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Frequently Asked Questions
- What is the Weight Management Initiative?
Launched in January 2002 by Kaiser Permanente's Care Management Institute (KP-CMI) in concert with the eight KP regions, the Weight Management Initiative unites clinicians, researchers, insurers, and policymakers in a collaborative strategic effort to address the critical public health issue of obesity in the U.S.
- Who's involved?
KP expert clinicians from around the country are foundational to the Initiative. In addition, several organizations were represented at Initiative meetings during 2002:
- HealthPartners
- National Institutes of Health
- Geisinger Clinic
- Robert Wood Johnson Foundation
- American Dietetic Association
- American Academy of Family Practice
- American Association of Health Plans
- North American Association for the Study of Obesity
- International Life Sciences Institute Center for Health Promotion.
A smaller group of external organizations formed a coalition with KP-CMI, co-sponsoring a policy discussion in August, 2003. A particularly strong collaboration has been forged between CMI and the Nutrition and Physical Activity Program of the Centers for Disease Control and Prevention (CDC).
- How does the KP/CDC collaboration work?
In 2002, a collaborative working group established four goals:
- identify practical, effective, nonsurgical approaches for the prevention and treatment of overweight and obesity;
- increase the likelihood of adoption and implementation of these interventions and partnerships, thus leading to improved health outcomes for KP members and communities;
- identify clinical research opportunities supporting these goals; and
- create a forum linking colleagues in the academic and research communities, federal agencies, and practicing clinicians who are actively engaged in assessing and implementing programs for overweight and obese patients.
Two working meetings in 2002, jointly chaired by William Caplan, MD, KP-CMI Director of Clinical Development and William Dietz, MD, PhD, Director of the Division of Nutrition and Physical Activity, CDC, convened national experts in fields such as:
- pharmacotherapy,
- prevention and treatment in adults,
- prevention and treatment in children,
- increasing physical activity,
- behavioral therapy,
- nutrition,
- culturally competent care,
- community-based interventions,
- national, state, and community weight management initiatives,
- the perspective of employer purchasers of health insurance, and
- community-based interventions.
The meetings identified practical, effective strategies that could be rapidly implemented to help prevent and treat obesity among Kaiser's 8.3 million members.
- How widespread is the problem of overweight and obesity?
Approximately 30% of the adult population could be classified as obese in 1999-2000; 64% of the population was classified as overweight or obese. Roughly 15% of children were above the 95th percentile for weight. Without aggressive action to reverse the trend, obesity rates are projected to double over the next 30 years. Kaiser Permanente is the largest integrated health care delivery system in the country, with 8.1 million members. Nearly 2 million adult KP members are overweight, and another 1.6 million can be classified as obese. KP--and the nation as a whole--face an epidemic of obesity.
- Aren't overweight and obesity just cosmetic problems?
Overweight and obesity are associated with a higher incidence of many chronic conditions. The higher an individual's body mass index, or BMI, the greater the risk of heart disease, stroke, some types of cancer, Type 2 diabetes, sleep apnea, high blood pressure, and degenerative arthritis. Individuals whose BMI is 29 or above have a risk of death from all causes that is twice that of individuals whose BMI is 19 or less.
- Why not simply advise people who are overweight and obese to lose weight? Why launch an initiative?
When an epidemic occurs, providing care to those already affected isn't enough. Prevention is key. In infectious diseases, such as the flu, a single bacteria or virus is responsible for an epidemic. Control its spread and you control the disease.
In contrast, overweight and obesity result from complex interactions of social, economic, and physiologic forces. Developing effective prevention strategies requires going outside the medical system into homes, schools, workplaces, and communities. As the changing popularity of fad diets shows, some controversy exists about how to help those who already suffer from overweight and obesity. Appropriate interventions also vary according to the degree of excess weight, from increasing exercise among those who are mildly overweight to performing surgery on severely obese individuals.
At each level, KP Regional experts who are part of the Initiative gather the best available medical evidence and identify effective ways to implement best care practices. Understanding broad social forces contributing to obesity, developing effective prevention strategies, and identifying and implementing successful practices is an enormous undertaking. To meet the challenge, KP-CMI and the eight KP Regions launched the Weight Management Initiative.
- What are the components of the Weight Management Initiative?
Efforts related to the Initiative are based on a strategic model with five interrelated components:
- a network of researchers actively investigating the causes of and successful interventions for overweight and obesity;
- the wide dissemination of successful prevention and treatment practices;
- legislative and public policy;
- community partnerships; and
- effective clinical management of overweight and obesity.
In addition, the Weight Management Initiative focuses on four areas of concern:
- prevention and treatment of obesity in children and adolescents;
- preventing overweight and obesity in adults;
- identifying and managing adults at high risk of an adverse medical event; and
- treating severe obesity.
Each area is addressed on an ongoing basis by a group of clinical and research experts from throughout KP. Physicians, dieticians, nurse practitioners, health educators, program administrators, and KP-CMI staff meet regularly, identifying and involving stakeholders, mobilizing interest and support, and identifying opportunities for programs and interventions that lead to improved health outcomes.
- What programs and interventions has KP implemented to combat overweight and obesity?
BMI as vital sign
Body mass, or BMI, is a key indicator of overweight and obesity. A BMI Wheel has been developed to calculate BMI based on height and weight for adults and children. A Programwide electronic health record being developed will capture BMI. In the meantime, clinicians are encouraged to record both weight and height in the medical record. For more information on BMI wheels, go to: www.trowbridge-associates.com.
Key motivational messages in posters and tipsheets
Adapting work initially done by the Regional Health Education department in the Northern California Region, experts from the Weight Management Initiative endorsed a poster and supporting tipsheets that communicate key weight management messages for children and adolescents. The posters are in English and Spanish. The tipsheets are in English, Spanish, and Chinese. To date, more than 15, 000 pediatric posters and 5, 000 adult posters in English and Spanish have been disseminated across KP and community clinics.
An adult poster, Getting in Balance©, was developed by experts from the Weight Management Initiative. The poster displays four motivational messages for adults:
- get up and get moving
- eat healthy
- take time to take care of yourself
- start by maintaining your current weight.
The tipsheets incorporate motivational strategies by asking questions like, “How ready are you to make a change and to get in balance?”
The poster for children, Get More Energy©, incorporates similar messages:
- get up and play hard
- cut back on TV and video games
- eat five helpings of fruits and vegetables a day
- cut down on sodas and juice drinks.
The accompanying tipsheets advise parents how to better motivate and support their children in managing weight. The Weight Management Initiative goal is to hang a Get More Energy poster on the wall of every KP pediatric exam room nationwide.
Guidelines
HealthPartners of Minneapolis, in conjunction with KP-CMI, is conducting a literature review from which evidence-based care guidelines, models of care, and successful practices for the evaluation and treatment of overweight and obesity can be developed.
Kaiser Permanente 10,000 Steps® Program
Through collaboration with HealthPartners, the Kaiser Permanente 10,000 Steps® Program is now available to KP employees and members at a reduced cost. Non-members are also welcome to join.
Participants are encouraged to set a goal of 10,000 steps each day. They receive health prompts, tips, and recipes by email and register on a Web site that helps them track their progress.
Tailored, online weight management programs are available to KP members at kp.org.
Regional programs and interventions
In addition to the initiative-sponsored activities noted above, each KP region offers an array of weight management programs and interventions, ranging from health education to meal replacement and bariatric surgery.
- How does KP help clinicians change practice patterns around weight management?
Several opportunities exist for clinicians to share information and to learn new strategies for helping KP members manage their weight.
Each region has formed an obesity task force. These groups share strategies and tools and promote them at a grassroots level.
In Northern California, the Regional Health Education office created a training program on motivational interviewing, which teaches adult and pediatric clinicians how to help members change behavior according to their level of motivation. The training is part of regular continuing medical education programs.
The training includes:
- background information on the epidemic of overweight and obesity
- how to use vocabulary research-documented as non-offensive to individuals who are overweight or obese
- how to suspend judgment about a member's weight and address health issues
- how to to focus on the member's experience of his or her weight, as opposed to making assumptions about the nature of that experience
KP members -- who have paid their own way – have spoken to the KP Primary Care Conference. They talked eloquently about their experiences managing their weight within the KP system.
KP and its partners in the initiative have also made presentations at state and national medical conferences outside KP.
KP-CMI also developed a How-to Guide to help clinicians make decisions about treatment options.
- What kinds of community partnerships are involved?
KP collaborates with CDC and HealthPartners, Inc., on a CDC workgroup to translate and disseminate recommendations and promising practices for obesity prevention and control in medical care settings. KP's Direct Community Benefit Investment (KP-DCBI) program also works with schools and community-based clinics to provide training, tools and education. KP's Educational Theater Program educates children in kindergarten through grade five about eating healthy food and exercising in a production called “Zip's Great Day”. The pediatric poster Get More Energy© is available to schools hosting educational theater presentations. KP-CMI partnered with the TV TurnOff Network to launch KP TV Turnoff Week in 2004, and, in conjunction with KP-DCBI and KP's National Environmental Health and Safety Division, co-sponsors farmer's markets. Currently, ten markets are in place at KP medical centers, increasing access to healthy foods for KP employees and members and encouraging healthy eating habits.
- What public policy efforts are underway?
In August 2003, CMI and KP's Institute for Health Policy, along with the American Association of Health Plans, CDC, HealthPartners, the Robert Wood Johnson Foundation, and the Washington Business Group on Health, sponsored a roundtable discussion, Prevention and Treatment of Overweight and Obesity: Toward a Roadmap for Advocacy and Action. Representatives, 47 in all, from a broad spectrum of providers, consumers, the food industry, health plans, community-based organizations, researchers, analysts, and policymakers generated recommendations in seven areas of concern. Outside of the Weight Management Initiative, numerous state and community programs and legislative activities address the overweight and obesity epidemic in the United States.
- How will KP measure the effectiveness of its efforts?
The WMI launched a national effort to assess the size of the KP overweight and obese population and track relevant measures of care and health outcomes. A group of KP experts recommended 40 data elements that are also integrated into KP-CMI's Clinical Outcomes Reporting and Evaluation (CORE) System. The CORE system also includes information on almost two million KP members with chronic conditions like diabetes, coronary artery disease, and heart failure, making it easier for KP to understand the relationships between excess weight and other health conditions. In addition, 30 KP scientists in six regions formed a Programwide research network to, among other goals, increase the efficiency and effectiveness of KP's weight management efforts. The KP Garfield Memorial Fund has also established a Weight Management Research Initiative, allocating research funds to evaluate strategic issues in weight management in KP and the larger community. Currently, the KP Division of Research is conducting an outcomes evaluation of weight management programs.
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