Childhood Obesity: A
Practical Approach in the
Primary Care Setting
Jonathan Evans, MD
Div. Pediatric Gastroenterology
Nemours Children’s Specialty Care
Co-Chair, Childhood Obesity Prevention
Coalition
Jenna Braddock, MSH, CSSD,
RD, LD/N
Brooks College of Health
University of North Florida
I have no commercial
disclosures
Objectives
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Understand the role of the primary care
provider in the prevention and treatment of
childhood obesity
Describe a practical approach to childhood
obesity in the primary care setting
Review NE FL community resources and
tools included in the childhood obesity starter
kit
Acknowledgements
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NEFPS
Player’s Center/JWCH and Megan Denk
Duval County Health Dept and Monique Ellis
Nemours Children’s Specialty Care
Brooks College of Health
 Dr Christie
 Jenna Braddock
 UNF interns
Samantha Tyler
Members of the Coalition
Childhood Obesity in the Primary Care
Setting
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Support for the PCP has been a long time coming
The Starter Kit:
 Tools to help approach the problem from the 1ary care
perspective
 A new and original idea?
 Designed and adapted to meet our NE FL needs
 Its structure will guide tonight’s talk
 Left side: J Evans
 Right side: J Braddock
 All materials (and more!) available online at
www.HJCOPC.org
Why is This Important?
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Obesity is epidemic
Children should be the focus!
Primary care should be the focal point for
addressing this epidemic
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Recognized nationally (AAP)
Recognized locally
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2001: HJCOPC
2009 Call to Action
Support for our PCPs has been a long time coming
2009 Call to Action for NE FL
An Integrated Framework f or the Prevention and
Treatmentof Obesity and its RelatedChronic Diseases.
Dietz WH, et al Health Affairs 2015
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A new model for the integration of clinical and
community services
Delineates the central role of the PCP but integrates
ancillary providers both internal and external to the
medical office
Emphasizes the need to change behaviors using
motivational interviewing amongst others
Also discusses role of empowerment, engagement,
policy changes, financing, governance, metrics, etc
An Integrated Framework for the Prevention and
Treatmentof Obesity and its RelatedChronic Diseases.
Dietz WH, et al Health Affairs 2015
“Effective care requires practitioners who can enable
behavior changes within and beyond medical
treatment. Training in how to change behaviors must
become an essential element of provider education.
Likewise, providers can play a key role in referring
patients to community resources… that reinforce
clinical strategies.”
“Change proceeds at the speed of trust”
Why is This so Difficult?
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Obstacles facing the PCP
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External
Internal:
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Lack of time
Lack of reimbursement
Lack of resources:
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Office personnel
Nutrition support
Community
The result?
Can the obstacles be overcome?
How do I do it?
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Certainly not perfect or complete!
Before I enter the room:
 Vitals and health questionnaire completed
 I know their weight classification and vital signs
While I am in the room
 Review diet, physical activity, screen time
 Ask permission to discuss/ mod. motivational interview
 Discuss relevance to CC, risk factors, goals
When the family leaves
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2 resources
Screening labs
Follow up: RD/ARNP/MD
How to get Started
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Recommendations for Treatment of Child and
Adolescent Overweight and Obesity. Spear
BA, Barlow SE, et al. Pediatrics
2007;120;S254-S288
The Role of the Pediatrician in Primary
prevention of Obesity. Daniels, SR, Hassink
SG. Pediatrics 2015; 136:e275-e292
AAP Recommendations for Treatment
AAP recommendations for Prevention
“This clinical report describes the rationale for pediatricians to be an integral part of the
obesity-prevention effort”
A Simplified Algorithm for all Ages
The Office Environment
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Engage your staff: it’s a team effort!
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Discuss their beliefs
Host a healthy lunch
Promote participation
Adopt a core message
Create a healthy environment
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Healthy lifestyles BB, videos, etc
Replace food rewards with stickers and other non-food
items
Promote a monthly food or community resource
The Office Environment
Office Equipment and Materials
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Scales for infants, children/adolescents
Stadiometers: standing and supine
Growth Charts
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Weight for age
Length for age
BMI for age (2-18yrs)
WFL (0-23mths)
Metric conversion charts
BMI calculators
Sphygmomanometer and BP charts
BMI Percentile for Age
Office Personnel
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MD/ARNP/PA
RN
Medical Asst.
RD
Office staff
It is important that each team member understand their role
and be properly trained!
The Office Encounter
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At each office visit ideally!!!
Measure growth parameters and VS (MA)
Wgt, hgt, BMI for age charted (MA)
Children with overweight/obesity ID’ed and
flagged (MA)
High BPs for age are flagged (MA)
PCP reviews data and decides appropriate
intervention level, further studies, etc
The Office Encounter
The Office Encounter
The Office Encounter
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Family, patient and PCP discussion and
mutual agreement of Rx plan and goals
Screening labs as indicated
Additional counseling by trained personnel
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Nutrition
Physical activity
Review of appropriate community resources
Follow up scheduled
Messaging!!
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Effective interventions need to address
nutrition, physical activity and behaviors
Motivational interviewing
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Key to engaging the patient and family
Addresses behaviors, values, goals in an open,
non-judgmental fashion
ABP MOC part 2 module
Motivational Interviewing Tips
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Ask permission to
discuss weight but focus
on health!!
Use open ended
questions
Focus on the positives
Roll with resistance
Let the patient/family set
goals
Obesity Coding in ICD-10
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New codes since
October 1, 2015
Are they better than
ICD-9?
Are they easier to
use?
Our Next Steps?
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ary
Each 1 care office is unique and different
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What are the strengths?
What are the obstacles
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Use QI methodology to improve interventions
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“share seamlessly and steal shamelessly”
Before we move on …
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Provide me with your feedback
Ver. 2.0?
3 blatant plugs:
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Free nutrition screenings at the YMCA
Free fitness screenings at the YMCA
Free monthly healthy lifestyle classes at Nemours