Lynn Clark, MS, RN-BC, [email protected]
Britney Cox, MS, RN-BC, [email protected]
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!