Weight Management Checklist
Patients with BMI>95th percentile
Nutrition	Nutritional Consult from Registered Dietitian Doctor Ordered Calorie Count Healthy Snacks/ No sweetened drinks from nurse’s station	□ □ □
Screening / PHYSICAL assessment
Measurements	Weight Circumference Body Mass / Fat composition	□ □
Labs	Lipid Profile Liver Enzymes Hemoglobin A1c Measurement Fasting Insulin	□ □ □ □
Screening	Obtain Family Medical History Look for signs of Type 2 Diabetes (Acanthosis Nigricans/ Polyuria/ Polydipsia) Asthma Blount Disease (tibia vara) Sleep Apnea (Listen for loud snoring and pauses in breathing during sleep/ daytime sleepiness)	□ □ □ □ □
Proper Equipment	Large Blood Pressure Cuff / Appropriately Sized Wheelchair Stepping Stools Assess Special Needs of Patient’s Family (ex Adequate space in patient’s room) Educational Material that Promotes a Healthy Lifestyle (Coloring Books/ Puzzles/ Activity sheets)	□ □ □ □
Psychological Assessment
Psych. Screening	Order Psychological Consult High Risk of: (Depression, Anxiety, ADHD, Eating Disorders)	□ □
Referral	Refer to Weight Management Clinic	□

Inpatient Checklist for Obese Children

                                            Identification

› Institute standard BMI-recording practices

o   (Automatically calculated in electronic medical records)

› BMI >95^th percentile identified as obese and a specialized care plan for these patients adopted. (Family should be informed  of this information in both inpatient and outpatient settings)

                                 Nutrition

Have a nutritional consult for obesity specifically

› -Calorie controlled diet

› Food records

› Doctor ordered calorie count

› No sweetened drinks from the nurse’s station

› Healthy snacks

› Portion control

› Education throughout stay and at discharge

                  Psychology

› Behavioral Assessment

› Establish clear measurable goals

› Low self-esteem in obese children can be very dangerous.

› Institute a psych screening for:

› Depression

› Anxiety

› ADHD

› Eating disorders

                  Proper Equipment etc.

› Appropriately sized wheelchair

› Large sphygmomanometer

› Adequate space in rooms when they are equipped with large beds.

› Considerations for the families of patients.

› Stepping stools

› Promote healthy lifestyle with posters and educational material in waiting and examination rooms (Books, puzzles, and activity sheets)

                                       Physical Assessment/ Blood work

› Obtain physical activity and dietary behaviors

› Waist circumference/ Body mass/ Fat and muscle composition

› Lipid profile

› Alanine transaminase and aspartate transaminase measurement (fasting)

› Metabolic profile

› Hemoglobin A1c measurement

› Assess readiness to change

                                     Screening

› Family Medical History

› Type 2 Diabetes

› Acanthosis Nigricans

› Polyuria

› Polydipsia

› Obesity hypoventilation syndrome

› Asthma

› Hypothyroidism

› Polycystic Ovary Syndrome

›  Blount disease (tibia vara)

›  

› Sleep apnea

› Listen for loud snoring with pauses in breathing and restless sleep

Creating a Special Checklist

The goal of my project is to formulate a special checklist for obese patients that will be included in their chart upon admission. This checklist will incorporate specifically tailored interventions that will need to be performed while the patient is in the hospital.  Some examples of specific items that will need to be on the checklist include appropriate sized blood pressure cuffs, a consult for obesity by the registered dietitian, a screen for endocrine and metabolic disorders, psychological counseling for possible depression, and a host of other interventions.  A more specific approach to care for the obese segment of the population should aid in the quality of care these patients receive in the inpatient setting.