Referrals

At Prisma Health Children’s Hospital–Upstate, New Impact: A Healthy Lifestyles Program is the weight management partner of Prisma Health Children’s Hospital–Upstate 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 18 years old who are obese, overweight or crossing weight percentiles, including adolescents who may be interested in pursuing bariatric intervention Prisma Health Weight Management Institute.

New Impact provides comprehensive, multidisciplinary evaluation and treatment of obesity, including evaluation for possible underlying medical conditions. Team members include general pediatricians, registered dietitians (RD), and trained YMCA wellness coaches.

Lab Work

Please have screening lab work completed prior to the initial visit. New Impact labs include: Lipids, HgbA1C, and CMP. Include 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 864-522-2105.

  • 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 (CMP, HbA1c, Lipid Panel)

2. A Patient Representative will call 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 Prisma Health Children’s Hospital–Upstate 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 Prisma Health Children’s Hospital–Upstate 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.

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