Unhealthy life-style choices: The Elephant in the Room!

1
Unhealthy life-style choices The Elephant in the
Room!

• Lynn Clark, MS, RN-BC, CPNP-PC
• Lynn.clark_at_childrens.com
• Britney Cox, MS, RN-BC, CPNP-PC
• Britney.cox_at_childens.com
• Pain Management Nurse Practitioners
• Childrens Medical Center Dallas
• Although the world is full of suffering,
• It is also full of the overcoming of it.
• -Helen Keller

2
Conflict of Interest Disclosure

• Conflicts of Interest for ALL listed
  contributors.
• Clark, L None
• Cox, B None
• A conflict of interest is a particular financial
  or non-financial circumstance that might
  compromise, or appear to compromise, professional
  judgment. Anything that fits this should be
  included. Examples are owning stock in a company
  whose product is being evaluated, being a
  consultant or employee of a company whose product
  is being evaluated, etc.
• Taken in part from On Being a Scientist
  Responsible Conduct in Research. National
  Academies Press. 1995.

3
Objectives

• Participants will be able to
• Describe consequences of obesity and sedentary
  life-style on the health of pediatric patients
• Learn 3 challenges for pediatric patients that
  impact the ability to make healthy life-styles
  choices
• List 3 pain conditions (co-morbidities) that are
  frequently related to obesity and sedentary
  life-style
• Describe an intervention that is helpful to
  address the elephant in the room in relation to
  managing pain

4
Background on Obesity

• Center for Disease Control
• Comparing children of the same age and sex
• Overweight BMI gt85th - 95th percentile
• Obese a BMI at or above the 95th percentile
• 17 (12.5 M)of US Children are obese
• 33 (72 M) of US Adults are obese

5
Do you know your BMI?
BMI pounds/(inches2) 703 160/(662)
703 160/4356703 25.82185
6
Epidemiology
7
Trends
8
Rates
9
Culture Crisis

• Obese children are more likely to become obese
  adults.
• Adult obesity is associated with a number of
  serious health conditions including heart
  disease, diabetes, and some cancers.
• If children are overweight, obesity in adulthood
  is likely to be more severe.

10
Nutrition Culture/ Practices

• School influence
• Sugary drinks less healthy food
• Advertising
• Day cares not regulated like public schools
• Lack of daily, quality physical activity in
  school
• lt 4 of elementary schools have PE
• Increasing portion sizes
• Lack of breastfeeding support
• TV and media
• 2-4 hours daily

11
Culture/ Practices

• Perceptions
• 67 of obese children were perceived as
  overweight by their mothers
• 14 of overweight boys and 29 of overweight
  girls perceived themselves as overweight
• Ethnic minority women have a great acceptance of
  body image than white women.
• Education
• Mothers with HS or less education were less
  likely to identify children as overweight

12
Times have changed

• Poor Role Modeling
• 9 out of 10 kids are driven to school (compared
  to 50 a generation ago)
• Home cooked meals are rare and fast-food and
  eating out are the norm.
• Foods are more dense in calories
• Lack of Limit setting
• Fewer hours of sleep higher likelihood for
  obesity
• Screen Time
• Limited adult exercise

13
Familial Influence

• Study by Whitaker et al.
• (4432 families with 7078 kids)
• Incidence of childhood obesity
• 2 normal weight parents 2.3
• 2 overweight (but not obese) 4.9
• 2 obese parents 21.7
• 2 severely obese parents 35.3
• Association of child BMI has a stronger link to
  maternal BMI

14
Socioeconomical
15
Sedentary Lifestyle
16
Dietary Risk Factors

• Skip breakfast or lower energy meal
• Eat lunch at school
• Ate supper while watching TV gt 5 days/wk
• Separated/ divorce parents
• Eating alone
• High energy meal at dinner
• Clean plate club
• Snacking and watching TV (sedentary)

17
Physical consequences include

• Cardiovascular disease (70 had 1 symptom 39
  had 2 orgt)
• Hypertension
• high cholesterol/ triglycerides
• Endocrine
• Hyperinsulinism
• type 2 diabetes
• Neurologic
• pseudo tumor cerebrii
• Migraine/ Headaches
• MS
• Respiratory
• Asthma
• OSA
• GU
• Polycystic ovarian syndrome

• Gastrointestinal
• Fatty liver disease
• Gallstones
• Gastro-esophageal reflux
• Encopresis
• Constipation
• IBS
• FAP
• Low Vitamin D
• Musculoskeletal
• Tibia vara (Blounts)
• Slipped capital femoral epiphysis (SCFE)
• Musculoskeletal problems
• Back pain
• Chronic pain

18
Psychological Consequences

• Children lt 15 yo Victim of Bullying
• Overweight 26 more likely
• Obese 85 more likely
• Aggression, withdrawn friendships, rumors, lies,
  name calling, teasing, hitting and kicking
• Children gt 15 yo who are obese are more likely to
  be a perpetrator of bullying
• School based friendship clusters

19
Psychological Consequence

• Psychological crisis
• Depression
• Lower Self-esteem
• Appearance
• Widespread bias
• Anxiety
• Stress
• Socially withdrawn

20
Psychological Consequence

• Poor quality of life

21
Why Obesity and pain?

• Stress on joints
• Inflamatory process

22
Chronic Pain

• Affects 25-37 of children and adolescents
• Combination of pain and obesity
• decreased QOL and functioning
• BMI should be a routine screen for patients with
  chronic pain

23
Pain Amplification

• Adults
• 30 were overweight
• 47 were obese
• Pain Amplification symptoms are increased with
  sedentary life-style
• Treatment includes exercise
• Kinesophobia
• Obesity contributes to the continued presence and
  increase in severity of symptoms

24
Headache

• Increased BMI increase frequency disability
  related to HA
• Patients who lost wt had decrease in headache
  frequency
• Overweight females are 4x more likely to develop
  headaches than normal-weight girls

25
Chronic Back Pain

• BMI gt 30 increase risk of LBP
• Mechanical stress
• CVD which decrease blood flow to the lumbar spine
• Wt loss may or may not address pain
• Children gt 95 BMI are more likely to have LBP
  and pain in at least 1 joint.

26
Lower extremity pain (knees, ankles, hips)

• Mechanical issues
• Overweight patients are at 2.2x higher risk for
  development of osteoarthritis
• 69 of knee replacement surgeries in adult women
  are related to obesity

27
Why is there an elephant in the room?

• Emotional
• Political
• Controversial
• Perception is skewed / cultural barriers
• Lack of community education and support
• Fear by provider of an emotional reaction
• Fear of promoting disordered eating behaviors

28
Addressing the elephant

• Addressing the vital statistics
• Discuss BMI with the patient and family
• State why we assess the whole patient and their
  behaviors
• Nutritional, dietary behavioral and activity
  assessment
• Diagnose the patient appropriately
• Build trust to achieve outcomes

29
(No Transcript)
30
Promote positive change in your practice

• Communication and building trust
• Collaborative process
• SMART goals
• Set 1-2 nutrition goals
• Set 1 physical activity goals

31
Education

• Hot Cheetos
• Creative BASIC Handouts
• Engaging the family
• Address negative behaviors
• Giving permission
• Limit setting

32
CDC-Division of Nutrition, Physical Activity, and
Obesity

• http//www.cdc.gov/nccdphp/dnpao/index.html

33
Follow up

• Follow up phone call at one month
• Follow up appt at 2 months
• Reassess and reevaluate goals
• Global impression of change
• Affect on pain
• New goals
• Discuss as a life style change

34
Outcomes

• Compliance with set goals
• Functionality
• Perception of improvement
• Global impression of change

35
Acheivements

• Participants will be able to
• Describe consequences of obesity and sedentary
  life-style on the health of pediatric patients
• Learn 3 challenges for pediatric patients that
  impact the ability to make healthy life-styles
  choices
• List 3 pain conditions (co-morbidities) that are
  frequently related to obesity and sedentary
  life-style
• Describe an intervention that is helpful to
  address the elephant in the room in relation to
  managing pain

36
Take home points

• Recognize the epidemic
• Address the elephant in the room
• Listen
• Ask
• Act
• Be SMART
• Praise and reassess
• Multimodal treatment is the Key!