Kaiser Permanente: Insurance company joins with CDC to take on obesity research

Biotech Week

© Copyright 2003, Biotech Week via NewsRx.com

2003 JAN 22 - (NewsRx.com & NewsRx.net) -- As obesity reaches epidemic proportions, Kaiser Permanente's Care Management Institute (CMI), the U.S. Centers for Disease Control and Prevention (CDC) and others have joined forces to find effective ways to prevent and treat it.

"With 30% of the population having a body mass index (BMI) of 30 or more and 15% of children and adolescents at or above the 95th percentile for weight, the effective treatment of obesity is a public health issue. It's essential that the CDC has partners to help push this treatment agenda forward," said William Dietz, MD, PhD, the CDC's director of the Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion.

"Kaiser Permanente, with nearly 9 million members, is an important partner for us. That's the level of interest we need, and it's a real tribute to Kaiser that they've embarked on this effort," says Dietz.

The KP/CDC collaboration has focused on identifying effective interventions to prevent and treat obesity that can be implemented rapidly and broadly throughout Kaiser Permanente and elsewhere. The forum links practicing clinicians with leading national experts from academia, medicine, healthcare delivery systems, research, and the federal government.

"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," says William Caplan, MD, director of clinical development for Kaiser Permanente's CMI. "In short, we're asking ourselves, what do we know enough about now to bring forward into action?" said Caplan.

Two working meetings brought together Kaiser Permanente 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

Subgroups identified effective interventions that could be implemented. Each subgroup included representatives from all Kaiser Permanente 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 program wide and sensitive to local variations in practice and resources.

Members of the working group looked at a number of issues during the course of the two meetings, including counseling overweight and obese patients, nutritional and physical activity messages, culturally competent care, and the roles of behavioral modification, pharmacotherapy, and bariatric surgery in treating obesity.

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

The subgroups developed several approaches for immediate implementation within Kaiser Permanente, including:

  • Distribution of colorful posers for use in the exam rooms of pediatric and family practice providers. The images of children playing sports reinforces four messages:
  • Play hard for at least 30 to 60 minutes a day, cut back on TV and video games to no more than 1-hour per day, eat five helpings of fruits and vegetables daily, and cut-back on sweetened beverage intake.
  • A training program to help clinicians more effectively talk to patients about obesity and how to set weight management goals.
  • A pedometer-walking program. Every Kaiser Permanente Region is starting a program - with Kaiser Permanente clinicians and employees also participating in the motivational approach.

Presurgery and post-surgery protocols for severely obese patients were assessed, and nonsurgical interventions also were developed.

A nutritional message for adults also focuses on the energy density of foods. Barbara Rolls, PhD, Gutherie Chair of Nutrition, Pennsylvania State University, discussed the concept of "volumetrics," in which the key concept is the relative caloric density of foods, rather than macronutrient (fat, carbohydrate, protein) content. Rolls' research shows that the energy density - not the fat content - of a diet affects energy intake. To that end, she recommends modifying portion size according to the energy density of foods.

Cultural competence in delivering care for overweight and obese individuals is also emphasized. Njeri Karanja, PhD, of Kaiser Permanente's Center for Health Research, focuses on morbidity/mortality data, salient demographics and economic characteristics, and the cultural and psychosocial experience of African Americans, as well as recommendations for intervening effectively to prevent and treat obesity in this population.

Addressing culturally competent care with Mexican Americans, John Foreyt, PhD, Baylor College of Medicine, notes that culturally competent weight management programs require a behavioral analysis of factors and barriers affecting weight.

This article was prepared by Biotech Week editors from staff and other reports.