Overweight/Obesity Algorithm

GHS Overweight/Obesity Algorithm for Patients Up to 21 Years Old

At Children’s Hospital of Greenville Health System (GHS), New Impact: A Healthy Lifestyles Program is the weight management partner of the Division of Pediatric Endocrinology. We work closely together to optimally manage patients and their co-morbidities.

New Impact Referral

Overview

New Impact is the initial point of referral for the majority of patients up to 21 years old who are obese, overweight or crossing weight percentiles, including patients who may be interested in pursuing bariatric intervention at ProTeens (a surgical weight-loss program for teens ages 14-21).

New Impact provides comprehensive, multidisciplinary evaluation and treatment of obesity, including evaluation for possible underlying medical conditions. Staff members include general pediatricians, registered dietitian (RD), clinical psychologist, nurse case manager and trained YMCA wellness coaches.

Program Structure

All patients receive a comprehensive medical evaluation at their initial visit. A psychological consultation can be scheduled for families who need those services. The New Impact treatment phase varies in length and services depending on individual needs, but families typically complete the program in 6 months. You will meet with the New Impact dietitian for up to 4 visits and a YMCA wellness coach for 5 visits. You will follow up with our physicians for accountability visits and goal setting. Healthy goals will be individualized for your child and family.

Fee

We no longer have a program fee. You will be charged a co-pay, based on your insurance, for physician and psychologist visits. You will also be responsible for your insurance deductible. The reduced rate YMCA family membership costs $60, payable at participating YMCAs. This includes a 2-month family membership and 5 wellness coach visits for the New Impact patient for the purpose of education and goal setting. This part of the program is optional; however, it is considered a requirement for our surgical candidates.

Lab Work

Please have screening lab work completed prior to the initial visit. New Impact labs include: Lipids, 25 OH Vit D, HgbA1C, and CMP. Add thyroid testing only if there is a strong family history of thyroid disease or clinical suspicion. Routine thyroid testing or insulin levels are NOT recommended.

Process

A physician referral is required. 

To refer a patient to New Impact, please follow these steps:

1. FAX the following to (864) 627-9131.

  • Current patient demographics
  • Last yearly well-child checkup summary
  • Growth charts
  • Any and all lab work completed within the past year, including New Impact screening labs noted above
  • The completed Parental Readiness to Change Questionnaire (if possible)

2. (864) 675-3488, to schedule an appointment.

Pediatric Subspecialist Referral

Quick Facts

Fewer than 1% of children with obesity will have an underlying medical cause.

Obese children who are tall or growing normally have an extremely low risk of endocrinopathy and are unlikely to need further endocrine evaluation. If the New Impact physician is concerned about possible endocrinopathy, a referral will be made.

We do not recommend drawing fasting or random insulin levels. If these labs are drawn, patients with elevated insulin only should be referred to New Impact.

Obesity-related Co-morbidities

New Impact collaborates with and refers to GHS Children’s Hospital subspecialists for obesity co-morbidities according to pediatric guidelines for issues including PCOS, prediabetes, sleep, elevated BP, transaminemia, dyslipidemia and orthopaedic issues. New Impact arranges ambulatory BP monitoring. Pediatric Nephrology staffs a monthly hypertension clinic at New Impact.

Additional Referral to Pediatric Endocrinology

Consider additional referral to Pediatric Endocrinology if the patient has one or more of the following conditions:

  • Short stature or slowing growth velocity
  • Oligomenorrhea, hirsutism or acne in girls
  • Precocious or delayed puberty
  • HgbA1C > 6.0% or any lab-verified blood glucose level ≥200
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