Developing an Implementation and Evaluation Plan for California’s Obesity Prevention Plan Webinar - December 16, 2009 Nutrition, Physical Activity and Obesity Prevention Project Laurie Pennings, MS, RD, IBCLC Erin Abramsohn, MPH CHDP Judy Sundquist, MPH, RD Robin Qualls, MPH, PHN

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Your Expertise is Valuable  As a community leader in the Health Care Insurer and Provider sector, we are pleased to hear from you.  Your feedback will help shape the strategies and activities included in the California Obesity Prevention Implementation and Evaluation Plan.

Webinar Objectives 1.Provide a background for CDC Cooperative Agreement. 2.Provide an overview of two strategies in the Health Care Insurer and Provider sector. 3.Determine what COPP activities are most important to key stakeholders. 4.Solicit recommendations for modification or removal of existing COPP activities 5.Determine gaps in the COPP implementation plan 6.Identify key partners or potential key partners to implement COPP activities

Obtaining Your Comments  “COPP Webinar Additional Comments” Worksheet  Covers the same questions asked today in the webinar.  Gives you time to think about the strategies and activities, if desired and provide feedback later.

Build Upon What You Are Doing  Many nutrition and physical activity efforts are currently underway  The COPP will bring attention to effective interventions  This is not a request to do more!

Creation of CA Dept Public Health Health Care Reform Publication of CA Obesity Prevention Plan Get Healthy CA Workgroup est. Governor’s 10 Step Vision for a Healthy CA and the Summit on Health, Nutrition, and Obesity Receipt of CDC cooperative agreement for nutrition, physical activity, and obesity prevention

California Nutrition, Physical Activity, and Obesity Prevention Program  CDC cooperative agreement  $730,398 per year for five years  Establishes a “Connector Team” Create and disseminate an implementation and evaluation plan for the current California Obesity Prevention Plan Strengthen policy and environmental change efforts - Public and private Manage workflow Facilitate implementation of policies and programs

 Prevent and control obesity guided by the California Obesity Prevention Plan  Reduce the adverse impact of obesity- related chronic conditions and diseases  Decrease obesity-related health inequities Connector Team Goals

“Enhanced” Plan  Build on the current California Obesity Prevention Plan Retain sectors, primary goals, and strategies  Create an implementation and evaluation plan Add specific details for implementing and evaluating the strategies

Building upon:  Evidence-based reviews  Local obesity prevention plans  Strategic plans of sister state agencies  Other California chronic disease prevention plans  National guidelines  Feedback from local community leaders

Development of Activities  Early stages  May be similar to each other – consolidation will occur based on comments  Exact wording has not been finalized

Evaluation Plan  Progress on the CDC workplan  Progress on the California Obesity Prevention Plan  Develop indicators, measures, and milestones for progress on decreasing obesity prevalence in California: Behavior changes (e.g. physical activity habits) Policy changes Environmental changes Overall prevalence of obesity

7 Sectors

CDC Key Target Areas Breastfeeding Promotion Physical Activity Fruits and Vegetables Sugar-Sweetened Beverages Television Viewing Time High Energy Dense Foods (high-calorie, low-nutrient)

Public Feedback on the Plan Listening Sessions Network Conference – March ‘09 Childhood Obesity Conference – June ‘09 School Wellness Conference – October ’09 Regional Community Forums Orange County – September 25, 09 Redding – October 22, ’09 Central Valley – October 29, ’09 Bay Area – November 2, ’09 Bay Area – November 19, ‘09

Additional Input for Health Care Insurer and Provider Sector  Provisional Breastfeeding Workgroup  California Breastfeeding Roundtable  CHDP Executive Committee  Medi-Cal Managed Care Health Education and Cultural and Linguistics Workgroup  Tentative Medi-Cal Managed Care Directors meeting – January

Next Steps in Plan Development  Committees and CDPH will review all comments  Connector Team will incorporate comments and gain necessary state approvals  Targeted date for publication: Spring 2010

What time is it?

So, Let’s Get Started!

Questions We Will Ask You 1) Do you think this strategy or activity should be deleted? 2) Do you think the wording of the strategy or activity should be changed? 3) Do you think an activity is missing? 4) What partners should be involved?  We will take verbal or written comments.

1. COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). 2. Proposed New Strategy: Increase workforce capacity and competence for obesity prevention and weight management. Two Strategies:

1. COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). Categories of Recommended Activities: Access to Care Policies and Clinical Guidelines Adequate Reimbursement for Services Incentives Resources

1. COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). Access to Care A.Ensure access to preventive health care, especially for children and adolescents (rather than simply free physicals for certain age groups.) B.Develop unique incentives or strategies to increase the number of teens receiving annual well visits.

1. COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). Policies and Clinical Guidelines C. Incorporate obesity prevention into routine visits for children and adolescents per the 2007 American Medical Association Expert Committee Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity. D. Incorporate obesity prevention into routine visits for adults per the American Medical Association Assessment and Management of Adult Obesity Guidelines. E. Include obesity prevention and screening (BMI) in quality assessment measures.

1.COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). [CONTINUED] Policies and Clinical Guidelines F.Promote adoption of the new HEDIS measure regarding child and adult obesity (including BMI measurement) by all California health plans. G.Conduct universal BMI screening and health assessment (including appropriate labs and referrals as appropriate). H.Document and track individual BMI trends.

COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). [CONTINUED] Policies and Clinical Guidelines I.Provide universal evidence-based messaging for providers to use for nutrition and physical activity counseling. J. Document nutrition and physical activity counseling and referrals (Providers). K. Use cost-benefit studies when developing policies for preventive obesity services.

COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). [CONTINUED] Policies and Clinical Guidelines L. Use appropriate anthropometric measurement devices that are routinely calibrated. M. Increase documentation of nutrition and physical activity in the Indian Health Services’ Electronic Health Record/Resource and Patient Management System (EHR/RPMS).

1. COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). Adequate Reimbursement for Services N. Support Medi-Cal and private insurance coverage for nutrition and physical activity counseling by health care providers. O. Support Medical Nutrition Therapy (MNT) as an initial treatment approach for patients who are identified as overweight or obese. P. Develop a certification program for community outreach workers that includes education on the prevention of obesity and diabetes. Q.Develop reimbursement criteria for Medi-Cal and Medi-Care for health education services delivered by certified community outreach workers.

COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). Incentives R. Develop unique incentives for private providers who implement obesity prevention strategies for routine care in their office systems.

COPP Strategy: Promote PREVENTION as the first step in responding to the obesity epidemic in a manner sensitive to culture, age, and abilities (rather than bariatric surgery and pharmaceuticals that are interventions of last resort, particularly for children). Resources S. Provide free multicultural health education materials at third grade reading level in multiple languages to providers working with low-income populations. T. Identify community specific resources to facilitate provider referrals and to promote collaboration between community programs and clinical practice. U. Increase awareness, training, and use of obesity prevention toolkits by health care personnel.

Partners: What organizations should be involved in implementing these activities? 1.? 2.? 3.? 4.? 5.? 6.? 7.?

Proposed New Strategy: Increase workforce capacity and competence for obesity prevention and weight management. Recommended Activities: A. Provide technical training to health care provider offices with consideration to provider office turnover regarding BMI screening, assessment and anthropometric measurements B. Provide provider training on counseling for nutrition and physical activity counseling (including motivational interviewing techniques). C. Train health care personnel to be culturally and empathically skilled in working with overweight and obese individuals in order to present culturally sensitive, standardized information (existing curricula/materials) on nutrition and physical activity.

Proposed New Strategy: Increase workforce capacity and competence for obesity prevention and weight management. Recommended Activities: D. Increase awareness, training, and use of evidence-based practices regarding prevention i.e. healthy weight management vs. obesity treatment. E. Increase the number and types of trained personnel who plan, facilitate, deliver, and evaluate services related to healthy weight management. F. Strengthen workforce skills and role modeling behaviors related to nutrition and physical activity by implementing staff wellness policies and programs.

Partners: What organizations should be involved in implementing these activities? 1.? 2.? 3.? 4.? 5.? 6.? 7.?

Contact Information: Judy Sundquist, MPH, RD Statewide Nutrition Consultant CA DEPARTMENT OF HEALTH CARE SERVICES, Systems of Care Division, Children's Medical Services Branch Phone: (916)

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