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February 25, 2010 Volume VI, No. 39

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In response to first lady Michelle Obama's efforts to fight childhood obesity in America, this issue of the DM Update is focused on this epidemic. You will learn whether increased rates of obesity and other chronic conditions in children will improve over time and when efforts to prevent obesity among children should in fact begin.

Also provided in this issue is information about the Partnership for a Healthier America, a new initiative with a goal of solving childhood obesity within a generation.


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

This week's DM news:

Table of Contents

  1. Obesity Rates Rise in Children
  2. Childhood Obesity Tipping Point
  3. Integrating Health Coaching into Primary Care
  4. Resisting Dieting Messages
  5. Healthcare Trends: Obesity & Weight Management
  6. "Let's Move" to Target Childhood Obesity
  7. Health & Wellness Incentives Use

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Please send comments, questions and replies to jpapay@hin.com.

Publisher:
Melanie Matthews, mmatthews@hin.com

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Obesity, Other Chronic Health Problems in American Children: Here to Stay?

A new study confirms that rates of obesity and other chronic health problems have risen in American children in recent years, but it also shows that many children's conditions will improve or resolve over time. The findings that appear in the February 17 Journal of the American Medical Association support the need for continuous access to health services and suggest directions for future research. Chronic health conditions — such as asthma, diabetes or ADHD — are conditions that require long-term treatment or interfere with a child's ability to perform the typical activities of children of the same age. Previous studies of the extent of these conditions in children have always looked at rates at a specific time. The current study was designed to analyze rates of chronic conditions over time and especially whether the incidence was increasing and if conditions persist or resolve over time.

The research team analyzed data collected in annual surveys conducted by the U.S. Bureau of Labor Statistics. Focusing on the children of women who became participants in a larger survey in 1986, the current study analyzed information from three groups of children who were ages 2 through 8 in 1988, in 1994 and in 2000. Every two years, in-home interviews — including height and weight measurement — were conducted with both the children in these three groups and their mothers; and each group was followed for six years. Complete data were compiled for 2,337 children in the first group, 1,759 children in the second and 905 in the third group.

The results showed that the presence of chronic conditions when children entered the study increased from 11 percent in the 1988 group to 16 percent in the 1994 group and 25 percent in the 2000 group. The likelihood of reporting a chronic condition during any part of the study period rose about 10 percent with each subsequent group — from 30 percent in the first group to 50 percent in the third — but conditions persisted until the end of each study period only 40 percent of the time. The authors note that some of the increase in chronic health conditions could be attributed to the fact that children in later groups were born to older mothers, which is known to increase the risk of health problems. While the study did not examine factors underlying the rise in obesity and other conditions, the investigators speculate that involved factors could range from food choices and lifestyle, to the greater survival of children with serious health problems, and the increased likelihood that health problems will be diagnosed.

According to Jeanne Van Cleave, M.D., of the Center for Child and Adolescent Health Policy at MassGeneral Hospital for Children, "the prevalence of these chronic conditions speaks to the continuing need for high quality healthcare, especially primary care, where many of these conditions are diagnosed and treated. What we need to investigate now is why conditions resolve for some children and not for others — the rates of persistence didn't vary according to the type of health condition — and ways to prevent these conditions from developing in the first place."

To learn more about this research, please visit:
http://www.mgh.harvard.edu/about/...

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Is Age Two a Childhood Obesity Tipping Point?

While many adults consider a chubby baby healthy, too many plump infants grow up to be obese teens, saddling them with Type-2 diabetes, elevated cholesterol and high blood pressure, according to an article published this month in the journal Clinical Pediatrics. The research suggests that the "tipping point" in obesity often occurs before two years of age, and sometimes as early as three months, when the child is learning how much and what to eat.

This study comes in the midst of a national initiative to reduce childhood obesity, which now ranks as one of the most prominent health concerns in the United States. While some hospitals have begun offering healthy eating and weight loss programs for children, what hasn't been as clear is how early to intervene. Researchers examined records from a pediatric practice of 111 children whose BMI exceeded 85 percent of the general population. The researchers determined that these children had started gaining weight in infancy at an average rate of .08 excess BMI units per month. On average, this progression began when the children were three months old. Over half the children became overweight at or before age 2 and 90 percent before reaching their fifth birthday.

The Clinical Pediatrics study suggests obesity prevention efforts should begin before age two, when children reach a "tipping point" in a progression that leads to obesity later in life. "Our study suggests that doctors may want to start reviewing the diet of children during early well-child visits," said principal investigator Dr. John Harrington, a pediatrician at Children's Hospital of The King's Daughters and an assistant professor at Eastern Virginia Medical School. "Getting parents and children to change habits that have already taken hold is a monumental challenge fraught with roadblocks and disappointments. This study indicates that we may need to discuss inappropriate weight gain early in infancy to affect meaningful changes in the current trend of obesity."

To learn more about this research, please visit:
http://www.chkd.org/About/PressReleases/Read.aspx?news=2573

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Integrating Health Coaching into Primary Care

In this podcast, Margaret Moore, CEO of Wellcoaches Corporation, discusses how a physician's health choices and behaviors can influence a patient's compliance with health coaching, the role of a medical fitness coach in primary care, and the impact of positive psychology on health coaching.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/2008Podcasts/podcast_2008.htm#57

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Resisting Dieting Messages

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Peggy Crum, registered dietician and nutrition consultant in Michigan State University's Health4U program.

Question: How do certain dieting messages affect obese or overweight patients?

Response: I write a publication called Nutrition Matters E-Message, in which I report and interpret a current study on a diet-related trend. One recent topic addressed the oft-touted suggestion to use a smaller dish as a strategy to eat smaller portions. The message to use a smaller plate is not helpful. We don't need to use gimmicks to trick ourselves into eating less. These messages distract you from what your body is telling you. Your body can tell you what and how much to eat. In addition, I think that schools' well-intentioned attempts at restricting unhealthy foods are setting children up for disordered eating. It is ill-advised for schools to tell parents what kids can and cannot take to school. I have no problem with taking soda machines out of schools; they never belonged there in the first place. But to set arbitrary rules — telling a child that they cannot have a cookie — is contributing to the good food-bad food dilemma. Rather than criticize the family, school officials need to recognize and support the power of the family in influencing nutrition. There are many benefits to having family meals, including increased nutrient intake. Treatments for obesity have become more drastic and expensive, yet the population is getting heavier and heavier. At some point, we must recognize that current treatments are not working, and recognize that many accepted dieting interventions and messages are in fact leading to people becoming fatter.

For more benchmarks on obesity and weight management, please visit:
http://store.hin.com/product.asp?itemid=3893

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

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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 millions of obese and overweight Americans. In an August 2008 e-survey, nearly 300 healthcare professionals told the Healthcare Intelligence Network (HIN) how they are managing and working to prevent this growing problem.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerobmgmt.html

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New Foundation Targets Childhood Obesity

The "Partnership for a Healthier America" foundation aims to support the national goal to solve the childhood obesity challenge within a generation that has been set by first lady Michelle Obama, who will also serve as its honorary chair. The partnership will bring together the public and private sectors, business and thought leaders, the media, and states and local communities to make meaningful and measurable commitments to fighting childhood obesity.

The nationwide initiative seeks to solve the challenge of childhood obesity, so that America's youngest children reach adulthood at a healthy weight. The plan offers four pillars:

  • Offering parents the tools and information they need to make healthy choices for their kids.
  • Getting healthier food into our nation's schools.
  • Ensuring that all families have access to healthy, affordable food in their communities.
  • Increasing opportunities for kids to be physically active, both in and out of school.
The partnership will support these pillars through a campaign to unite and inspire families across the country to take real and sustained actions to eat better, be more active and make a commitment to embrace healthier lifestyles. The partnership will develop a strong network of members across public and private sectors who will commit to accelerating efforts to address childhood obesity toward the first lady's national target of solving childhood obesity within a generation. In addition, the organization will objectively track and report performance of members to hold them accountable. It will not conduct programmatic activities, engage in grassroots organizing or lobbying, or compete with existing foundations.

The nonpartisan organization was created by a number of leading foundations and nonprofits, including The California Endowment, Kaiser Permanente, Nemours, the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation and the Alliance for a Healthier Generation. In the week since the program was announced, the USDA, the US Surgeon General and the U.S. Secretary of Education have pledged their support of the Let's Move! campaign via posts on the Let's Move! blog.

To learn more about the Partnership for a Healthier America foundation, please visit:
http://www.ahealthieramerica.org/about-the-foundation/...

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Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate, both as a response to escalating healthcare costs and a shift of more health ownership to consumers. Join the more than 130 organizations that have already described how they use incentives to promote health and wellness. Complete HIN's second annual Survey of the Month on this topic by February 28, 2010. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/incentives

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