PEDIATRICIAN - AAP-CA

snacks.” They were better able to identify
foods from the four major food groups and
on average they claimed that they exercised
five days per week. There was high satisfaction
across all three programs. Nintey-two
percent of all respondents stated that they
were “Very satisfied.” One hundred percent
of all respondents would recommend the
program to others and rated the instructors
as excellent or good, and at least 92% of all
respondents reported that the information
provided about nutrition and exercise was
“Very useful.”
At PowerPlayMD-OC the only medically-based
program in our county, the
following additional comorbidities not
previously diagnosed were identified and
listed in the table:
Additional Comorbidities
Detected
26 Acanthosis nigricans
15 Elevated Blood Pressure over 95%
for gender, age and % of height
8 Hypertriglyceridemia
5 Hypercholesterolemia
7 Asthma
6 Family History of at least one
parent with Diabetes
3 Prediabetes
2 Hyperinsulinemia
1 Elevated Liver Function Tests
10 Miscellaneous diagnoses (e.g.,
sleep Apnea, polycystic ovary
disease, etc.)
One year later, 14 of the pilot’s clients
had discontinued the program because they
had moved or we were unable to reach
them. The 33 patients
remaining in the program
represent 66% of the initial
group.
PowerPlayMD-OC
clients had an average
BMI reduction of 0.7%,
an average waist circumference
reduction of 1.35
inches, an average height
growth of 1.29 inches,
and an average weight
gain of 1.9 pounds. Other
randomized programs in other states have
had similar results. 5
We found that the identification of at
risk members by primary care providers is
very low. Few of them document BMI or
measure blood pressure adequately and in
accordance with current standards of practice.
6 Referral resources for the treatment
of obesity and the knowledge of community
resources are very limited. Coordination
and communication between health
networks and primary care providers is
challenging and coordination with disease
management programs is limited. In order
to succeed, it is vital to have a well-funded
program with a strong health network collaboration.
Even extremely overweight children
and their parents may not accurately perceive
their children as obese. They may
not perceive the negative consequences of
failing to make difficult lifestyle changes
that result in weight loss, as well.
It is important to solicit participants’
initial commitment, to reduce attrition due
to the long commitment and competing
family priorities and/or transportation. A
well-prepared and motivating orientation
is necessary to achieve this objective.
Cultural, ethnic and linguistic diversity,
require group and individual adjustments. 7
Assessment of mental health, parenting
education, nutrition, physical activity,
medical examinations, and post-maintenance
fitness activity are vital components
that need to be incorporated in all programs
to be successful.
Science continues to lag behind the
obesity epidemic and many gaps in applying
best practices remain. 8 Awareness,
screening, and recording of BMI and
blood pressure are necessary to decrease
the morbidities associated with pediatric
obesity and its impact on individuals, families
and society. Our experience in Orange
County amounts to more than 800 patients
treated since our opening in 2005.
In spite of the difficulty in changing
the lifestyle of obese children and their
families we demonstrated that a familybased
medically designed program that
teaches nutrition, behavior modification,
and fitness can lower BMI, waist circumference,
body fat and blood pressure.
References
1. Prevalence of Overweight Among Children and
Adolescents: United States, 2003–2004. http://
www.cdc.gov/nchs/products/pubs/pubd/hestats/
overweight/overwght_child_03.htm
2. California Pediatrician, Spring 2006.
3. 13th. Orange County Conditions of Children
Report http://www.ochealthinfo.com/cscc/report/
4. Percentage of public school students in grades
five, seven, and nine who are overweight. Data
Source: California Center for Public Health Advocacy,
The Growing Epidemic, 2005. Retrieved
02/13/07. http://www.publichealthadvocacy.org
5. Mary Savoye, RD, CD-N, CDE, Yale center for
Clinical investigation, Yale University School of
Medicine, http://jama.ama-assn.org/cgi/content/
full/297/24/2697
6. h t t p : / / j a m a . a m a - a s s n . o rg / c g i / c o n t e n t /
abstract/298/8/874, http://www.pediatrichypertension.org/calcs.asp,
http://www.nhlbi.nih.gov/
guidelines/hypertension/child_tbl.pdf
7. Accuracy of Perceptions of Overweight and Relation
to Self-Care Behaviors Among Adolescents
With Type 2 Diabetes and Their Parents. Ashley
Cockrell Skinner, PHD, Morris Weinberger,
PHD, Shelagh Mulvaney, PHD, David Schlundt,
PHD and Russell L. Rothman, MD, MPP. Diabetes
Care 31:227-229,2008
8. Pediatrics, A supplement to Pediatrics, Assessment
of Child and adolescent Overweight and
Obesity, Dec. 2007, Volume 120, Supplement 4
/ CALIFORNIA PEDIATRICIAN—SPRING/SUMMER 2008