ERT Critical Care Consult
Approaches to Obesity Prevention and Treatment at School-Based
Health Centers
Matt Haemer MDAssistant Professor in Pediatrics Section of
Nutrition CU School of Medicine Medical Director LIFEStyle Medicine
Weight Management Childrens Hospital
[email protected]
1Faculty DisclosureDr Haemer has no relevant financial or other
conflicts to disclose.
2Objectivesto describe effective strategies to discuss weight
statusto understand tools to support lifestyle screening and
counseling and the potential benefitto describe effective
strategies to deliver clinical obesity prevention and treatment
services through SBHCsGuide behavior change using empirically
supported techniques
3Please Raise Your Hands if you:Think changing a familys
behavior for a childs weight can be hard?Discuss Body Mass Index at
every checkup >2yrs?Get a BMI (Ht/Wt) at sick visits?Had
difficulty describing weight status with a patients family?Have a
referral resource to send obese children for treatment?Audience
Survey:4#1. Range of Visit GoalsRaising Awareness of a weight
issue
Enhancing Motivation to change
Changing or Maintaining Healthy Behaviors with Specific
Goals55Objective 1: Strategies to Discuss Weight StatusA range of
goals for the visitDefinitions of weight statusAwareness of weight
statusIdeal language: motivating and non-stigmatizing
Guide behavior change using empirically supported techniques
6Awareness
*95% is overweightBMI / Weight Status>2y Percentile
Ranges:95th obese excess adiposity>99th severe Comorbidities~4%
population
7
3yo Girl: BMI 90th% = OverweightWhich Plot is Concerning?
8Awareness: BMI vs. Visual
95th % > 99th %
85-95th %
18mo 3yo 4 yo 3yohealthy
It is OK to devote a visit to raising awareness without setting
specific goals.The first step is Awareness of :-BMI status-healthy
behaviors Raising awareness tactfully may be all you can accomplish
in a visit. Resistant patients may be more willing to talk about
making changesat next visit. 10Awareness LanguageCommunicating with
children and familiesUse obesity for documentationEnglish:
overweight or unhealthy weight are more acceptable (Puhl PEDIATRICS
9.26.11)Spanish: demasiado peso por su salud is most motivating and
nonstigmatizing (Knierim PAS 2014) Focus groups followed by survey
of 525 parents in Denver Health
Krebs PEDIATRICS 2007 Seidell JC Arch Int Med 1996 Cameron AJ
Med J Aust 2009
11Language - English12Language - Spanish13Awareness LanguageAsk
if families are aware?Motivators for ChildrenPeer acceptance,
confidence, athletic performance, feeling comfortable in clothes
Motivators for Parents: consequences of Obesity in adulthood
FamHxDM, CVD, Cancer, Arthritis, Liver DiseaseAvoidance of Health
Risk may not be a sufficient motivator
Krebs PEDIATRICS 2007 Seidell JC Arch Int Med 1996 Cameron AJ
Med J Aust 2009
14Questions on Raising Awareness?
15Objective 2:Screening and Counseling for Healthy
LifestylesTools for Lifestyle ScreeningSkills for effective
counselingResults universal screening and MI counseling in SBHCs
and community health centers
HEDIS measures: document weight status with BMI, discuss
nutr/phys activity
16Generic Lifestyle Advice (5210)
