CHILDHOOD OBESITY: What Can We Do to Help?

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CHILDHOOD OBESITYWhat Can We Do to Help?

• Dominique R. Williams, MD, FAAP Patricia
  Belford-Cohen, LCSW
• Medical Director Licensed Clinical Social
  Worker
• CHKD Healthy You Program

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• Neither Dr. Williams nor Ms. Cohen have any
  financial relationships to disclose
• Neither intends to discuss off-label uses of
  pharmaceutical products or medical devices

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Learning Objectives

• Discuss psychosocial struggles of the obese child
• Become familiar with community resources

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Pick up the pieces
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CHKD Healthy You Clinical Team

• Dominique Williams, MD, Medical Director
• Barbara Babs Benson, RN, Program Manager
• Mary Jo Haney, RD, CSP, Registered Dietitian
• Patricia Belford-Cohen, LCSW, Licensed Clinical
  Social Worker
• Kira Davies, DPT, Physical Therapist
• Christina Dolenti, DPT, Physical Therapist
• 757.668.7035
• www.chkd.org/HealthyYou

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Why does childhood adolescent obesity matter?

• In the state of Virginia
• 60 of adults are overweight or obese
• 30 of 6-19 years olds are overweight or obese
• At least 2 million adults suffer from chronic
  diseases
• Yearly health care costs exceed 24 billion

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Select Metropolitan Area Risk Trends
HR VA-NC () VA () U.S. ()
Health Status of adults reporting general health as fair /poor 13.1 12.7 14.4
Exercise of adults reporting doing no leisure time exercise or physical activity in the past 30 days 26.6 23.6 24.6
Diabetes of adults told by a doctor they have diabetes 9.7 7.9 8.3
Obesity of adults reporting BMI gt30 24.6 25.8 26.7
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Important Definitions
Body Mass Index the proportion of weight to height Body Mass Index the proportion of weight to height Body Mass Index the proportion of weight to height
Children Adolescents Adults (kg/m2)
Underweight lt 5th percentile lt18.5
Healthy Weight 5th to 84th percentile 18.5 to 24.9
Overweight 85th to 94th percentile 25 to 29.9
Obese gt95th percentile gt30
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Girls
Boys
Body Mass Index-for-Age Percentiles
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Childhood Obesity in Virginia
Virginia () U.S. ()
Percent 10-17 yo overweight/obese 30.5 30.6
By Family Income By Family Income By Family Income
lt100 Federal Poverty Line gt400 FPL 45.8 22.3 39.8 22.9
By Insurance By Insurance By Insurance
Public Private 46.9 25.9 39.6 26.7
By Race By Race By Race
Black, non-Hispanic White, non-Hispanic 41.0 24.6 37.7 29.5
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The Story of Chrystal
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The Story of Alexis

• Mother concerned about weight for past 2 years
• Changing clothes size every 3-4 months
• Suffers from asthma, eczema, and alopecia
• Currently in the 4th grade, on the Honor Roll

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Additional History

• Diet

• Activity

• Beverages
• Drinks water and 2 milk
• Sodas are treats
• Drinks 3 cups of juice or lemonade a day
• Sneaks food
• Occasionally eats take out

• Does not like to play outside
• Not involved in organized sports
• Spends 4 hours/day in front of a screen (TV,
  videogames)
• Family usually does not eat together
• Often eats in front of the TV

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Additional History

• Family History

• Social History

• Multiple relatives with DM, high cholesterol
• Also family history of heart disease, stroke,
  hypothyroid
• Obesity on both sides
• Older sib is healthy weight

• Lives with mother and older sib
• Parents divorced 2 years ago
• Sees father infrequently
• Mother works full-time
• Maternal relatives in the area that offer support

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Detailed Psychosocial History

• Red Flags

• Weight gain started around the time parents were
  separating
• Binge eats for comfort, sneaks food, used to make
  herself throw up
• Shunned, teased by children in her neighborhood
  and at school (i.e. call her hippo)
• Minimizes eating behaviors, issues with
  self-esteem or body image

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Evaluation

• Obtain labs - screen for chronic diseases
• Arrange follow-up
• Determine need for referrals

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Plan

• Additional visits monthly to quarterly
• Emphasize importance of well child assessments
  and staying in touch w/ PCP
• Assess familys readiness to change

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Follow-up

• LCSW/Counseling
• Did not show up for scheduled follow-up
  appointment
• Has not attempted to reschedule
• MD/Pediatrician
• Observed very flat affect during appointments
• Encouraged follow-up with counseling, expressed
  concern about mood disorder
• Her negative cognitions, anhedonia are likely
  preventing her from fully engaging in exercise
  and HYP

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Health Nutrition

• Short-term effects of overweight obesity
• Issues with mobility
• Knee or hip pain
• Sleep disturbances
• Low self-esteem
• Poor body image
• Difficulty establishing peer groups

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Health, Nutrition, and Education

• Issues of Health School Performance
• School absences
• Inattentiveness and hyperactivity
• Fatigue and daytime somnolence
• Teasing and bullying
• Mood or adjustment disorders

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What can we do?

• Providers

• Community Resources

• Intervene early
• Tackle one issue at a time
• Timely follow-up
• Healthy You

• Healthy You
• Involve mental health
• Insurance coverage
• Community Connections

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Healthy You Program

• Serves all of Hampton Roads
• Developed in 2001
• Physician referral required
• Financial assistance and scholarships available

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HY Weight Management Program

• HY Clinic

• HY Lifestyle Classes

• Open to children 5 years old
• BMI gt85th percentile
• Consultation with
• Physician
• Physical Therapist
• Registered Dietitian
• Licensed Clinical Social Worker
• Year long follow up

• Open to children 8 years old
• Classes grouped 8-11 years and 12-18 years
• 10-week twice a week classes
• Parents are required to attend
• 8-week membership to YMCA

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In Conclusion

• Persevere
• Encourage
• Advocate
• Resist
• Learn
• Set Goals