Pediatrics and Pediatric Emergency Medicine

Biography

Biography: Rupesh Raina

Abstract

Background Pediatric obesity has assumed epidemic proportions with prevalence rates of ≈17% in children between 2-19 years. Childhood overweight and obesity is associated with much co-morbidity that adversely affects a child’s physical, mental, social and emotional wellbeing. It is directly related to obesity in adulthood with risk of progression of various co-morbid diseases, and even early mortality, thus portending a tremendous financial and social burden to the society. Aim To determine the prevalence of obesity in children (6-18 yrs.) in our center’s ambulatory clinics; to define it’s demographic characteristics; risk stratification; and appraise the adequacy and consistency of recommended screening tests as compared to guidelines outlined by the “Expert Committee Recommendation on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity” and endorsed by AAP. Further, to illustrate the establishment of a multidisciplinary, comprehensive Pediatric Weight Management and Wellness Program at our center and a unique partnership with a leading non-profit public sector managed Care Company. Methods This study utilized existing data sets of children aged 6-18 years with at least one visit in the Department of Pediatrics between 2008 and 2012. We categorized the group into four sub-groups. Demographic characteristics- BMI percentile, age, gender, race/ethnicity, and insurance type were evaluated to define each subgroup. We then analyzed each sub-group for prevalence of common obesity-related comorbidities, laboratory screening, and the proportion of patients in each sub-group that were referred to the N.E.W. Clinic or to a registered dietitian. A method was developed to establish a standardized, multidisciplinary, comprehensive weight management program, and a way to sustainably provide the lifestyle services, free of charge to the patients and their families- we negotiated and achieved a unique partnership with a leading non-profit public sector managed care company. Results 28,443 children met the criteria and had all demographic data available for analysis.11,649 children (41%) exceeded the 85th BMI %ile (18% overweight, 17% obese and 7% morbidly obese). Only 13.7% of the children above 85th%ile had fasting lipid profiles completed at least once per recommended guidelines. 5,913 children were overweight with 2 or more risk factors or obese, which requires additional screening for diabetes and fatty liver. Within this high-risk population (n=5,913), only 50% had a screening glucose and 23.8% had screening ALT/AST completed. 21% of children with BMI >85th%ile had a co-morbid condition and there was a statistically significant increase in the number of comorbidities across weight categories, with 1.03 (+ 0.15) of the overweight having a co-morbid diagnosis, 1.26 (+ 0.56) of the overweight + 2 RF population, 1.45 (+0.82) of the obese and 1.82(+1.13) of the morbidly obese (p < 0.0001). It was also found that only 24% of obese and 46% of morbidly obese children were referred to NEW Clinic and of children not referred to NEW Clinic, only 13% of obese and 15% of morbidly obese received a referral for Nutrition consult within the past 5 years. Conclusion The prevalence of overweight and obesity in our center is almost 41%, exceeding the national rates significantly. There were significant gaps in the rates of screening for various co-morbidities as compared to expert committee recommendations, due mainly to a lack of a standardized obesity management protocol and program. A dire need for a standardized, multidisciplinary, comprehensive fatty liver, weight management and wellness program existed for our patients. We illustrate the unique components of our recently developed program. Through a series of processes, our Pediatric Weight Management and Wellness Program accomplished a unique partnership with a leading non-profit managed care company to provide sustainable lifestyle services to our vulnerable obese children and their families