A Health Plan’s Active Measures to Curb the Disease

Overweight and obesity affect all of us, whether it is a personal struggle or trying to support family and friends. Despite evidence that obesity rates in children continue to rise, many clinicians and payers are not equipped to address this issue with their patients and members. This article will explore the financial and individual health costs of obesity and explore an innovative approach one Medicaid health plan is using to impact this condition.

National data from the 2003 Survey of Children’s Health shows that 31 percent of children are overweight or obese. More alarming, 40 percent of children on public insurance are overweight or obese. The numbers are worse for adults: 65 percent of American adults are overweight or obese (NHANES 1999-2002).

Defining overweight and obesity is different for adults and children. For adults, body mass index (BMI) determines their weight category. However, for children (2-20 years old) BMI, gender, and age are considered when determining their weight category. This information is plotted on a growth chart to determine their BMI percentile. (See Chart 1 on the next page.)

It is important to remember that BMI is a screening tool. Some individuals with an elevated BMI have increased muscle mass. When treating female adolescents, for example, it is especially imperative to monitor their BMI trend. During growth periods, girls will gain weight before they grow taller, which presents as elevated BMI. Without monitoring BMI trends, overweight or obesity may be misdiagnosed. Screening for overweight and obesity risk factors is also helpful when evaluating weight trends, especially during critical growth periods of adolescents.

Pediatric obesity has been described as a family problem that requires a family approach for sustainable success. There has been much research on risk factors for pediatric obesity. Expert committee recommendations include screening for obesity risk factors at least annually. Many providers choose to include this screening in well child exams. Recommendations for reducing risk factors of pediatric overweight and obesity include:

• Limiting consumption of sugar-sweetened beverages (juice, soda, sweetened milk, etc.).
• Consuming recommended quantities of fruits and vegetables. (Currently, USDA recommends nine servings/day. Many programs recommend starting at five servings/day.)
• Limit screen time (TV, video games, computer) to two hours/day or less.
• Eat breakfast daily.
• Consume family meals at home.
• Be active at least 60 minutes/day.

After screening for risk factors, the most effective treatment method is to help the family select one area to focus on and set a goal to make a behavior change in that area. Follow up is recommended at least every three to six months. Many providers find greater success when they let the family choose their goal and follow-up schedule.

The Cost of Obesity

It is estimated that Americans spent $147 billion on obesity-related medical costs in 2006. Per capita, obese adults spend 42 percent more ($1,429) on medical expenses than their normal-weight peers. In 1998 the percent difference in per capita medical spending compared to normal weight adults was 37 percent. The increasing cost and prevalence of obesity paint a grim picture of the viability of the health care system.

Elevated BMI is linked to increased risk for co-morbidities such as diabetes. Pediatric diabetes and pre-diabetes are increasingly concerning as a result of the increasing prevalence of overweight and obesity. The prevalence of pediatric type 2 diabetes is relatively low and more often found in older youth. However, the incidence of type 2 diabetes is increasing in the pediatric population, according to recent data.

The American Diabetes Association has defined pediatric screening criteria as the following: Children should be screened for elevated fasting plasma glucose (FPG) at 10 years old or at the onset of puberty if they have a BMI in the 95th percentile or greater, or a BMI  in the 85-94 percentile with at least two risk factors. Diabetes pediatric screening in the at-risk population should be done biannually. 
Risk factors include:

• Family history of type 2 diabetes in first or second-degree relative.
• Race/ethnicity (e.g., Native American, African American, Latino, Asian American, and Pacific Islander).
• Signs of insulin resistance or conditions associated with insulin resistance (e.g., acanthosis nigricans, hypertension, dyslipidemia or PCOS).
• Maternal history of diabetes or GDM. (See chart 2.)