Obesity and Opportunities for Education

Sandeep K. Gupta MDAssociate Professor of Clinical Pediatrics,

Division of Pediatric GastroenterologyRiley Hospital for Children,

Indiana University School of Medicine,Indianapolis, IN 46202

sgupta@iupui.edu

No conflicts of interest with this presentation

Introduction

• Obesity has taken epidemic proportions

• Development of effective prevention and intervention models is a public health priority

• Containment requires multi-pronged strategy due to complex etiological factors and multitude of stake-holders

• Stakeholders include: families, schools, universities, health care-providers and payors, health department, local government, employer, media, food industry etc

Obesity Education

• Education in obesity can be an effective tool

• Education in obesity is actually a required tool

• Includes education of various components– Patient/family– Health-care provider – physician, nurse practitioner,

nurse, resdients, students– Society/Environment: schools, food industry, payors,

marketing/media, policy-makers

Longjohn MM. Ped Annals 2004;33:55-63

Patient Education

• Includes – Understanding the condition and underlying reasons– Recognizing the detriments to health– Knowledge of interventions

Patient Education: Nutrition

• Popular drinks are caloric-dense:

Soda 12 oz =120 calories

Juice 16 oz = 220 calories

• Big Mac 590 calories

Large Fries 540 calories

Large Drink 410 calories

Adds up to 1540 calories !!!

(and this is not Super-size!)(and this is not Super-size!)

(Newman C. National Geographic 2004;Aug:46-61)

Health-Care Provider Education

• Includes – Understanding the condition and etiology– Recognizing co-morbidities– Knowledge of interventions

• From Basics to Esoteric

• ?easiest piece of puzzle

Body Mass Index (BMI)

BMI = kg/m2

BMI adult: 20-25 kg/m2 Normal

25-29 kg/m2 Overweight

> 30 kg/m2 Obese

Obese I 30-34.9

Obese II 35-39.9

Extreme obese > 40

Super obese > 50

Mega obese >70

Pediatric BMI interpretation

Complications

• Liver Disease:

-Non-alcoholic fatty liver disease (NAFLD)

-Non-alcoholic steatohepatitis (NASH)

• Metabolic Syndrome

• Endocrine issues– Type 2 diabetes– Lipid dysmetabolism

Society Education

• Schools

• Health and Education Departments

• Social Services – WIC program

• Food Industry

• Payors

• Media/Marketing

• A picture is worth a thousand words…….

(Skinner JD, et al. Am Dietetic Association 2004)

37

29

(Newman C. National Geographic 2004;Aug:46-61)

Some Examples

• McDonald’s Garden salad 100 calories

Ranch Dressing (1 pkt) 170 calories!!!

• Cheesecake Factory Carrot Cake 1560 calories/1 slice

• Fat-free or sugar-free does not equate calorie-free

1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2006

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2006

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

• The obesity epidemic has been linked to unprecedented outbreak of what disease among young people?

A. Psoriasis

B. Type 2 Diabetes

C. Type 3 Diabetes

D. Mad Cow Disease

• The obesity epidemic has been linked to unprecedented outbreak of what disease among young people?

A. Psoriasis

B. Type 2 Diabetes

C. Type 3 Diabetes

D. Mad Cow Disease

How can we effectively deliver the message?

• Education at all levels

Health-Care Providers

• Educate the health-care provider

• Enpower to evaluate and educate the family

• Bullet messages: e.g be able to identify the problem – do BMI

• Lectures, seminars, audio-conferences, mailings

52%They were already aware of the Local Wellness Policy Mandate

56%They will participate in the drafting/implementing of the Local Wellness Policy in their school program

86%They would use knowledge gained to educate others on obesity

97%They would apply the information learned to their clinical practice

97%The program met their personal expectations and needs

100%The presenter and presentation demonstrated independence, objectivity, balance and scientific rigor

100%The speaker communicated clearly and effectively

100%The format was effective and convenient

100%The program was up to date

100%The program was of appropriate level

100%The program met its stated objectives

100%Obesity is a major health problem and physicians can empower others to tackle the program

% Respondents who Agreed or

Strongly AgreedCriteria

52%They were already aware of the Local Wellness Policy Mandate

56%They will participate in the drafting/implementing of the Local Wellness Policy in their school program

86%They would use knowledge gained to educate others on obesity

97%They would apply the information learned to their clinical practice

97%The program met their personal expectations and needs

100%The presenter and presentation demonstrated independence, objectivity, balance and scientific rigor

100%The speaker communicated clearly and effectively

100%The format was effective and convenient

100%The program was up to date

100%The program was of appropriate level

100%The program met its stated objectives

100%Obesity is a major health problem and physicians can empower others to tackle the program

% Respondents who Agreed or

Strongly AgreedCriteria

Immediate Response

Conclusions from CPOA

• The overall impression of CPOA was extremely positive and prompted changes in healthcare practice by nearly two-thirds of respondents

• Helped narrow the knowledge gap of healthcare providers in Indiana local communities

• Audio-conferences with distribution of presentation slides for subsequent use by attendees can be an effective tool to prompt awareness and action by healthcare providers in rural communities

Patients/Families

• Illustrate problem objectively – e.g. plot BMI

• Provide programs/support services

• Take every opportunity to educate

Health Promotions Learn and Live Well

CTK Program – School Based

• Fitness and nutrition program to teach practical ways to implement long-term healthy lifestyle changes

• 14 hour program; flexible to meet a school schedule

• 3 components to each lesson; can be split through the day– Nutrition– Behavior management– Physical Activity

• All lessons tied to state educational standards in Health, Physical Education, Science, Reading, Writing and Math

• Optional grading assignments available for each lesson as is option to use these assignments as homework if teacher wishes

Preliminary Results/Lessons

• Complete data available on 29/162 high school and 63/126 elementary school students

• The elementary group, but not high school group, as a whole decreased their BMI – highlights import of early intervention

• Ability to meld into regular curriculum a huge plus

• Cost of program: about $20/participant

CTK Program - Family

• 10 week long program – one hour session each week for 10 weeks

• Evening sessions – parent and child attend

• Addresses Nutrition Education, Behavior Management, and Physical Activity

Web-based Education

• SAIL (Stay Active In Life) program

• Web-based program for patients and families

• General and Disease-specific components

• http://rileychildrenshospital.com/parents-and-patients/programs-and-services/sail/index.jsp

Health Promotions

Learn and Live Well

Fight the Fat

• Educates and gives adults the tools to live active and healthy lifestyles

• Along with teaching Nutrition and Fitness, it places emphasis on Behavior Management such as Stress Management, Goal setting, Diet Diaries, Exercise Logs, Journaling and Overcoming barriers

• 1 hour per week for 8 sessions

Payors

• Various Agencies lobbying as services are not being reimbursed

• Care involves Physicians, Nurses, Dietitians, Social Workers, Physical Therapists, Exercise Physiologists, Others

• Lack of specific ICD-9 codes and nuances e.g. ICD-9 783.1 (excessive weight gain) may pay better than 278.0 (obesity)

• Effective educational tool would include associated co-morbidities and health-care costs

Schools

• Many opportunities but not primary responsibility

• Effective tools include the Local Wellness Policy (Public Law 108-265)

Legislator/Policy Makers

• Vending machines in schools

• Juices by WIC program

• Mandating physical education in schools

• Effective tools: beverage intake slide, decreasing physical education slide, CDC slides

Food Industry, Media

• Very important to bringing these on board

• Effective tools: serving sizes slide, hidden calories (dressings), minimizing children advertisement blitzes

So, where does the Buck stop?

• Ultimately patient/family is responsible, but…

• We need to provide a conducive environment

• We have come a long way – from thinking that there is a medical reason to most obesity (leptin deficiency)…..

Nature 1994

So, where does the Buck stop?

• Ultimately patient/family will be responsible• We need to provide a conducive environment• We have come a long way – from thinking that there is a medical

reason to most obesity (leptin deficiency) to recognizing that it is a societal and environmental problem that can not be solved during a 30 minute visit to the physician but rather by addressing the various components