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Slide 1 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee
Slide 2 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight
Slide 3 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22
Slide 4 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report
Slide 5 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report
Slide 6 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature
Slide 7 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight
Slide 8 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history
Slide 9 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea
Slide 10 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes
Slide 11 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children
Slide 12 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children Referral & Care Management for Abnormal Test Results Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral* Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year* Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral* *Clinical judgment should be used
Slide 13 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children Referral & Care Management for Abnormal Test Results Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral* Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year* Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral* *Clinical judgment should be used Screening Guide
Slide 14 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children Referral & Care Management for Abnormal Test Results Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral* Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year* Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral* *Clinical judgment should be used Screening Guide Billing Instructions
Slide 15 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children Referral & Care Management for Abnormal Test Results Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral* Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year* Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral* *Clinical judgment should be used Screening Guide Billing Instructions Completing the PM160 25 26 Blood glucose Use Code 25 and/or 26 ONLY if collecting the sample. Otherwise, denote: “Sent for glucose and/or cholesterol lab.” Laboratories Blood Glucose – Code 25 Cholesterol – Code 26 Blood/Serum Cholesterol
Slide 16 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children Referral & Care Management for Abnormal Test Results Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral* Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year* Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral* *Clinical judgment should be used Screening Guide Billing Instructions Completing the PM160 25 26 Blood glucose Use Code 25 and/or 26 ONLY if collecting the sample. Otherwise, denote: “Sent for glucose and/or cholesterol lab.” Laboratories Blood Glucose – Code 25 Cholesterol – Code 26 Blood/Serum Cholesterol Resources For the AMA 2007 Expert Committee Recommendations, go to: www.ama-assn.org/ama/pub/category/11759.html For the AAP policy on lipid screening and heart health in children, go to: www.aap.org/advocacy/releases/july08lipidscreening.htm American Diabetes Association: Type 2 Diabetes in Children and Adolescents. Pediatrics 105:671-680, 2000
Slide 17 - Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee Goal To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight Agenda Review the medical conditions associated with pediatric overweight/obesity Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22 Overweight & Obese Children California children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Overweight & Obese Children California children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report Accurate Weight & Stature BMI Percentile Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements > 99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight BMI % Growth Chart Obese Overweight Normal* Underweight Lab Tests (cholesterol & glucose) In-depth Medical Assessment Note in chart: “Counsel & Follow-up” Measurements Weight Height Age Plot Assessment Algorithm + - *Further tests may be warranted depending on family history Conditions Associated with Childhood Overweight Cardiovascular Conditions High Blood Cholesterol Lipid Disorders Hypertension (HTN) Endocrine Conditions Type 2 Diabetes Insulin Resistance Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Accelerated Growth Hip Disorders Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children Referral & Care Management for Abnormal Test Results Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral* Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year* Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral* *Clinical judgment should be used Screening Guide Billing Instructions Completing the PM160 25 26 Blood glucose Use Code 25 and/or 26 ONLY if collecting the sample. Otherwise, denote: “Sent for glucose and/or cholesterol lab.” Laboratories Blood Glucose – Code 25 Cholesterol – Code 26 Blood/Serum Cholesterol Resources For the AMA 2007 Expert Committee Recommendations, go to: www.ama-assn.org/ama/pub/category/11759.html For the AAP policy on lipid screening and heart health in children, go to: www.aap.org/advocacy/releases/july08lipidscreening.htm American Diabetes Association: Type 2 Diabetes in Children and Adolescents. Pediatrics 105:671-680, 2000 Summary Lab screening is necessary to provide quality care for children who are overweight/obese Glucose and cholesterol screening facilitates early identification of children who are at risk for diabetes and cardiovascular disease Abnormal lab results can help guide providers to initiate early intervention and/or referral to treatment
 

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