Kaiser's Care Management Institute and the CDC form national coalition to address obesity and overweight

In an effort to develop a national, broad-based approach to the public health crisis of obesity and overweight, the Centers for Disease Control and Prevention and Kaiser Permanente's Care Management Institute (CMI) have brought together leading experts from academia, medicine, health care delivery systems, research, and the federal government.

In a series of working meetings, the forum has linked practicing clinicians who are actively engaged in assessing and implementing programs for overweight and obese patients with their colleagues in the academic and research communities and federal agencies.

"With 45 million obese adults and 15% of children and adolescents overweight, the effective treatment of obesity is a public health issue. It's essential that the CDC involve other organizations to push the treatment agenda forward," says William Dietz, MD, PhD, director of the Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, about the value of the collaboration from the CDC's perspective.

"Kaiser Permanente, with more than 8 million members, is ideally suited to help us with this task. That's the level of interest we need, and it's a real tribute to Kaiser that they've embarked on this effort," says Dr. Dietz.

William Caplan, MD, CMI director of clinical development, comments on the value of the joint effort to KP. "Bill Dietz and his colleagues are an enormous center of excellence, knowledge, and experience. It's very exciting for KP and for CMI to have an opportunity to work with CDC in this way. They also have an enormous network of partnerships with other organizations, institutions, and individuals across the country and worldwide. Our collaboration provides KP greater access to those venues and experts."

Groups collaborating with KP and the CDC include: the National Institutes of Health, the North American Association for the Study of Obesity, the American Dietetic Association, HealthPartners, Geisinger Clinic, General Motors, the American Association of Family Practitioners, and the American Association of Community Health Plans.

The initiative is spearheaded by Drs. Dietz and Caplan, and Trina Histon, PhD, CMI care management consultant, brought together KP clinicians and experts from around the country.

Within the larger working group, four subgroups focused on:

  • prevention and treatment of obesity in children and adolescents
  • primary prevention in adults
  • identification and management of high-risk patients
  • severe obesity

Implementation focus

From its inception, the KP/CDC collaboration has focused on identifying effective interventions to prevent and treat obesity that can be implemented rapidly and broadly throughout KP.

To that end, says Dr. Caplan, "We bring together caregivers and their colleagues who are engaged in research so that we can more rapidly translate lessons from science and experience into applications that will make a difference. In short, we're asking ourselves, what do we know enough about now to bring forward into action?"

"We're looking to build the infrastructure to manage overweight and obesity as an organization," comments Warren Taylor, MD, the Northern California Region's Medical Director for Chronic Conditions Management. "In NCR, we're hoping to be one of the leading Regions largely on the strengths of our regional health education group."

Adds Dr. Taylor, "Unlike some of the other population management programs for chronic conditions, which focus on managing risks or getting the right drugs to the right people, intervening in overweight and obesity requires a coalition similar to what we did with smoking. We've been effective with smoking. The national rate is 23%; in California, it's18%, and 12% in KP members."

Rachelle Mirkin, MPH, director of prevention and women's health for the Northern California Region, adds, "Our team adapted our 2003 plans based on the conference. With the learnings from the conference, we decided to focus on two main adult interventions and two pediatric interventions. We will also be spending more time connecting with the community and identifying patients early."

Subgroups identify effective interventions

Subgroups met through the summer and into the fall to identify effective, implementable interventions. Each includes representatives from all KP Regions who bring the recommendations back to their home territory for implementation.

In this way, the interventions sponsored by the working group can be put into action in ways that are both uniform Programwide and sensitive to local variations in practice and resources.

Members of the working group looked at a number of issues in treating obesity during the course of the two meetings, including:

  • counseling overweight and obese patients
  • nutritional and physical activity messages
  • culturally competent care
  • roles of behavioral modification, pharmacotherapy, bariatric surgery

Other presenters took a broader view, addressing school-and community-based weight management interventions, weight management in the worksite, and state level initiatives.

Extending the evidence base

Throughout both meetings, gaps between the available and optimal evidence received frequent mention. All working group participants noted the importance of evaluating the effectiveness of weight management interventions.

To that end, a research agenda including small studies, observational, prospective observational and modeling studies, controlled implementation, and randomized control trials pertinent to weight management was identified.

Impeccable timing

Trina Histon comments on the timing of KP and CDC's collaboration to address obesity. "In 1998, there were 200 articles in the media about weight. In 2002, there have been nearly 2000. There's been an exponential increase in the public's interest in obesity. We want to take that interest, mobilize it, and set the agenda for weight management in KP and, potentially, the country as a whole."

Speakers at KP-CMI/CDC meetings featured nationwide experts

Speakers at the KP-CMI/CDC meetings have included: William Dietz, MD, PhD, director of the Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; William Caplan, MD, director of clinical development, Kaiser Permanente's Care Management Institute; Esther Myers, PhD, RD, FADA, Scientific Affairs and Research, American Dietetic Association; Barbara Rolls, PhD, Gutherie Chair of Nutrition, Pennsylvania State University; Rodolfo Valdez, PhD, epidemiologist, CDC/Division of Diabetes Translation; Thomas Wadden, PhD, director of weight and eating disorders program, department of psychiatry, University of Pennsylvania School of Medicine; Njeri Karanja, PhD, KP Center for Health Research; John Foreyt, PhD, Baylor College of Medicine; Tom Robinson, MD, MPH, Stanford University; and Gail Woodward-Lopez, MPH, RD, associate director, Center for Weight and Health, University of California Berkeley; Scott Gee, MD, associate director of preventive medicine, The Permanente Medical Group; Kelly Brownell, PhD, director, Yale Center for Eating and Weight Disorders; Lawrence D. Hammer, MD, professor of pediatrics, Stanford University; Xavier Pi-Sunyer, MD, professor of medicine, Columbia University College of Physicians and Surgeons; Warren Taylor, MD, director, chronic conditions management, The Permanente Medical Group; Nico Pronk, PhD, research investigator, vice president, Center for Health Promotion, HealthPartners; Jim Hill, PhD, director, Center for Human Nutrition, University of Colorado.