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Posted September 27, 2013
Pediatric Medicine Unit Teams With Fit4AllKids to Combat Obesity

It is often a delicate and difficult conversation to initiate. But All Children's RN clinical leaders Carrie Kleinmeier and Paula Bullard believe it is a talk that can enhance and, perhaps one day, help save lives.

They and their colleagues on the Pediatric Medicine Unit began noticing a trend over the past few years - the increasing number of patients admitted to the 8th floor who were visibly overweight.  The caregivers were confronted with a dilemma:  Should they ignore a warning sign of a potential health problem, or find a way to gently raise the topic to parents as a way of helping their child make better nutritional and fitness choices?

The decision was an easy one, no matter how hard it might be to broach the topic. The result is a new hospital-wide undertaking that has been in the works for nearly a year. Against the backdrop of Obesity Awareness Month this September, the program is set to officially launch soon on multiple fronts with the goal of raising obesity awareness.

A multidisciplinary team of physicians, nurses, and dieticians created an eating- disorder protocol years ago. More recently, this group realized there is no similar program available to benefit patients living with obesity, a condition that has been on the rise among children in the United States.

 "We often admit patients who are overweight, but we don't do anything because obesity isn't the reason for their admission, and it's not an acute illness," Kleinmeier said. "But without saying or doing something, I felt we were allowing our patients to be at high risk for heart disease, asthma, type 2 diabetes, and sleep apnea that could affect them the rest of their lives. So I thought there's got to be a better way. We have to at least address it."

Kleinmeier began by reaching out to ACH's Kellie Gilmore, coordinator of Fit4AllKids - the hospital's family fitness and nutritional health program - and discussing ways it could help the new program. That led to the formation of the Wellness Nutrition committee, with Kleinmeier and Bullard serving as co-chairs.

"It started off with just introducing Fit4AllKids and an obesity packet for the high risk patients," she explained. Next, they zeroed in on several areas for improvement: adding more healthy choice options to the in-room menus, re-designing placemats with more attention paid to a healthy lifestyle, and adding health-oriented videos to the in-room Get Well Network.

"Our placemats had a crocodile eating 20 hamburgers, so we looked at the culture of the hospital and what we were portraying," she said. "Now we've designed new placemats and menus. We created one called the Fit4Kid menu and can be ordered by the physicians."

The committee worked with ACH's Family Practice Advocacy Group, run by Neonatal Intensive Care Unit Director Cindy Driscoll, and distributed surveys for kids and parents to fill out with their nutritional preferences.

"We don't want it to be such a drastic change that nobody likes the food, either," Kleinmeier said. "We want a happy medium. We're hoping to plant the seed, per se. We know we're not going to solve the issue of obesity in the world while a child is here for asthma. But we want them to have some resources and support."

Raising the subject of obesity isn't easy, and the parents often get upset. "How do you address this issue with parents when their child is here for a different problem?" remarked Gilmore. "As Carrie and I started to talk, we realized we could positively affect not only certain families, but create a healthier environment for the entire hospital."

Showing parents their child's height, weight and growth charts reinforces the staff's efforts to provide assistance. If a patient's Body Mass Index (BMI) exceeds the accepted range, the protocol will be initiated with the parents and child. "Once we initiate it, we'll try to change their activity status, their diet orders," said Holly Ward, an 8 North nurse involved with the program. "We'll try to get referrals and outpatient care. We give them a huge education pack about meals they can cook at home, how they can shop, and how they can involve their kids in the process."

Various subcommittees have tackled individual tasks. The Wellness committee - including doctors, members of the information technology department and dietary/nutrition staff- convene each month to measure progress and identify goals.

The job of educating the staff on the program belongs to Ward. "I'm going to be the one teaching all the nurses and physicians about the project, what their role is going to be, and how they're going to help us implement it," she said. "We need buy-in from everybody, as we roll this out. So we can all take part in educating the patients and reinforcing with the parents."

What's the biggest challenge she foresees?

"Acceptance," Ward said. "No parent wants to hear, 'My child is overweight or obese.' But family involvement is essential for success. So that's going to be the biggest hurdle: Getting parents to accept our help and educating them on the resources we can provide. "