1345-1455-smb_adult-obesity-clinical-pathway-9-12-13

illinoiseggoSoftware and s/w Development

Oct 28, 2013 (3 years and 8 months ago)

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SMB


1


MiPCT Clinical Pathway:
Adult

Obesity


Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

Impact of
Obesity

O
besity is associated with
more chronic medical
conditions

than

smoking
or excessive drinking.


http://wwwKhea牴Ko牧/idc/gr
oups/hea牴
-
public/@wcm/@fc/docum
ents/downloadable/ucm_4
28180Kpdf


Michigan is among the top
states in the nation with
ove爠30% of individuals
obeseK

http://wwwKcdcKgov/obesit
y/data/adultKhtml


䉥tween 1988

1994 and
㈰〷

2008 the
p牥valence of obesity
inc牥ased in adults at all
income and education
levelsK

http://
wwwKcdcKgov/obesit
y/indexKhtml


卩nce 1980, obesity
p牥valence among
child牥n and adolescents
has almost t物pled
K

http://
wwwKcdcKgov/obesit
y/indexKh
tml


ff cu牲rnt t牥nds in the
偡tient/
ca牥giver

unde牳tands the
significance of
weight
management

and can
ve牢alize cause

/

effect of diet and
exe牣ise

on self
-
management of
achieving and
maintain a healthy
weight and lifestyleK

that
is eea牴
aisease?

(
AeA

http://wwwKhea牴Ko牧/
e䕁oTlod/Conditi
ons/Mo牥/Myeea牴a
nd却牯kekews/Co牯
na特
-
A牴e特
-
aisease
-

Co牯na特
-
eea牴
-
aisease_rCM_43S4
1S_A牴icleKjsp


that A牥 eigh
䉬ood Choleste牯l
and T物glyce物des?
⡐(tient b牯chu牥⤠

⡁eA)

http:/
/wwwKhea牴Ko牧/
idc/g牯ups/hea牴
-
public/@wcm/@hcm
/documents/downloa
dable/ucm_300308K
灤p


that ao My
Choleste牯l ievels
Mean? ⡐(tient
b牯chu牥⤠⡁eA)

http://wwwKhea牴Ko牧/
idc/g牯ups/hea牴
-
public/@wcm/@hcm
/documents/downloa
dable/ucm_300301K
灤p


Centers for Disease
Control and
Prevention (CDC):

http://
www.cdc.gov/o
besity/index.html


American Heart
Association (AHA):

http://www.heart.org

State resources:


Michigan
Department of
Community Health
(MDCH)
:


http://www.michigan.
gov/primarycare


Health Alliance Plan


Weight
Management

HAP HMO Clients
(800) 422
-
4641
Alliance Clients (888)
999
-

4347

E
-
mail:
weightwise@hap.org

http://www.hap.org/h
ealth/programs/weigh
tmanagement.php


Henry Ford Weight
Management
American Medical
Association (AMA)

http://www.ama
-
assn.org/ama


American Heart
Association (AHA)

http://www.heart.org

American Stroke
Association (ASA)

http://www.strokeassociation.
org/STROKEORG/AboutStro
ke/UnderstandingRisk/Unders
tanding
-
Stroke
-
Risk_UCM_308539_SubHom
ePage.jsp


Centers for Disease Control
and Prevention (CDC):

http://
www.cdc.gov/obesity/in
dex.html


Dietary Guidelines for
Americans
2010

http://www.health.gov/dietary
guidelines/dga2010/DietaryG
uidelines2010.pdf


Adult Obesity Facts

(CDC)
:

http://www.cdc.gov/obesity/da
ta/adult.html


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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

growth of obesity

continue, total healthcare
costs attributable to
o
besity could

reach $861
to $957 billion by 2030,
which would account for
16% to 18% of US health
expenditures.

http://www.heart.org/idc/gr
oups/heart
-
public/@w
cm/@sop/@sm
d/documents/downloadabl
e/ucm_319588.pdf



Excess fat, especially
around the waist
increases risk for other
health problems such as:



Coronary heart disease



Type 2 diabetes



Cancers (endometrial,
breast, and colon)



Hypertension (high
blood press
ure)



Dyslipidemia (for
example, high total
cholesterol or high
levels of triglycerides)



Stroke



Liver and Gallbladder
disease



Sleep apnea and
respiratory problems



Osteoarthritis (a
degeneration of
cartilage and its
Program

Henry Ford Health
System

13355 E. 10 Mile Rd,
Warren, MI

48089

Phone: 800
-
HENRYFORD

http://www.henryford.
com/body.cfm?id=46
426


Medical Network
One

The Community Care
Travel Team (CCTT)
is a team of
h
ealth

care professionals
dedicated to
empowering patients
to take control of their
chronic conditions
.

http://www3.medneto
ne.net/Patients/CCTT
.aspx


St John Providence
Outpatient Nutrition
Management
Services Program

St John Providence
Health System

16001 W. 9 Mile Rd.,
Southfield, Michigan
48075

Phone: 248
-
849
-
3903

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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

underlying bone within a
joint)



Gynecological problems
(abnormal menses,
infertility)


http://www.cdc.gov/obesit
y/adult/causes/index.html



One out of every five
individuals who are
overweight is affected by
a metabolic condition
known as “Syndrome X.”
The factors that
characterize this
condition
such as high blood
pressure or insulin
resistance can increase
the individual’s risk for
developing more serious
health problems including
heart disease, diabetes,
and stroke.


http://www.heart.org/HEA
RTORG/GettingHealthy/
WeightManagement/Obes
ity
/Obesity
---
Stroke
-
Connection_UCM_31177
1_Article.jsp

http://www.stjohnprov
idence.org/providenc
e/specialties/nutrition/


St Joseph Mercy
Health System
Nutrition

& Weight
Management

http://www.stjoesann
arbor.org/weightloss

University of
Michigan Weight
Management

Programs

http://hr.umich.edu/m
healthy/programs/wei
ght/healthy_life/


MHealthy

University of
Michigan Health
System Community
Health Services

2850 S. Industrial,
Suite 600, Ann Arbor,
MI 48104
-
6773

Phone: 734
-
975
-
3024

E
-
mail: mfit
-
weight
-
management@med.u
mich.edu

http://hr.umich.edu/m
healthy/


LOCAL
PROGRAMS:

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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References


Check with local
parks and recreation
departments for
information on local
exercise programs,
local trail ways/parks,
and also farmers
markets.


Other community
resources can be
found at your local
health department,
YMCA, and hospital.

What is
Obesity
?

Obesity
means you are
20% or more above your
ideal weight
.

For adults, a
BMI of 30 or greater is
considered obese.

http://www.heart.org/HEA
RTORG/GettingHealthy/
WeightManagement/Obes
ity/Obesity
-
Information_UCM_30790
8_Article.jsp


O
besity

has been
designated

as a disease
requiring treatment and
prevention efforts
.

http://www.heart.org/HEA
RTORG/GettingHealthy/O
besity
-
and
-
Overweight_UCM_30601
6_Article.jsp

Patient / caregiver will
verbalize
understanding of
causes, management
options of obesity

and

the
importance of
inst
ituting
proactive
life style changes and
management

to
prevent co
-
morbid
conditions
.

http://www.heart.org/id
c/groups/heart
-
public/@wcm/@fc/doc
uments/downloadable/
ucm_428180.pdf

Heart
360

online
tool:

https://www.heart36
0.org/Default.aspx



See above
resources

See above resources

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5


Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References


Obesity
occurs when
more calories than are
used up in physical
activity and daily life

are
consumed. O
ther factors
may also contribute to
obesity including genetics,
limited access to healthy
foods or unsafe
environment for physical
activity
.

http://newsroom.heart.org/
news/american
-
medical
-
association
-
says
-
obesity
-
is
-
a
-
disease


B
ody weight

is the result
of genes, metabolism,

behavior
,

environment,
socioeconomic status
,
and
culture
;

of these
behavior and environment
are the greatest areas for
prevention and treatment
actions.

http
://
www.cdc.gov/obesit
y/index.html

Classifications
of Obesity in
adults


Waist circumference
measurement and body
mass index (BMI) are the
recommended ways to
estimate body fat. A high
-
risk waistline is 35 inches
or higher for women, and
40 inches or higher for
Patient
/caregiver

is
able to verbalize
awareness of the
ap
propriate weight for
their individual health
status and age
.






The body mass index formula
assesses body weight relative
to height. Weight in kilograms
is divided by height in meters
squared (kg/m2). Or multiply
weight in pounds by 703,
divide by height in inches,
then divide again by height in
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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

men.



BMI Classifications

(World Health
Organization


WHO)
:



Unde
rweight:



Severe thinness
-

<16.00



Mod thinness



16.00
-
16.99



Mild thinness



17.00


18.49



< 18.5 underweight



Normal weight

18.5



24.9
9




Overweight



25.0
0



Pre
-
obese

25.00


29.99



Obese



30.00



Class I
-

30.0

34.9
9




Class II
-

35.0

39.9
9




Class III
-



40.0
0

http://apps.who.int/bmi/ind
ex.jsp?introPage=intro_3.
html

inches.

http://www.hear
t.org/HEART
ORG/GettingHealthy/Obesity
-
and
-
Overweight_UCM_306016_A
rticle.jsp


BMI Classifications

(World
Health Organization


WHO)
:

http://apps.who.int/bmi/index.j
sp?introPage=intro_3.html

Prevention
Programs
,

Community
Initiatives

and
teaching
Guides


C
onsumption of a
balanced daily
diet
containing five or more
servings o
f fruits and
vegetables per day
contributes to weight
management.

http://www.strokeassociati
on.org/STROKEORG/Abo
utStroke/UnderstandingRi
sk/Understanding
-
Stroke
-
Patient/caregiver

will
verbalize an
increased
awareness of
supportive programs
for weight
management.



Losing Weight Tips
and Tools

with links
to resources for:



Healthy Cooking



Make Smart



Choices



Mak
ing healthy
choices at the
store



Healthy eating




when you dine out

The Michigan 4 X 4
Tool

http://www.michigan.
gov/healthymichigan



MI Healthier
TOMORROW

*Mobile apps
available on website
also

Michigan.gov/
mihealt
American Heart
Association

http://www.heart.org/HEART
ORG/GettingHealthy/Weight
Management/Weight
-
Management_UCM_001081_
SubHomePage.jsp


Dietary Guidelines for
Americans
2010

http://www.health.gov/dietary
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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

Risk_UCM_308539_Sub
HomePage.jsp


Engaging in
a brisk walk,
taking

the stairs,
parking
further away from the
entrance to buildings,
engaging in formal
exercise classes or a
video at home contribute
to weight management
.
It
is recommended
to get a
total of a
t least 30 minutes
of activity
5 days a week.

http://www.strokeassociati
on.org/STROKEORG/Abo
utStroke/UnderstandingRi
sk/Understanding
-
Stroke
-
Risk_UCM_308539_Sub
HomePage.jsp


The
Portion plate

is a
visual guide for daily
consumption of proper
portions for va
rious food
groups.

http://www.theportionplate
.com/



Understanding
food labels

http://www.heart.org/
HEARTORG/Getting
Healthy/WeightMan
agement/LosingWei
ght/Losing
-
Weight_UCM_3079
04_Article.jsp


Dietary Guidelines
for Americans
2010

http://www.health.go
v/dietaryguidelines/d
ga2010/DietaryGuid
elines2010.pdf


How Can I Monitor
My Cholesterol,
Blood Pressure and
Weight?

American Heart
Association

http://www.heart.org/
idc/groups/heart
-
public/@wcm/@hcm
/documents/downloa
dable/ucm_300461.
pdf

hiertomorrow


www.facebook.com/
mihealthiertomorrow


Rec 101:

The Department of
Natural Resources
offers many FREE
activity programs for
individuals to engage
in. (Taught by DNR
staff or expert
volunteers)

www.michigan.gov/re
c101


Fresh Air Fit:

Fitness
-
focused
classes
held
in
various nature
settings; t
he beach,
the woods, and
a

camp
.


www.michigan.gov/st
ateparks


Enhance
®
Fitness
:

an exercise program
designed for elder
adults and individuals
with physical
li
mitations.

http://www.projectenh
ance.org/

guidelines/dga2010/DietaryG
uidelines2010.pdf


MI Healthier TOMORROW

*Mobile apps available on
website also. Engage
patients in the online and
Facebook options. Patients
get a free “Getting Started
Kit.”

Michigan.gov/
mihealthiertomo
rrow


www.facebook.com/mihealthi
ertomorrow


Weight
Exercise:

Patient/caregiver will
LEAN
Works!

Recommended
Dietary Guidelines for
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Standards of
Care

Educational Information

Outcomes

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Handouts

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Resources

Health Professional
Resources & References

management
guidelines

Get

at least 150 minutes
of moderate or 75 minutes
of vigorous physical
activity a week. Make a
goal of getting 30 minutes
of physical activity, 5
times a week to keep your
body moving.

(Page 18)

Limit screen time (Page
19).

http://www.health.gov/diet
aryguide
lines/dga2010/Di
etaryGuidelines2010.pdf



BMI:

Maintain

a healthy BMI
and waist
-
to
-
hip ratio
(WHR). WHR is the
measure of your waist
(abdomen) in inches
compared to the measure
of your hips in inches
.

http://www.heart.org/HEA
RTORG/GettingHealthy/
WeightManagement/Obes
ity/Obesity
---
Stroke
-
Connection_UCM_31177
1_Article.jsp


Diet:



Decrease consumption
of sugar
sweetened
beverages.



Consume less than 10
percent of calories from
saturated fatty acids by
verbalize knowledge
of evidence
-
based
guidelines to ensure a
healthy weight loss
and lifestyle with
exercise.

Leading Employees
to Activity and
Nutrition is a Web
-
based resource that
offers interactive
tools and evid
ence
-
based resources
that can be used to
design effective
workplace programs
t
o prevent and
control obesity.
http://www.cdc.gov/l
eanworks


The Healthy Weight
Web site includes a
body mass index
(BMI) calculator and
gives people
information and
tools to help them
achieve and
maintain a
healthy
weight for a lifetime.
http://www.cdc.gov/h
ealthywei
ght


Calorie consumption
table for age and
activity level (Page
14)

http://www.health.go
v/dietaryguidelines/d
ga2010/DietaryGuid
elines2010.pdf

Community
Strategies and
Measurements to
Prevent Obesity in
the United States:
Implementation and
Measurement Guide

http://www.cdc.gov/o
besity/downloads/co
mmunity_s
trategies_
guide.pdf

Americans
2010

http://www.health.gov/dietary
guidelines/dga2010/DietaryG
uidelines2010.pdf


Obesity & Stroke
Connection (
AHA
)
:

http://www.heart.org/HEART
ORG/GettingHealthy/Weight
Management/Obesity/Obesity
---
Stroke
-
Connection_UCM_311771_A
rticle.jsp


The Body Mass Index:

Considerations for
Practitioners fact sheet

summarizes the science
behind BMI. It emphasizes
that BMI is not a di
agnostic
tool, but a population
surveillance tool and a
screening tool designed to
identify people who may be at
risk for health problems
because of their weight.
http://www.cdc.gov/obesity/do
wnloads/BMIforPactitioners.p
df [PDF
-
142KB]


CDC:
Nutrition Resources for
Health Professionals

http://www.cdc.gov/nutrition/p
rofessionals/index.html


Healthy eating
-

10 Tips link

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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

replac
ing them with
monounsaturated and
polyunsaturated fatty
acids.



Keep
trans
fatty acid
consumption as low as
possible by limiting
foods that contain
synthetic sources of
trans
fats
.




Reduce the intake of
solid fats and added
sugars.



Limit the consumption o
f
fo
ods that contain
refined grains.



If alcohol is consumed, it
should be consumed in
moderation

up to one
drink per day for women
and two drinks per day
for men
.



Increase vegetables,
especially dark
-
green
and red and orange
vegetables and beans
and peas.



Increase intake of fat
-
free or low
-
fat milk and
milk products, such as
milk, yogurt, cheese, or
fortified soy beverages.



Increase the amount
and variety of seafood
consumed by choosing
seafood in place of

Nutrition Care
manual
:

weight
management
specific to
patient’s
individual calorie
needs.
(Patient
handouts)

www.nutritioncarem
anual.org



(Can print and review with
your patient during office
visi
t)
:
http
://
www.choosemyplate.go
v/healthy
-
eating
-
tips/ten
-
tips.html


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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

some meat and poultry.



Choose foods that
provide
more potassium,
dietary fiber, calcium,
and vitamin D, which are
nutrients of concern in
American diets. These
foods include fruits,
vegetables, whole
grains, and milk and
milk products.

http://www.health.gov/diet
aryguidelines/dga2010/Di
etaryGuidelines2010
.pdf

Self
-
Management
Goal

Patient/caregiver
establishes personal goal
and revises as
appropriate or necessary.



Patient
/caregiver

is
able to achieve and
maintain a healthy
weight.

United States
Department of
Agriculture
(
USDA
)
, Center for
Nutrition Policy
and Promotion:

The Food Pyramid
Guide

(Booklet)

http://www.cnpp.usd
a.gov/Publications/M
yPyramid/OriginalFo
odGuidePyramids/F
GP/FGPPamphlet.p
df


BMI Calculator:

http://www.cdc.gov/h
ealthyweight/assessi
ng/bmi/adult_bmi/en
glish_bmi_calculator
/bmi_calculator.html



Achieving your SMART
health goal. Stanford
University.

http://bewell.stanford.edu/sm
art
-
goals


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Standards of
Care

Educational Information

Outcomes

Teaching
Handouts

Community
Resources

Health Professional
Resources & References

Blank food pyramid
to fill in and
personalize

http://www.learnnc.o
rg/lp/media/lessons/
ElizabethCarswell52
32002877/Pyramid.r
tf


How Can I Manage
My Weight?
(Patient
brochure)

American Heart
Association

http://www.heart.org/
idc/groups/heart
-
public/@wcm/@hcm
/documents/downloa
dable/ucm_300655.
pdf


How Can

Physical
Activity Become A
Way of Life?
(Patient brochure)

American Heart
Association

http://www.heart.org/
idc/groups/heart
-
public/@wcm/@hcm
/docum
ents/downloa
dable/ucm_300470.
pdf


How to Get SMART
About Goal Setting.
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Standards of
Care

Educational Information

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Teaching
Handouts

Community
Resources

Health Professional
Resources & References

A Healthier
Michigan.org.

http://www.ahealthie
rmichigan.org/2011/
01/12/how
-
to
-
get
-
smart
-
about
-
goal
-
setting/