Viewed as a leading cause of preventable death, obesity, or excess body fat, is associated with a host of poor health outcomes, including higher rates of heart disease, osteoarthritis, Type 2 diabetes and some cancers. The problem is compounded by a number of hard-to-address factors, including lack of access to nutritious food in many urban and rural areas and low socio-economic status.
Hospitals and physicians have traditionally stuck to doling out simple advice about exercise and healthy eating when confronted with obese patients. But that hands-off approach is quickly becoming a thing of the past.
For instance, Jacksonville, Fla.-based Nemours, which is one of the country's largest children's health systems, has had a weight management program in place for patients in Delaware for more than 20 years. In response to a growing prevalence of obesity in Florida, Nemours created a sister program there in an outpatient setting six years ago called Healthy Choices Clinic, which provides dietitians, mental health counselors, nurses and exercise specialists who can tailor programs that meet the needs of young people struggling with their weight.
Kids who stay with the program for longer than a year have seen a reduction in their body mass index, a measurement that indicates if a person is overweight or obese, according to Dr. Lloyd Werk, who has run the clinic since its inception. “Whether the health consequence is walking down the road to Type 2 diabetes, or sleep apnea, or Blount's disease (a disorder of the growth of leg bones), there's increasing recognition that being obese and overweight is not without consequences,” Werk said.
In January, the Academic Pediatric Association granted Nemours a two-year provisional accreditation for physician obesity fellowships, the first program that centers specifically on pediatric obesity. “Health systems need qualified, well-trained people to meet the needs of an overweight population,” Dr. George Datto, director of the fellowship, said in a statement after the announcement. And the system's newly built Nemours Children's Hospital, Orlando, Fla., features KidsTRACK, a family research center that includes a teaching kitchen where parents can learn how to prepare healthy meals for their children.
Sentara Williamsburg (Va.) Regional Medical Center is using its parent system's ownership of an insurance company to bolster its population health management efforts, said Bob Graves, president of the 145-bed hospital. Ten-hospital Sentara Healthcare owns Optima Health, a health plan.
Norfolk, Va.-based Sentara has also used the plan to target its own employees who struggle with obesity-related diabetes and other chronic conditions. It uses quarterly appointments with health coaches and offers premium-lowering incentives for participation. Optima Health has also launched obesity-related initiatives for non-employee members, he added.
These stepped-up efforts by providers and insurers take place against a backdrop of obesity rates that have risen substantially in recent decades and show few signs of receding despite heightened national consciousness about its health impact. The Centers for Disease Control and Prevention reports more than one-third of adults and almost 17% of youth in the U.S. were obese in 2009 and 2010, and there had been no change in the prevalence of obesity among adults or children from 2007-08 to 2009-10.
Healthcare costs related to obesity nearly doubled to about $147 billion in 2008 from roughly $75 billion in 1998, according to Terry O'Toole, senior adviser in the CDC's division of nutrition, physical activity and obesity. Meanwhile, the average American adult is 25 pounds heavier today than the average adult was in 1960.
O'Toole said the campaign to address obesity began around 2004 and got a shot in the arm when first lady Michelle Obama launched the Let's Move campaign, her well-advertised effort to move kids away from television and computer screens and onto playgrounds and dance floors. “No doubt we've seen more activity with Let's Move,” O'Toole said. However, it's essential to adopt broader strategies that improve the environment in ways that make healthy living easier, he said. For this to happen, communities need to determine what changes are necessary to boost physical activity in schools, promote safe options for bicycle transportation and provide access to nutritious foods.