# Presentation: 492208

## Preventing Childhood Overweight and Obesity:The Pediatrician’s Role

- Renee R. Jenkins, MD, FAAP
- President-Elect
- American Academy of Pediatrics
- October 26, 2006

## Childhood Overweight & Obesity

- 	The mission of the American Academy of Pediatrics is to attain optimal physical, mental and social health and well-being for all infants, children, adolescents and young adults. To accomplish this mission, the Academy shall support the professional needs of its members.

## Childhood Overweight & Obesity

- Childhood Obesity is compromising the health and well being of our children
- The American Academy of Pediatrics cares!
- And we are  doing  something about it!

## Why We Care

- 	Obesity is currently the single most prevalent chronic disease in childhood.

## Why We Care

- 	Obesity increases the burden of disease for children and adolescents
- Cardiovascular disease
- Type 2 diabetes, DKA
- Polycystic ovarian syndrome
- Respiratory disease
- Slipped capital femoral epiphysis, Blount’s disease
- Nonalcoholic steatohepatitis
- Pseudotumor cerebri
- Depression, low self-esteem, decreased quality of life

## Why We Care

- 	The lifetime risk of diabetes for babies born in 2000:
- 1 in 3 for males
- 2 in 5 for females
- Narayan KM, et al. *JAMA*290 :1884 –1890,2003

## Why We Care

- 	Minority populations are hardest hit:
- 	In 1998, 21.5 percent of African American children, 21.8 percent of Hispanic children and 12.3 percent of Caucasian children had a Body Mass Index (BMI) greater than the 95 percentile for age and gender.*
- 	*Strauss RS, Pollack HA. Epidemic increase in childhood overweight, 1986-1998. *JAMA* 2001;286:2845-8.

**Notes:**
The proportion of children who are obese is increasing at epidemic proportions. Particularly in minority populations. 

## Why We Care

- 	Obese children constitute a significant portion of every primary care and specialty practice in Pediatrics

## Childhood Obesity is a Strategic Priority for the AAP

## Childhood Obesity is an AAP Strategic Priority

**Childhood Obesity is an AAP Strategic Priority**

**Notes:**
The AAP formed a Task Force on Obesity in May 2003 in response to our grassroots chapters’ call for creation of such a group to comprehensively address the current epidemic of obesity among children in the United States.

Obesity officially became one of our strategic priorities a year later in May 2004

## Obesity-Related Key Objectives

- Obesity prevention is part of every routine child health supervision visit
- Increase clinical skill in identifying and treating overweight and obese children, including comorbidities
- Collaborate with medical schools, residency programs and fellowship programs to integrate obesity prevention and treatment into the curricula

## Obesity-Related Key Objectives

- Pediatricians will actively promote policies, programs, and interventions that support
- Pediatricians will be recognized by insurers, employers, the medical community, and legislators as critical providers of obesity prevention and treatment

## AAP’s Obesity Activties

- 	In order to engage in obesity prevention, intervention and treatment of obesity, Pediatricians need:
- Education
- National, state and local advocacy support
- Community networking
- Practice Management Support
- Reimbursement
- Research into causes and effective prevention and treatment strategies.

## Educational Activities

- AAP policy statements, including:
- Prevention of Pediatric Overweight and Obesity
- Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity
- CME programming

**Notes:**
Policy statements available at www.aappolicy.org

## Educational Activities

- Pediatrics for the 21st Century Program: “Fact, Fiction, or Future of Pediatric Obesity”
- Sample slide sets for public use
*AAP News* articles
- Obesity curriculum for pediatric residents

**Notes:**
Sample slide sets and other resources can be accessed at www.aap.org

AAP News at www.aap-news.org

## Resources for Patients & Families

- AAP overweight and obesity web site (average 55K hits; 4K unique visitors PER MONTH)
- Books
- Brochures

## Partnerships With Private Sector and Federal Agencies

- CDC, MCHB, AMA: consensus guidelines
- CDC: VERB! Campaign
- AHRQ: DVD for parents/children
- OSG: Shaping America’s Youth
- NIH: We Can!
- American Heart Assoc: dietary guideline/obesity initiative
- Assoc of Children's Museums:"Go Kids!" initiative
- Shape Up America
- Action for Healthy Kids

## Community-level Collaboration

- Grant Opportunities
- Community-based approaches
- Advocacy summit and workshops
- Local wellness policy promotion
- Legislation and public policy tracking/issue briefs

**Notes:**
Healthy People 2010 Grants:
The AAP awarded $20,000 each to five chapters to develop programs to network within their communities and to support the development and implementation of programs that address nutrition, overweight, and physical fitness.

Both CATCH and the Healthy Tomorrows Partnership for Children Program have provided grants for community-based programs related to obesity, nutrition and/or physical activity.
Summaries are available at www.aap.org

Also available online are technical assistance resources for pediatricians and other child health advocates interested in community-based child health efforts. 

AAP has developed a legislative brief for members to use in communicating with state legislators and other public officials about childhood obesity-related issues.

## Practice Management Support and Reimbursement Resources

- Meetings with national carriers
- Recommendations for obesity coverage
- Obesity Coding Fact Sheet
- Template letter and negotiation resources

**Notes:**
Ensuring that pediatricians receive appropriate reimbursement for obesity-related services is a complicated matter.
Many insurance companies will deny claims submitted with “obesity” codes, essentially carving out obesity-related care from the scope of benefits

## Research

- Periodic Survey of Fellows
- Pediatric Research in Office Settings Network:  healthy lifestyle study

**Notes:**
Periodic Survey:
AAP just completed  Periodic Survey on the prevention and treatment of obesity and overweight in primary care
Conducted in collaboration w/the Univ of Rochester, NY
Surveyed approx 1,600 nonretired AAP member in the US
Response rate: 63%
Initial findings are expected to be available in Jan 2007

The Healthy Lifestyles Pilot Study:
Pilot test of the effectiveness of an obesity prevention intervention in kids 3 through 7.
Fielded in 2004 and 2005
The intervention was based in large part on brief motivational interviewing - a patient-centered directive method for enhancing a patient's internal motivation to change. (The focus here of course was the parent, not the actual patient.)  This method contrasts with the more traditional provision of information.
Early findings suggest that the method is more successful than standard practice at producing body-mass index change; decreases in BMI-for age percentiles and improved dietary behavior were seen in the intervention patients.
Based on this early success, a large-scale study is envisioned and PROS is working with PI Dr Ken Resnicow to obtain federal funding for a multiyear-multisite trial.

## For More Info: www.aap.org/obesity

**For More Info: www.aap.org/obesity**

**Notes:**
Log onto the AAP Website for more information on our obesity-related programs, activities, and resources, including:
Publications
Policy statements
Model programs
Articles
Links to other related sites
Etc...

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