1. Recommended Actions for Childhood Obesity Prevention and Treatment results of research, planning and community forums Subcommittee on Childhood Obesity State of Missouri Children’s Services Commission Missouri Council on Activity and Nutrition Changing the Future of Childhood Obesity: Aligning and Amplifying Statewide Efforts April 21, 2015 | Columbia, MO Sarah Hampl, MD Children’s Mercy Hospitals & Clinics Kansas City shampl@cmh.edu Denise Wilfley, PhD Washington University St. Louis wilfleyd@psychiatry.wustl.edu Chairpersons

2. Subcommittee Purpose 1.Review the issue of childhood obesity, the evidence for effective approaches to prevent and treat, Missouri's current approaches, and the gaps in services and resources. 2.Compile recommendations to create a comprehensive approach that includes access to treatment in Missouri that will fill identified gaps and decrease prevalence of obesity. 3.Present the report and recommendations to the Missouri Children's Service Commission which will in turn, inform the Governor and General Assembly. Subcommittee on Childhood Obesity State of Missouri Children’s Services Commission

3. Project Timeline February 2014Subcommittee held inaugural meeting March-AprilPrepared outline for report May-AugCompiled preliminary recommendations Meetings and conference calls Sept-OctHeld public hearing(s) for input on recommendations - 122 people attended Springfield (Sept 19), St. Louis (Sept 29), Columbia (Oct 1), Kansas City (Oct 7) Oct-NovSubcommittee meeting and conference calls, incorporated feedback, prepared executive summary DecemberPresent draft to Children's Services Commission Jan-Mar 2015Finalize report and release to stakeholders

4. Graciela Couchonnal, PhD Health Care Foundation of Greater Kansas City Ann Davis, PhD, MPH, ABPP Center for Children’s Healthy Lifestyles and Nutrition University of Kansas Medical Center Dawnavan Davis, PhD KC Blue Cross Blue Shield Johanna B. Derda American Academy of Pediatrics, Missouri Chapter Meredith Dreyer Gillette, PhD Children’s Mercy Hospitals and Clinics, Kansas City Janet E. Farmer, PhD University of Missouri School of Health Professions Sarah Hampl, MD, FAAP, Co-Chair Children’s Mercy Hospitals and Clinics, Kansas City Megan Klenke, MSW Child Care Aware of Missouri, St. Louis Timothy Kling, MD, FACOG Missouri HealthNet Missouri Department of Social Services Deborah Markenson, MS, RD Weighing In, Children’s Mercy Hospitals and Clinics, Kansas City Ann McCormack, MPH, RD Bureau of Community Food and Nutrition Assistance Missouri Department of Health and Senior Services Donna Mehrle, MPH, RD, LD Missouri Council for Activity & Nutrition (MOCAN) University of Missouri Extension Samar Muzaffar, MD, MPH Missouri HealthNet Missouri Department of Social Services L. Carol Scott, PhD Child Care Aware of Missouri, St. Louis Member of Children’s Services Commission Pat Simmons, MS, RD, LD Missouri Department of Health and Senior Services Amy Stringer Hessel, MSW Missouri Foundation for Health Aneesh Tosh, MD University of Missouri School of Medicine Denise Wilfley, PhD, Co-Chair Washington University in Saint Louis subcommittee members project staff Eric S. Armbrecht, PhD Angela Lima, MBA, RD, LD Emily Meissen-Sebelius, MSW Stephanie Seger Allison Yee, MPH

5. THANK YOU Health Care Foundation of Greater Kansas City & Missouri Foundation for Health Funds provided by the Health Care Foundation of Greater Kansas City and Missouri Foundation for Health have been used to support writing, research, meeting facilitation and public forums per direction of the volunteer members of the Subcommittee for Childhood Obesity. Public Forum Hosts Springfield-Greene County Department of Health Missouri Foundation for Health Columbia-Boone County Department of Public Health Kansas City Health Department

6. Rationale and Context Over the past 30 years, obesity rates have more than doubled for children and quadrupled for adolescents 1 in 3 children are overweight or obese –much higher for children with Medicaid Obesity as co-morbidity increases costs for other childhood conditions* –30% higher: analysis of MoHealthNet claims in 2012 –Obesity co-morbidity with: asthma (42%), depression (50%), diabetes (54%), hypertension (80%) Serious, direct health consequences during childhood and beyond Research shows that adult obesity originates in childhood Given current trends, Missouri will spend $12 billion annually on obesity- related healthcare by 2030 Subcommittee on Childhood Obesity State of Missouri Children’s Services Commission * Edison, Greever-Rice et al 2014

8. Types of Recommended Actions 1.Prevention 2.Treatment 3.Infrastructure Subcommittee on Childhood Obesity State of Missouri Children’s Services Commission

9. Subcommittee on Childhood Obesity Recommended Actions for Childhood Obesity Prevention and Treatment Update child care licensing rules to align with the latest evidence on nutrition, physical activity, and screen time. Train and support child care professionals to meet new standards. prevention early childhood Missouri Council for Activity and Nutrition | April 21, 2015 | Columbia, MO

10. State of Missouri Children’s Services Commission Subcommittee on Childhood Obesity Recommended Actions for Childhood Obesity Prevention and Treatment prevention schools Establish an Office for Student Wellness to maintain expectations for health and physical education curricula. Modify school accreditation by creating and maintaining a health and wellness component. Train and support school staff to implement best practices and school wellness policies related to nutrition, physical activity and physical education. Missouri Council for Activity and Nutrition | April 21, 2015 | Columbia, MO

11. State of Missouri Children’s Services Commission Subcommittee on Childhood Obesity Recommended Actions for Childhood Obesity Prevention and Treatment treatment reimbursement Reimburse licensed professionals with specialized training in evidence-based weight reduction programs through all Medicaid plans. Reimburse services provided in health care or community settings for children with a body mass index (BMI) at or above the 85th percentile. Missouri Council for Activity and Nutrition | April 21, 2015 | Columbia, MO

12. State of Missouri Children’s Services Commission Subcommittee on Childhood Obesity Recommended Actions for Childhood Obesity Prevention and Treatment infrastructure centers of excellence Establish Centers of Excellence across Missouri to provide evidence-based weight management services; coordinate access to treatment; train health care providers, school staff, and others about screening, treatment options, and referral coordination; and train health care and community agencies on prevention strategies. Missouri Council for Activity and Nutrition | April 21, 2015 | Columbia, MO

13. State of Missouri Children’s Services Commission Subcommittee on Childhood Obesity Recommended Actions for Childhood Obesity Prevention and Treatment infrastructure commission Establish a Commission on Child Health and Wellness to oversee implementation of the Subcommittee’s recommendations, study effectiveness of obesity prevention strategies, and provide an ongoing forum for education and future actions. Missouri Council for Activity and Nutrition | April 21, 2015 | Columbia, MO

14. Next Steps

15. Thank You