Amanda Hogan

HCM 3010: Health Care Organization

November 22, 2015

Childhood Obesity Intervention: The Healthy Living Program

The prevalence of childhood obesity has more than doubled in

children and quadrupled in adolescents in the past 30 years (Childhood

Obesity Facts, 2015). According to the Centers for Disease Control and

Prevention (CDC), 1 in 6 young people are affected by obesity that is, their

sex and age-specific Body Mass Index (BMI) is at or above the 85 th percentile

(Adult Child & Teen BMI, 2015). Likewise, the childhood obesity crisis is not

isolated to young Americans. In 2015, the World Health Organization

described childhood obesity as one of the most serious pubic health

challenges of the 21st Century (World Health Organization n.d).

Consequently, obese children are more likely to remain obese into adulthood,

which is associated with a number of serious health conditions including

heart disease, diabetes, and cancer (About Child & Teen BMI, 2015).

Prevention programs such as healthy school nutrition/physical activity

plans, limiting the sale of sugary beverages, creating and mainlining safe

neighborhoods are all important initiatives that play an important role in

curtailing the future growth of childhood obesity (Combating Childhood

Obesity, 2015). However, these prevention programs are not equipped to

address the current state of childhood obesity alone. Healthcare providers

and insurance organizations play a central role combating childhood obesity.

It will take everyone to make effective change, but healthcare systems plays

a major role and needs to use innovative, outside of the box programs to

address the issue. Specifically, Colorado insurance organizations under the

Medicaid umbrella, including Denver Health, Colorado Access, and Rocky

Mountain Health, have a unique opportunity to embrace a comprehensive,

family-inclusive, community based weight management program called the

Healy Living Program (HeLP) through sustainable funding of the

program through health insurance coverage. HeLP is Colorados best

option for combatting childhood obesity because it aligns with the

recommended treatment protocols by several independent national

organizations. It provides a much needed referral resource for physicians, and

it reaches the low-income Latino families in Colorado, which are most

effected by childhood obesity-related health problems. This is what is

costing insurance companies the most amount of money

As previously mentioned, several protocols for treating childhood

obesity have been suggested, however, its commonly accepted that a

multifaceted treatment protocol is the most appropriate method for handling

childhood obesity. The US Preventive Services Task Force (USPSTF), an

independent, volunteer panel of national experts in prevention and evidence-

based medicine, recommends the use of behavior intervention programs

that include dietary, physical activity, and behavior counseling components

(Clinical Summary, 2010). Furthermore, this recommendation is given a

Grade B status indicating there is reasonable certainty that the

net benefit of a comprehensive intervention program will yield

moderate to substantial results as demonstrated by the research

reviewed. Additionally, in 2007, 15 representatives from the American

Medical Association (AMA), Health Resources and Service Administration

(HRSA) and the CDC were nominated to participate in an Expert Committee

to establish a standard of care guideline for primary care physicians related

to the identification and treatment of childhood obesity. Again, the

recommendations included the use of comprehensive, multidisciplinary

interventions (Implementation Guide for Expert Committee

Recommendations on the Assessment, Prevention and Treatment of

Child and Adolescent Overweight and Obesity, 2007).

While great in theory, these recommendations are not widely

accepted among primary care physicians as demonstrated by the surprisingly

low adoption rates. In fact, studies showed a declining trend for diet/nutrition

counseling during well-child preventative visits with primary care physicians

between 2006 and 2009. Moreover, exercise counseling remained low,

around 20% of visits, after the Expert Committee guidelines were established

(Tanda & Salsberry 2014). According to Perrin and Finkle Pediatricians

reference several hurdles to the prevention and treatment of

obesity, including lack of time and perceived ineffectiveness

(Citation). Also, pediatricians report their own low self-efficacy as a

barrier in managing overweight(IN OWN WORDS or quote?)( 2009).

Whats more disconcerting is Latino parents with overweight

children who were seen by physicians where there was an issue of

language incongruence (Physicians who spoke limited/no Spanish

and parents who spoke little/no English) are less likely to receive direct

communication from Physicians regarding their childs overweight status

(Turer, Montao, Lin, et. al, 2014). Language incongruence is.

Similarly, Latino parents reported receiving inadequate advice related to

nutrition education and physical activity from physicians more often

compared to white counterparts. In addition, Latino parents were more

likely than white parents to indicate that the advice they did receive was fair

or poor (Taveras, Gortmaker, Mitchell, et al, 2008).

NEED TRANSITION. Not surprisingly, 21.2% of Hispanic children and

adolescence were obese, compared to 14% on non-Hispanic white children

based on 2009 data. (Cason-Wikerson, Goldberg et. al, 2015). In addition,

Hispanic children, part of the Latino community which is largest and fastest

growing ethnic minority in the United States, are disproportionally affected by

diseases like type 2 diabetes and fatty liver disease which are chronic

conditions caused by obesity (Haemer, Ranade, Baron & Krebs, 2013). These

negative health implications on Latino youth, and the nation, cannot be

overlooked.

Between 2000 and 2010, the Hispanic population segment increased

43% while only 10% of the total population increased (Shi & Sign, 2015), and

according to a 2010 poll it is estimated that that the Latino population will

continue to rise. As a result, the negative health effects in this large

minority population is likely to impact the health of the nation as a

whole, leading to higher heath care expenses, high disability rates,

loss of work/productivity, and stunted economic growth (Nyberg, K.,

Ramirez, A., & Gallion, K. (2011).

As one might expect, the financial implications of childhood obesity are

massive. Obesity is among the largest drivers of preventable chronic

diseases and healthcare costs in the United States. (Obesity Rates & Trends,

2015). Currently, estimates for these costs range from $14.7 billion to nearly

$210 billion per year. (Obesity Rates & Trends, 2015). When extrapolated
over the course of a lifetime, researches that analyzed a SEGMENT OF 10

year old boys, estimate the costs associated with childhood obesity to be

$19,000 more than a normal weight child. (Finkelstein, Grahm & Malhotra,

2014). Alarmingly, when the research team multiplied the $19,000 price tag

by the number of obese 10 year olds in the US, they found the lifetime costs

for that age group alone reached roughly $14 billion (Finkelstein, Graham &

Malhotra, 2014). Extrapolated to the nation, elevated BMI in childhood was

associated with an additional $14.1 billion in additional prescription drug,

emergency room, and outpatient visit costs annually (Trasande, L., &

Chatterjee, S. (2009). Its

HeLP was designed specifically to encompass the recommendations by

USPS and Committee on childhood obesity treatment. The programs

curriculum offers a combination of nutrition education, physical activity, and

behavior modification classes over the course of 12 weeks, which is

consistent with the recommended intensive intervention timeline

(REFERENCE). How to transition? MORE SPECIFICS ON THE

CIRRICULUM? GIVE EXAMPLES

HELP GIVES PROVIDERS A TREMENDOUS REFERRAL

RESOURCE..

HELP ADDRESSES THE LATINO POPULATION..

HELP ADDRESSES THE COST ISSUE AND GIVES A ROI OF

192%.....

a. Not only are they more effective, but they are shown to be the
most cost effective
b. When compared to recently clinical childhood
obestiyprograms, which includes only 5 hours of treatment
and cost $1100 per child. Orlistat coasts over $1000 / year
and bariatric surgery at $28,000. (need proper citing here.
 Haemer, Wald, Weiner) Family based programs are more cost
effective and show other benefits ourside of BMI zcore
reductions.

II. Topic 3 WHAT the HeLP does specifically and why its the best
option
a. Taking into consideration all of the abovementioned Reaches
their target population
i. Volume
1. Linked to the primary care home, with traingih
providers etc., its an internal referral that
members of the clinic run.
ii. Demographic
b. Effective as proven by:
i. High Attendance
ii. Positive outcomes (BMI, Fitness)
iii. Cost effective esp compared other programs
(emergency/office visit compared to comprehensive 6
week program)
c. Acceptance by providers, patients
i. Doctors referrals and clinical integration, good
resource
ii. Positive reviews, completion of program numbers high,
etc
d. Best curriculum
i. Hands on - Cooking / preparation
ii. Shopping
iii. Nutrition education
iv. FAMILY focused
e. Can be implemented easily
i. Replication
ii.
iii. As seen in Commerce City, Mont Bellow etc similar
outcomes
III. Conclusion
a. Making an argument that points out the unique of the
opportunity, scarcity of the opportunity, doesnt come
knocking everyday, (what are competitors doing in other
states?) There are programs that are funed in other states..
Staying on trend staying current and cutting edge ofc are.
Childhood obesity is a major problem
b. Preventative healthcare is the way of the future
c. The HeLP is the best program available and benefits everyone
d. Strong closing statement
References

1. About Child & Teen BMI. (2015, May 15). Retrieved November 16,

2015, from

http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/a

bout_childrens_bmi.html

2. Cason-Wikerson, R., Goldberg, S., Albright, K., Allison, M., &

Haemer, M. (2015). Factors Influencing Healhty Lifestyle

Changes: A Qualitative Look at Low-Income Families Engaged in

Treatment for Overweight Children. CHILDHOOD OBESTITY, 11(2).

doi:10.1089/ehi.2014.0147

3. Childhood Obesity Facts. (2015, August 27). Retrieved October

28, 2015, from http://www.cdc.gov/

healthyschools/obesity/facts.htm

4. Clinical Summary. (2010, January 18). Retrieved November 7,

2015, from

http://www.uspreventiveservicestaskforce.org/Page/Document/Cli

nicalSummaryFinal/obesity-in-children-and-adolescents-screening
5. Combatting Childhood Obesity. (2015, October 21). Retrieved

November 16, 2015, from

http://www.cdc.gov/features/preventchildhoodobesity/

6. Finkelstein, E., Graham, W., & Malhotra, R. (2014). Lifetime Direct

Medical Costs of Childhood Obesity. Pediatrics, 5, 854-862.

doi:10.1542/peds.2014-0063

7. Grady, D. (2012, April 29). Obesity-Linked Diabetes in Children

Resists Treatment. Retrieved October 28, 2015, from

http://www.nytimes.com/2012/04/30/health/research/obesity-

and-type-2-diabetes-cases-take-toll-on-children.html?_r=0

8. Haemer MA, Ranade D, Baron AE, Krebs NF. A clinical model of

obesity treatment is more effective in preschoolers and Spanish

speaking families. Obesity (Silver Spring). 2013;21(5):1004-1012.

9. Implementation Guide for Expert Committee Recommendations

on the Assessment, Prevention and Treatment of Child and

Adolescent Overweight and Obesity. (2007, June 6). Retrieved

November 16, 2015, from

http://obesity.nichq.org/resources/expert committee

recommendation implementation guide

10. Kitzmann KM, Dalton WT, 3rd, Stanley CM, et al. Lifestyle

interventions for youth who are overweight: a meta-analytic

review. Health Psychol. 2010;29(1):91-101.

11. Nyberg, K., Ramirez, A., & Gallion, K. (2011, December 1).

Addressing Nutrition, Overweight and Obesity Among Latino

Youth. Retrieved November 17, 2015, from https://salud-

america.org/sites/saludamerica/files/NutritonBrief.pdf

12. Obesity Rates & Trends. (2015, September 1). Retrieved

October 28, 2015, from http://stateofobesity.org/rates/

13. Perrin, E., Finkle, J., & Benjamin, J. (2009, June 8). Obesity

prevention and the primary care pediatricians office. Retrieved

November 7, 2015, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692353/

14. Shi, L., & Singh, D. (2015). Health Services for Special

Populations. In Delivering health care in America: A Systems

Approach (6th ed.). Boston: Jones and Bartlett.

15. Statistics About Diabetes. (2015, May 18). Retrieved

October 28, 2015, from http://www.diabetes.org/diabetes-

basics/statistics/?referrer=https://www.google.com/

16. Tanda, R., & Salsberry, P. (2014). The Impact of the 2007

Expert Committee Recommendations on Childhood Obesity

Preventive Care in Primary Care Settings in the United States.

Retrieved November 7, 2015, from

http://www.medscape.com/viewarticle/824187

17. Taveras EM, Gortmaker SL, Mitchell KF, et al. Parental

perceptions of overweight counseling in primary care: the roles

of race/ethnicity and parent overweight. Obesity (Silver Spring).

2008;16(8):17941801.

18. Trasande, L., & Chatterjee, S. (2009). The Impact of Obesity

on Health Service Utilization and Costs in Childhood. Obesity,

17(9), 1749-1754. doi:10.1038/oby.2009.67

19. Turer, C., Montao, S., Lin, H., Hoang, K., & Flores, G.

(2014, November 1). Pediatricians Communication About Weight

With Overweight Latino Children and Their Parents. Retrieved

November 17, 2015, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210795/
 20. Wald AB, Uli NK. Pharmacotherapy in pediatric obesity:

current agents and future directions. Rev Endocr Metab Disord.

2009;10(3):205-214.

21. Weiner JP, Goodwin SM, Chang HY, et al. Impact of bariatric

surgery on health care costs of obese persons: a 6-year follow-up

of surgical and comparison cohorts using health plan data. JAMA

Surg. 2013;148(6):555-562.

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obesity. (n.d.). Retrieved October 28, 2015, from

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Social Cost is minimized!

minimize cost for chidcare

travel costs are minimized because we localized the program really

the only social coast is travel.

afterhours minimizing the loss of work costs.

Not having to feed their families is a huge benefit.

How to contract ourselves

- What else has been published about cost effectiveness on

programs, and our program compares pretty fariliby compared to

tother studies.

1. Contract of business as uksual in hospiteal vs. interentions in

communitu
a. Chaper
b. More efficient
c. More families comes
i. HAS TO HAVE High Attandance
ii. Evidence based programing that is cultureally

effective
iii. Results on livestyel changes.
1. Shopping with grocery list?
2. Running out of food less?
3. BMI
4. Supported by process data.
5. Changes they way famlilies cook togheter eat

togeterhphysical fitness,
6. Quality of life includes.
 iv. NOT JJUST THE Numbers, there are so man y more

benefits,
v. Kids feel better about themselves.
vi. Analyzing hard vs. soft outcomes
2. Create a map of the insurance values. Which vaues are you as an

insurance company value most!

a. Stakeholders interest, protecting health, lower cost, whats

the motivation? What drives your decision-making?

b. What are the external sources for which you make decions?
i. Squeezed by ACA? Have to provide more benefits,

Have to cover kids until 26. Feeling taxed?

ii. What is their financial status?

Look at CMS.com Applied to the federal government to run an

innovation model. Colorado is a new state to got a grant Search

Colorado State Innovation Model? Colorado SIM. Link to 70 pg grant! To

implement pay for performance programs. Maybe look a the list of

measures.

Obestity, tabacco, ashtly, cancer screening, vascular idease,

depression, etc. these are all chronic condiditons. Wanting to integrate

public health for primary care. . Training PR