Referrals

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

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 14-18).

New Impact provides comprehensive, multidisciplinary evaluation and treatment of obesity, including evaluation for possible underlying medical conditions. Staff members include general pediatricians, registered dietitians (RD), a clinical psychologist, 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 6 visits and a YMCA wellness coach for 5 visits. You will follow up with our physicians as needed after the initial consultation. Healthy goals will be individualized for your child and family.

Fee

There is no program fee. You will be charged a co-pay, based on your insurance, for physician, dietitian and psychologist visits. You will also be responsible for your insurance deductible.

The reduced rate YMCA family membership costs $30 per month, payable at participating YMCAs. This includes a 2- to 3-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 ProTeens surgical candidates.

Lab Work

Please have screening lab work completed prior to the initial visit. New Impact labs include: Lipids, HgbA1C, and CMP. Additional 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.

Referral Process

A physician referral is required. 

To refer a patient to New Impact, please have your primary care provider 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

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

Pediatric Subspecialist Referrals

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 to GHS Pediatric Endocrinology.

We do not recommend drawing fasting or random insulin levels. If these labs are drawn by a referring provider, those patients with elevated insulin ONLY should be referred directly to New Impact. It is not usually necessary for them to see the endocrinologist.

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, elevated liver enzymes (suspected NAFLD), dyslipidemia and orthopaedic issues. New Impact arranges ambulatory BP monitoring, as needed.

Suspected NAFLD/Elevated LFTs

The only proven current effective therapy for treating NAFLD is weight loss/lifestyle change. Pediatric Gastroenterology recommends the following management in children with obesity who have no other signs/symptoms of liver disease.

  • IF AST and ALT < 2x normal (or <100): Repeat in 3-6 months after healthy lifestyle changes are initiated. If labs are stable or decreasing, repeat every 3-6 months until normal. When normal, repeat yearly until BMI is normal.
  • If AST or ALT > 2x normal (or > 100): Initiate intensive lifestyle therapy and test to evaluate for additional causes of hepatitis (Acute hepatitis panel (A,B,C), ANA, anti-smooth muscle antibody, anti-liver kidney microsomal antibody, ANCA, ceruloplasmin, alpha-1 antitrypsin phenotype, RUQ ultrasound). If bloodwork is normal and liver is either normal or fatty infiltration of the liver is indicated on US, continue healthy lifestyle changes and follow every 3-6 months until normal. If the testing listed above is abnormal, or if liver enzymes increase or fail to improve after weight loss, refer to Pediatric Gastroenterology for further management.
  • Referrals to Pediatric Gastroenterology that appear to be NAFLD who have not yet instituted healthy lifestyle changes may be deferred until the above guidelines are met.

Referral to Pediatric Endocrinology

Consider additional referral to Pediatric Endocrinology for a child with obesity 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