Physicians for Healthy Communities Initiative: An obesity prevention project of the CMA Foundation

CMA Foundation Mission The CMA Foundation champions improved individual and community health through a partnership of leaders in medicine, related health professions, and the community. To fulfill our mission, the CMA Foundation acts as a bridge linking physicians to their communities. We work in collaboration with all of our many partners to achieve significant improvement in key health issues. We receive funding for our projects through physician, corporate, and foundation support.

The CMA Foundations Physicians for Healthy Communities project will… Prevent obesity, focusing on youth, underserved communities and high-risk ethnic groups. Train and support Physician Champions to educate, advocate, and shape policies on overweight and obesity. Strengthen physicians impact on public health.

Obesity Timeline 1980s: screen time increases, physical activity decreases 1985: NIH classifies obesity as disease 1990s: fast-food and computer use explodes 1992: USDA creates Nutrition Facts and Food Pyramid 2001: U.S. Surgeon General issues Call to Action 2004: LA Unified Schools bans soft drinks 2004: Institute of Medicine report Preventing Childhood Obesity 2005: California passes the most strict school nutrition bills in the country

From the AAP: …Prevalence of overweight and its significant co-morbidities in pediatric populations has rapidly increased and reached epidemic proportions. Advocacy is needed in the areas of…early recognition and management of overweight and obesity… – Committee on Nutrition, Prevention of Pediatric Overweight and Obesity (2003)

From the American Academy of Family Physicians (AAFP): Family Physicians should offer assistance to patients that are obese or overweight or who request assistance to prevent obesity. Family physicians should also participate in local, state and national efforts to prevent obesity, and encourage physical activity for both children and adults. –Policy and Advocacy (2004)

From the AMA: The war on obesity cannot be fought only on the clinical front. It requires a collaborative and coordinated effort by many groups, and physicians…are in the unique position of being able to negotiate many of those arenas. - Recommendations for Physician and Community Collaboration on the Management of Obesity (2005)

From the Institute of Medicine (IOM): An epidemic of childhood obesity…is occurring in boys and girls in all 50 states,…across all socioeconomic strata,… and African Americans, Hispanics, and American Indians are disproportionately affected…our children [are] gaining weight to a dangerous degree and at an alarming rate. –Preventing Childhood Obesity (2005)

From the CMA: …CMA encourages physicians to become knowledgeable about community resources and referral services that can assist with the management of diabetic, overweight and obese patients…CMA recognizes the many benefits of educating parents, children and physicians about obesity, its treatment and about healthy lifestyles. – (2005)

National and State Efforts National Government –Public education handbooks & toolkits –Outreach campaigns –Focus: Growing obesity issue & adopting healthy lifestyles –Focus: Shaping individual and family behaviors in home & community California –Changes in school environments: vending machines, wellness policies, etc. –Several state programs promoting healthy, active lifestyles –Examples: California Nutrition Network California 5 a Day Project Lean California Works Well Health Promotion Program StayWell Program California Obesity Initiative California Diabetes Program

Governors 10-Point Vision for a Healthy California 1.Emphasis on importance of physical activity and healthy eating. 2.Childrens daily participation in physical activities. 3.Adults will be physically active every day. 4.Only healthy foods and beverages in schools. 5.Market only healthy foods and beverages to children 12 years old and younger. 6.Affordable and readily available produce and healthy food. 7.Community and neighborhood support of physical activity. 8.Access, affordability and promotion of healthy foods and beverages in grocery stores, restaurants and entertainment venues. 9.Promotion of physical activity and healthy eating by insurers and health care providers. 10.Employee access to physical activity and healthy food options. Governors Vision for a Healthy California. Governors Summit on Health, Nutrition and Obesity. Sept. 15, 2005.

Context for Action The prevalence of adult obesity has doubled over the last 20 years. California has experienced the fastest increase in adult obesity of any state in the nation. Nearly 2/3 of the U.S. adult population is overweight & 32% of those are considered obese Overweight adults have a: –60% increased risk for diabetes –80% increased risk for high blood pressure –50% higher chance for elevated cholesterol levels 17% of children and adolescents are overweight –15 % of children and adolescents are at risk & 70% - 80% of obese adolescents will become obese adults. The incidence of obesity is higher in African-American, Latino, and underserved, low-income populations. Health Plans Emerging As Pragmatic Partners in Fight Against Obesity. National Institute for Health Care Management. April Report.pdf Report.pdf Department of Health and Human Services. Healthy People 2010, 2 nd ed. With understanding and improving health, and objectives for improving health. Washington, DC: Government Printing Office, 2000.

Populations at Risk Low-income <185% of Federal Poverty Level $34,873 for a family of 4 African-Americans Latinos Youth *California Obesity Prevention Initiative. The Obesity Problem. Available at Retrieved 9 November *Department of Health and Human Services. Healthy People 2010, 2 nd ed. With understanding and improving health, and objectives for improving health. Washington, DC: Government Printing Office, 2000.

Obesity Rates by Race/Ethnicity Body Mass Index by Race/Ethnicity in California Race/Ethnicity BMI over 25.0 African American 70.4% Latino/Hispanic 69.6% White 53.0% Other includes Asian, Pacific Islander, Native American 40.4% Source: California Behavioral Risk Factor Surveillance Survey, 2004

Rates of Overweight and Unfit Children in California EthnicityOverweight (2004)Unfit Children (2002) *based on CDE standards WHITE 20.6%33.5% LATINO 35.4%44.5% AFRICAN AMERICAN 28.7%46.0% AI/AN 31.7%38.9% ASIAN 17.9%35.7% PACIFIC ISL. 35.9%44.0% OTHER 24.4%Not reported FILIPINO 24.7%Not reported California Center for Public Health Advocacy. Rates of Childhood Overweight and Obesity in California Cities and Counties.

California Neighborhoods & Opportunities for Children to Get Physical Activity Race/Ethnicity% NO WHITE32% LATINO49% AFRICAN AMERICAN51% TOTAL 38% Nearly 4 in 10 Californians rated their neighborhoods as fair, poor or very poor in opportunities for children to get physical activity. California Field Poll - Childhood Obesity, November 2003

Who do patients want to hear from? Physicians As Key Messengers to Spread the Word Play Major Role% Physicians/Healthcare Providers 88%* Local Public Schools82% State Government59% Local Community & Civic Orgs.38% Federal Government 52% Faith Based Organizations 35% *This was highest among Latinos and African Americans, at 90% and 96% respectively. California Field Poll - Childhood Obesity, November 2003

Economic Consequences Health care costs for obese individuals = 36% (average) higher compared to normal weight individuals. Direct and indirect cost of obesity is currently $100 billion/year nationally. $28.1 Billion in California Health Plans Emerging As Pragmatic Partners in Fight Against Obesity. National Institute for Health Care Management. April Report.pdfhttp:// Report.pdf

Projected Cost for 2005: $28 BILLION Source: California Department of Health Services, 2005

Why Clinicians need to talk to their patients about overweight and obesity In a 2003 Field Poll, nearly 90 percent of Californians surveyed wanted physicians to be their primary source of information about nutrition, physical activity, and other issues associated with obesity. Physicians report identifying obesity in only 8.6% of all patients seen in their offices and less than 30% of overweight patients report being counseled by their physician. Studies have shown that for obese children, obesity is documented in the medical record for only 53% of these children. Stafford et al. Archives of Family Medicine. Galuska et al. JAMA 1999 OBrien et al. Pediatrics 2004.

Multifaceted strategies involve the efforts of many stakeholders including: –Individuals –Families –Employers –Health plans –Schools –Communities –Government –Policy Makers –Healthcare Providers Health Plans Emerging As Pragmatic Partners in Fight Against Obesity. National Institute for Health Care Management. April Report.pdfhttp:// Report.pdf Preventing Childhood Obesity, Health In the Balance. Institute of Medicine Strategies for Combating Obesity

Significant culture changes to promote healthy lifestyles. New model of care and significant cultural change to address the non- medical causes and management. Leverage public and private resources and expertise. Focus on the community as well as lifestyle. Education Health Plans Emerging As Pragmatic Partners in Fight Against Obesity. National Institute for Health Care Management. April Report.pdf Report.pdf