Full Clinical Guidelines - Community First Health Plans.

19.3 Weight Management Algorithm for Oveweight Children & Adolescents
D i a b e t e s t r e a t m e n t a l g o r i t h m s
Weight Management Algorithm for
publication # 45-12083
obtain Accurate Height (Ht) & Weight (Wt)
2
Calculate Body Mass Index (BMI-see page 3 of 4)
th (refer to gender-specific bMi chart on page 4 of 4)
BMI = Wt in kg
2
reinforce Healthy lifestyle, diet, and exercise;
2
2
2 2 >95th%ile bMi for Age & Gender
3
sleep Apnea; pseudotumor cerebri; dyslipidemia (elevated ldl-c and/or tG; low Hdl-c); Htn;
nAFld; Gerd; Wt-bearing Joint pain; pcos /Hyperandrogenism; An; psychological Adjustment disorders; t2dM (FpG≥126 mg/dl;
post challenge pG ≥200 mg/dl)
Assess for Risk Factors and/or Contributing Factors
4 birth Wt; post Malignancy pt/Family not Motivated
5 Offer Medically Supervised Wt
educate patient and Family; Manage
Management Intervention
comorbidities and risk Factors;
u reassess readiness periodically
u Pubertal: = 10% body Wt loss
pt/Family Motivated
pt/Family Motivated
85th%ile bMi with comorbidities
Pre-pubertal: ≥age 7 = 1–2 lbs per Month Wt loss
Education; Lifestyle Changes 2 ; Nutrition;
Overweight 2
treatment
(Ht in m) 2
pt/Family Motivated
degree of Wt loss will depend on the severity of
the comorbidity
Increased Physical Activity; Behavior
Modification; Nutrition/Family Counseling.
Approved 04/28/05
= Wt in lb x 703
(Ht in inches) 2
pt/Family not Motivated
≥6 months
Consider Obesity Pharmacologic Monotherapy as Adjunct to
lifestyle changes if bMi ≥27 with comorbidities or if bMi ≥30
Maintain Healthy lifestyle, diet and exercise;
reinforce education; Monitor Wt Weekly for life with
periodic Follow-up by Hcp
Consider Bariatric Surgery 8 for adolescents
who meet criteria. (See page 2)
Wt Loss
Maintenance
targets Maintained
Targets Met
Motivated & targets not Met
≥6 months
Appetite Suppressant
Sibutramine 6
contraindicated in: uncontrolled
Htn; Glaucoma (narrow-angle);
Arrhythmia; cvA; cvd; cHF;
concurrent ssri; MAoi therapy;
pregnancy; bulimia/Anorexia
nervosa Hx
Lipase Inhibitor Orlistat 7
contraindicated in:
chronic Malabsorption;
cholestasis; orlistat
Hypersensitivity; concurrent
cyclosporin therapy; pregnancy
1 of 4 – Weight Management Algorithm for overweight children and Adolescents – Approved 04/28/05 See disclaimer at www.tdctoolkit.org/algorithms_and_guidelines.asp
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