Term
| since 1962, the number of obese children in the US has ____ |
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| type 2 diabetes is now ___% of cases; ___fold increase from 1982-1994 |
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Term
| non-modifiable risk factors |
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Definition
| genes, metabolism, culture, poverty |
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Term
| Family/Patient Self Management: Enviroment, Medical system |
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Definition
environment: family, school worksite, community
medical system: information systems, decision support, delivery system design, self- management support |
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Definition
Height, weight, BMI, BP, HR
Family history
ROS
physical exam
Lab tests |
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Term
| Behavioral and attitude risks |
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Definition
| Diet behavior, physical activity behaviors, attitudes |
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| for patient communitcation with BMI % |
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Definition
| weight or excess weight, BMI, risk for Diabetes and heart disease |
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5% = underweight
5-84% = healthy
85-94% = overweight
95-98% = obese
>99% |
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parental obesiy
CV disease, hypertension, dyslipidemia
NIDDM, Insulin Resistance |
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Definition
depression - anxiety, school avoidance, social isolation
type 2 diabetes - polyuria, polydypsia, ewight loss
pseudotumor cerebri - headaches
sleep apnea, asthma, hypoventilation syndrome - night breathing difficulties
sleep apnea, hypoventilation, depression - day time sleepiness
GE reflux, gall bladder disease, constipation - abdominal pain
slipped capital femora epiphysis - hip or knee pain
polycystic ovary syndrome - oligomenorrhea or amenorrhea |
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Term
| assess behaviors and attitudes: diet behaviors, physical activity, attitudes |
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Definition
diet - sweeten beverage consumption, fruit and vegetables, frequency of eating out and family meals, consumption of excessive portion sizes, daily breakfast consumption
physical activity - amount of moderate physical activity, level of screen time
attitudes - selfperception or concern about weight, readiness to change, successes, barriers, and challenges |
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Term
| things to look for on a physical exam |
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Definition
poor linear growth - cushings, hypothyroidism, Pradder-Willi
dysmorphic features - genetic disorders, Prader-Willi
Acanthosis nigricans - NIDDM, insulin resistance
hirsutism and excessive acne - polycystic ovary syndrome
violaceous striae - cushing's
papilledema, cranial verve VI paralysis - pseudotumor cerebri
tonsillar hypertrophy - sleep apnea
abdominal tenderness - gall baldder disease, GERD, NAFLD
hepatomegaly - NAFLD
undescended testicle - Prader Willi
limited hip range of motion - slipped capital femoral epiphysis
lower leg bowing -Blount's disease |
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Term
| lab tests: BMI 85-94% without risk |
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Definition
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Term
| lab tests: BMI 85-94% with risk factors over 10 y.o. |
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Definition
every 2 years
fasting lipid profile, ALT and AST, fasting glucose |
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Term
| lab tests: BMI >95% age 10 or older |
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Definition
every 2 years
fasting lipid profile, ALT and AST , fasting glucose, other tests indicated by health risks |
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Term
| Prevention of Childhood obesity |
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Definition
| BMI for all children > 2, give consistent evidence based prevention messages, use patient-centered communication (EPE), health professional advocacy |
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| Empathize/ Elicit, Provide, Elicit |
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Term
| treatment goals of childhood obesity |
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Definition
| behavioral goals and parenting skills, self esteem and self efficacy, BMI velocity, weight loss targets and BMI percentile |
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Term
| a staged approach of treatment |
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Definition
| prevention plus, structured weight management, comprehensive, multidisciplinary intervention, tertiary care intervention |
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Definition
| family visits with physician, frequency individualized to family needs |
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| stage 2: structured weight management |
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Definition
| family visits with pysician, visit with a dietician, exercise therapist, or counselor, goal setting and rewards |
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Term
| stage 1 and 2 behavioral recommendations |
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Definition
| decrease screen time, minimize sugar beverages, 5 servings of fruits and vegetables daily, physically active for more than 1 hour, healthy breakfast, family lifestype changes |
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| stage 3: comprehensive multidisciplinary intervention |
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Definition
| multidisciplinary team with experience in childhood obesity; frequency often weekly group sessions |
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| stage 4: tertiary care intervention |
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Definition
for children only when provided by experienced programs
medications (sibutramine, orlistat), very low calorie diets, weight control surgery |
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| overcoming challenges of obesity |
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lack of patient motivation and provider skills (EPE, motivational interviewing)
not enough time (office systems and tools, team based care)
no reimbursement (coding strategies, advocacy) |
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Term
| Step 1: prevention at well care visits |
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Definition
| assess all children for obesity by measuring BMI and weight diagnosis, measure BP, family history, behaviors and attitudes, signs of co-morbid conditions |
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Term
| Step 2: prevention plus visits |
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Definition
| office based approach for follow up of overweight and obese children: Health educational materials, behavioral risk assessment and self monitoring tools, action planning and goal setting tools |
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Term
| Step 3: beyond the practice |
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Definition
| advocate for improved access to fresh fruits and vegetables, promote community services that encourage health, develop more intesive weight management interventions, join childhood obesity action network |
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