Full Clinical Guidelines - Community First Health Plans.

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III. Within this category, goal should be weight maintenance or gradual weight loss until BMI less than 85th percentile and should not exceed 1 lb/month in children aged 2-5 years, or 2 lbs/wk in older obese children and adolescents. The Expert Committee recommends the following for children with BMI > 95th percentile, with significant comorbidities and who have not been successful with Stages 1-3 or children > 99th percentile who have shown no improvement under Stage 3 (Comprehensive Multidisciplinary Intervention): STAGE 4. TERTIARY CARE PROTOCOL. Referral to pediatric tertiary weight management center with access to a multidisciplinary team with expertise in childhood obesity and which operates under a designed protocol. 1. This protocol should include continued diet and activity counseling and the consideration of such additions as meal replacement, very-low-calorie diet, medication, and surgery. The Expert Committee recommends that the following weight loss targets should be considered when implementing the staged treatment plan: Age 2-5 Years 85th-94th BMI Weight maintenance until BMI< 85th percentile or slowing of weight gain as indicated by downward deflection in BMI curve. ≥ 95th Weight maintenance until BMI < 85th percentile; however if weight loss occurs with a healthy and adequate caloric diet it should not exceed 1 lb/month. If greater loss is noted, monitor for causes of excessive weight loss. BMI (>21 or 22) (Rare, very high) Gradual weight loss, not to exceed 1 lb/mo. If greater loss occurs, monitor for causes of excessive weight loss. Age 6-11 Years 85th -94th BMI Weight maintenance until BMI< 85th percentile or slowing of weight gain as indicated by downward deflection in BMI curve. 95th -98th BMI Weight maintenance until BMI< 85th or gradual weight loss of approximately 1 lb/month. If greater loss is noted, monitor for causes of excessive weight loss. ≥99th BMI Weight loss not to exceed an average of 2 lb/wk. If greater loss is noted, monitor for causes of excessive weight loss. Age 12-18 Years 85th – 94th BMI Weight maintenance until BMI< 85th percentile, or slowing of weight gain as indicated by downward deflection in BMI curve. 95th -98th BMI Weight loss until BMI < 85th percentile--no more than an average of 2 lbs/wk. If greater loss is noted, monitor for causes of excessive weight loss. ≥99th BMI Weight loss not to exceed an average of 2lb/wk. If greater loss is noted, monitor for causes of excessive weight loss. The Expert Committee recommends that in children aged 12-18 years, with BMI greater than or equal to the 99th percentile, primary care physicians and other allied healthcare providers may begin treatment with stages 1, 2, or 3 as indicated based on patient/family readiness to change. 156 H EALTH PLANS www.cfhp.com
PREVENTION RECOMMENDATIONS 1. The Expert Committee recommends that physicians and allied healthcare providers counsel the following: a. For children aged 2-18 years whose BMI is at or above the 5th percentile and no greater than the 84th percentile: i. Dietary Intake: 1. Limiting consumption of sugar-sweetened beverages and encouraging consumption of diets with recommended quantities of fruits and vegetables. ii. Physical Activity: 1. Limiting television and other screen time to 1 or 2 hours per day in children starting as young as age 5 years, as advised by the American Academy of Pediatrics and removing television and computer screens from children’s primary sleeping area. iii. Eating Behaviors: 1. Eating breakfast daily. 2. Limiting eating out at restaurants, particularly fast food restaurants. 3. Encouraging family meals in which parents and children eat together. 4. Limiting portion size. 2. The Expert Committee recommends that physicians, allied healthcare professionals, and professional organizations advocate for: a. The federal government to increase physical activity at school through intervention programs as early as grade 1 through the end of high school and college, and through creating school environments that support physical activity in general. b. Supporting efforts to preserve and enhance parks as areas for physical activity, informing local development initiatives regarding the inclusion of walking and bicycle paths, and promoting families’ use of local physical activity options by making information and suggestions about physical activity alternatives available in doctors’ offices. 3. The Expert Committee recommends using the following techniques to aid physicians and allied healthcare providers who may wish to support obesity prevention in clinical, school, and community settings: a. Actively engaging families with parental obesity or maternal diabetes, because these children are at increased risk for developing obesity even if they currently have normal BMI. b. Encouraging an authoritative * parenting style in support of increased physical activity and reduced sedentary behaviour, providing tangible and motivational support for children. c. Discouraging a restrictive † parenting style regarding child eating. d. Encouraging parents to model healthy diets and portion sizes, physical activity, and limited television time e. Promoting physical activity at school and in child care settings (including after school programs), by asking children and parents about activity in these settings during routine office visits. 4. The Expert Committee suggests that children of healthy weight participate in 60 minutes of moderate to vigorous physical activity daily. i. The 60 minutes can be accumulated throughout the day, as opposed to only single or long bouts. ii. Ideally, such activity should be enjoyable to the child iii. Whereas some health and psychological benefits may be attained by achieving the 60 minute goal, greater duration should yield increased benefit 5. The Expert Committee also suggests counselling patients and families to perform these behaviors: i. Dietary Intake: 1. Eating a diet rich in calcium 2. Eating a diet high in fiber 3. Eating a diet with balanced macronutrients (calories from fat, carbohydrate, and protein in proportions for age recommended by Dietary Reference Intakes) 4. Encouragement, support, and maintenance of breastfeeding ii. Eating Behaviors: 1. Limiting consumption of energy-dense foods. * Authoritative parents are both demanding and responsive. “They monitor and impart clear standards for their children’s conduct. They are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive. They want their children to be assertive as well as socially responsible, and self-regulated as well as cooperative” (Baumrind, 1991, p. 62). † Restrictive parenting (heavy monitoring and controlling of a child’s behavior) H EALTH PLANS www.cfhp.com 157
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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COMMUNITY FIRST HEALTH PLANS BEHAVI
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Criteria Requirements 33. Release o
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The evaluation of breast disease is
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Prevent Child Texas, a non-profit o
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AMERICAN ACADEMY OF PEDIATRICS: Fai
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possible), a careful, complete, and
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Examination/Test Oral / Dental Insp
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GLYCEMIC CONTROL BIBLIOGRAPHY • R
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Publication # 45-11647 Targets* A1
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WORKSHEET Revised 10-20-05 Advancin
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D. Optimizing analog insulin use Re
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Publication # 45-11266 Age 126 mg/d
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Hypertension Algorithm for Diabetes
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Lipid Algorithm For Type 1 and Type
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References: Revised 1-24-08 • Col
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WEIGHT LOSS ALGORITHM FOR OVERWEIGH
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Publication #45-11825 Screening 1 :
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Publication #45-12000 DIABETIC FOOT
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DIABETIC FOOT CARE/REFERRAL ALGORIT
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Publication # 45-12083 WEIGHT MANAG
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Revised 10-25-07 IV INSULIN INFUSIO
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Revised 10-25-07 Publication #: 45-
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Revised 2-21-08 Publication #: E45-
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Abbreviations AGI Alpha-Glucosidase
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Orders for Adults with DKA and Hype
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D i a b e t e s t r e a t m e n t a
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CFHP has adopted the National Insti
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No CHD; 0 to 1, or 2+ Risk Factors
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NATIONAL CHOLESTEROL EDUCATION PROG
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NATIONAL CHOLESTEROL EDUCATION PROG
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Identification, Evaluation, and Tre
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11.3 Treatment of Hypertension H EA
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ALGORITHM FOR TREATMENT OF MAJOR DE
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CFHP has established guidelines for
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A. Documentation ______ B. Continui
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CFHP PCP MEDICAL RECORD REVIEW TOOL
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