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

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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

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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

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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

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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

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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

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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

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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”

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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

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Horizon NJ Health, a product of Horizon HMO*

Causes

• Poor diet

• Lack of or insufficient physical activity

• Family history

• Poor choices

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Unhealthy Nutrition

• Bigger portion sizes

• More fast foods

• Advertisements – Encourages fast foods– Soft drinks– Sweets – Sugar loaded foods like breakfast cereals

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Horizon NJ Health, a product of Horizon HMO*

Unhealthy Nutrition

• Large meal=less cost

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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

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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

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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%

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Lack Of Physical Activity

• Fewer PA classes at school

• Lack of safe areas

• Television

• Computer

• Video games

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Childhood ObesityChildhood ObesityCauses & EffectsCauses & Effects

Type II Diabetes

SocialIssues

Low Self-EsteemStress On

Joints

ChildhoodObesity

PediatricHypertension

Heart

Disease

Psychological Issues

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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

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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

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When It’s Time To Eat…

• Offer a variety of foods

• Regular schedule

• Set a good example

• Turn OFF the TV

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Horizon NJ Health, a product of Horizon HMO*

Give Them Less…

• Doughnut

• French fries

• Regular chips

• Soda

• Fried chicken nuggets

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Horizon NJ Health, a product of Horizon HMO*

Who We Need?

• Parents

• Schools

• Government

• Healthcare

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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!

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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%

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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

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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

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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

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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