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:
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.
