Kathryn Hawn UCLA Department of Pediatric Dentistry
BACKGROUND The number of children affected by obesity has risen substantially in the past few decades. According to 2007-08 NHANES (National Health and Nutrition Examination Survey) data, approximately 32% of U.S. children and adolescents 2-19 years of age are classified as overweight (>85 th BMI percentile), and approximately 17% are obese (>95 th BMI percentile). i In industrialized countries like the US, children from lower socioeconomic groups are at increased risk for obesity. ii
There are also disparities amongst different racial groups and ethnicities. For example, according to the 2007-08 NHANES data, Hispanic boys were 1.6 times more likely to be overweight and 1.80 times more likely to be obese than non-Hispanic white boys. Error! Bookmark not defined. Similarly, non-Hispanic black girls were 1.58 times more likely to be overweight and 1.7 times more likely to be obese than non-Hispanic white girls. Error! Bookmark not defined. The trends in childhood obesity are especially alarming when the health risks of childhood obesity are considered. A serious public health threat, obesity puts children at increased risk for a multitude of medical conditions including obstructive sleep apnea, asthma, obesity-linked hypoventilation syndrome, hypertension, insulin resistance, type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, and menstruation abnormalities. Error! Bookmark not defined. Furthermore, obese children are 2 to 6.5 times more likely to be obese in adulthood. iii Along with these medical conditions linked to childhood obesity, adult obesity carries increased risk for coronary heart disease, stroke, gallbladder disease, arthritis, and cancer. iv In the US, adult obesity is responsible for approximately 112,000 deaths annually. v
Mirroring the physical health risks, obese children may also face mental health problems and impaired socialization. Social stigma often begins early in life, with children assigning negative characteristics such as laziness, meanness, or dirtiness to their obese peers. Error! Bookmark not defined. This stigma continues to impact obese young adults, who may face discrimination in renting apartments or applying to college. Error! Bookmark not defined. In adulthood, obesity has been linked to lower levels of education and income. Error! Bookmark not defined. Associations between obesity and mental health conditions have been difficult to establish, presumably because many factors impact an individuals body satisfaction, self esteem, levels of anxiety, and propensity toward depression. At the same time, the perception of overweight and obesity often differs depending upon the childs gender and ethnicity. Error! Bookmark not defined.
Considering the complexity of mental health, it is not surprising that some studies demonstrate associations between obesity and depression or anxiety, while others show no association. Error! Bookmark not defined.
Beyond the toll on childrens health, the economic burden is substantial. Hospital costs related to childhood obesity from 1997-99 were $127 million, accounting for approximately 1.7% of total US hospital costs. vi These costs have more than tripled when compared to hospital cost estimates taken just two decades from 1979-81. Error! Bookmark not defined. Moreover, the cost of adult obesity is staggering, estimated by the World Health Organization in 1990 to account directly for approximately $458,000 million in the US, or 6.8% of total US health costs. Error! Bookmark not defined. In a more recent study from the Centers for Disease Control and Prevention (CDC) and the Research Triangle Institute, the annual US cost of obesity had reached as high as $147 billion in 2008, accounting for 9.1% of total US health costs. vii This enormous rate of increase in spending will be difficult to sustain and has the potential to exacerbate the already-out-of-control national health budget. This past year the Surgeon General encouraged all healthcare providers to recognize and treat obesity during routine visits. viii As an integral part of the healthcare team, dentists can and should play a role in screening, dietary counseling, and referrals for childhood obesity. ix,x,xi Based on findings from the 2000-2002 Medical Expenditure Panel Survey (MEPS), children ages 6-12 visit their physician for well-child examinations approximately 0.44 times each year. xii According to the 2003 MEPS, children ages 2-11 who had at least one dental visit in 2003 averaged 2.0 dental visits annually. xiii As a result, among school-aged children with an established dental home, their dentist may be the first healthcare provider to detect overweight and obesity. In addition to positively influencing the overall health of their patients, screening for childhood overweight and obesity provides dentists an opportunity for more effective caries prevention and dental treatment. In a recent review of the topic, Bimstein and Katz underscored that many of the risk factors for obesity are the same risk factors for caries. Error! Bookmark not defined. Examples include frequent sugar exposures, frequent snacking, soda consumption, juice consumption, and low socioecomonic status. While studies linking caries and obesity have mixed results, reducing risk for childhood obesity and reducing risk for caries involves many of the same behavior modifications. In addition to the potential link with caries, studies show that obesity also impacts dental development. xiv For example, patients who are overweight or obese often present with an accelerated dental age. Error! Bookmark not defined. This is particularly critical for early orthodontic interventions, such as serial extractions, which need to occur earlier for a patient with a higher BMI. Error! Bookmark not defined. Therefore, tracking a patients BMI provides additional information to gauge the appropriate time for referral to an orthodontist. Error! Bookmark not defined.
An important sometimes overlooked issue relates to the fact that obesity can reduce the safety and efficacy of sedation in the dental office. Error! Bookmark not defined.,xv Obese patients may be overdosed if dentists use the maximum dosage for their weight. Error! Bookmark not defined. While it is advisable to reduce the maximum dosage to accommodate for an obese patient, this may result in a less effective sedation. Error! Bookmark not defined. Furthermore, when sedated for dental procedures, obese patients face increased risk of respiratory complications, hypertension, gastric regurgitation, and aspiration pneumonia. Error! Bookmark not defined. Respiration is further compromised by the use of opioids or chloral hydrate, so extra care is needed when selecting oral sedative drugs. Error! Bookmark not defined. By screening for childhood overweight and obesity, dentists will be aware of these factors prior to planning for sedation. To detect childhood overweight and obesity, dentists must effectively screen for it. Methods used to identify overweight and obesity in children include skinfold thickness measurements, waist circumference percentiles, and BMI percentiles. xvi Because of the ease of collection, acceptable sensitivity, specificity, and accuracy, BMI percentiles are the most commonly used metric to determine weight status in childhood. Error! Bookmark not defined. Children are accustomed to having their height and weight measured when visiting their physician, and the BMI (kg/m 2 ) is easily calculated from these measurements. To make the BMI calculation convenient and easy, the CDC provides an online calculator at http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx. xvii This online link also determines the BMI percentile, using CDC BMI-for-age growth charts, which account for age and sex. Error! Bookmark not defined. If computer access is not readily available in the dental office, SmartPhone applications can also provide this service. After obtaining the BMI percentile, children can be classified as either underweight, normal weight, overweight, or obese. A normal weight is considered to be between the 5 th percentile and the 84 th percentiles. xviii
Childhood underweight is defined as a BMI less than the 5 th percentile. Error! Bookmark not defined. Overweight is defined as a BMI at or above the 85 th
percentile, and childhood obesity is defined as a BMI at or above the 95 th
percentile. Error! Bookmark not defined.,xix
Recently Tseng et al. suggested guidelines for overweight and obesity screening, subsequent treatment, and referral. Error! Bookmark not defined. These involve determining the BMI and BMI percentile at least annually for all pediatric patients ages 2 and older. Error! Bookmark not defined. Findings are explained to parents, which may easily provide an opening for obesity-related dietary counseling, should the dental practitioner feel confident in its provision. Error! Bookmark not defined. Based on the BMI percentile, recommendations are then made to the patient and his or her parents. For patients at a healthy weight (BMI >584), dentists should provide positive reinforcement, as well as guidance and encouragement to continue maintaining a healthy weight. Error! Bookmark not defined. For both underweight patients (BMI <5%) and overweight patients (BMI >8594), a referral should be made to a pediatrician or family physician. Error! Bookmark not defined.
For the obese children (BMI >95), a referral to a pediatrician or family physician is necessary, and referral to a registered dietitian (RD) should also be considered. Error! Bookmark not defined.
In a recent pilot study xx , two community dental clinics adopted a protocol similar to the guidelines advocated by Tseng et al. Error! Bookmark not defined. In addition, the protocol called for individualized report cards and recommendations for each patient. Error! Bookmark not defined. The dental hygienists involved in the study found that the protocol was feasible, not a burden to the providers, and acceptable to both patients and parents. Error! Bookmark not defined. As one dimension of this pilot study, a parent survey was distributed. Of parents participating in the study, 59% believed that the dental office was a good place to record their childs weight and height measurements, and 65% of parents believed that the report card program helped them to make healthy changes. Error! Bookmark not defined.
The aforementioned pilot study did not report the race and ethnicity of the study participants, which may affect parental attitudes toward obesity-related dietary counseling. In Nevada, a survey was administered to overweight preschool children and their mothers, who were participants in a Nevada Special Supplemental Nutritional Program for Women, Infants, and Children (WIC). xxi Nearly 90% of the study participants were Hispanic. 61.5% of mothers did not perceive their child as overweight, and 50% had not attempted to control their childs diet because they perceived no problem with the current weight. Error! Bookmark not defined. The findings of this study suggest that Hispanic mothers may be less likely to perceive overweight as a problem, and thus may be less accepting of obesity interventions, including such programs in the dental office setting. In addition to parental receptiveness, the attitudes of dentists toward obesity- related dietary counseling must also be considered. In a recent survey of pediatric dentists in North Carolina, all respondents believed overweight to be a health problem and 84% felt that obesity-related dietary counseling in the dental office would benefit patients. xxii Even so, less than 25% provided obesity-related dietary counseling in their offices and 81% had never referred a child to another healthcare provider for weight management. Error! Bookmark not defined. Two-thirds of respondents did not obtain weight measurements routinely and only 6% of respondents routinely obtained height measurements. Error! Bookmark not defined. Respondents who received general nutrition training during residency were more likely to offer obesity-related dietary counseling. Error! Bookmark not defined. Other characteristics that increased the likelihood of respondents providing counseling included knowledge, confidence in providing counseling, increased practice experience (more than ten years), and respondents gender (female). Error! Bookmark not defined.
Respondents cited lack of trained staff (60%) and lack of knowledge (47%) as barriers to implementing obesity-related dietary counseling in their practices. Error! Bookmark not defined. In a more recent 2010 study of nearly 3000 dentists across the US, only 4.8% of dentists were currently providing obesity-related screening or counseling in their practices, but 50.5% were interested in doing so. xxiii The barriers cited for not currently providing these services included fear of offending parents or patients (53.8%), fear of appearing judgmental of parents or patients (52%),
lack of trained staff (46.3%), and a patient population not accepting of obesity-related interventions provided by a dentist (45.7%). In this study, pediatric dentists were more likely to note fear or offending patients or parents and fear of appearing judgmental than general dentists. Without a user-friendly practice-ready protocol, dentists may feel that attempting to implement their own obesity-related dietary counseling would be cumbersome, beyond their knowledge base, beyond their comfort level, potentially offensive to parents or patients, and possibly detrimental to practice productivity. In contrast, when given a protocol in a pilot study, dental practitioners were able to incorporate it successfully into hygiene appointments. Error! Bookmark not defined. Therefore, a potential way to empower private dental practitioners to screen for childhood overweight and obesity would be the availability of an easy, efficient, and effective screening tool or instrument.
MATERIALS AND METHODS
Two sites participated in the study, the Childrens Dental Center in Los Angeles, California and the Fort Bend Family Health Care Center in Stafford, Texas. Subjects were recruited from patients ages 2-14 presenting for oral health maintenance visits at these clinics from May 2012 through July 2012. All children who obtained parental consent received a Wellness Report Card, available in English or Spanish (WRC see Appendix). Children whose parents consented to participate in the study received the same treatment (dental exam, radiographs as needed, dental prophylaxis, and fluoride treatment) as children whose parents decline to participate in the study.
During the dental appointment, children had their height and weight recorded. Next, the BMI and BMI percentile were calculated using a Smartphone application. The WRC was then be filled out using this information and the information from the patients clinical exam. A brief explanation of the data was provided, and questions from the parents were addressed, provided the questions were within the scope of a dental practitioner. For more complex questions, parents were encouraged to ask their physician.
Following the receipt of the WRCs, to gauge their attitude toward the WRC program, parents of subjects participating in the study completed a short anonymous survey (see Appendix), available in English or Spanish. This survey was adapted from a similar investigation by Tavares et al. 20
To maintain anonymity thereby encouraging honest feedback, parents folded their surveys and placed them in a designated box.
RESULTS
30 surveys were collected from the California site, and 20 were collected from the Texas site. Of the study participants, 31 of the parents were English-speaking parents and 19 of the parents were Spanish-speaking. Due to an unfortunate mistranslation on the Spanish version of the survey, only question number 9 could be compared between the English-speaking parents and the Spanish-speaking parents. Analysis of questions 1 through 8 will be presented using only the English- speaking surveys.
Question 2 in the survey was designed to determine whether parents viewed the WRC as too lengthy or inconvenient. Overall, parents strongly disagreed that receiving a WRC made the childs visit take too long (median 1 out of 5). As Figure 2 shows, 58% strongly disagreed (score 1 out of 5), 25.8% disagreed (score 2 out of 5), 6.5% were neutral (3 out of 5) and 9.7% agreed (score 4 out of 5). None of the parents strongly agreed (score 5 out of 5) that it made their childs visit take too long.
Questions 3, 4, and 5 were asked to determine the childs level of comfort with the WRC process. As figure 3 demonstrates, 76.7% of parents strongly agreed (scored 5 out of 5) that their child was comfortable having their height and weight measured at the dental office, 20% agreed (scored 4 out of 5). 3.3% disagreed (scored 2 out of 5). None of the parents were neutral or strongly disagreed.
As noted in Figure 4, 83.9% of parents strongly agreed (scored 5 out of 5) that their child was comfortable getting his or her weight and BMI results at the dental office, 12.9% agreed (scored 4 out of 5), and 3.2% felt neutral (scored 3 out of 5). None of the parents disagreed or strongly disagreed that their child was comfortable getting his or her weight and BMI results at the dental office.
Question 5 received the same response as Question 4, as evidenced by Figures 4 and 5. 83.9% of parents strongly agreed (scored 5 out of 5) that their child was comfortable having their WRC completed at the dental office, 12.9% agreed (scored 4 out of 5), and 3.2% felt neutral (scored 3 out of 5). None of the parents disagreed or strongly disagreed that their child was comfortable having their WRC completed at the dental office.
Questions 6 and 7 addressed whether parents felt that the dental office was a good place to conduct obesity screening. As figure 6 shows, 80.6% of parents strongly agreed (scored 5 out of 5) that the dental office is a good place to get their childs height and weight measured, 12.9% agreed (scored 4 out of 5), and 6.5% were neutral (scored 3 out of 5). None of the parents disagreed or strongly disagreed that the dental office was a good place to get their childs height and weight measured.
As figure 7 demonstrates, 61.3% of parents strongly agreed (scored 5 out of 5) that the dental office is a good place to receive and discuss their childs weight and BMI status. 61.3%, 19.4% agreed (scored 4 out of 5), and 19.4% felt neutral (scored 3 out of 5). None of the parents disagreed or strongly disagreed that the dental office was a good place to receive and discuss their childs weight and BMI status.
Questions 1 and 8 were designed to determine whether parents view the WRC as a helpful tool. Question 1 was the most divided question in the survey, with 48.3% of parents strongly agreeing (scoring 5 out of 5) that the information in the WRC was new to them, 10.3% agreeing (scoring 4 out of 5) that the information in the WRC was new to them, 13.8% claiming to be neutral (scoring 3 out of 5), 13.8% disagreeing (scoring 2 out of 5), and 13.8% strongly disagreeing (scoring 1 out of 5). Figure 1 illustrates this point.
As figure 8 demonstrates, 77.4% of parents strongly agreed (scored 5 out of 5) that the WRC was a helpful tool to receive at the dental visit, 19.4% agreed (score 4 out of 5), and 3.2% were neutral (scored 3 out of 5). None of the parents disagreed or strongly disagreed that the WRC was a helpful tool to receive at the dental visit.
Question 9 asked parents if a health care provider had discussed your childs BMI or weight in the past. 43% of all parents indicated that a health care provider had previously discussed BMI or weight. This question was able to be compared between English-speaking and Spanish-speaking parents. 61% of English-speaking parents had previously discussed BMI or weight with a health care provider, which was considerably more than indicated by Spanish-speaking parents (17%). This difference was statistically significant (p<.01).
If patients had been informed, most (76.5%) had been notified within the past year. As figure 9 shows, 41,2% had been notified within the past 0-6 months, 35.3% within the past 6-12 months, 5.9% within the past 1-2 years, 11.8% within the past 2-3 years, and 5.9% had been notified over 3 years ago.
None of the questions revealed a statistically significant difference between parents in Texas and parents in California.
DISCUSSION
In this study, most parents felt that the dental office was be a good place for obesity screening, believed that their child was comfortable with the WRC protocol, and identified the WRC as a helpful tool.
39% of English-speaking parents and 83% of Spanish-speaking parents did not remember hearing this information from a health care provider previously.
This study was conducted in two very different states. Texas is considered to be a more conservative state than California, and its population struggles more with obesity (Texas ranks 12 th in the nation in obesity, while California ranks 40 th .) Interestingly, no statistically significant differences were found between these two groups of subjects. This finding may be explained by the fact that both settings serve mainly individuals of a lower socioeconomic status, who are more at risk for obesity and may for that reason be more receptive. In addition, individuals of a lower socioeconomic status may be less easily offended than individuals of a higher socioeconomic status.
One limitation of the study is the setting in which it was conducted. The subjects participating were enrolled as patients in either a university setting (California) or a comprehensive community health clinic (Texas), and as such, may be more tolerant of longer appointments and public health related interventions. In addition, these settings serve mostly individuals of a lower socioeconomic status. Therefore, the results may not be generalizable to other settings, such as private practice dental offices.
CONCLUSION
Because 43% of the parents surveyed were unaware of their childs weight status, the Wellness Report Card (WRC) could make a difference in addressing childhood obesity. According to survey responses received, the WRC is acceptable to parents, with 96.8% of parents either agreeing or strongly agreeing that it is a helpful tool to receive at their childs dental visit.
REFERENCES
i. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM: Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 303: 242-249, 2010. ii. Lobstein T, Baur L, Uauy R: Obesity in children and young people: a crisis in public health. Obesity Reviews, 5: 4-85, 2004. iii. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T: Do obese children become obese adults? A review of literature. Preventive Medicine. 22: 167-177, 1993. iv. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults the evidence report. National Institutes of Health. Obes Res. 2:51S- 209S, 1998. v. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 293: 1861-1867, 2005. vi. Wang G, Dietz WH: Economic burden of obesity in youths aged 6 to 17 years: 1979- 1999. Pediatrics 109: E81-1, 2002. vii. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs. 28: w822- 831, 2009. viii. US Department of Health and Human Services. The Surgeon Generals Vision for a Healthy and Fit Nation. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General, January 2010.
ix. Bimstein E, Katz J: Obesity in children: a challenge that pediatric dentistry should not ignore review of the literature. J Clinical Pediatric Dentistry 34: 103-106, 2009. x. Vann WF, Jr., Bouwens TJ, Braithwaite AS, Lee JY. The childhood obesity epidemic: a role for pediatric dentists? Pediatric Dentistry. 27: 271-276, 2005. xi. Tseng R, Vann WF, Jr., Perrin EM. Addressing childhood overweight and obesity in the dental office: rationale and practical guidelines. Pediatric Dentistry 32: 417-423, 2010. xii. Selden TM. Compliance with well-child visit recommendations: evidence from the medical expenditure panel survey, 2000-2002. Pediatrics. 118: 1766-1778, 2006. xiii. Brown E, Jr. Childrens Dental Visits and Expenses, US, 2003. Statistical Brief #117. Agency for Healthcare Research and Quality. Rockville, MD: March 2006.
xiv. Hilgers KK, Akridge M, Scheetz JP, Kinane DE. Childhood obesity and dental development. Pediatric Dentistry 28: 18-22, 2006. xv. Baker S, Yagiela JA. Obesity: a complicating factor for sedation in children. Pediatric Dentistry. 28: 487-493, 2006. xvi. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics. 120: S193-S228, 2007. xvii. Centers for Disease Control and Prevention. BMI percentile calculator for child and teen: English version. Available at: http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx. Accessed January 1, 2011. xviii. Centers for Disease Control and Prevention. Child and Teen About BMI. Available at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.ht ml. Accessed January 1, 2011. xix. Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity. National Health Stat Report. 25: 1-5, 2010. xx. Tavares M, Chomitz V. A healthy weight intervention for children in a dental setting: a pilot study. JADA. 140: 313-316, 2009. xxi. Hackie M, Bowles CL. Maternal perception of their overweight children. Public Health Nursing. 24(6): 538-546, 2007.
xxii. Braithwaite AS, Vann WF Jr., Switzer Br, Boyd KL, Lee JY. Nutritional counseling practices: how do North Carolina dentists weight in? Pediatric Dentistry. 30: 488-495, 2008. xxii Curran AE, Caplan DJ, Lee JY, Paynter L, Cizlice Z, Champagne C, Ammerman AS, Agans R. Dentists attitudes about their role in addressing obesity in patients: A national survey. JADA. 141(11): 1307-1316, 2010.
WELLNESS REPORT CARD
Plaque Level: Low Medium High The Plaque Level tells us how clean the teeth are today. Plaque is a sticky film of made up of bacteria that causes gingivitis (inflammation of the gums) and tooth decay. Number of Cavities Today: ________ One of our goals is for your child to have a cavity-free check-up. If cavities were found today, please schedule an appointment for treatment. Also, please consider the following modification(s) to improve your childs oral health and his or her chances of a cavity-free check-up at the next dental exam visit: __________________________________________________________________ Weight: _____ pounds Height: ______ inches We are checking your childs weight and height today for several reasons. First and foremost, we strive to promote the overall health and wellbeing of our patients. In addition, these measurements can be useful in the dental office. For example, a childs weight allows us to calculate how much medicine we can give when teeth are numbed for fillings. Tracking your childs weight and height also helps with the timing of orthodontic treatment. Body Mass Index (BMI): _______ BMI Percentile for Age and Gender: ________ The BMI is calculated using height and weight. The BMI estimates the amount of body fat. If you would like, well be happy to discuss with you what your childs BMI score means and address any questions you may have. Further information and educational activities are available at the websites below. If youd like additional information about where to obtain help with nutritional planning, please ask Dr. ________________________.
Here are a few sources of information to help keep your child healthy:
Interactive BMI calculator that you and your child can use together: http://apps.nccd.cdc.gov/dnpabmi/ Error! Bookmark not defined.
Healthy meal ideas and guidelines: http://mypyramid.gov/kids/ xxii
Call 1-888-779-7264 (8am to 3pm Eastern time, Mon-Fri, closed Federal holidays)
PARENT SURVEY Dear Parent, To evaluate and improve our Wellness Report Card program, we need your honest feedback. Please complete the short survey below, fold, and place in the box labeled Parent Surveys. All responses are anonymous. Thank you for your honest feedback!
*Please rate the following 8 statements on a scale from 1 to 5 by circling the corresponding number. 5 = Strongly Agree, 4 = Agree, 3 = Neutral, 2 = Disagree, 1 = Strongly Disagree 1. The information presented in the Wellness Report Card was new to me. Strongly Agree 5 4 3 2 1 Strongly Disagree
2. Receiving a Wellness Report Card made my childs dental care visit too long. Strongly Agree 5 4 3 2 1 Strongly Disagree
3. My child was comfortable getting his or her height and weight measured at the dental office. Strongly Agree 5 4 3 2 1 Strongly Disagree
4. My child was comfortable getting his or her weight and BMI results at the dental office. Strongly Agree 5 4 3 2 1 Strongly Disagree
5. My child was comfortable getting the Wellness Report Card at the dental office. Strongly Agree 5 4 3 2 1 Strongly Disagree
6. The dental office is a good place to get my childs height and weight measured. Strongly Agree 5 4 3 2 1 Strongly Disagree
7. The dental office is a good place to receive and discuss my childs weight and BMI status. Strongly Agree 5 4 3 2 1 Strongly Disagree
8. The Wellness Report Card was a helpful tool to receive at my childs dental cleaning/checkup visit. Strongly Agree 5 4 3 2 1 Strongly Disagree
9. Has a health care provider discussed your childs BMI or weight with you in the past? Please circle your answer: Yes No 10. If you answered yes to question #9, how long has it been since you had this discussion? Please circle your answer: 0-6 months 6-12 months 1-2 years 2-3 years more than 3 years Please give us One Good Idea on how we can improve the Wellness Report Card: _______________________________________________________________________ FIGURES Figure 1 Question 1: The information presented in the WRC was new to me.
Figure 2 Question 2: Receiving a Wellness Report Card made my childs dental care visit too long. 0 5 1 0 1 5 F r e q u e n c y 0 1 2 3 4 5
Question 1
Figure 3 Question 3: My child was comfortable getting his or her height and weight measured at the dental office.
Figure 4 Question 4: My child was comfortable getting his or her weight and BMI results at the dental office. 0 5 1 0 1 5 2 0 F r e q u e n c y 1 2 3 4
Question 2 0 5 1 0 1 5 2 0 2 5 F r e q u e n c y 1 2 3 4 5
Question 3
Figure 5 Question 5: My child was comfortable getting the Wellness Report Card at the dental office.
Figure 6 Question 6: The dental office is a good place to get my childs height and weight measured.
Figure 7 Question 7: The dental office is a good place to receive and discuss my childs weight and BMI status. 0 5 1 0 1 5 2 0 2 5 F r e q u e n c y 1 2 3 4 5
Question 4 0 5 1 0 1 5 2 0 2 5 F r e q u e n c y 1 2 3 4 5
Question 5 0 5 1 0 1 5 2 0 2 5 F r e q u e n c y 1 2 3 4 5
Question 6
Figure 8 Question 8: The Wellness Report Card was a helpful tool to receive at my childs dental cleaning/checkup visit.
Figure 9 Question 10: How recently has a health care provider discussed your childs BMI or weight with you (if applicable)?
0 5 1 0 1 5 2 0 F r e q u e n c y 1 2 3 4 5
Question 7 0 5 1 0 1 5 2 0 2 5 F r e q u e n c y 1 2 3 4 5
Question 8 0 . 1 . 2 . 3 . 4 D e n s i t y 0 - 6 mo. 6-12 mo. 1-2 yr. 2-3 yr. >3 yr.
Prevalence and Risk Factors For Obesity and Overweight Among Elementarystudents at West Visayas State University - Integrated Laboratory School in 2013