Pediatric+Obesity


 * Diagnosis of Obesity**
 * Start evaluating BMI at 2 years of age. Monitor blood pressure percentile of school age children.
 * **Overweight = BMI for age 85-94%**
 * **Obese = BMI for age __>__95%**
 * Guidelines for Prevention, Diagnosis, Management, Comorbidities, Labs, and Referrals**
 * Prevention**
 * **Infants**- Encourage exclusive breastfeeding until 6 months, continue breastfeeding to one year if possible. See wikipage for breastfeeding information: http://ccrmc.wikispaces.com/Breastfeeding+Information
 * **Toddlers** - **"5-2-1-0"**
 * 5 Fruits and Vegetables a day
 * 2 or less Hours of Screen Time
 * 1 Hour of Active Play
 * 0 Sugary drinks (juice, Capri-Sun, soda, Nesquick, Gatorade, horchata)
 * **School Age** - See above. Also ask about fast food, junk food. Assess for disordered eating, body image, comorbidities of obesity
 * **All ages** - Document family history of obesity, diabetes, hypertension, and hyperlipidemia.


 * Treatment**
 * Appropriate to follow-up every 3-6 months until the child's velocity of weight gain has slowed.
 * For overweight children, the goal is to maintain the same BMI over months to years.
 * Gradual weight loss is the goal for children 2-5 years old with a BMI __>__ 99% and for children > 5 years old with a BMI __>__ 95%.


 * Co-morbidities of Obesity - Labs and Referrals**
 * Labs - consider fasting glucose, fasting lipids, AST/ALT, BUN, Cr in:
 * BMI __>__ 85% who are:
 * 10 years and older with a positive family history for obesity, diabetes, or hyperlipidemia
 * Hispanic/African American
 * Signs of insulin resistance such acanthosis nigricans
 * Referral is indicated for:
 * Persistent Hypertension (BP __>__ 95 Percentile + 5 mmHg x 3) - CHO nephrology or cardiology
 * Glucose Intolerance (Fasting glucose __>__ 125 x 2) - CPMC Endocrinology
 * Elevated AST/ALT (__>__ 60 after efforts to lose weight) - CHO GI
 * Dyslipidemia (total fasting cholesterol __>__ 190) - CHO cardiology or Healthy Hearts Clinic


 * Patient Education - Patient Handouts and Options Counseling Tools**
 * [|La Clínica Pediatric Patient Information Handouts] - English and Spanish, Healthy Eating and Active Lifestyle, Patient Friendly
 * [|MyPlate Website] - USDA website with MyPlate graphics, patient handouts, recipes
 * [|Chop Chop] - Healthy Recipes Website and Magazine
 * [|Champions for Change]
 * [|Kidshealth.org] - English and Spanish, Variety of Topics, Patient Friendly
 * Kaiser Options Tools - Pediatric Weight Management, Physical Activity, Healthy Eating
 * Turn off TV Handout - English, Spanish
 * Have Fun and Be Healthy Bicycling Fruits Handout - English, Spanish
 * Community Resources for Healthy Eating and Physical Activity**
 * Community Sports and Activities - Martinez, Concord, Pittsburg, West County (under construction)
 * [|East Bay Parks District]
 * [|Farmers' Markets]
 * [|Food Stamp Information]


 * Referrals for Prevention and Treatment of Pediatric Obesity**
 * Infants and Breastfeeding - PHN breastfeeding referral, Lactation clinic referral, WIC, or Lactation consultant warmline 925-313-8986
 * Ages 2-5 - nutrition classes at First Five, see locations and schedules at different sites in the county at: First Five
 * Ages 2-11, BMI% for age __>__ 95%ile - CCHP Pediatric Obesity Disease Management Program: Families are contacted quarterly and sent information about healthy lifestyles. CCHP will also give providers feedback and assist with referrals every 3-6 months. To refer in ccLink, type "pediatric obesity" in meds and orders field.
 * Ages 5-11 - WeCan - a 5 session series of group visits. To refer in ccLink, type "pediatric obesity" in meds and orders field.
 * Ages 2-18 with medical complications of obesity - specialty clinic at Children's Hospital Oakland - Healthy Hearts Preventive Cardiology Clinic at Children's Hospital Oakland - To refer in ccLink, type "CHO" in meds and orders field to generate prior auth. Fill out CHO forms and send to care coordinator/PHN.
 * Ages 12-18 in East County - Kaiser Nutrition Class, free, held quarterly in Antioch.
 * All ages - Dietitians can see patients up to 4 times a year, tailoring counseling to individual families.


 * Information and CME for Providers**
 * Obesity/Overweight Guidelines - CCRMC pediatric obesity guidelines, NICHQ pediatric obesity guide
 * CME - AAP section on pediatric obesity training
 * Motivational Interviewing - Quick Tips and Tools by Sharon Abramowitz [[file:ccrmc/MIAbramowitz.doc|Abramowitz.doc]] ,Kaiser Tutorial
 * Breastfeeding - AAP breastfeeding curriculum, Wellstart Module
 * Information for We Can Providers