Overweight Children The Role of Health Care in Prevention and Treatment

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Overweight ChildrenThe Role of Health Care in
Prevention and Treatment

• Presentation to
• 2004 AcademyHealth Meeting
• San Diego, CA
• June 6, 2004 5-630 PM

Scott Gee, MD Medical Director, Prevention
Health Information Regional Health Education -
Northern California
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Today we will discuss...

• The Overweight Epidemic
• Treatment of Overweight Children
• The Role of Schools and Communities

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By the end of this lecture participants will be
able to

• Name 3 strategies to prevent childhood
  overweight.
• Name 3 health care strategies to address
  overweight children.
• Name 3 environmental approaches to addressing
  overweight children.

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Kaiser PermanenteNorthern California

• Integrated, group model, not-for-profit health
  maintenance organization
• 3.2 million health plan members
• 19 medical centers and 22 medical offices in
  region
• Robert Pearl, MD, Executive Director and CEO, The
  Permanente Medical Group

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Very Promising Evidence-Based Overweight
Intervention Strategies
Physical Activity Patterns Increase PE
participation Increase recreational physical
activity Decrease television viewing Dietary
Factors Decrease sweetened beverages Familial
Psychosocial Influences Improve
limit-setting Avoid using food as
reward Parental modeling of healthy behaviors
Position Paper - Prevention of Childhood
Overweight What Should Be Done? Center for Weight
and Health - U.C. Berkeley 10/02
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Prevention Early Intervention Strategies

• Prenatal Care appropriate weight gain, glycemic
  control and tobacco cessation during pregnancy to
  prevent
• Small for Gestational Age
• Large for Gestational Age
• Birth to One Year breast-milk for the first of
  life or longer and limit juice.
• One to Two Years Wean from bottle at 12 months,
  limit TV, avoid using food as a reward and clean
  the plate. Parent weight management.
• Two to Five Years low-fat/non-fat milk at 2
  years, no TV in bedroom, early adiposity rebound
  toddler intervention.

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Evaluation and Treatment of Overweight Children
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KP Activities to Address Overweight
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Kaiser Permanente Northern California Addressing
Overweight Children at Office Visits

• Evidence Review, Clinical Practice Guideline
• Develop Term Goal Reduce the Prevalence of
  Overweight Children among KPNCR Members
• Recruit Local Opinion Leaders
• Implement Office Systems
• Get More Energy poster Patient Education
  Materials
• BMI Conversion Wheel
• CDC BMI for Age Growth Chart
• Provide On-Site, Multi-Session Staff Training
• Provide BMI Audit and Feedback
• BMI Administrative Data Capture at Well Child
  Care Visits Ages 2-18 Years
• Prevalence of Overweight and At Risk Patients
• Department Level Feedback

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Get More Energy! Poster
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KP Northern California Provider Training Program

• KP Northern California 500 pediatricians caring
  for 800,000 children.
• Current Training Program
• 1 hour, on-site, full department, overview
  (epidemiology, BMI, in-depth medical assessment,
  treatment options, office system tools)
• 1 hour, on-site, provider only, introduction to
  communication skills and community advocacy
  (communication overview, brief focused advice,
  the role of the provider in community advocacy)
• 8 hour, on-site or regional, provider only,
  advanced communication skills (brief negotiation)

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KPNCR 2003 BMI Completion Rates at Well Child
Care Visits Ages 2-18 Years
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Mean Body Mass Index (BMI) Coding Completion at
Well Care Visits (2-18 Yrs) for Number of On Site
Training Sessions - August 2003
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What we have learned so far

• Recruiting proactive local opinion leaders and
  convening quarterly meetings provides structure
  for continuous quality improvement activities.
• Training medical assistants to calculate and plot
  BMI for age improves compliance.
• Multi-session, 1 hour, on-site lunch training is
  more effective than a single 1-4 hour training.
• Get More Energy poster in the exam room
  encourages dialogue and reinforces key messages.
• BMI conversion wheel is faster, easier and more
  accurate than BMI conversion tables.
• Provider level BMI compliance audit and feedback
  may be more effective than department level.

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Weight Interventions
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KP Childhood Weight Management Programs
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Environmental Approaches
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What do Californians think about overweight
children?
Policy Proposals Supported by Most (gt66)
Surveyed

• Create more community recreational programs
  (96).
• Require schools to teach students about nutrition
  physical activity (96).
• After-school athletic facilities open and
  available (93).
• Require PE classes in high school (92).
• Require restaurants to post nutritional
  information on menus (87).
• Encourage businesses to promote physical activity
  among their employees (86).
• Create a public advertising campaign to raise
  awareness (83).
• Prohibit the sale of soda, chips and candy in
  secondary schools (68).

1,068 random sample CA residents, telephone
survey 10-11/2003 http//calendow.org/caobesityatt
itudes/index.htm
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TV-Turnoff Week

• A grassroots project that works with the
  community - families, local schools, clubs, and
  libraries
• Endorsed by more than 65 national organizations
  including Kaiser Permanente

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Work Site Strategies

• Work Site Health Promotion
• Motivational Signage to Encourage Use of Stairs
• Pictures in Stairwells
• Cafeteria Modifications
• Food nutrition labeling.
• Food pricing strategies.
• Healthy food choices in vending machines.

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KP Were Moving Together!
The Step Sisters Walk Across America 2003 1st
Place
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SB 19 Escutia Pupil Health Chaptered - This
bill establishes, as of 1/1/04, various
prohibitions on the sale of beverages in schools
and places nutritional standards on the type of
foods that may be sold to pupils. 10/01 Board of
LA school district votes to ban soda sales in
schools. 8/02 McDonald's reported its first-ever
quarterly loss. 1/03 SF school board approves
ban on sale of unhealthy snacks' in schools.
1/03 SB 677 Soda Ban SB 65 School Food
Contracts Signed by Governor Davis 9/03
Is fat the next tobacco?
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We have the opportunity to be leaders in the
health care environment and do ground-breaking
work to fight the obesity epidemic.
Even the longest journey begins with a single
step.
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Appendix - Reference List
1Story MT et al. Management of Childhood Obesity
Attitudes, Barriers, Skills and Training Needs
among Health Care Professionals. Pediatrics.
2002110210-214 2Barlow SE, and Dietz WH.
Obesity Evaluation and Treatment Expert
Committee Recommendations. Pediatrics. 1998 102
1-11 3Whitaker RC, et al. Early adiposity rebound
and the risk of adult obesity. Pediatrics 1998
101E5 4Ritchie L, Crawford P, et al. Position
Paper - Pediatric Overweight A review of the
Literature. University of California Berkeley.
2002 1-15 5Rollnick S, Heather N, Bell A.
Negotiating behavior change in medical settings
the development of brief motivational
interviewing. J Ment Health. 1992
125-37 6Committee on NutritionPrevention of
Pediatric Overweight and ObesityPediatrics 2003
112 424-430
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