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January 21, 2010 Volume VI, No. 34

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to a study published this month in JAMA, progress has been made in reducing the rate of obesity in the U.S. In this week's issue, you'll learn about another recommendation for reducing obesity rates from researchers in Oregon. Also, discover whether or not obesity is a bigger threat to quality of life than smoking, and some encouraging news about obesity rates among young children.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Obesity, Smoking & Quality of Life
  2. Declining Obesity Rates Among Youth
  3. Finding Success in Health Behavior Change
  4. Improving Health Program Participation
  5. Healthcare Trends: Obesity & Weight Management
  6. Parks, Recreation & Obesity
  7. Medication Adherence

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Obesity Out Weighs Smoking As Threat to Quality of Life

As the US population becomes increasingly obese while smoking rates continue to decline, obesity has become an equal, if not greater, contributor to the burden of disease and shortening of healthy life in comparison to smoking. In an article published in the February 2010 issue of the "American Journal of Preventive Medicine," researchers from Columbia University and The City College of New York calculate that the Quality-Adjusted Life Years (QALYs) lost due to obesity is now equal to, if not greater than, those lost due to smoking, both modifiable risk factors.

The 1993–2008 Behavioral Risk Factor Surveillance System (BRFSS), the largest ongoing state-based health survey of US adults, has conducted interviews of more than 3,500,000 individuals; annual interviews started with 102,263 in 1993 and culminated with 406,749 in 2008. This survey includes a set of questions that measures HRQOL, asking about recent poor health days and tracking overall physical and mental health of the population. The authors analyzed these data and converted the measures to QALYs lost due to smoking and obesity.

From 1993 to 2008, when the proportion of smokers among US adults declined 18.5 percent, smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. During the same period, the proportion of obese people increased 85 percent and this resulted in 0.0464 QALYs lost. Smoking had a bigger impact on deaths while obesity had a bigger impact on illness.

To learn more about this research, please visit:

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Study Shows Striking Decline in Obesity Rates Among U.S. Youth

New data from the National Health and Nutrition Examination Survey (NHANES) show that the efforts of parents, communities, schools, governments and business leaders are beginning to make a difference. According to the data, the prevalence of obesity and overweight among children and adolescents in the U.S. declined slightly since the 2003-2006 NHANES study period. Overall, the percentage of children who are obese or overweight dropped in 2007-2008 to 31.7 from 31.9 in 2003-2006. The Robert Wood Johnson Foundation defines “obese or overweight” as body mass index (BMI) at or above the 85th percentile on CDC growth charts.

The data show a striking decline in obesity rates (BMI greater than or equal to 95th percentile) among children ages 2 to 5. Obesity prevalence among that age group declined to 10.4 percent in 2007-2008 from 12.4 percent in 2003-2006. This means that, among children ages 2 to 5, the nation returned to obesity rates it last saw in 1999-2000. Because obese children are at higher risk for growing into obese teens and obese adults, this decline is a positive indicator for the future. The data also show a troubling lack of progress in eliminating racial and ethnic disparities. Obesity and overweight prevalence is 8.9 percentage points higher among Hispanic children ages 2 to 19 than among non-Hispanic whites. Among non-Hispanic black children, it is 6.6 percentage points higher.

According to Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, "while the data are encouraging, we cannot allow this progress to lull us into a sense of complacency. Nearly one-third of our children are overweight or obese, placing them at heightened risk for heart disease, type 2 diabetes and a host of other serious diseases. And BMI continues to increase among the heaviest boys ages 6 to 19. We cannot rest until the childhood obesity epidemic is reversed."

To learn more about this research, please visit:

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Finding Success in Health Behavior Change

A move backward in readiness to change should not be perceived as a failure on the client's part but rather as an opportunity to readjust behavior goals, observes Kate Larsen, president of Winning LifeStyles, Inc., an ICF-certified professional coach and a WellCoaches® faculty member and mentor coach. There's value in reminding clients that health coaching is a journey and in checking coaching egos at the door to improve listening skills and allow clients to own their behavior change goals, notes the author of "Progress, Not Perfection."

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Ways to Improve Health Program Participation

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Dr. Craig Nelson, M.S., D.C., director of health services research with American Specialty Health; and Dr. Paul Terry, Ph.D., president and CEO of StayWell Health Management.

Question: What are some creative approaches to increasing health promotion program participation?

Response: (Dr. Craig Nelson) The single most important factor is that these coaching programs just don’t drop in from the blue unrelated to anything else that’s going on inside the company. The participation, results and improvement will be a direct function of the buy-in from senior management and from their demonstration of their belief in the effort — not only in terms of the ROI, but in terms of whether this is the right thing to do for their employee population. Anything that communicates that message will be important.

(Dr. Paul Terry) It is not about one thing; no clever idea of the month is going to win the day long-term for programs that we work with. Thankfully, companies are mostly in it for the long-term and mostly interested in a comprehensive ongoing approach. I would liken it to any movement or any other large communications campaign. The trick is not so much the cleverest way to attract attention on any given month, but how you build in continuous and a contiguous set of opportunities and processes if we’re going to use incentives. For example, to get people to a health screening, to a coach or to some other intervention, we better make sure that intervention is knock-down fantastic and that they have a wonderful experience in doing that, so that the next opportunity that comes up is one that they’ll have an even easier time saying yes to. It’s more about execution than any particular silver bullet.

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Healthcare Trends & Studies: Obesity & Weight Management — Weighing in on the Growing Epidemic

Increasingly, healthcare organizations are creating initiatives aimed at the 67 million obese and 85 million overweight Americans. In an e-survey, nearly 300 healthcare professionals told the Healthcare Intelligence Network (HIN) how they are managing — and working to prevent — this growing problem.

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Parks and Recreation Programs Declining as Obesity, Health Concerns Rise

One way to help address the epidemic of obesity in the United States is improved access to pleasant hiking trails and an ambitious parks and recreation program, a recent study suggests, but programs such as this are increasingly being reduced in many states due to budget shortfalls. The analysis, conducted by researchers in Oregon, found that some of the health issues that plague overweight and obese people can be aided by a stronger commitment to recreational opportunities. Cutting such programs to save money may be counterproductive to community health, scientists said.

What’s badly needed, the researchers said, are more recreation facilities and non-motorized trails, with information about them made readily available to the public, and more education about the value of physical activity. But even as more findings about these issues are being made, parks and recreation budgets are often under attack.

“The health aspects of outdoor recreational opportunities are poorly appreciated, and often these programs end up getting funded only if there’s money left over after they take care of everything else,” said Randy Rosenberger, an associate professor in the Department of Forest Ecosystems and Society at Oregon State University. “However, Oregon is fairing better than their neighbors due to the allocation of lottery funds to state parks and conservation, renewable in 2014. Washington has cut 49 percent of its state parks budget and may close 40 parks. California was facing a 21 percent cut in its parks budget. Even here in Oregon we have a $39 million backlog in state parks maintenance,” said Rosenberger.

Of some interest, the researchers said, is that the recreational problem is not necessarily a rural-urban divide. Living in a city doesn’t necessarily predict less physical activity. Oregon’s larger metropolitan areas sometimes have recreational opportunities and levels of public physical activity that exceed those of people living in more rural, less populated or coastal counties. The recent study identified 11 of Oregon’s 36 counties as having inadequate levels of current and projected physical activities — Baker, Columbia, Crook, Douglas, Harney, Hood River, Josephine, Morrow, Tillamook, Umatilla and Wallowa County. These areas are considered “at risk” in terms of recreational options and could most benefit from increased opportunities, the scientists said.

To learn more about this research, please visit:

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Medication Adherence

Of 1.8 billion prescriptions dispensed annually in the U.S., only 50 percent are taken correctly by the patient, according to the World Health Organization. Beyond increasing risk of death, poor medication adherence is tied to as much as $290 billion annually in increased medical costs and responsible for 33 to 69 percent of all medication-related hospital admissions in the U.S., at a cost of about $100 billion per year. Join the more than 65 companies that have already shared their organization's efforts to improve medication adherence by completing HIN's Survey of the Month by January 31, 2010. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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