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Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
REDUCING CHILDHOOD OBESITY:
Public Policy AndBroad-Based Strategies
Philip M. Bonaparte, MD
Chief Medical Officer
Horizon NJ Health
March 31, 2007
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Definitions• Obesity
– High amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher
• Overweight – Body Mass Index between 25 and 29
• Children Overweight – BMI is > 95th percentile according to the age and
gender
* Source: CDC, 2005
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
BMI • Measure of a person’s weight in relation to
height
• Adults and children – Weight in kilograms divided by the square of
his or her height in meters.
* Source: CDC, 2005
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
National Center For Health Statistics
• Children – 16% of children and teens (over 9 million) aged
6-19 years are considered overweight
• Adults – 65% overweight or obese – 30% of U. S. adults 20 years of age or older (60
million) are obese
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
NJ Behavioral Risk Factor Surveillance System
Percent
Overweight Obese
Overall 36.717.7
Gender
Males 47.818.2
Females 26.5 17.2
Race/ethnicity
White, non-Hispanic 35.7 17.0
Black, non-Hispanic 42.5 25.0
Hispanic 38.3 19.5*Source: NJ Dept. of Health and Human Services
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Kids ROCK Program
• Kids Reaching Out to Create Healthy Kids
• HNJH Pilot Program 5-13 yrs old 3 Physician groups: Husband and wife PCP, North
Hudson Community Action and CamCare Children >85th percentile
• Collaboration between Physician and HNJH Diabetes DM Program
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Kids ROCK Program• Goals- No increase in weight. Make life style
changes
• AAP Policy Statement
• CDC guidelines: BMI
• Outcomes Measures- Life Style Survey. BMI changes
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Kids ROCK Program
Member education materials – How to Read a Food Label– Portion Control visual scale of What is a
Portion (uses palm of hand, thumb, fist)– TV Zombies and Soda Monsters– Member incentives include: jump ropes,
frisbees, H2O bottle, pedometer
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Kids ROCK Program
Physician Support :• Reinforcement of physician education
• Encourage members to keep visits
• Link members to community resources including mental health, family counseling, nutritional education
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Kids ROCK Program
• Over 108 children registered
• Majority of children did not keep follow up appointments (about 90%)
• Incorporated, “Dancing To Your health”
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Energy Imbalance
• Weight gain– Calories consumed > Calories used
• Weight loss– Calories consumed < Calories used
• No weight change– Calories consumed = Calories used
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Causes
• Poor diet
• Lack of or insufficient physical activity
• Family history
• Poor choices
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Unhealthy Nutrition
• Bigger portion sizes
• More fast foods
• Advertisements – Encourages fast foods– Soft drinks– Sweets – Sugar loaded foods like breakfast cereals
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Unhealthy Nutrition
• Large meal=less cost
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Fast Foods• McDonalds
Calories Fat
– 4 pieces chicken nuggets 210c 13g
– 12 fl. Oz. Coca Cola 110c 0g
– Cheeseburger 330c 14g
– Small French Fries 210c 10g
– Cookies 2 oz bag 230c 8g
– Hot fudge sundae 360c 12g
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Fast Foods
Calories Fat• Cinnabon
– Classic Cinnabon Cinnamon Roll 816 32• Pizza Hut
– 1 slice cheese pan pizza 285 14 – 1 slice cheese thin’n crispy 210 9
• KFC – Drumstick 140 8 – Mash potatoes 120 6– Macaroni & cheese 180 8– Baked beans 190 3
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Age at first visit to McDonald’s, Burger King or Wendy’s
5 and under 6-12 13+ Never ate there
McDonald’s 54% 26% 19% 1%
Burger King 36% 24% 36% 2%
Wendy’s 28% 24% 45% 4%
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Lack Of Physical Activity
• Fewer PA classes at school
• Lack of safe areas
• Television
• Computer
• Video games
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Childhood ObesityChildhood ObesityCauses & EffectsCauses & Effects
Type II Diabetes
SocialIssues
Low Self-EsteemStress On
Joints
ChildhoodObesity
PediatricHypertension
Heart
Disease
Psychological Issues
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
What Changes Are Needed?
• Teach parents and children to read labels
• Warn against the dangers of Trans Fat
• Safer neighborhoods
• Increase PE at school
• PSA campaign on Healthy Lifestyle
• Open dialogue with Fast Food Chain
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Read The Label Start here
Check calories Quick guide to %Daily Value
5% or less is low20% or more is high
Limit these
Get enough of these
Footnote
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
When It’s Time To Eat…
• Offer a variety of foods
• Regular schedule
• Set a good example
• Turn OFF the TV
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Give Them Less…
• Doughnut
• French fries
• Regular chips
• Soda
• Fried chicken nuggets
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Who We Need?
• Parents
• Schools
• Government
• Healthcare
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Increase Physical Activity
• Make it fun!
• 30 minutes at once or 10 minutes at a time
• Start at a moderate level and gradually increase
• Make it a family or friends activity!
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Healthy People 2010
• Reduce the prevalence of children and adolescents (6-19 y/o) who are overweight to 5%
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Obesity - A Global Epidemic
• Worldwide, more than a billion people, 10% of whom are children, are obese or overweight
• It is the sixth most important risk factor in the overall burden of disease
• No coordinated obesity prevention efforts
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Obesity - US
• The US has the highest rate of overweight and obese people
• Set to overtake smoking as the main preventable cause of illness and early death
• Obesity shortens life and increases the risk of developing heart disease and stroke, diabetes, arthritis and certain types of cancer Source: The Lancet Medical Journal
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Risk: Lack of Parental Concern
• Many healthcare providers assume that parents are eager to make changes to help their children lose weight
• Not all parents open to making lifestyle changes even if they could help their overweight children shed pounds– Of 151 parents studied, 44 % of parents were not
planning on making lifestyle changes any time soonSource: Pediatrics, July 2005
Independent licensees of the Blue Cross and Blue Shield Association*
Horizon NJ Health, a product of Horizon HMO*
Risk: Lack of Parental Concern
• Parents more open to change if they viewed themselves as overweight
• Study included mostly African American and Hispanic families seen at a Philadelphia pediatric practice
• The children were between the ages of 2 and 12, and all were either overweight or at risk of becoming so