Transcript Training module - Every Woman North Carolina

Healthy Weight Matters
YOUNG WOMEN & THE
REPRODUCTIVE CONSEQUENCES OF
OBESITY
Acknowledgements
 This training was developed by the North Carolina
Preconception Health Campaign, a program of the North
Carolina Chapter of the March of Dimes, under a contract
and in collaboration with the North Carolina Division of
Public Health, Women’s Health Branch.
 This material was developed through support provided by
the U.S. Department of Health and Human Services, Office
of the Assistant Secretary for Health, Office of Adolescent
Health (grant #SP1AH000004).
Acknowledgements
 Many thanks to these agencies and individuals for their
generosity in sharing their resources:
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Corrine Giannini, RD, LDN
Shannon Kellner, RN, MPH
Merry-K Moos, FNP, MPH, FAAN
Alvina Long Valentin, RN, MPH
North Carolina Division of Public Health, Women’s Health and Physical
Activity & Nutrition branches
 Specific resources used to guide the development of this training:
 Eat Smart Move More North Carolina resources
 The National Preconception Curriculum and Resources Guide for
Clinicians (Module 1: Preconception Care: What it is and what it isn’t)
Young Moms Connect
 Brings together community partners to address challenges
faced by pregnant or parenting teens using collaborative,
multi-faceted strategies
 One component of Young Moms Connect is training for
health care providers on six maternal and child health best
practices
MCH Best Practices
 Early entry and effective utilization of prenatal care
 Establishment and utilization of a medical home (for non-
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pregnant women)
Reproductive life planning
Tobacco cessation counseling using the 5 A’s approach
Promotion of healthy weight
Domestic violence prevention
Objectives
• Understand the relationship between healthy weight status
and opportunistic preconception health counseling
• Understand trends in overweight/obesity for women of
childbearing age
• Increase awareness about the connections between weight
status and birth outcomes
• Improve weight status assessment and counseling skills
Objectives (continued)
• Improve service delivery (within a practice or across
agencies/partners) to encourage patient weight status
screening and weight management counseling
• Increase awareness of reimbursement options for weight
status counseling
• Increase awareness of healthy weight resources for
patients and providers
What is preconception care?
 Identification of modifiable and non-modifiable risk factors
for poor health and poor pregnancy outcomes before
conception
 Timely counseling about risks and strategies to reduce the
potential impact of the risks
 Risk reduction strategies consistent with best practices
CDC National Preconception Curriculum and Resources Guide for Clinicians (Module 1) http://beforeandbeyond.org/?page=cme-modules
Components of preconception care
 Giving protection
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(eg.: folic acid,
immunizations)
 Managing conditions
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(eg.: diabetes, maternal PKU,
obesity, hypertension,
hypothyroidism, STIs, sickle
cell)
 Avoiding exposures
known to be teratogenic
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(eg.: medications, alcohol,
tobacco, illicit drugs)
CDC National Preconception Curriculum and Resources Guide for Clinicians (Module 1) http://beforeandbeyond.org/?page=cme-modules
“Opportunistic” care
 Preconception care is for
every woman of
childbearing age every
time she is seen
 Every woman, every time
CDC National Preconception Curriculum and Resources Guide for Clinicians (Module 1) http://beforeandbeyond.org/?page=cme-modules
Weight status prior to pregnancy
 Women of childbearing age who are overweight or obese
are at higher risk of poor maternal and birth outcomes than
women who enter pregnancy at a healthy weight
 Achieving and maintaining a healthy weight is one key
component of preconception care
Obesity in North Carolina
• In 2010, nearly two-thirds (65%) of adults in
North Carolina were either overweight or obese
• From 2001 to 2010, the proportion of N.C. adults
who were overweight or obese increased from 59%
to 65%
NC Behavioral Risk Factor Surveillance System, 2011
Women & weight in North Carolina
• 58% of women in NC of childbearing age (18-44) are
overweight or obese
• 43% of young women ages 18-24 are overweight or obese
• There is also a racial disparity in weight status
• 56% of white women are overweight or obese
• 73% of African American women are overweight or obese
• 56% of other minorities are overweight or obese
NC Behavioral Risk Factor Surveillance System, 2010
Obesity among North Carolina mothers
Trends in the Percentage of N.C. Obese PrePregnancy Mothers by Race (1997-2005)
Percentage of Mothers
50
40
30
21%
20
28%
25%
14%
16%
18%
2000-2002
2003-2005
10
0
1997-1999
White
African American
Source: North Carolina Pregnancy Risk Assessment Monitoring System Survey Data. N.C. State Center for
Health Statistics (1997-1999, 2000-2002, 2003-2005)
Pieces of the puzzle
http://www.eatsmartmovemorenc.com/ESMMPlan/Texts/ESMMPlan_Reduced.pdf
Consequences
 U.S. society focuses on external consequences of overweight
and obesity, i.e. how we look
 As health professionals it can be helpful to re-frame
discussions toward medical/physical consequences of
overweight and obesity
 For women of childbearing age the consequences of
overweight & obesity span two generations
 Risk of consequences increases progressively as BMI
increases
Kellner, S. Maternal weight: An opportunity to impact infant mortality in North Carolina. 2010.
Pregnancy risks
• Increased pre-pregnancy BMI is associated with increased
risk of:
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Preeclampsia
Gestational Diabetes
Gestational Hypertension
C-section
Induction of labor
Post-Partum hemorrhage
Kellner S, Maternal weight: An opportunity to impact infant mortality in North Carolina, 2010.
And for the baby…..
• Macrosomia
• Preterm delivery
• Poor APGAR scores
• NICU admission
• Shoulder dystocia
• Late fetal death
• NTDs (Anencephaly and spina bifida)
Kellner S, Maternal weight: An opportunity to impact infant mortality in North Carolina, 2010.
The cycle repeats
 Babies born to
overweight mothers are
more likely to become
obese children
 The likelihood that
overweight children will
become obese adults is
almost nine times higher
than the risk for children
who are not overweight
Beyond pregnancy…
 Women who are
overweight or obese are
more likely to have:
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A higher risk of uterine
cancer (2-5 times greater)
Increased risk of death
from uterine and breast
cancers
Problems getting pregnant
Greater risk of
contraception/birth
control not working
Irregular periods
Depression
P-Sunyer FX.. Medical hazards of obesity. Ann Intern Med. 1993;119;655-660.
How do you define healthy weight?
• A weight range that correlates with a less than average risk
for health conditions like heart disease, high blood
pressure, and diabetes
Giannini C, 2009
Providers and weight
• Most overweight patients believe they should lose weight,
but this is seldom discussed during visits with health care
providers
• Most patients want more help with weight management
than they are getting from their primary care physicians
Potter MB, Vu JD, Croughan-Minihane M. Weight management: what patients want from their primary care
physicians. Fam Pract. 2001 Jun;50(6):513-8.
Why don’t patients ask for help?
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Frustration from prior attempts
Lack of motivation
Lack of knowledge
Lack of family or community support
Fear of embarrassment
Cost concerns
Racial disparities- Caucasian women had a more negative
view of obesity than did African American women
Bardia A, Holtan SG, Slezak JM, Thompson WG. Diagnosis of Obesity by
Primary Care Physicians and Impact on Obesity Management. Mayo Clin
Proc. 2007;82(8):927-932.
Why don’t providers bring it up?
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Lack of time to counsel
Lack of knowledge
Fear of embarrassing patient
Frustration from prior attempts
Forgetting to talk about it or document it
Perception of patient motivation
Lack of belief the treatment will be effective
Possible influence of provider’s weight status
Bardia A, Holtan SG, Slezak JM, Thompson WG. Diagnosis of Obesity by
Primary Care Physicians and Impact on Obesity Management. Mayo Clin
Proc. 2007;82(8):927-932
Tips for talking with patients
• Don’t ignore weight
• Set small goals! Every little bit helps! Example: No more
weight gain before next pregnancy
• Use objective measures such as BMI
BMI: Body Mass Index
• An objective way to start the conversation about a patient’s
weight
• In focus groups, young women, 18-24, were impacted by
seeing their BMI on a chart
• Combined with the words “overweight” and “obese” their
awareness of their weight was raised and they felt
motivated for change
BMI
• A measure used to compare your weight to your height to
assess your risk for weight-related health conditions
• BMI=
(_Weight in Pounds_) X 703
(Height in inches) x (Height in inches)
• Opportunities: Family Planning Flow Sheet, Physical
Activity & Nutrition Behaviors Monitoring Form
BMI
Underweight
<18.5
Healthy weight
18.5 - 24.9
Overweight
25 - 29.9
Obese
30+
Body mass index for adolescents
 The BMI chart is designed
for adults ages 20 and up
 For patients under 20,
first calculate BMI with
regular chart
 Then use this adolescent
chart and find BMI on left
 Then find age at bottom
and see where the two
numbers meet
U.S. Office on Women's Health
Healthy Habits for Life!
 Interactive booklet
 Review with client
 Based on Eat Smart
Move More
 Order from Women’s
Health Branch or NC
Healthy Start
Foundation
 Let’s take a look…
Rethink Your Drink
Choose To Move More Everyday
Track It!
Eat Smart Move More (ESMM)
• A statewide campaign that promotes increased
opportunities for healthy eating and physical activity
• Offers different tools for people in different settings
including:
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Community
Family
Worksite
Health care
How can this work for you?
 Think about a particular
patient that you recently saw
who is overweight or obese
 Which target behavior do
you think would be the
easiest for them to change?
 Do you think this would be a
good place to start?
 Can you see yourself using
these tips?
Seven ESMM Target Behaviors
1. Breastfeeding
2. Rethink your drink
3. Choose to move more every day
4. Tame the tube
5. Enjoy more fruits and veggies
6. Prepare more meals at home
7. Right size your portions
Eat Smart Move More
• For more information visit:
http://www.eatsmartmovemorenc.com/
Improving service delivery
• Are you motivated to begin or continue calculating your
patients’ BMI’s?
• Who will have this responsibility?
• What change in practice can you make based on our
discussion today?
• What other tools do you need to begin?
Eat Smart, Move More, Weigh Less
• Eat Smart, Move More, Weigh Less is a 15-week weight
management program that uses strategies proven to work
• The program is offered to worksites and other groups
interested in eating smart, moving more and achieving a
healthy weight
• Each of the one-hour lessons informs, empowers and
motivates participants to live mindfully as they make
choices about eating and physical activity
• The program provides opportunities for participants to
track their progress and keep a journal of healthy eating
habits and physical activity behaviors
Eat Smart, Move More, Weigh Less
• http://www.esmmweighless.com/
• Trained instructors located in ________:
Additional resources
• Everywomannc.com
• Nchealthystart.org
• Beactivenc.org
• Livestrong.com (free daily tracker: my plate –
livestrong.com/myplate)
• Shapeup.org
• Letsmove.gov
Reimbursement options
 CPT code 97802. Medical nutrition therapy; initial
assessment and intervention, individual, face-to-face with
the patient, each 15 minutes (service must be provided by a
licensed dietitian/nutritionist or registered dietitian).
 CPT code 97803. Medical nutrition therapy; re-assessment
and intervention, individual, face-to-face with the patient,
each 15 minutes (service must be provided by a licensed
dietitian/nutritionist or registered dietitian).
Healthy weight before and between pregnancies
Provider perspective:
• Your patient’s weight today can impact her health and the
health of her future children
• Almost half of all pregnancies in North Carolina are
unplanned
• The next time you see your patient, she may be pregnant
Patient perspective:
• Losing weight is a goal for many women
• Women actively planning pregnancy are often not aware of
risks to themselves or baby due to overweight/obesity
Summary
 Healthy weight is a critical component of preconception
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care
Overweight and obesity is associated with increased risk for
poor maternal and infant outcomes
Providers can help by assessing female weight status at
every visit and discussing Eat Smart Move More tips
Weight management counseling reimbursements are
available
Many resources are available for patients, including the
Healthy Habits brochure, online food trackers and phone
apps