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Addressing childhood obesity through partnerships between healthcare and community

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Addressing childhood obesity through partnerships between healthcare and community Sarah E. Barlow, MD, MPH Baylor College of Medicine Addressing Obesity within the ... – PowerPoint PPT presentation

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Title: Addressing childhood obesity through partnerships between healthcare and community


1
Addressing childhood obesity through partnerships
between healthcare and community
  • Sarah E. Barlow, MD, MPH
  • Baylor College of Medicine

2
IOM report Preventing Childhood Obesity 2005
3
Addressing Obesity within the Healthcare System
  • Benefits of this setting
  • Framing the condition in terms of health rather
    than appearance
  • Care of associated medical problems
  • Care of individual and of family

4
Addressing Obesity within the Healthcare System
  • Disadvantages of this setting
  • Time
  • Reimbursement
  • Expertise
  • Office visit structure
  • Accessibility for patient

5
Office visit model
Symptoms and signs
Diagnosis
Treatment
Headaches with nausea
Medication
Migraines
Education, motivation, parenting skills, social
work, screen and address comorbidities
Soda, fast food, school food, video games,
poverty, unsafe neighbor-hood, single mother,
poor parenting, depression
Obesity
6
  • Pediatricians feel overwhelming sense of futility
  • I just feel kind of powerlesswhat more can I
    do?
  • Giving them handouts just placates me
  • I can talk until Im blue in the faceyou know
    at home these kids are just following the
    overweight parents footsteps, and theres not
    really anything thats going to change that

7
Hercules carrying the world
8
Addressing Obesity within Community Setting
  • Benefits
  • Accessibility
  • Implementation as well as education
  • Opportunity for environmental change
  • Context of behavioral setting

9
Addressing Obesity within Community Setting
  • Disadvantages
  • Low intensity
  • Limited scope or duration
  • Exercise class, nutrition class
  • Lack of individualization
  • Medical
  • Behavioral

10
Community programs Shape Up Somerville
  • Somerville MA and 2 control communities grades
    1-3
  • Intervention
  • Before school breakfast, walk to school
  • During school staff development, food service,
    curriculum, recess
  • After school aftercare curriculum, walk from
    school
  • Home newsletter, coupons, family events
  • Community farmers market, Ethnic-minority group
    collaborations, city ordinances on walkability,
    bike-ability

Economos 2007 Obesity 15, 1325
11
Shape Up Somerville
Estimated effect on weight over 8 months Boys
0.82 lb Girls 0.95 lbs
12
Integrating Healthcare and Community Resources
13
Chronic Care Model
Environment
Medical System
Family/Patient Self-Management
Family School Worksite Community
Information Systems Decision Support Delivery
System Design Self Management Support
14
Chronic Care Model
  • Self-Management Patients have a central role in
    determining their care
  • Decision Support Health organizations integrates
    guidelines into day-to-day practice
  • Delivery System Design Providers have clear
    roles and tasks patient information is
    centralized and up-to-date.
  • Clinical Information System Information systems
    can track individual as well as groups of
    patients.
  • Organization of Health Care Health care systems
    can create an environment in which organized
    efforts to improve chronic illness care flourish.
  • Community Healthcare forms partnerships with
    state, local, and private entities.

Wagner EH. Effective Clinical Practice.
19981(1)2-4
15
Expert Committee Recommendations for Prevention,
Assessment and Treatment of Child and Adolescent
Obesity
Assessment Medical risk Behaviors Attitude
BMI Category (calculated yearly from weight and
height)
Prevention
Treatment Stages 1 Prevention Plus 2 Structured
Weight Management 3 Comprehensive
Multidisciplinary 4 Tertiary Care Intervention
Barlow SE and Expert Committee, 2007. Pediatrics
120 suppl 4.
16
Stages of intervention
Intensity
Tertiary Care
Age BMI Medical status Motivation
Comprehensive Multidisciplinary
Structured Weight Management
Prevention Plus
Who What and How
17
1. Prevention Plus
  • WHAT
  • 5 fruits and vegetables
  • 2 hours screen time
  • 1 hours physical activity
  • Reduce sweet drinks
  • Eating behaviors (3 meals, family meals, etc.)
  • Family-based change
  • HOW
  • Office-based
  • Trained office support
  • MD, PNP, PA, RN
  • Scheduled follow-up visits
  • Advance to next level depending on response and
    interest

18
2. Structured Weight Management
  • WHAT
  • Reduced calorie eating plan
  • 1 hour screen time
  • gt 1 hour physical activity
  • Monitoring
  • HOW
  • RD, MD, RN with training in assessment,
    counseling
  • Office-based
  • Support from referrals and outside programs
  • Monthly visits
  • Advance if needed

19
Goals with community partners coordinating
programs
  • Programs for physical activity
  • Fun
  • Inclusive (rather than select)
  • Available and affordable/free
  • Some targeted for overweight children
  • Programs for better nutrition
  • Parent education, culturally appropriate
  • Child education
  • Access (Farmers markets, supermarkets)

20
Healthy Kids-Houston(Project KidFIT)
  • Partners Baylor College of Medicine
  • Texas Childrens Hospital
  • Houston Parks and Recreation Dept
  • Houston Metropolitan Authority
  • 6-week after-school physical fitness and
    nutrition education program
  • 128 children 6-12 years of age
  • 61 African American, 39 Hispanic
  • 54 with BMI gt 95th ile

21
Healthy Kids-Houston Decreased weight and BMI
in obese youth
Bush CL et al. J Peds 2007 151513
22
Viva La Salud Infantil Weight Loss Intervention
Pilot Study
  • Baylor College of Medicine, Childrens Nutrition
    Research Center, Nancy Butte PhD, principal
    investigator
  • Ripley HouseNeighborhood Center
  • Bringing resources, education and connection to
    underserved neighborhoods
  • To compare a 4 month intervention for overweight
    Hispanic 7-12 year olds and families
  • weekly diet behavior modification
  • vs.
  • weekly diet behavior modification plus structured
    aerobic exercise 3x a week

23
Viva La Salud Results
  • 24 children enrolled, 21 completed
  • Weekly sessions 94
  • Exercise sessions 84
  • Weight change both groups
  • -2.2 kg 2.7 diet
  • -3.3 kg 2.7 diet ex
  • Improved Quality of Life (p0.04)

24
Viva La Salud Infantil Weight Loss Intervention
Pilot Study
25
  • 2 week residential camp
  • Partners
  • Camp Cho-Yeh, Livingston TX
  • Texas Childrens Hospital / Texas Childrens
    Pediatric
  • Associates
  • Baylor College of Medicine
  • USDA/ARS Childrens Nutrition Research Center
  • Harris County Hospital District Foundation

26
Kamp Kaana
27
Kamp Kaana Program
  • Healthy food
  • 1 pass cafeteria line
  • Unlimited salad
  • 1800 kcal per day
  • Traffic Light labels
  • Lessons
  • Daily for 1 hour
  • 4 nutrition
  • 6 behavior

28
Kamp Kaana Activities
29
Kamp Kaana Outcome
  • Improved weight -3.7 1.2 kg
  • -1.6 0.5 kg/m2
  • Improved self-esteem
  • Kamp Kaana 2009
  • www.bcm.edu/kampkaana

Wong w et al. JPGN 2009 in press.
30
Adult program Community referral for promoting
physical activity among primary care patients
  • Kevin O. Hwang, MD, MPH, UT Houston
  • Partners YMCA and UT Houston Physicians General
    Clinic
  • Prescription for physical activity alone vs.
    prescription plus referral to YMCA and vouchers
  • Results both groups increased physical activity,
    with no difference between the groups

31
Stages of interventionImprove, integrate, and
evaluate
Intensity
Tertiary Care
Kamp Kaana
Comprehensive Multidisciplinary
Viva La Salud Healthy Kids Houston
Structured Weight Management
Healthcare Alliance Texas Pediatric Society
toolkit
Prevention Plus

32
Obesity care is a team activityHealthcare and
community partnerships
33
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34
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