Weighty issue; Two new info packets address childhood obesity

Intelligencer Journal Lancaster, PA October 21, 2004 | Susan Lindt It’s just a couple pounds of baby fat. What can it hurt?

Plenty.

If you haven’t already gotten that message from the media blitz on childhood obesity, local health care providers are driving it home again on two fronts – at your doctor’s office and at your children’s school.

The Centers for Disease Control and Prevention reports 64 percent of American adults are overweight, and 30 percent are obese. And along with that extra weight comes all the ailments obesity brings.

Nationally, 16 percent of children between ages 6 and 19 are overweight, an increase of more than 10 percent from just a decade ago.

When Highmark Blue Shield looked at the children it covers in central Pennsylvania and the Lehigh Valley, the figures were more dire, with 32 percent overweight.

And for a health insurance company, the bottom line is the bottom line. If those children remain overweight into adulthood, it will cost considerably more to keep them healthy.

“(Obesity/overweight) is probably in the top five major problems we face as insurers,” said Dr. Brent O’Connell of Highmark Blue Shield. “Every system in the body is involved with obesity: cardiac, musculoskeletal, vascular. You’re dealing with people’s joints being replaced, cardiac disease, just about everything.” Despite the national trend, many doctors aren’t addressing the obesity problem with patients. In April, the CDC reported only 40 percent of physicians told obese patients to lose weight in 2000, a decrease from 1994, when 42.5 percent of doctors raised the issue with patients.

But it’s worth a doctor’s time to mention it. Patients who were advised to lose weight were nearly three times more likely to drop excess pounds than those who didn’t discuss weight with their doctor, according to the CDC report.

“(Doctors) should recognize that obesity, similar to hypertension and diabetes, is a chronic condition and, as such, requires continued follow-up,” CDC researcher Dr. Omer Abid said. “We need to investigate why advice from the health care profession is low.” In 1998, federal guidelines urged physicians to discuss weight with patients because obesity leads to major ailments, including diabetes, stroke, high blood pressure, heart disease and some cancers. The CDC reported some physicians don’t feel they have the formal training to advise patients about weight loss and nutrition.

“I wish I could say with a straight face that they know all this stuff,” O’Connell said. “You would expect that. But with all the new technology and prescription drugs coming on the market, most of them are not up to date on nutrition and new treatments.” Highmark Blue Shield hopes to fill the gap in its participating physicians’ nutrition know-how and cut into childhood obesity figures with a packet it sent to more than 2,000 doctors in central Pennsylvania and Lehigh Valley.

“The way you take care of a problem like this is to educate the people who will be your customers down the road,” said O’Connell, who was a pediatrician for 20 years before joining Highmark. “If we can get kids to understand the importance of not being obese, it will pay off for us in the long run by having reduced numbers of obese patients with fewer complications down the road.” The physicians’ packet includes guidelines for treatment, prevention and self-help materials, a resource list, body mass index growth charts for boys and girls and a BMI calculator that uses height and weight measurements to determine if a child is proportionate, overweight or obese. here highmark blue shield

“(The packet) is a reminder to physicians of what they should be doing and how to do it,” O’Connell said.

The packets also include three versions of a poster physicians can hang showing a child at a healthy weight and the same child who appears slightly chubbier. Under each photo are the child’s statistics showing how a mere 6 pounds can dramatically change where he or she falls on the BMI scale and his or her risk for obesity- related illnesses.

Meanwhile, at Lancaster General, a similar packet is being developed for school nurses, who are mandated by the state Department of Health to record students’ BMI and send home results to their parents. While the American Academy of Pediatrics recommends all children’s BMI be measured yearly, some school and health officials worried how the information would be received by parents who may not understand BMI.

“At face value, I think (the packets) are a good thing, with obesity on the rise,” Conestoga Valley High School nurse Nancy Lopez said. “But just giving people information is not enough.” Lancaster General’s packet explains BMI, nutrition and lifestyle choices to parents and offers direction in curbing potential weight problems in their children.

“Our hope is that schools send our packet home to parents a week before the BMI results are sent home so parents have time to read the information,” said Alice Yoder, Lancaster General’s director of community health. “We’re also offering a free lecture series to schools about about BMI, the importance of physical activity, making healthy food choices and positive parenting. We’ll even offer parents a brief consultation after the program about what to do.” The Lancaster General packet uses principles from Shapedown, a weight-management program with a 20-plus-year track record for slimming down families by teaching nutrition, exercise and lifestyle modification.

Lancaster General started holding 10-week Shapedown classes more than a year ago, and the results have been so impressive, Highmark offered scholarships to help parents with the $350 cost. Lancaster General also successfully lobbied health insurance companies to reimburse families for the classes.

“The educational piece is so integral,” said registered nurse Rosemary Search of Lancaster General’s Education & Wellness Center. “That’s hard to measure sometimes, but you can see the results long term.” Getting back to basics could save lives and the nation’s health care system, which is suffering under the weight of obesity-related costs totaling $117 billion annually, according to Secretary of Health and Human Services Tommy Thompson. go to web site highmark blue shield

“We need to find effective interventions to deal with this on multiple levels &tstr; the schools, at home, in the workplace – because clearly this is a major driver in terms of growth in health care spending,” said Kenneth Thorpe of Emory University, which conducted a 15-year study showing treatment of obese patients costs 37 percent more than treating those in normal weight ranges. The difference costs the health care system an extra $301 per person.

Insurers are beginning to step up prevention efforts, which prove less costly than treating obesity-related conditions.

In July, the Centers for Medicare & Medicaid Services, which runs the health program for elderly and disabled Americans, changed policy and paved the way for millions of overweight Americans to make medical claims for obesity treatment. Many private health insurers are expected to follow suit, and North Carolina’s largest health insurance company already has.

Blue Cross and Blue Shield of North Carolina announced this week the most comprehensive package ever offered to prevent and treat overweight and obesity. The company already covers weight-loss surgery, but now it also pays for four annual doctor visits specifically to assess a patient’s weight and provide treatment, nutritional counseling sessions with dietitians and two prescription diet drugs for those who already are overweight.

For more information about Lancaster General’s ongoing Shapedown programs for children between 5 and 17, including scholarship applications, call 544-3145.

Susan Lindt