Lynn Clark, MS, RN-BC, CPNP-PCLynn.clark@childrens.com

Britney Cox, MS, RN-BC, CPNP-PCBritney.cox@childens.com

Pain Management Nurse PractitionersChildren’s Medical Center Dallas

Although the world is full of suffering,It is also full of the overcoming of it.

-Helen Keller

Conflicts of Interest for ALL listed contributors.Clark, L: NoneCox, B: None

A conflict of interest is a particular financial or non-financial circumstance that might compromise, or appear to compromise, professional judgment. Anything that fits this should be included. Examples are owning stock in a company whose product is being evaluated, being a consultant or employee of a company whose product is being evaluated, etc. Taken in part from “On Being a Scientist: Responsible Conduct in Research”.

National Academies Press. 1995.

Participants will be able to:Describe consequences of obesity and sedentary life-style on the health of pediatric patientsLearn 3 challenges for pediatric patients that impact the ability to make healthy life-styles choices List 3 pain conditions (co-morbidities) that are frequently related to obesity and sedentary life-styleDescribe an intervention that is helpful to address the elephant in the room in relation to managing pain

Center for Disease ControlComparing children of the same age and sexOverweight: BMI >85th - 95th percentileObese: a BMI at or above the 95th percentile

17% (12.5 M)of US Children are obese33% (72 M) of US Adults are obese

BMI= pounds/(inches2) * 703160/(662) *703

160/4356*703= 25.82185

Obese children are more likely to become obese adults.

Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, and some cancers.

If children are overweight, obesity in adulthood is likely to be more severe.

School influenceSugary drinks & less healthy foodAdvertisingDay cares not regulated like public schools

Lack of daily, quality physical activity in school< 4 % of elementary schools have PE

Increasing portion sizesLack of breastfeeding supportTV and media

2-4 hours daily

Perceptions:67% of obese children were perceived as overweight by their mothers14% of overweight boys and 29% of overweight girls perceived themselves as overweightEthnic minority women have a great acceptance of body image than white women.

Education: Mothers with HS or less education were less likely to identify children as overweight

Poor Role Modeling:9 out of 10 kids are driven to school (compared to 50% a generation ago)Home cooked meals are rare and fast-food and eating out are the norm.Foods are more dense in calories

Lack of Limit setting: Fewer hours of sleep = higher likelihood for obesity Screen TimeLimited adult exercise

Study by Whitaker et al.(4432 families with 7078 kids)Incidence of childhood obesity:2 normal weight parents = 2.3 %2 overweight (but not obese) = 4.9%2 obese parents = 21.7%2 severely obese parents= 35.3%Association of child BMI has a stronger link to maternal BMI

Skip breakfast or lower energy mealEat lunch at schoolAte supper while watching TV > 5 days/wkSeparated/ divorce parentsEating aloneHigh energy meal at dinnerClean plate clubSnacking and watching TV (sedentary)

Cardiovascular disease (70 % had 1 symptom & 39% had 2 or>) Hypertensionhigh cholesterol/ triglycerides

EndocrineHyperinsulinismtype 2 diabetes

Neurologicpseudo tumor cerebriiMigraine/ HeadachesMS

RespiratoryAsthmaOSA

GUPolycystic ovarian syndrome

GastrointestinalFatty liver diseaseGallstonesGastro-esophageal refluxEncopresisConstipationIBSFAPLow Vitamin D

MusculoskeletalTibia vara (Blount’s)Slipped capital femoral epiphysis (SCFE)Musculoskeletal problemsBack painChronic pain

Children < 15 yo –Victim of Bullying Overweight = 26% more likely Obese = 85% more likely

Aggression, withdrawn friendships, rumors, lies, name calling, teasing, hitting and kicking

Children > 15 yo who are obese are more likely to be a perpetrator of bullying

School based friendship clusters

Psychological crisisDepressionLower Self-esteem

AppearanceWidespread bias

AnxietyStressSocially withdrawn

Poor quality of life

Stress on jointsInflamatory process

Affects 25-37% of children and adolescents

Combination of pain and obesitydecreased QOL and functioning

BMI should be a routine screen for patients with chronic pain

Adults: 30% were overweight47% were obese

Pain Amplification symptoms are increased with sedentary life-style

Treatment includes exerciseKinesophobiaObesity contributes to the continued

presence and increase in severity of symptoms

Increased BMI = increase frequency & disability related to HA

Patients who lost wt had decrease in headache frequency

Overweight females are 4x more likely to develop headaches than normal-weight girls

BMI > 30 = increase risk of LBPMechanical stressCVD which decrease blood flow

to the lumbar spineWt loss may or may not address

painChildren > 95% BMI are more

likely to have LBP and pain in at least 1 joint.

Mechanical issuesOverweight patients are at 2.2x

higher risk for development of osteoarthritis

69% of knee replacement surgeries in adult women are related to obesity

Emotional PoliticalControversialPerception is skewed / cultural barriersLack of community education and supportFear by provider of an emotional reactionFear of promoting disordered eating

behaviors

Addressing the vital statisticsDiscuss BMI with the patient and

familyState why we assess the whole patient

and their behaviorsNutritional, dietary behavioral and

activity assessmentDiagnose the patient appropriatelyBuild trust to achieve outcomes

Communication and building trustCollaborative process

SMART goalsSet 1-2 nutrition goalsSet 1 physical activity goals

Hot CheetosCreative BASIC HandoutsEngaging the familyAddress negative behaviors

Giving permissionLimit setting

http://www.cdc.gov/nccdphp/dnpao/index.html

Follow up phone call at one monthFollow up appt at 2 months

Reassess and reevaluate goalsGlobal impression of changeAffect on painNew goalsDiscuss as a life style change

Compliance with set goalsFunctionalityPerception of improvementGlobal impression of change

Participants will be able to:Describe consequences of obesity and sedentary life-style on the health of pediatric patientsLearn 3 challenges for pediatric patients that impact the ability to make healthy life-styles choices List 3 pain conditions (co-morbidities) that are frequently related to obesity and sedentary life-styleDescribe an intervention that is helpful to address the elephant in the room in relation to managing pain

Recognize the epidemicAddress the elephant in the roomListenAskActBe SMARTPraise and reassessMultimodal treatment is the Key!