Accelerating Progress in Obesity Prevention Solving the Weight of the Nation (2012) / Chapter Skim
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8 Health Care and Work Environments
8 Health Care and Work Environments
Pages 285-328
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for prevention, screening, diagnosis, and treatment of overweight and obesity to help children, adoles cents, and adults achieve and maintain a healthy weight, avoid obesity-related complications, and reduce the psychosocial consequences of obesity. Health care providers also should advocate, on behalf of their patients, for improved physical activity and diet opportunities in their patients' communities.
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, including instruction in prevention, screening, diagnosis, and treatment of overweight and obesity in children, adolescents, and adults; and • health care providers serving as role models for their patients and providing leadership for obesity prevention efforts in their communities by advocat ing for institutional (e.g., child care, school, and worksite) , community, and state-level strategies that can improve physical activity and nutrition resources for their patients and their communities.
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Potential actions include • public and private employers promoting healthy eating and active living in the worksite in their own institutional policies and practices by, for example, increasing opportunities for physical activity as part of a wellness/health promotion program, providing access to and promotion of healthful foods and beverages, and offering health benefits that provide employees and their dependents coverage for obesity-related services and programs; and • health care organizations and providers serving as models for the incorpora tion of healthy eating and active living into worksite practices and programs. Strategy 4-4: Encourage healthy weight gain during pregnancy and breastfeeding, and promote breastfeeding-friendly environments.
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By engaging in obesity prevention and treatment strategies, such as providing community-level resources (education, support, and opportunities) for individuals and their families, health care and work environments can help catalyze individual and, ultimately, popu Accelerating Progress in Obesity Prevention 288
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, attention to obesity prevention, screening, diagnosis, and treatment must be considered.1 RECOMMENDATION 4 Health care and health service providers, employers, and insurers should increase the support structure for achieving better population health and obesity prevention. As depicted in Figure 8-1, health care and work environments are interconnected with the other four areas of focus addressed in this report and are a necessary component of the committee's comprehensive approach to accelerating progress in obesity prevention.
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Potential actions include • health care providers' standards of practice including routine screening of body mass index (BMI) , counseling, and behavioral interventions for chil 8-1 dren, adolescents, and adults to improve physical activity behaviors and dietary choices; Accelerating Progress in Obesity Prevention 290
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To maximize the value of patient visits and help children, adolescents, and adults achieve and maintain a healthful lifestyle, health care providers should adopt standards of practice for the prevention, screening, diagnosis, and treatment of obesity that include screening of BMI, counseling, and behavioral interventions aimed at improving the physical activity and dietary behaviors of their patients. Standards of practice, or clinical practice guidelines, are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options (IOM, 2011a)
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committee that produced the report Early Childhood Obesity Prevention Policies recommended that health care professionals consider a child's BMI, rate of weight gain, and parental weight as risk factors for obesity (IOM, 2011b)
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Including BMI screening as part of routine visits would give health care providers a platform through which they could engage patients (and their families) on the health benefits of a healthy weight and lifestyle and the health consequences of overweight and obesity (including elevating parental concern about childhood obesity if a patient was at risk)
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In addition to BMI screening, the use of physical activity as a vital sign is considered a promising way to increase the frequency with which health care providers counsel patients about physical activity. It has been found to be a valid clinical screening tool (Greenwood et al., 2010)
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. These recommendations for children, adolescents, and adults also have been included in a list of preventive services to be provided with no copay under the federal health care reform legislation signed into law in March 2010 (USPSTF, 2010b)
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• The Let's Move campaign (Let's Move, 2011) , in partnership with the AAP, is working with the broader medical community to educate health care pro viders about obesity and ensure that they regularly monitor children's BMI, provide counseling on healthy eating early on, and even write prescriptions describing the simple things individuals and families can do to increase physical activity and healthy eating.
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For example: • The AAP has recommended that physicians and health care professionals work with families and communities and advocate for the encouragement of physical activity and improved nutrition, especially through in-school programs (Krebs and Jacobson, 2003)
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Indicators for Assessing Progress in Obesity Prevention for Strategy 4-1 Process Indicators • Increase in the proportion of primary care providers who regularly measure the body mass index of their patients. Source for measuring indicator: National Survey on Energy Balance-Related Care Among Primary Care Physicians • Increase in the proportion of physician office visits by children, adolescents, and adult patients that include counseling and/or education related to physical activity and nutrition.
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Potential actions include • insurers, including self-insured organizations and employers, considering the inclusion of incentives in individual and family health plans for maintaining healthy lifestyles; • insurers considering (1) benefit designs and programs that promote obesity screening and prevention and (2)
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. Health care insurers can address obesity by giving employers health plan options that include promising and innovative evidence-based strategies for encouraging policyholders and their families to maintain a healthy weight, increase physical activity, and improve the quality of their diet (IOM, 2005)
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. Moreover, while these physiologic compensatory mechanisms would be advantageous for a lean person in a food-scarce environment, energy-dense food is abundant and physical activity is largely unnecessary in most environments today, so relapse after weight loss is not surprising (Sumithran et al., 2011)
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Indicators for Assessing Progress in Obesity Prevention for Strategy 4-2 Process Indicators • Increase in the number of health plans that include incentives for maintain ing healthy lifestyles. Sources for measuring indicator: National Survey of Energy Balance-Related Care Among Primary Care Physicians and NAMCS Accelerating Progress in Obesity Prevention 302
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Potential actions include • public and private employers promoting healthy eating and active living in the worksite in their own institutional policies and practices by, for example, increasing opportunities for physical activity as part of a wellness/ health promotion program, providing access to and promotion of healthful foods and beverages, and offering health benefits that provide employees and their dependents coverage for obesity-related services and programs; and • health care organizations and providers serving as models for the incor poration of healthy eating and active living into worksite practices and programs. 303 Health Care and Work Environments
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Creating an emotion ally and physically healthy workplace, supporting employees' community-based physical activity, and offering onsite purchase of fruits and vegetables to bring home are examples of the potential results of a business focus on employee well ness. Worksite health promotion programs are employer initiatives designed to improve the health and well-being of workers (and often their dependents)
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. Successful worksite wellness/health promotion programs have included strategies for providing employees with a healthy work environment; opportuni BOX 8-1 Potential Benefits of Workplace Wellness Programs Potential benefits to employers: • Reduces costs associated with chronic diseases • Decreases absenteeism • Reduces employee turnover • Improves worker satisfaction • Demonstrates concern for employees • Improves morale Potential benefits to employees: • Ensures greater productivity • Reduces absenteeism • Improves fitness and health • Provides social opportunity and a source of support within the workplace SOURCE: CDC, 2011b.
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. The 2009 IOM report Local Government Actions to Prevent Childhood Obesity recommends that worksites, specifically those with high percentages of youth employees and government-run and -regulated worksites, develop poli cies and practices that build physical activity into routines (for example, exercise breaks at certain times of the day and in meetings or walking meetings)
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Employers also could take advantage of existing stand-alone wellness, weight loss, physical activity, or incentive programs by providing access to or subsidizing membership fees for such programs during the work day or at the worksite. In the health care sector, several hospitals and health care organizations are already promoting active living and healthy eating.
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Strategy 4-4: Encourage Healthy Weight Gain During Pregnancy and Breastfeeding, and Promote Breastfeeding-Friendly Environments Health service providers and employers should adopt, implement, and monitor policies that support healthy weight gain during pregnancy and the initiation and continuation of breastfeeding. Population disparities in breastfeeding should be specifically addressed at the federal, state, and local levels to remove barriers and promote targeted increases in breastfeeding initiation and continuation.
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. Guidelines for maternal gestational weight gain have been released by 309 Health Care and Work Environments
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. Pre- and inter conceptional counseling also improves attitudes and behavior with respect to physical activity and nutrition in response to behavioral interventions (Hillemeier et al., 2008)
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. Additionally, a number of systematic reviews on the relationship between breastfeeding and childhood obesity have concluded that, as reported by the IOM (2011b)
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. To meet the recommendations for pregnancy weight gain, many women need preconception counseling, which may include plans for weight loss.
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SOURCE: WHO/UNICEF, 1989. Texas is one state where the Baby-Friendly Hospital Initiative has received strong support.
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. Home-visiting programs, which involve periodic visits by fam ily health nurses or other health care providers, also have been found to be effec tive models for delivery of support for parents and their children, particularly for vulnerable populations, and have been found to be feasible options for addressing risk factors for childhood obesity (Hodnett and Roberts, 2000; Wen et al., 2009)
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10) : The California Public Health Foundation WIC (Special Supplemental Nutrition Program for Women, Infants, and Children)
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, nurse, nutritionist, or physician with specific training in skilled lactation care; • leadership and support from management, staff access to IBCLCs, and com munity partnerships for making and receiving referrals; and • integration of peer support within the overall health system, which appears to contribute to the ongoing maintenance of a program. Accelerating Progress in Obesity Prevention 316
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Foundational Indicator • Elimination of disparities in breastfeeding initiation and maintenance. Source for measuring indicator: NIS NOTE: CDC = Centers for Disease Control and Prevention; IFPS-II = Infant Feeding Practices Survey II; mPINC = National Survey of Maternity Practices in Infant Nutrition and Care; NIS = National Immunization Survey.
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However, these three components have tended to work independently. For example, individuals may hear messages in the workplace about healthy lifestyle change but have no access to additional visits with their health care provider or community resources because of a lack of health insurance coverage; conversely, individuals may see their health care provider for obesity treatment but lack healthy physical activity and nutrition choices at the worksite.
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2009. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review.
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2009. Health care providers' perceived role in changing environments to promote healthy eating and physical activity: Baseline findings from health care providers participating in the healthy eating, active communities program.
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2009. Randomized controlled trial of a mailed toolkit to increase use of body mass index percentiles to screen for childhood obesity.
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2010. The Physical Activity Vital Sign: A primary care tool to guide counseling for obesity.
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2009a. Local government actions to prevent childhood obesity.
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:S77-S84. Accelerating Progress in Obesity Prevention 324
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2007. Gestational weight gain and child adiposity at age 3 years.
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2007. The workplace as a setting for interventions to improve diet and promote physical activity: Background paper pre pared for the WHO/WEF joint event on preventing noncommunicable diseases in the workplace.
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U.S. Primary care physicians' diet-, physical activity-, and weight-related care of adult patients.
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2009. Evaluation of a feasibility study addressing risk factors for childhood obesity through home visits.
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