Pediatric and Adult Pre-Work Learning Objectives
- Understand the physiologic and metabolic consequences of visceral adiposity in overweight and obesity throughout the lifecycle.
- Identify co-morbidities associated with overweight and obesity in childhood, their potential for persistence into adulthood, and their potential relationship to adult chronic disease.
- Recognize the functions of adipose tissue as an endocrine organ and the metabolic implications.
- Define liver fat as one of the major sites of visceral fat.
- Recognize the terms adipocytes, cytokines, adipokines, and their respective metabolic consequences observed in overweight and obesity.
- Explain the metabolic pathways, both afferent and efferent, which regulate appetite, energy storage and energy production including the central and peripheral roles of such hormones as insulin, leptin, ghrelin, and PYY to increase the participant’s understanding of the pathophysiology of overweight and obesity.
- Understand genetic imprinting and intrauterine environment and the impact on rates of obesity throughout the lifecycle.
- Recognize the metabolic pathways and various hormones that regulate hunger and satiety and their roles in affecting appetite and body weight regulation.
- Describe physiological and metabolic changes associated with weight loss and weight plateau and potential causes of weight regain.
- Describe the microbiome and its impact on obesity.
- Investigate the role of sleep on obesity in childhood and adulthood.
Obesity Management through the Life Stages (Life Transitions):
- Identify physiologic, metabolic and psychological factors at each stage of the life cycle that may predispose a patient to weight gain (e.g. maternal health (fetal programming) gestational weight gain, stages of growth in childhood, puberty, pregnancy, menopause, sarcopenia).
- Describe age- and developmentally-appropriate activity patterns, feeding practices, eating behaviors for toddlers, children, and adolescents.
- Describe the impact of parental food choices and feeding practices on pediatric eating behaviors and risk for developing overweight or obesity.
- Discuss the genetic component in the prevalence and development of pediatric overweight and obesity to help the participants understand gene-environment interactions of pediatric overweight and obesity.
- Describe strategies for assessment of excess weight at each stage of the life cycle.
- Compare strategies for prevention of excess weight gain at each stage of the life cycle.
- Demonstrate modification/adaptation of treatment approaches for patients at various life stages.
Behavior Modification and Counseling:
- Recognize the major models of behavioral management and their application to pediatric and adult health, weight management, including Behavior Therapy (BT), cognitive behavior therapy (CBT) and motivational interviewing (MI).
- Practice the tenets of client-centered counseling for the prevention and management of overweight and obesity.
- Assess the patient’s level of readiness to change and implement lifestyle changes.
- Implement client-centered counseling appropriate for the patient’s level of readiness to change.
- Identify assessment tools to screen for learning, behavioral and eating disorders, depression/anxiety, and family dysfunction prior to initiating MNT.
- Compare and use key strategies appropriate for use in individual and group counseling.
- Exercise professional judgment with respect to making referrals and within the boundaries of self-disclosure.
Pharmacological Interventions for Overweight and Obesity for Pediatric and Adults
- Describe the role of pharmacotherapy as treatment for overweight & obesity in the pediatric population and adults.
- List FDA-approved weight loss medications.
- Identify appropriate applications of pharmacotherapy for management of overweight and obesity in children and adults.
- Utilize Obesity/American Association of Clinical Endocrinologists (AACE) Guidelines to indicate use of pharmacotherapy.
- Identify appropriate weight loss medications for the management of obesity in the pediatric population.
- Ensure discussion of comorbidities and behavioral.
Nutritional Care of the Bariatric Surgery Patient for Adults and Pediatrics
Describe when bariatric surgery may be indicated for patients with high risk obesity.
Describe the various types of bariatric surgery commonly performed in the U.S.
Describe how each procedure differs in influencing the weight regulatory system; for example, how does the sleeve gastrectomy (SG) differ from the roux-en-Y gastric bypass (RYGB)?
Describe how each bariatric procedure influences vitamin and mineral status.
Describe the metabolic and weight loss outcomes after bariatric surgery.
Describe the role of bariatric surgery as a treatment for obesity in pediatrics and adults. Identify appropriate applications of bariatric surgery for obesity management in pediatrics and adults.
Implement evidence-based nutrition and physical activity guidelines for bariatric patients pre- and post-surgery including diet protocols, micronutrient needs, and nutrition-related complications.
Environmental Influences on Pediatric and Adult Overweight and Obesity:
- Describe the Social Ecological Model (SEM) framework and the synergistic effects of the intrapersonal and societal levels of influence that determine dietary and lifestyle behaviors.
- Identify the domains of the food environment that influence what and how much people eat and what food choices are available.
- Identify the environmental changes that have occurred over the past 35 years that have led to changes in the type and amount of food Americans consume.
- Provide examples of federal-, state- and local-level health promotion policies that have been implemented and their impact on dietary behaviors.
- Describe the key features of healthcare system transformation.
- Discuss healthcare initiatives such as the Patient-Centered Medical Home (PCMH), Accountable Care Organizations (ACOs) and the Comprehensive Primary Care Initiative (CPC and CPC+).