Identifying Obesity and Obesity
Complications in Pediatrics
PI: Sandra Benavides, PharmD
Co-I: Jessica M. DeLeon, PhD
Co-I: Magdaline Exantus, BS
Background & Significance
From: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm, accessed 1/9/11
From: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm, accessed 1/9/11
Florida Overweight & Obesity Rates
From: The Report of the Governor’s Task Force on the Obesity Epidemic.
Florida Overweight & Obesity Rates
From: The Report of the Governor’s Task Force on the Obesity Epidemic.
Complications of Obesity
From: http://mozartinshape.org/misvsobesity/whymis.php?id=ch02, accessed 1/9/11
Current Problem
• High rates in south Florida
• US Preventive Services Task Force recommends
all children > 6 years be screened1
• In clinical practice, barriers exist in timely
identification of obesity and complications
• On study reports only 34% of obese patients
were correctly identified2
• Only 8% of general pediatric visits have
screening for complications3
Current Problem
• Reasons for under-diagnosis may be4,5
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Time limitations
Limited knowledge of diagnostic criteria
Poor patient counseling techniques
Lack of effective interventions
Objective of Study
Develop a Center for Child and
Adolescent Health (CCAH)
• Pharmacist-managed clinic
• Screen and identify children & adolescents with
obesity or complications of obesity
• Pharmacist will provide assessments of children
& adolescents requiring further
treatment/referral
• CCAH will provide patient education on wellness
and pharmacotherapy (when indicate)
Research Design & Methods
Specific Aims:
• Specific Aim 1:
▫ Development of the CCAH
• Specific Aim 2:
▫ Identify and assess children & adolescents at high risk
for developing complications secondary to obesity
• Specific Aim 3:
▫ Assess the patient and parent/guardian satisfaction
with the clinic and perform a needs assessment to
determine future weight loss intervention strategies
SA 1: Development of the CCAH
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Pharmacist managed
Two days per week (10-15 hours)
Located in proximity to Pediatricians
Referred by Pediatrician or self-referral
Detailed to all Pediatricians in area
Serve as a clerkship site to 4th year pharmacy
students
SA 2: Assessment of Children
• Assessments conducted
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Complete medical history
Weight, height, body mass index
Waist circumference
Blood pressure measurement
Point-of-care testing
 Blood glucose
 Lipid profile (TC, HDL, LDL, triglycerides)
 High sensitivity C-reactive protein
▫ Quality of life assessment
SA 2: Assessment of Children
• Detailed analysis provided to referring physician
with recommendations
▫ Further testing
▫ Treatment
• When indicated, referral to dietician and/or fitness
program
• Pharmacist will educate the child/adolescent and
parent/guardian one healthy lifestyle
▫ Exercise
▫ Disease prevention
▫ Medication (when appropriate)
SA 3: Patient satisfaction/needs
assessment
• Survey provided to child/adolescent
▫ Satisfaction with the CCAH
▫ Determine what activities the child/adolescent
would be interested in participating in
• Survey provided to parent/guardian
▫ Satisfaction with the CCAH
Study Participants
• Available for all children & adolescents ages 6-18
• Will exclude pregnant females
• No cost to the child/adolescent
• Will not bill insurance
Data Analysis & Measurement
Instruments
SA 1: Development of CCAH
• Primary outcome:
▫ Utilization (referrals) of the CCAH
 Number (%) of physicians referring patients
 Number (%) of children & adolescents attending
• Secondary outcome:
▫ Viability of the CCAH as a 4th year pharmacy
clerkship site
 Ability to meet learning outcomes required
SA 2: Assessment of Children
• Primary outcome:
▫ Improvements in the following parameters
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Weight and BMI
Waist circumference
Diastolic and systolic blood pressure
Blood glucose
Total cholesterol, HDL, LDL, triglycerides
hs-CRP
Quality of life assessment
▫ Descriptive, 2-tailed paired t-test (QOL—Mann
Whitney t-test), p<0.05
SA 3: Patient satisfaction/needs
assessment
• Primary outcome
▫ Satisfaction and acceptance of CCAH by
children/adolescents and parents
 Data collected from surveys
Current status…
Obstacles
• Community partner is no longer involved
• Explored other community partners
▫ FLIPANY
• Potential future partners being considered
▫ Memorial Regional Hospital
▫ Pediatric Associates
References
1.
2.
3.
4.
5.
US Preventive Services Task Force. Screening for obesity in children and
adolescents: US Preventive Services Task Force Recommendation
Statement. Pediatrics 2010;361-7.
Benson L, et al. Trends in the diagnosis of overweight and obesity in
children and adolescents: 1999-2007. Pediatrics 2009;123:e153-8.
Riley MR, et al. Underdiagnosis of pediatric obesity and underscreening
for fatty liver disease and metabolic syndrome by pediatricians and
pediatric subspecialties. J Pediatr 2005;147:839-42.
Dorsey KB, et al. Diagnosis, evaluation, and treatment of childhood
obesity in pediatric practice. Arch Pediatr Adolesc Med 2005;159:632-8.
Spivack JG, et al. Primary care providers’ knowledge, practices and
perceived barriers to the treatment and prevention of childhood obesity.
Obesity 2009;1-7 (advanced online publication) DOI:
10.1038/oby.2009.410
Stature-for-age & Weight-for-age
Percentiles
Available at: http://www.cdc.gov/growthcharts/
BMI-for-age Percentile
Available at: http://www.cdc.gov/growthcharts/
Blood Pressure in Pediatrics
Lipid and Lipoprotein Distribution in Ages
5-19 years
From: Pediatrics 2008;122:198-208