Improving Outcomes in Child [& Adult]

Obesity Management

WE CAN IMPACT THIS GLOBAL HEALTH PROBLEM

Maggie Argentine, PhD, RN Professionally Certifi ed in Obesity Management, Prevention & Education

~ Helping Adults, Teens & Seniors achieve Optimal Health & Longevity

Argentine Health Partners Syracuse, NY June 5, 2015

Objectives1. Relate current economic and best practice clinical evidence

for obesity management and risk reduction in children & adolescents to each encounter with patients, families & communities of care.

2. Examine results of a provider-referred, multidisciplinary interventional pilot program for overweight/obese adolescents with co-morbidities to avoid pitfalls in management.

3. Identify 3 strategies in obesity management I can implement immediately, inclusive of tracking outcomes.

Argentine Health Partners Syracuse, NY June 5, 2015

Current Evidence GLOBAL MACRO LEVEL

GLOBAL ECONOMIC LEVEL

CLINICAL BEST PRACTICE

Argentine Health Partners Syracuse, NY June 5, 2015

Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2011

*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.

15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%

CA

MT

ID

NVUT

AZNM

WY

WA

OR

CO

NE

ND

SD

TX

OK

KS

IA

MN

AR

MO

LA

MI

IN

KY

ILOH

TN

MS AL

WI

PA

WV

SC

VA

NC

GA

FL

NY

VT

ME

HI

AK

PRGUAM

NHMARICTNJDEMDDC

15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%

Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2012

*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.

CA

MT

ID

NVUT

AZNM

WY

WA

OR

CO

NE

ND

SD

TX

OK

KS

IA

MN

AR

MO

LA

MI

IN

KY

ILOH

TN

MS AL

WI

PA

WV

SC

VA

NC

GA

FL

NY

VT

ME

HI

AK

NHMARICTNJDEMDDC

PRGUAM

15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%

Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013

*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.

CA

MT

ID

NVUT

AZNM

WY

WA

OR

CO

NE

ND

SD

TX

OK

KS

IA

MN

AR

MO

LA

MI

IN

KY

ILOH

TN

MS AL

WI

PA

WV

SC

VA

NC

GA

FL

NY

VT

ME

HI

AK

NHMARICTNJDEMDDC

PRGUAM

Global Macro Evidence

Argentine Health Partners Syracuse, NY June 5, 2015

Economics

Macro Level Evidence

McKinsey Global Institute

November 2014

Obesity

global economic burden $ 2.0 trillion

Argentine Health Partners Syracuse, NY June 5, 2015

Economic

Macro Level EvidenceMcKinsey Global Institute, November 2014

Economic – Macro Level Evidence, McKinsey Global Institute, November 2014

Weight Management Programs

Surgery

Pharmaceuticals Sufficient

Evidence Weight Change

Workplace Wellness

Parental EducationLimited

Evidence Weight Change

Portion Control

Sufficient

Evidence Behavior Change

Interventional Pilot Program Results FIT KIDS OF MADISON COUNTY OVERVIEW & BACKGROUND

PILOT STRUCTURE & PROCESS

PILOT OUTCOMES

PITFALLS & LESSONS LEARNED

FKMC OHC & MADISON COUNTY FUTURES

Argentine Health Partners Syracuse, NY June 5, 2015

FKMC Overview

Argentine Health Partners Syracuse, NY June 5, 2015

community based, medically referred, interventional pilot program for overweight and/or obese children, ages 11-14 in Madison County, New York.

initially conceived: 6 week program evolved: two 12-week programs with same children & families

FKMC places the individual and family at the center of healthy initiatives, encircled by a supportive community of neighbors and professionals, mindful of what is needed to “help individuals and families thrive.”

Fit Kids of Arizona template, FKMC is unique to Madison County for 4 components: nutrition; fitness; counseling, habits & behavior; and social support

FKMC Pilot Program – 2012-2014 Background

FKMC Pilot Program – Structure & Process

Referral & Intake

MedicalNutritionFitnessCounseling, Habits & BehaviorSocial Support

Two 12 Week Programs

Per Week:* 4 > 3 Fitness* 1 Nutrition* 1 Counseling, Habits & Behavior* End of Program Healthy Shared Dish Dinner & Awards

Evaluation

* Satisfaction* Attendance* Fitness Change* Medical Labs Improvement* Behavior

FKMC Pilot Program – Medical Intake

FKMC Pilot Program – Nutrition Intake

FKMC Pilot Program – Fitness Intake

FKMC Pilot Program – Counseling, H&B Intake

FKMC Pilot – Medical Outcomes

FKMC Pilot – Conclusions & Lessons Learned

• Scheduling• Orientation• Referrals• Mixed ages of Kids

System & Structure

FKMC OHC & Madison County Futures

County-Wide Organizations

Fit Kid & Family

County-Wide

* OHC – Northern County - maintaining* ??? Southern County* Rural Health Council & Mad. Cty DOH* Colgate Upstate Institute

Referring Providers Oneida Healthcare Community Memorial Hospital

Expert, Kid-Friendly, Evidence-Based: Registered Dietician Youth Credentialed Fitness Trainer Counselor, Social-Worker Program Coordinator Researcher, Data Analyzer

Obesity Management STRATEGIES & TRACKING

Argentine Health Partners Syracuse, NY June 5, 2015

NIH Publication No. 12-7486A, October 2012

Recommendations based on Evidence Review

Directed towards all primary pediatric care providers (pediatricians, family practitioners, nurses & NP, PA, and registered dieticians)

more than 1,000 citations from the published literature and is available at: http://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines/index.htm

Continued to next slide: Strength of Recommendations

Continued from previous slide: Strength of Recommendations

State of the Science & Strategies, Oct 2012Risk Factor

DevelopmentFamily Hx Early

Athersosclerotic CV Disease

Nutrition & Diet Physical Activity Tobacco

State of the Science & Strategies, Oct 2012High Blood Pressure Lipids &

LipoproteinsOverweight &

ObesityDiabetes Mellitus & Other Predisposing

Risk Factor Clustering &

Metabolic Syndrome

https://www.nhlbi.nih.gov/files/docs/peds_guidelines_sum.pdf

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Summary Report, October 2012. NIH Publication No. 12-7486A, October 2012

Discussion & Conclusions AUDIENCE EXAMPLES

WHERE TO GO FROM HERE

MY OBESITY MANAGEMENT STRATEGIES

Argentine Health Partners Syracuse, NY June 5, 2015

My Obesity Management StrategiesStrategy Tactics Outcomes Tracking Resources

Needed

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