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

1. NEW Kids™Nutrition, Exercise, and Weight Management for Kids Brian Fidlin, PsyD Program Director of NEW Kids Assistant Professor of Gastroenterology

2. 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.

3. 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%.

4. 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

5. 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.

6. 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.

7. Who’s Problem Is It? Prevention and Treatment of Pediatric Obesity HEALTHCARE COMMUNITY FAMILY SCHOOL ENVIRONMENT GOVERNMENT

8. Where is Wisconsin? • University of Baltimore – US Obesity Report Card based on efforts to pass obesity control measures at the state level

9. 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

10. 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

11. 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

12. 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

13. 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!

14. 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

15. 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.