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NEW Kids ™ Nutrition, Exercise, and Weight Management for Kids. Brian Fidlin, PsyD Program Director of NEW Kids Assistant Professor of Gastroenterology. Obesity is a complex medical, social and psychological phenomenon. Has implications for business, law, health and public policy.

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NEW Kids ™ Nutrition, Exercise, and Weight Management for Kids

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NEW Kids™Nutrition, Exercise, and Weight Management for Kids

Brian Fidlin, PsyD

Program Director of NEW Kids

Assistant Professor of Gastroenterology


  • Obesity is a complex medical, social and psychological phenomenon.

  • Has implications for business, law, health and public policy.

  • Adult obesity affects health insurance, employee productivity, workforce development, public policy, litigation and legal precedent.

  • Pediatric obesity affects school performance, self esteem, medical health, mental health and our nation’s future.


Pediatric ObesityA Growing Problem

  • Since 1970, childhood obesity has almost quadrupled among children aged 6-11 and more than doubled among adolescents aged 12-19.

  • As of 2003-04, 17.1% of children aged 2-19 are clinically overweight

    • This is more than three times greater than the Healthy People 2010 goal of 5%.


Consequences of Pediatric Obesity

  • Pediatric obesity impacts:

    • Physical health

    • Mental health

      • Obese children were found to have a poor quality of life, comparable to that of pediatric chemotherapy patients

    • Medical care costs

    • Mortality

www.obesityhelp.com


Today Obese Children, Tomorrow…

  • Obese youth are likely to become obese adults

    • In a study following children for an average of 17 years, 77% of those who were overweight as children remained obese as adults, compared with 7% who were “normal” weight as children became obese in adulthood.


Costs of Obesity

  • Severe overweight children miss 4x as much school as normal weight kids.

  • Obesity associated annual hospital costs for children increased more than threefold from $35 million during 1979-1981 to $127 million during 1997-1999.

  • National health expenditures related to adult obesity range from $98-129 billion annually.

  • No one can predict what the cost will be in the future with the increased number of medical co-morbidities that we are seeing in our current pediatric population.


Who’s Problem Is It?

Prevention and Treatment of Pediatric Obesity

HEALTHCARE

COMMUNITY

FAMILY

SCHOOL

ENVIRONMENT

GOVERNMENT


Where is Wisconsin?

  • University of Baltimore – US Obesity Report Card based on efforts to pass obesity control measures at the state level


Types of Legislation Introduced and in Some States Passed

  • Nutrition Standards: Controlling types of foods and beverages offered during school hours

  • Vending Machine Usage: Prohibiting types of foods and beverages sold in school and prohibiting access to vending machines at certain times

  • BMI Measured in the Schools

  • Recess and Physical Education: State mandated additional recess and physical education time


Types of Legislation Introduced and in Some States Passed (Cont.)

  • Obesity Programs and Education: Programs established as part of curriculum

  • Obesity Research: Legislative support for other institutions or groups to study obesity

  • Obesity Treatment in Health Insurance: Expanding health insurance to cover obesity treatment

  • Obesity Commissions: legislature established commissions designed to study obesity


What is NEW Kids?

Multidisciplinary Clinic

  • Medical, Psychologist, Dietitian, Physical Therapist

  • Physician referred

  • Need secondary co-morbidity to be seen

  • Hospital based clinic

  • Individualized treatment

  • Family based

Nutrition, Exercise, & Weight management for Kids

NEW Kids at the Y

  • 12 week educational curriculum

  • Physician referred

  • Overweight but no co-morbidity

  • Offered at 4 YMCA locations

3-2-1-0 Blast Off to a Healthier Family!

  • PMD Toolkit for use in office

  • Teaching for residents

Web Based Programs

  • Parents and caregivers

  • Teens and school age children


Current Barriers

  • INSURANCE REIMBURSEMENT FOR MEDICAL COMORBIDITY, BUT REIMBURSEMENT FOR OBESITY/OVERWEIGHT IS PROBLEMATIC

    • Excludes children who are “obese” but do not have a secondary complication YET

    • Willing to pay more money to treat versus prevent disease

  • MENTAL HEALTH INSURANCE COVERAGE

    • Lack of ideal mental health insurance coverage for families

    • Lack of universal coverage of Health & Behavior Codes

    • Lack of insurance copies taking on additional providers

      • Obese children have been shown to have a lower quality of life

      • Depression

      • Social Stigma

      • Bullying

  • LACK OF INSURANCE COVERAGE FOR PREVENTATIVE SERVICES BY REGISTERED DIETITIANS


Suggested Solutions

  • Medical reimbursement of preventive services for obesity

  • Medical reimbursement of treatment for obesity

  • Universal coverage of Health & Behavior Codes

  • Increased Medicare coverage of dietitians for preventive services…process has been started!


MultilevelPyramid Model of

Stepped Care Interventions

Intensity / Cost

Reach

Lowest

Highest

Specialty

Primary Care

Health Systems

Community and Neighborhood

Media

Policies

Highest

Lowest

Source: Glasgow, Diabetes Care 2003; 26:2451


References

Action for Healthy Kids (2005). Childhood Obesity: The preventable threat to America’s youth, fact sheet. Retrieved from http://www.actionforhealthykids.org/newsroom_facts.php on 7/18/08..

Cawley, J & Liu, F. (2008). Correlates of state legislative action to prevent childhood obesity. Obesity 16(1):162-7.

Cotton, A, Stanton, KR, Acs, ZJ, & Lovegrove, M (2005). The UB obesity report card: An overview. Retrieved from http://www.ubalt.edu/experts/obesity/

McCauley, LA, Kempf, A, Morgan, J, Katcher, ML, Remington, P (2005). Overweight among high school children: How does Wisconsin rank? Wisconsin Medical Journal 104(5): 26-31.

Schwimmer, JB, Burwinkle, TM, & Varni, JW(2003). Health-related quality of life of severely obese children and adolescents. JAMA 289(14): 1813-9.

Wilensky, S, Whittington, R, Rosenbaum, S (2006). Policy Brief: Strategies for improving access to comprehensive obesity prevention and treatment services for medicaid enrolled children. Retrieved from http://www.gwumc.edu/sphhs/departments/healthpolicy/chsrp/downloads/RWJ%20Medicaid%20Obesity%20Policy%20Brief.pdf on 7/18/08.


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