“Growing Healthy Kids III” Weight-Related Assessment and

Management Tools for Youth

Maria G. Boosalis, Ph.D., MPH, R.D., L.D.

University of Kentucky

Division of Clinical Nutrition

In Today’s Presentation

• Provide Tools & Resources to Identify & Assess Weight and Weight-related Co-Morbidities

• Provide Resources for Clinical Treatment Recommendations and/or “Best Practice” Advice

Identification of Weight Issues in Youth

• CDC Body Mass Index (BMI) for Age and Gender Growth charts available at http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/clinical_charts.htm#Clin%201

• Modules re: Measurement Techniques and Proper use of these Growth Charts are available at http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module2/text/intro.htm and http://www.depts.washington.edu/growth/module5/text/page1atext.htm

Identification/Treatment of Overweight/‘Obesity’ in Youth

• CDC Module on “Overweight Children and Adolescents: Screen, Assess and Manage” at http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module3/text/intro.htm

• Barlow & Dietz “Obesity evaluation & treat- ment: Expert committee recommendations. Pediatrics 102(3):e29, 1998 at http://www.pediatrics.org/cgi/reprint/102/3/e29.pdf

Identification/Treatment of Overweight/‘Obesity’ in Youth

• Certificate of Training in Childhood and Adolescent Weight Management, Commission on Dietetic Registration, 2004@ http://www.cdrnet.org/wtmgmt/childhood.htm

Identification/Treatment of Weight-Related Co-Morbidities

•Cardiovascular Disease

• Hypertension

• Type-2 Diabetes

Identification/Treatment Cardiovascular Disease in Youth

• AHA Scientific Statement: AHA Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease beginning in Childhood. Kavey et al., Circulation. 107:1562-1566, 2003 @

• http://circ.ahajournals.org/cgi/content/full/107/11/1562

Cardiovascular Health Promotion Goals for Youth [Circulation 107:1562-1566, 2003]

• Diet:– Maintain an Overall Healthy Eating Plan– Maintain an Appropriate Body Weight– Maintain Desirable Lipid Profile/Blood Pressure

• Smoking: – Don’t ever Start/Stop if have Started – Stay away from Second-hand Smoke

• Physical Activity:– Be Physically Active every day – Reduce Sedentary Time every day

Kavey et al AHA Scientific Statement Circulation 107:1562-

1566, 2003• Provides Guidelines for Identification

of Children and Adolescents at High Risk of Cardiovascular (CV) Disease

• Provides Guidelines for CV Risk Reduction: Intervention for Children and Adolescents with Identified Risk

Identification/Treatment Cardiovascular Disease in Youth

• AHA Scientific Statement: Cardiovascular Health in Childhood: A Statement for Health Professionals From the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young. American Heart Association. Williams et al., Circulation 106:143-160, 2002 @

• http://circ.ahajournals.org/cgi/content/full/106/1/143

Methods MD’s/HCP’s Can Use to Promote Desirable Body Weight

[Williams et al, Circulation 160:143-160, 2002]

• Identify obese children/adolescents and those at high risk of becoming obese (plot H/W/BMI, assess obesity in family as risk factor)

• Encourage a healthful diet to maintain a desirable weight (take diet history, discourage use of food as reward, educate on nutritious snacks and on appropriate portion sizes)

• Encourage a more active lifestyle

Methods MD’s/Health Care Providers Can Use to Promote Physical Activity [Williams et al, Circulation 160:143-160, 2002]

• Incorporate physical activity counseling into your practice (ask about patterns, encourage parents to move, recommend age specific activities)

• Encourage universal participation in increased physical activity (life-long vs team only sports)

• Improve children’s access to physical activity programs (advocate for school/neighborhood, promote life-long participation in & benefits of active lifestyle)

Identification/Treatment of Hypertension in Youth

• The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents Pediatrics 114(2):555-576, 2004 @

• http://pediatrics.aappublications.org/cgi/content/full/114/2/S2/555

“Hypertension” Definitions Pediatrics 114(2):555-576, 2004

• Average SBP and/or DBP that is ≥95th percentile for gender, age, and height on ≥3 occasions.

• Prehypertension in children is defined as average SBP or DBP levels that are ≥ 90th percentile but <95th percentile.

• As with adults, adolescents with BP levels ≥120/80 mm Hg should be considered prehypertensive.

Identification/Treatment of Type-2 Diabetes in Youth

• Standards of Medical Care in DiabetesDiabetes Care, 27(90001):s15–s35, 2004 @ http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s15

• American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 23:381–379, 2000 @ http://care.diabetesjournals.org/cgi/reprint/23/3/381?ijkey=d4c7bdd0eab2508d12569adf79658a68cc8ce324&keytype2=tf_ipsecsha

Identification/Treatment of Type-2 Diabetes in Youth

• An Update on Type 2 Diabetes in Youth From the National Diabetes Education Program. Pediatrics 114(1):259-263, 2004 @ http://pediatrics.aappublications.org/cgi/content/full/114/1/259

• Management of Dyslipidemia in Children and Adolescents With Diabetes. American Diabetes Association in Diabetes Care 26: 2194-2197, 2003 @http://care.diabetesjournals.org/cgi/content/full/26/7/2194

Bright Futures• National health promotion initiative dedicated

to the principle that every child deserves to be healthy and that

• Optimal health involves a trusting relationship between the health professional, the child, the family, and the community as partners in health practice.

• www.brightfutures.org

Organizations That Support Bright Futures

American Academy of Pediatrics American Academy of Pediatric Dentistry American Dietetic Association American Medical Association National Association of Pediatric Nurse Associates and

Practitioners American Academy of Physician Assistants American School Health Association American Public Health Association• and many more…

Bright Futures Materials for Health Professionals

Bright Futures in Practice Series

Bright Futures in Practice: Nutrition (2002)

• Guide that emphasizes prevention and early recognition of nutrition concerns and provides developmentally appropriate nutrition supervision guidelines for infancy through adolescence.

• Includes information on hyperlipidemia, hypertension, diabetes, obesity and eating disorders, to mention a few.

• Contains reproducible master copies of nutrition questionnaires appropriate for use in families with infants, children, & adolescents.

Bright Futures in Practice: Nutrition (2002)

• Guidelines at http://www.brightfutures.org/nutrition/index.html

• Nutrition Questionnaires at http://www.brightfutures.org/nutrition/pdf/pocket.pdf

Bright Futures in Practice: Physical Activity (2001)

• Provides developmental guidelines on physical activity for the periods of infancy through adolescence and current information on screening, assessment, and counseling to promote physical activity at http://www.brightfutures.org/physicalactivity/pdf/index.html

• http://www.brightfutures.org/physicalactivity/pdf/Tools.pdf

Consensus in Pediatrics: “Childhood Obesity” Vol 1(4), 2004

Feld LG & Hyams JS, Editors • Mead Johnson & Company Monograph that covers

– Overview of Childhood Obesity – Complications of Childhood Obesity– Interventions for its Prevention and Treatment

• Nancy Cooperman, M.D., R.D., C.D.N, and Marc Jacobson, M.D., Schneider Children’s Hospital, NY

• Includes “Obesity Prevention Checklist” which covers – Identification of child/adolescent at risk and gives– Age Appropriate Interventions

Institute of Medicine [IOM] Report, 2005

• In 2002, Congress charged the IOM to develop a prevention-focused action plan to decrease # obese youth in U.S.

• Action plan in Preventing Childhood Obesity: Health in Balance, 2005 @ http://www.iom.edu/report.asp?id=22596

• 2005 Dietary Guidelines Advisory Committee Report @ http://www.health.gov/dietaryguidelines/dga2005/report/

• Dietary Reference Intakes, IOM @ http://www.iom.edu/project.asp?id=4574

Thank you

Any Questions?