuss your health and weight?
How do you feel about your health and weight?
Step #2: Share Information (optional)
Your current weight puts you at risk for developing heart disease and diabetes. What do you make of this?
Some ideas for staying healthy include…. (see poster)
What are your ideas for working toward a healthy weight?
Effective Communication with Families, Kaiser Permanente, © 2004
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Brief Focused Advice Step #3: Make a Key Advice Statement
I would strongly encourage you to…
Get up and play hard, 30-60 minutes a day. Cut back on TV & video games to 60 min/day. Eat 5 helpings of fruits of vegetables every day. Cut back on sodas & juice drinks to 1 small cup/day. Use patient ideas from step #2
Step #4: Arrange for Follow up
Would you be interested in more information on ways to reach a healthier weight? AND / OR Let’s set up an appointment in 1-4 weeks to talk about this further.
Effective Communication with Families, Kaiser Permanente, © 2004
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What is Brief Negotiation?
A counseling style that provides an effective and structured approach to behavior change counseling in brief clinical encounters Based on behavior change theory and clinical research:
Stages of Change Model, DiClemente and Prochaska, 1998 Motivational Interviewing, Miller and Rollnick, 1991
Brief Negotiation Steps
Set the Stage Share Clinical Results Assess Readiness to Change Close Conversation/Transition to Referral
Effective Communication with Families, Kaiser Permanente, © 2004
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Motivate Families to Make Changes Using Brief Negotiation Open the Encounter Negotiate the Agenda Assess Readiness Explore Ambivalence
Tailor the Intervention Close the Encounter
Effective Communication with Families, Kaiser Permanente, © 2004
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Open the Encounter
Ask Permission Would you be willing to discuss your weight for the next few minutes? Ask an Open-Ended Question How do you feel about your weight? What do you think about your weight? What have you tried so far to manage your weight? Listen Summarize
Effective Communication with Families, Kaiser Permanente, © 2004
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Negotiate the Agenda
There are a number of ways to achieve
a healthy weight (refer to poster). They include: Get up and play hard Cut back on TV and video games Eat 5 helpings of fruits and vegetables a day Cut down on soda and juice
Is there one of these you’d like to discuss further today? Or maybe you have another idea…
Effective Communication with Families, Kaiser Permanente, © 2004
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Assess Readiness to Change
FOR HEALTH PROFESSIONALS
Not Ready
0 1 2 3 4 5 6 7 8
Ready
9 10
Straight question: “On a scale of 0-10, how ready
are you to think about [option chosen from poster] ?”
Backward question: “Why a 5 and not a 3?” Forward question: “What would it take to move
you from a 5 to a 7?”
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Explore Ambivalence
Ask a pair of questions to help the patient/parent explore pros and cons What are the things you like about ___? AND What are the things you don’t like about ___? OR What are the advantages of keeping things the same? AND What are the advantages of making a change? Summarize Did I get it all?
Effective Communication with Families, Kaiser Permanente, © 2004
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Tailor the Intervention
Not Ready
0 1 2 3 4 5 6 7 8
Not Ready 0-3
Raise Awareness Advise & Encourage
Ready
9 10
Unsure 4-6
Evaluate Ambivalence
Ready 7-10
Strengthen Commitment & Facilitate Action
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Close the Encounter
Summarize
Show appreciation
Offer advice, emphasize choice, express confidence
Confirm next steps/referral
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Health and Social Service Providers Responsibilities
Advise all children on the 4 key messages regardless of their shape or size. Identify children at risk or overweight. Motivate families at risk to make changes by assessing their readiness to change and identifying 1-2 key behaviors. Provide educational materials. Provide follow up with at risk families.
Effective Communication with Families, Kaiser Permanente, © 2004
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Tools for Primary Care Interventions
Growth Charts BMI Wheel Calculator Patient Education Materials Exam Room Poster
CDC
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
Environmental Changes and
Physician Advocacy
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
Are overweight children a personal or community issue?
Both 16% No Opinion 1%
Personal Issue 30%
Community Issue 53%
1,068 random sample CA residents, telephone survey 10-11/2003 http://calendow.org/caobesityattitudes/index.htm
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
What do Californians think the answer is?
Create more community recreational programs (96%). Require schools to teach students about nutrition & physical activity (96%).
After-school athletic facilities open and available (93%).
Require PE in high school (92%).
Require restaurants to post nutritional information on menus (87%).
1,068 random sample CA residents, telephone survey 10-11/2003 http://calendow.org/caobesityattitudes/index.htm
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
Health Care and Prevention of Overweight Children
Medical office visit – BMI screening, counseling and referral Environmental improvement at health care facilities and policy Health professionals working with community collaborative and advocacy Health care benefits
Social marketing
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
The Role of Health Care in Community Advocacy
JAMA January 7, 2004 - Vol. 291, No. 1 pp. 94-98
Provide quality care to individual patients in regular practice. Improve the system of care delivered by group/organization.
Provide quality care to uninsured patients. Improve insurance coverage, after-hours care and geographic distribution of services.
Environmental change in local schools and communities to address tobacco, injury prevention, and obesity. Public policy to address same issues.
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
The Role of Health Care in Community Interventions
Leadership
and Advocacy
Subject matter expertise and credibility Participation in community collaborative activities
Consultation on policy recommendations and interventions
Education
and Social Marketing
Presentations to government, school boards, teachers, parents and students Media interventions
Pediatrics Vol. 112 No. 4 October 2003, pp. e328-346 Pediatrics Vol. 115 No. 4 April 2005, pp. 1142-1147
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
What is the AAP policy on soft drinks in schools?
Health Care should work to eliminate sweetened drinks in schools. This entails educating school authorities, patients, and patients’ parents about the health ramifications of soft drink consumption. Health Care should advocate for the creation of a school nutrition advisory council comprising parents, community and school officials, food service representatives, physicians, school nurses, dietitians, dentists, and other health care professionals.
PEDIATRICS Vol. 113 No. 1 January 2004, pp. 152-154
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
What can schools do?
Salad bars and other low cost healthy meal options. Bans on soda contracts. More PE (at least 200 minutes every 10 school days). More fun PE, non-competitive activities. Walk to school events (www.cawalktoschool.com). Safe bicycle riding events. Teach children about healthy eating and physical activity in school. Link activities – school, after-school and home.
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
What can communities do?
Make healthy foods available and affordable (e.g., farmers markets, community gardens). Improve safety of and access to parks and other recreational areas.
Promote pedestrian and bicycle friendly zoning. Design new communities to be more walkable.
Healthy messages on TV, radio and posters.
The Role of Health Care in Prevention & Treatment
REGIONAL HEALTH EDUCATION
FOR HEALTH PROFESSIONALS
What resources are available for schools and communities?
The Children and Weight: What Schools and Communities Can Do About It Resource Kit http://www.cnr.berkeley.edu/cwh CDC School Health Index http://www.cdc.gov/
California Project LEAN http://www.californiaprojectlean.org/
Guide to Community Preventive Services http://www.thecommunityguide.org E. N. A. C. T. http://www.preventioninstitute.org/