I recently learned that the National Committee on Quality Assurance (NCQA) gave Kaiser Permanente Northwest top marks in counseling children for physical activity and nutrition. Through its Healthy Eating Active Living program, Kaiser Permanente physicians track their young patients' weight status at each office visit. When their Body Mass Index (BMI) is not appropriate for their age, the physicians have detailed conversations with the children and their parents.
Since childhood obesity is increasing at alarming rates, I wanted to learn more about how Kaiser Permanente has successfully mitigated the problem. I also was curious to learn if other insurers could implement comparable programs to obtain similar successes. Then maybe, just maybe, we could make a dent in this particular health crisis.
Keith Bachman, director of Weight Management at Kaiser Permanente Northwest, agreed to answer a few questions for me.
FHP: What specific steps does Kaiser take to combat childhood obesity?
Bachman: We follow national guidelines outlined by the American Academy of Pediatrics, among other organizations. The two most important steps include tracking weight status over time and giving lifestyle advice. Tracking of weight and BMI requires looking at age, gender, and weight simultaneously and comparing the changes in these variables. Our electronic record, Kaiser Permanente Health Connect, helps us do this consistently and accurately and graphs this data for review by both members and clinicians.
For advice, we want to make sure that parents are given a consistent message that is positive and clear, but also appropriate for their child's age and their family's concerns. Doing this in the clinician's office underscores the influence that activity and nutrition have on health.
In addition to our work in the clinical realm, Kaiser Permanente in the Northwest and nationally has community benefit programs that support community-based initiatives to improve nutrition and opportunities for physical activity.
FHP: What features made Kaiser's childhood obesity program so successful, as determined by NCQA?
Bachman: Documentation of clinician advice for physical activity and nutrition occurred at a very high rate. This was done regardless of the child's weight status, recognizing that in 2010 every child is at risk of overweight and obesity. Even if weight is not a concern, we know that children who are more physically active and less sedentary are healthier and learn better.
FHP: What is Kaiser's success rate, for example, can you quantify how many children have lost weight? How many children and parents has Kaiser educated thus far?
Bachman: NCQA data indicates our advice rates are very high. Most children and their families are given this advice. Consistent with national data, in our health plan data system, we note that childhood obesity rates are stable or possibly decreasing.
FHP: How do parents respond when approached about childhood obesity? If they resist suggestions, how does Kaiser continue to inform them?
Bachman: Most parents are supportive, though making changes is always difficult. Most are willing to identify small changes in their family environment that will support healthy eating or increased activity. Examples of useful strategies include things like limiting screen time, removing TV from bedrooms, choosing water or nonfat milk rather than sugary beverages, and aiming for at least 60 minutes of fun activity a day.
We understand that weight management can be a sensitive issue for families, and that clinician advice and guidance is only one of many factors that affects a child's weight. Genetics, the home environment and the school environment all play a role. Clinicians are trained to offer advice in a sensitive manner.
FHP: What are the benefits to other health insurers if they implement similar programs?
Bachman: The provision of health reform that children now will be covered until age 26 gives us an opportunity to care for our covered children for more years and help them avoid complications of obesity, inactivity and poor nutrition.
Emphasizing a family approach, changes to eating habits, and activity levels benefit adults and siblings as well. We recommend that whole families make these changes together. Evidence is strong that obese children are more expensive to manage than normal weight children, and that obesity in late childhood and adolescence is strongly related to development of chronic conditions and increased health care costs later in life.