5/20/2010. Pre Test Questions. Childhood Obesity: Why We Must Act Now! 1. Childhood obesity prevalence is the same today as it was 30 years ago.

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1 Reversing Childhood Obesity in Texas: Bigger is not Always Better TOMA/TxACOFP Joint Annual Convention 2010 June 19, 2010 Eduardo Sanchez, MD, MPH VP and Chief Medical Officer, BlueCross BlueShield of Texas Former, Texas Commissioner of Health Childhood Obesity: Why We Must Act Now! Dallas Regional Chamber May 21, 2010 Eduardo Sanchez, MD, MPH VP and Chief Medical Officer, BlueCross BlueShield of Texas Former, Texas Commissioner of Health Pre Test Questions 1. Childhood obesity prevalence is the same today as it was 30 years ago. a. True b. False 1

2 Pre Test Questions 2. The childhood obesity rate in the United States is approximately a. 1% b. 5% c. 15% d. 50% e. 75% Pre Test Questions 3. The USPSTF recommends that children six years old and older be screened for obesity and be offered or referred for appropriate intervention. a. True b. False Ready, Willing, And Unable To Serve (Mission: Readiness) Physically unfit: 27 percent of young Americans are too overweight to join the military. 2

3 Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Source: CDC Behavioral Risk Factor Surveillance System. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Source: CDC Behavioral Risk Factor Surveillance System. Causes of Death, United States 2005 Diseases of the heart All cancers Stroke Chronic lower respiratory disease Unintentional injuries Diabetes mellitus Alzheimer s disease Influenza and pneumonia Septicemia 5.9% 5.3% 4.8% 3.1% 2.9% 1.8% 1.4% 22.8% 26.6% 0% 9% 18% 27% 36% Source: cdc.gov 3

4 The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (Danaei,2009) Deaths attributable to individual risk (thousands) in both sexes Non-clinical factors affecting mortality Higher health literacy is correlated with lower mortality rates Mortality Rate 50% 40% 30% 20% 10% 0% Mortality Rates by Health Literacy Levels 39.4% 28.7% 18.9% Inadequate Marginal Adequate Literacy Level Definition: Levels of Health Literacy Adequate understands most reading tasks; misreads only complex information. Marginal sometimes misreads instructions and dosages and has difficulty with complex information. Inadequate often misreads Rx instructions and appointment slips. Note: Based on 3,260 Medicare managed-care who were interviewed in 1997 to determine their demographic characteristics, chronic conditions, selfreported physical and mental health, and health behaviors. Participants also completed the shortened version of the Test of Functional Health Literacy in Adults (S-TOFHLA) that included two reading passages and four numeracy items to assess comprehension of hospital forms and labeled prescription vials that contained numerical information. Main outcome measures included all-cause and cause specific (cardiovascular, cancer and other) mortality using data from the National Death Index through Source: Baker, DW., et al. (2007) Health Literacy and Mortality Among Elderly Persons. Archives of Internal Medicine 167(14): Copyright 2007 American Medical Association. All rights reserved. Medical costs due to obesity Medical costs related to obesity in America in 2008 may be as high as $147 billion. Average annual medical costs Health weight - $3400 Obese - $4900 4

5 The Impact of Obesity on Rising Medical Spending 27% of the rise in health care spending from 1987 to 2001 is accounted for by increases in the proportion of and spending on obese people relative to healthy weight individuals. Thorpe, et al. Health Affairs, Oct Cost of obesity projections (over 10 years by year in $ billions, assuming 5% increase annually) YEAR COST ($) $1.849 trillion STOP Obesity Alliance Survey Only 39% of patients with BMI of 30 or higher report being told by their physician that they are obese. 90% of them were told to lose weight. One third of them were not advised how to achieve and maintain a healthy weight. 72% of PCPs say no one in their practice is trained to address weight issues. 64% would like more time. 46% would like to know community resources. 44% would like tools to address obesity. 5

6 Prevalence of Childhood Obesity in the United States One in six children aged six to 19 are now considered overweight, up from just one in 10 only 15 years ago Children and Adolescents Considered Overweight by Age Group Percentage of Age Group Population 20% 16% 12% 8% 4% 0% 17.6% 17.0% 17.5% 17.0% 15.8% 16.0% 11.3% 10.5% Ages 6-11 Ages Note: Overweight is defined as body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the CDC Growth Charts: United States. Source: Centers for Disease Control and Prevention. Health, United States, 2007 and 2008 Prevalence of Childhood Obesity in the United States Almost 1/3 of children and adolescents are overweight or obese 11.3% of children and adolescents are very obese (97 th percentile) Ogden,2008, JAMA, 299(20), ) Prevalence of BMI > 95% in Boys (Ogden,2008, JAMA, 299(20), ) Age Range (in years) Whites Blacks Latinos

7 Prevalence of BMI > 95% in Girls (Ogden,2008, JAMA, 299(20), ) Age Range (in years) Whites Blacks Latinas Prevalence of BMI > 85% in Boys (Ogden,2008, JAMA, 299(20), ) Age Range (in years) Whites Blacks Latinos Prevalence of BMI > 85% in Girls (Ogden,2008, JAMA, 299(20), ) Age Range (in years) Whites Blacks Latinas

8 IOM Comprehensive approach for preventing and addressing childhood obesity Communities Worksites Health Care Schools and Child Care Home Demographic Factors (e.g., age, sex, SES, race/ethnicity) Psychosocial Factors Gene- Environment Interactions Other Factors Social Norms and Values Sectors of Influence Behavioral Settings Individual Factors Food & Physical Beverage Intake Activity Energy Intake Energy Expenditure Government Public Health Health Care Agriculture Education Media Land Use and Transportation Communities Foundations Industry Food Beverage Retail Leisure and Recreation Entertainment Energy Balance SOURCE: Institute of Medicine, Progress in Preventing Childhood Obesity, 2007, pg 20. 8

9 SOLVING THE PROBLEM OF CHILDHOOD OBESITY WITHIN A GENERATION (May 2010) Getting children a healthy start on life, with good prenatal care for their parents; support for breastfeeding; adherence to limits on screen time ; and quality child care settings with nutritious food and ample opportunity for young children to be physically active. Empowering parents and caregivers with simpler, more actionable messages about nutritional choices based on the latest Dietary Guidelines for Americans; improved labels on food and menus that provide clear information to help make healthy choices for children; reduced marketing of unhealthy products to children; and improved health care services, including BMI measurement for all children. Providing healthy food in schools, through improvements in federally-supported school lunches and breakfasts; upgrading the nutritional quality of other foods sold in schools; and improving nutrition education and the overall school environment. Improving access to healthy, affordable food, by eliminating food deserts in urban and rural America; lowering the relative prices of healthier foods; developing or reformulating food products to be healthier; and reducing the incidence of hunger, which has been linked to obesity. Getting children more physically active, through quality physical education, recess, and other opportunities in and after school; addressing aspects of the built environment that make it difficult for children to walk or bike safely in their communities; and improving access to safe parks, playgrounds, and indoor and outdoor recreational facilities. White House Task Force on Childhood Obesity A tale of two communities Somerville, Massachusetts El Paso, Texas 9

10 Lessons Learned from tobacco control initiatives Comprehensive approaches work best Single interventions haven t worked as well Programs need to be sustained Steps to prevent and reverse childhood obesity School-based Universal coordinated school health programs Science based nutrition guidelines for all foods in schools Universal school breakfast/lunch Fresh fruits and vegetables Farm to School School gardens 30 minutes per day physical activity in schools Classroom teaching about good eating and activity No child left behind 100% high school graduation Steps to prevent and reverse childhood obesity Toolkits for clinicians Physician advocacy Develop and standardize health/nutrition guidelines for FNS/SNAP/WIC Summer food programs for eligible children Community access to good food healthy, green, just, and affordable Water over soda No child left inside 10

11 The Role of Health Plans in Addressing Obesity Raising awareness and changing attitudes employers and members Partnerships Public policy Charitable giving Data sharing Wellness/Prevention Decision support tools - toolkits Aligned reimbursement strategies BCBSA Pediatric Obesity and Diabetes Prevention Pilot Program message 5 servings of fruits and vegetables daily limit TV or computer time to 2 hours or less daily participate in 1 hour or more of play or physical activity daily drink zero sweetened drinks every day BCBSA Pediatric Obesity and Diabetes Prevention Pilot Program More than 1,650 physician practices in five states will receive tool kits The tool kits include a pocket guide for the docs, charts for physicians to log information, a double-sided wall poster, tear-off sheets tailored towards different age ranges: ages 2 to 4, 5 to 9, and 10 years and older, patient workbooks that allow patients/parents to track their healthy habits and tri-fold brochures to help generate awareness and provide parents with basic information about Body Mass Index (BMI), behavioral risks and healthy tips. 11

12 USPSTF Screening for Obesity in Children and Adolescents (January 2010) Summary of Recommendation The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status. Grade: B recommendation. Policy Position Statement on the Prevention, Assessment, Diagnosis and Treatment of Child and Adolescent Obesity in the Healthcare Environment Assessment: Healthcare providers should perform, at a minimum, a yearly assessment of weight status in all children. Providers should qualitatively assess dietary patterns, screen time, and physical activity behaviors in all pediatric patients at each well child visit. All overweight and obese children should receive a thorough physical examination including BMI assessment, pulse rate and blood pressure measured with a large enough cuff. The following laboratory tests should occur for both the overweight and obese: fasting lipid profile, fasting glucose, aspartate aminotransferase, and alanine aminotransferase. In the obese patient, blood urea nitrogen and creatinine should be assessed. Healthcare providers should obtain a focused family history for obesity, type 2 diabetes, cardiovascular disease (particularly hypertension), and early deaths from heart disease or stroke to assess risk of current or future comorbidities associated with a child s overweight or obese status. Treatment: For overweight and obese children, treatment should occur in a staged approach based upon the child s age, BMI, related comorbidities, weight status of parents, and progress in treatment: a prevention plus protocol, structured weight management, comprehensive multidisciplinary protocol, and pediatric tertiary weight management. The child s primary caregivers and families should be integrally involved in the process. AHA Recommendations for Treatment of Child and Adolescent Overweight and Obesity Bonnie A. Spear, Sarah E. Barlow, Chris Ervin, David S. Ludwig, Brian E. Saelens, Karen E. Schetzina and Elsie M. Taveras Pediatrics 2007;120;S254-S288 Staged Treatment of Pediatric Obesity According to Age and BMI Percentile Age groupings 2-5 years 6-11 years years BMI percentile > 98 12

13 Local Government Actions to Prevent Childhood Obesity September 2009 The Childhood Obesity Epidemic 16.3% of children and adolescents are obese in U.S. (one in six) Obesity rates have tripled in the last 30 years While all children are increasingly obese, the poor, African Americans, Latinos, American Indians, and Pacific Islanders are disproportionately more overweight and obese. Consequences of Childhood Obesity May reduce life expectancy More likely to develop hypertension, type- 2 diabetes, and high cholesterol More likely to become obese adults Reduced quality of life Higher medical expenses 13

14 Evidence Analysis Evidence of effectiveness Effect size Outcomes and externalities Potential reach Impact and cost Feasibility L1 12 Most Promising Action Steps Attract supermarkets and grocery stores to underserved neighborhoods Require menu labeling in chain restaurants Mandate and implement strong nutrition standards for foods and beverages in government-run or regulated after-school programs 12 Most Promising Action Steps Adopt building codes to require access to, and maintenance of water fountains Implement a tax strategy to discourage consumption of foods and beverages that have minimal nutritional value Develop media campaigns to promote healthy eating and active living 14

15 Slide 41 L1 breatk up by goals? spread out more? Meyers, 9/7/2009

16 12 Most Promising Action Steps Plan, build, and maintain a network of sidewalks and street crossings that creates a safe and comfortable walking environment and that connects to destinations Adopt community policing strategies that improve safety and security of streets and parks Develop and implement a Safe Routes to School program 12 Most Promising Action Steps Build and maintain parks and playgrounds that are safe and attractive for playing, and close to residential areas Establish joint use of facilities agreements allowing playing fields, playgrounds, and recreation centers to be used when schools are closed Institute policies mandating minimum play space, physical equipment, and duration of play in preschool, after-school, and child-care programs Bottom Line Message Obesity is one of the most serious and expensive health problems facing our nation Through their decisions and actions, local officials either support or undermine efforts to get kids to eat healthy and be active Local officials can make it either easy or hard for kids to eat healthy and be active Local officials have the power to take steps to significantly cut the rate of childhood obesity Childhood obesity is a matter of healthy equity Act now 15

17 Tackling Obesity and Chronic Disease start upstream Better engage physicians Universal coordinated K-12 school health Adult wellness (DPP model) workplace, community, and home 30 minutes of physical activity daily Low fat, high fruit/vegetable diet Local Built environment changes Food related Physical activity related Why? Improved health status Lower medical costs - public and private A more productive workforce A more competitive local economy A healthy community Post Test Questions 1. Childhood obesity prevalence has over three decades. a. Doubled b. Tripled c. Stayed the same d. None of the above 16

18 Post Test Questions 2. Childhood obesity is associated with which of the following: a. Hypertension b. Type 2 diabetes mellitus c. Otitis media Post Test Questions 3. Treatment of childhood obesity should include: a. cardiac catheterization b. healthy lifestyle counseling c. renal ultrasound Post Test Questions 4. Which of the following is included in the 5/2/1/0 messaging: a. 5 servings of fruits and vegetables daily b. limit TV or computer time to 2 hours or less daily c. participate in 1 hour or more of play or physical activity daily d. drink zero sweetened drinks every day e. all of the above 17