Up-to-date disease management news and analysis

Disease Management Update
Volume IV, No. 20
September 6, 2007

Dear Healthcare Intelligence Network Client,

Obesity is a growing problem in our nation among many adults, teens and even children. As kids across the country are gearing up to head back to school this week, the Disease Management Update looks at two programs that are contributing to good eating habits in teens and young adults that can combat this obesity epidemic. How is your state faring in the obesity wars? Visit HIN's blog to read the results of the annual report from the Trust for America's Health.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. Nipping Obesity and Eating Disorders in the Bud
  2. Disease Management Q&A: The Impact of Obesity Initiatives
  3. HealthSounds Podcast: Get Coached to Your "Best Self"
  4. Family Ties Impact Quality of Diet and Meal Patterns
  5. Waging War on Cost of Chronic Disease

1. Nipping Obesity and Eating Disorders in the Bud

A study performed by researchers at the Harvard School of Public Health (HSPH) that set out to determine if an obesity prevention program could reduce the risk of eating disorder symptoms and harmful weight-control behaviors in adolescents showed that almost 4 percent of middle-school girls receiving only their regular health education began vomiting or abusing laxatives or diet pills, but just 1 percent of the girls in the prevention program did so. The results showed no effect of the program on middle-school boys.

"We are very encouraged by the results," said S. Bryn Austin, assistant professor at HSPH and a researcher at Children's Hospital in Boston. "We are hopeful that carefully designed health promotion programs like this one may help us prevent both eating disorders and overweight at the same time. The protective effect that we found was strong and held up under two rigorously designed studies," she said.

The program, called 5-2-1-Go! (eat 5 servings of fruits and vegetables daily, limit TV time to no more than 2 hours a day, and get at least 1 hour of physical activity daily), emphasizes eating a balanced diet, staying physically active and reducing the amount of time spent watching television. Researchers studied 1,451 sixth- and seventh-graders (749 girls, 702 boys) in 13 middle schools in Massachusetts between 2002 and 2004. Six schools used the 5-2-1-Go! curriculum and seven utilized just their regular health education. The results showed a two-thirds reduction in risk of adopting disordered weight control behaviors among girls in the 5-2-1-Go! program.

To learn more about the findings of this study, please visit:

2. Disease Management Q&A: The Impact of Obesity Initiatives

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Barbara Moore, Ph.D., president and CEO of Shape Up America!

Question: What kind of programs would have the greatest impact for childhood obesity problems? If you could only do one or two initiatives, what would you start with?

Response: (Barbara Moore) I would start with parenting skill building. This process should begin prior to conception. You should be counseling parents who are trying to conceive. You should also counsel pregnant women because there’s some evidence that they are more open to suggestions and behavioral lifestyle changes while they are pregnant and anticipating the birth of the new baby. There’s evidence that the pregnancy to pre-school period is a critical period for what we call self-regulation.

There are also studies regarding the ability of a child to regulate his or her own intake. When you place a large plate of food in front of a three-year-old, that three-year-old will not overeat. But if you do the same thing to a five-year-old, that five-year-old will overeat. That suggests that some of the neurological structures that are developing in children that relate to appetite and the regulation of energy balance are being shaped during this period between the ages of three and five. There are also very good interventions that have shown that vigorous physical activity---after-school programs where the kids have their heart rates up for as much as 90 accumulated minutes---have a powerful beneficial impact on body fat in teenagers as well as in preteens.

Children are not as turned off to vigorous physical activity as adults are. They aren’t afraid of the word “exercise” the way adults are. There are data supporting the value of vigorous activity for the regulation of energy balance. Exercising and healthy eating go hand in hand. There is evidence that if you get kids to exercise vigorously and do not pay attention to their nutritional status you can actually cause a decrease in bone mineral density of these children. This study showed that if children were consuming fewer than 800 milligrams of calcium a day in their diet, they would experience a decrease in bone mineral density with exercise. The subjects who were getting enough calcium from milk and milk products experienced an increased bone mineral density with increasing levels of vigorous activity. Any program that would emphasize one over the other is making a mistake.

To learn more about obesity control initiatives and impacts, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Get Coached to Your "Best Self"

This week's Disease Management podcast features a live coaching demo by "Coach Meg" (Wellcoaches CEO Margaret Moore). Moore helps volunteer client "Kathy Smith" (not her real name) identify life issues that are keeping her from being her "best self" in managing her thyroid condition and weight issues. You'll hear how Coach Meg builds positive psychology into this real-life health coaching session, which was conducted as part of "Teaching Health Coaches to Integrate Positive Psychology with Physical Health to Improve Disease Management Outcomes" an audio conference now available on CD-ROM or via an On Demand re-broadcast on the Web.

To listen to this complimentary HIN podcast, please visit:

4. Family Ties Impact Quality of Diet and Meal Patterns

Research at the University of Minnesota (U of M) finds that participation in family meals during the high school years has lasting positive effects on the diets of young adults. The frequency of family meals during adolescence predicted higher intakes of fruit, vegetables and key nutrients, as well as lower intakes of soft drinks during young adulthood.

Researchers analyzed the survey responses and dietary questionnaires of 1,700 young people in Minnesota high schools from 1998-1999, and again by mail in 2003-2004 as part of a Project EAT (Eating Among Teens) initiative. Young adults who reported having seven or more family meals per week as teens ate nearly one additional serving of fruits and vegetables per day in young adulthood than those who reported never eating family meals. Frequent family meals during high school also predicted that the teens, as young adults, would eat breakfast and dinner meals more frequently, as well as a place a high priority on meal structure and social eating.

The study concludes that family meals likely represent an important opportunity for teens to be exposed to healthful food choices and for parents to model healthy eating behaviors. “The longitudinal findings from this study add to the body of evidence from other Project EAT analyses, which have shown that family meals are cross-sectionally associated with a number of positive outcomes including improved dietary intake, fewer disordered eating behaviors, less substance use and higher grades in school," notes Dianne Neumark-Sztainer, Ph.D., principal investigator of the Project EAT study.

To see more of this survey's results, please visit:

5. Waging War on Cost of Chronic Disease

This week’s featured white paper discusses the prevalence of chronic diseases, points out key elements necessary in a successful disease management program and outlines the Beyond Disease Management program. It also highlights outcomes experienced by American Health clients, including drastic reductions in members’ overall ED visits, hospitalizations and absenteeism and disease-specific clinical outcomes.

To download this complimentary white paper, please visit:

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