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Gina Smith, MSN, FNP-C & Christina Turbeville, CDM

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Childhood Obesity Prevention: Models of Successful Programs Gina Smith, MSN, FNP-C & Christina Turbeville, CDM FirstHealth Montgomery County School Health Centers – PowerPoint PPT presentation

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Title: Gina Smith, MSN, FNP-C & Christina Turbeville, CDM


1
Childhood Obesity Prevention Models of
Successful Programs
  • Gina Smith, MSN, FNP-C Christina Turbeville,
    CDM
  • FirstHealth Montgomery County School Health
    Centers
  • Meg McHenry, RD, MPH, LDN Kara Richards, BA, MA
  • Wake Teen Medical Services

2
Objectives
  • Describe the magnitude of childhood obesity
  • Discuss the role of School Health Centers in
    addressing childhood obesity
  • Provide examples of successful SBHC programs
    utilizing best practices
  • Summarize resources available to providers for
    assisting in implementation of childhood obesity
    programs

3
Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
www.cdc.gov
4
Obesity Trends Among U.S. AdultsBRFSS, 2007
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
www.cdc.gov
5
Prevalence of At-Risk Overweight Among Children
and Adolescents
85
95
Ogden, et al. (2006). JAMA, 295(13),
1549-1555.

6
Health Risks of Obesity
  • Pulmonary
  • Sleep disorders
  • Asthma
  • Obesity-linked hypoventilations
  • Neurologic
  • Pseudotumor cerebri

7
Health Risks of Obesity
  • Orthopedic
  • Slipped capital epiphysis
  • Tibia vara (Blounts disease)
  • Tibial torsion
  • Flat feet
  • Ankle sprain
  • Fractures

8
Health Risks of Obesity
  • Cardiovascular
  • Hypertension
  • Dyslidemia
  • Fatty deposits
  • Left ventricular hypertrophy
  • Other
  • Systemic inflammation

9
Health Risks of Obesity
  • Gastrointestinal
  • Cholelithiasis
  • Non-alcoholic fatty liver disease
  • Gastro-esophageal reflux
  • Endocrine
  • Insulin resistance/Type II Diabetes
  • Acanthosis nigricans
  • Menstrual abnormalities
  • Polycystic ovary syndrome
  • Hypercoricism

10
Health Risks of Obesity Psychological
  • Obese children and their parents rate the quality
    of life as similar to pediatric cancer patients.
  • Schimmer, Burwinkle, Varni, 2003

11
Health Risks of Obesity Psychological
  • Actual and perceived overweight is an important
    risk factor for suicidal behaviors in youth
  • Risk factor for suicidality even after
    controlling for alcohol and illicit drug use
  • (Swahn, M., Reynolds, M., Tice, M., et. al,
    Journal of Adolescent Health, 2009.)

12
Significance of Problem
  • 80 of obese adolescents will become
  • obese adults
  • - NASBHC, 2009

13
The Role of SBHCs in Addressing Childhood
Obesity
  • Leader in child health to emphasize prevention
    and early intervention
  • Sensitive to unique needs of children and
    adolescents with the ability to provide
    culturally sensitive, age-appropriate services
  • Opportunity for access to students with services
    provided regardless of the ability to pay
  • Qualified, highly trained, interdisciplinary
    teams comprised of RD, nutritionist, FNP, RN

14
FirstHealth of the CarolinasMontgomery County
School Health Centers, East West
  • East West Middle Schools
  • Comprehensive, credentialed centers
  • 670 total registrants

15
BMI Data Collection 2007-08
  • Great partnership with Montgomery County Schools
  • Collaboration with school nurses, teachers and
    students
  • SBHC nurses
  • SBHC Nutritionist
  • SBHC FNP

16
BMI Discovery
17
Page Street Intervention HEAPHealthy Eating
Active Play
  • 3rd Graders 39 obese 16 overweight
  • Intervention developed RD, Nutrition Educator,
    FNP
  • Nutrition Educator as instructor
  • 4-week program
  • Pretest of knowledge and behaviors
  • One 45 minute class/week . Fun activities
    healthy snacks focusing on healthy eating and
    increasing physical activity
  • Post-test
  • BMIs recalculated

18
Week 1 What to Dump
  • SODA CHIPS
  • SWEET TEA COOKIES
  • KOOL-AID CANDY
  • LEMONADE DORITOS
  • SUNNY DELIGHT HOT FRIES
  • POWERADE CHEETOS
  • GATORADE LITTLE DEBBIES
  • FRUITOPIA CAKES PIES
  • YOOHOO BROWNIES
  • CAPRI-SUN CHOCOLATE
  • NABS HONEY BUNS
  • RICE KRISPY TREATS
  • KLONDIKE BARS

19
Week 1 What to Pick Up
  • 1 OR SKIM MILK
  • WATER
  • CAFFEINE FREE/ UNSWEETENED TEA
  • CAFFEINE FREE / DIET SODA
  • HOMEMADE LEMONADE WITH SPLENDA
  • 100 JUICE ONCE A DAY ONLY
  • LITE MICROWAVE POPCORN
  • CELERY / PEANUT BUTTER
  • CARROTS WITH LOW FAT DRESSING
  • PEANUT BUTTER CRACKERS (whole wheat)
  • APPLES-ORANGES-BANANAS-FROZEN GRAPES
  • STRING CHEESE
  • NUTS
  • RAISINS, DRY CHEERIOS, PRETZELS
  • FROZEN YOGURT

20
Week 2
  • WHAT FRUITS TO ADD TO BREAKFAST
  • Bananas
  • Raisins
  • Apples
  • Peaches
  • Cut up fruit to top your waffles versus syrup
  • Yogurt in place of syrup
  • Eat your fruit vegetables that come with lunch!
  • FRUITS VEGETABLES TO ADD TO
  • LUNCH SUPPER
  • Carrots celery sticks
  • Cucumber slices
  • Applesauce cups
  • Apples, oranges, or bananas
  • Bring salad to school
  • Supper ½ of your plate should be vegetables
  • Try the vegetables your mom makes at least
    three times before you say you dont like it.

21
Week 2 Healthy Eating and Physical Activity
Go Hand in Hand
  • Exercise can be fun in fact its childs play!
  • Make it a family affair
  • Limit TV viewing time to 2 hours or less/day
  • Be physically active for 60 minutes every
    day

22
Week 3
  • HOW SHOULD YOUR PLATE LOOK?
  • One-half (1/2) of your plate should have
    vegetables
  • One-fourth (1/4) of the plate should have your
    meat or protein
  • One-fourth (1/4) of the plate should have your
    starches (bread, pasta, rice, potatoes)

23
Week 4 Healthy Meals on the Run
  • RESTAURANTS CHOICES
  • McDonalds 1 milk, mandarin oranges,
  • unsweetened tea, apple dippers, or yogurt
    with fruit
  • Zenos Grilled chicken, vegetable pizza, salad
  • Sir Pizza Salad bar, fruit choices, vegetable
    pizza
  • Mazatlan Ask the waiter to take the
    chips off the table when you sit down. Take ½
    of your order home for a later meal.
  • Pennys Order the small order and stay away
    from sauces.
  • BoJangles Grilled chicken, no biscuit. Ask
    for a bun instead.
  • Subway Ask for the kids meal, salad and no
    chips.

24
Results???
  • BMI 1 decrease in obese students
  • from 39 to 38
  • Correct answers
  • Pretest 51
  • Post-test 98

25
  • 2008 NC Stars Fruit and Veggies Silver Award
    Healthcare Division

26
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27
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28
Page Street 5th Graders 09-10
Page Street 5th Graders
2009-10
0
39
41
BMI

95
BMI 85-94
BMI Normal
BMI lt 5
20
29
Childhood Obesity Action Network. State Obesity
Profiles, 2008. National Initiative for
Children's Healthcare Quality, Child Policy
Research Center, and Child and Adolescent Health
Measurement Initiative.
30
2008-09 Childhood Obesity Efforts
  • Nutritional assessment utilizing HEAP quiz on all
    students enrolled at the SBHCs (EMS/WMS)
  • Ht/wt/BMI calculated and plotted
  • Early referrals made to SBHC nutritionist for BMI
    ? 85
  • Referral to SBHC RD for BMI 95
  • 2-3 nutritional counseling sessions 1345
    nutrition visits

31
SHC/school-wide 2008-09 Efforts
  • Alignment with MCS system goals Promote a
    child-centered culture of health, rigor, and high
    expectations
  • Nutrition educator collaborated with school staff
    in forming after school walking clubs at both
    middle schools 130 miles walked
  • Health Eating Every Day (HEED) classes for school
    staff
  • BMI data collection for all MCS students grades
    pre-K-12

32
SHC/school-wide 2008-09 Efforts
  • HEAP presentations
  • Presented to Candor 3rd graders last year were
    most obese in MCS at 41 obese
  • Green Ridge 3rd graders
  • Mt. Gilead 4th graders
  • 176 HEAP students this year

33
2008-09 BMI Trends
Montgomery County Schools BMI Data

2008-09
2
27
BMI

95
BMI 85-94
BMI Normal
52
BMI lt 5
19
34
2008-09 BMI Trends
Childhood Obesity Action Network. State Obesity
Profiles, 2008. National Initiative for
Children's Healthcare Quality, Child Policy
Research Center, and Child and Adolescent Health
Measurement Initiative.
35
SHC BMI Trends
36
SHC BMI Trends
37
SHC BMI Trends
38
SHC BMI Trends
39
SHC BMI Trends
  • Overall decrease in BMI of
  • OB/OW students 71
  • n 279

40
2008-09 HEAP Results
41
2008-09 HEAP Results
42
2008-09 HEAP Outcomes
  • Candor/Green Ridge/Mt. Gilead
  • Pretest 58 Correct
  • Post-test 93 Correct

43
Additional School-wide efforts
  • SPARK curriculum in K-8
  • www.spark.org
  • Fitnessgram software to track BMI
  • Healthy Kids/Healthy Communities grant
  • School Nutrition Director developing healthier
    menus
  • 3 schools received fruit grants

44
2009-10 SHC Efforts
  • Nutritional assessment on all SBHC enrollees
  • Prevention/early intervention
  • 5-3-2-1-Almost None
  • Increased nutritional services for SHCS in
    2009-10 by increased nutritional services to 4
    days total/week
  • Registered Dietician for students 99
  • Actively seek resources/funding for innovative
    methods for addressing childhood obesity

45
2009-10 SHC BMI Trends
  • Nutrition Referrals for OB/OW
  • n261
  • BMI 99 19
  • BMI 95-98 42
  • BMI 85-94 - 36
  • BMI lt5 or other 3
  • 61 obese!!

46
Additional Efforts
  • Present HEAP program to Green Ridge 1st graders
    BMI 33OB/30OW
  • Fasting glucose, lipids, ALT, AST, etc.
  • Actively seek resources/funding for innovative
    methods for addressing childhood obesity
  • Look for ways to incorporate more physical
    activity into the SHC programs
  • Collaborate on a local, state and national level
    in addressing childhood obesity

47
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48
Childhood Obesity Prevention Models of
Successful ProgramsBe Fit, Get Moving
  • Kara Richards, MA
  • Meg McHenry, RD, MPH, LDN

49
Wake Teen Medical Services
  • Wake Teen Medical Services is a non-profit
    medical service provider for adolescents through
    young adults ages 10 to 23
  • Services include
  • Primary health care
  • Mental health care
  • Health education
  • Nutrition counseling

50
Wake Teen Medical Services
  • Saw 1473 patients in the last year
  • Patient demographics
  • 975 female, 498 male
  • 989 African American, 446 White, 38
    Other/Unidentified
  • Over 30 of patients fall at or above the 85th
    BMI percentile
  • Wake County obesity prevalence
  • For ages 12-17, 21 classify as overweight and
    30 as obese

51
Be Fit, Get Moving
  • Kate B. Reynolds-funded multidisciplinary healthy
    lifestyle program that includes
  • Health care screening
  • Individual nutrition counseling
  • Individual exercise counseling
  • Mental health counseling (if needed)
  • Weekly group educational seminars, exercise
    sessions, and field trips

52
Be Fit, Get Moving
  • Target population
  • Youth ages 10 through 23
  • At or above the 85th BMI percentile
  • Highly motivated to make a change
  • Program Participants
  • Began October 2008 for Wake Teen patients only
  • In March 2009, we opened the program to outside
    participants (schools, physician offices, etc.)
  • We have served 65 of all participants referred,
    reaching well over 100 teens in Wake County
  • 76 are female, 60 African American, 98
    financially needy

53
Intended Outcomes and Results
  • Intended Outcomes at 12 months
  • Decreased BMI in 65 of participants
  • 70 will be active for 20 min/5x/wk
  • 85 show improvements in cardiovascular health
  • 90 will increase nutrition knowledge
  • 85 will eat healthy breakfast 5x/wk
  • 90 improve self-perception
  • Results at 9 months
  • 31 decreased, 50 maintained
  • 100 participants increased activity time, 70
    active at least 5xwk
  • 55 decreased resting heart rate, 80 decreased
    blood pressure
  • 80 increased nutrition knowledge
  • 65 eating breakfast daily 100 increased from
    baseline
  • 75 increased, 25 maintained or improved
    minimally

54
Measurement Tools Used
  • BMI Heights/weights taken at exercise
    appointments CDC growth charts
  • Activity Exercise logs/self-report to exercise
    specialist
  • Cardiovascular health BP/RHR from exercise
    specialist or medical record
  • Nutrition knowledge 20-question quiz developed
    by staff nutritionist
  • Healthy breakfast food records/self-report to
    nutritionist
  • Self-perception 12-question quiz developed by
    mental health staff

55
Additional Outcomes
  • WHR 65 improved from baseline
  • Pushups 100 improvement
  • Squats 100 improvement
  • Qualitative results
  • If I had not participated in BFGM, I would still
    be drinking sugared drinks, eating chips all day,
    going to McDonalds almost everyday I would be
    extremely obese M, 15
  • One achievement Im proud of is that I lowered
    my blood sugar. When I first started this
    program, it was in the 300s. Now Im getting
    results in the low 80s. F, 18
  • Within two weeks of starting the program, I
    noticed my son is more confident he wants to
    ride bikes with other kids, he is more willing to
    be active, and he smiles a lot more. Mother of
    M, 14

56
Process
  • Program Structure
  • Tuesday education seminars and neighborhood
    walk/boot camp
  • Thursday boot camp
  • Individual nutrition counseling
  • Individual exercise counseling
  • Field trips

57
Dining Out
58
Eating Out
59
Physical Activity
60
Community Support
61
Contact Information - Wake Teen Medical Services
  • Kara Richards, Project Coordinator
  • krichards_at_waketeen.org
  • Meg McHenry, Nutritionist
  • mmchenry_at_waketeen.org
  • Telephone 919-828-0035
  • www.waketeen.org

62
Contact Information - FirstHealth Montgomery
County School Health Centers
  • Gina Smith, FNP, SHC Manager
  • rpsmith_at_firsthealth.org
  • Christina Turbeville, Nutrition Educator
  • cturbeville_at_firsthealth.org
  • Telephone 910-428-9392, East
  • 910-572-1979, West

63
Resources
  • USDA Food Guide Pyramid www.mypyramid.gov
  • Eat Smart, Move More www.eatsmartmovemorenc.com
  • Shield, J. and Mullen, C.M. (2008). Counseling
    Overweight and Obese Children and Teens Health
    Care Reference and Client Education Handouts.
    Chicago, Il American Dietetic Association
  • Videos
  • Obesity in a Bottle www.learningzoneexpress.com
  • Fast Food Survival Guide www.learningseed.com

64
Resources
  • NASBHC - http//ww2.nasbhc.org/RoadMap/CONVENTION0
    9/D7_1.pdf
  • NASBHC CQI Tool http//www.nasbhc.org/site/c.jsJ
    PKWPFJrH/b.2719357/k.6312/EQ_Quality_Improvement.h
    tm
  • NICHQ http//www.nichq.org
  • http//www.nichq.org/documents/coan-papers-and-pu
    blications/COANImplementationGuide62607FINAL.pdf

65
Resources
  • Expert Committee Recommendations Regarding the
    Prevention, Assessment, and Treatment of Child
    and Adolescent Overweight and Obesity Summary
    Report http//pediatrics.aappublications.org/cgi/r
    eprint/120/Supplement_4/S164
  • CDC BMI Calculator for Children Teens -
    http//apps.nccd.cdc.gov/dnpabmi/
  • NC Prevention Partners www.ncpreventionpartners.
    org
  • NC Healthy Schools www.nchealthyschools.org

66
Questions??
67
Merry Christmas!!
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