5-2-1-0 Healthy Choices CountChildhood Obesity Prevention in Iowa

Jennifer Groos, MD, FAAPBlank Children’s Pediatric Clinic

Chair of the IA AAP Committee on Obesity

National AAP Section on Obesity COACH

W.I.C. Conference

6/21/18

• Overview of the Issue

• Multi-sector Approach to Childhood Obesity-5-2-1-0 Healthy Choices Count

• Weight Stigma

• Motivational Interviewing

• Resources

Objectives

Iowa Statistics

Adult Data

65.9% of Iowa adults have overweight or obesity

32.2% of Iowa adults have obesity-13th in the nation Source: Trust for America's Health and Robert Wood Johnson Foundation. The State of Obesity

2017 [PDF]. Washington, D.C.: 2017.

Youth Data

29.9% of children 10-17 have overweight or obesity Source: stateofobesity.org/children1017

14.7% of 2-4-year olds have obesity-21st in the nation Source: stateofobesity.org/wic

Slide adapted from IHCW Building a Foundation for Healthy Active Living: Overview Module

The prevalence of obesity and severe obesity among US children 2 to 19 years of age

from 1999 to 2016.

Asheley Cockrell Skinner et al. Pediatrics

2018;141:e20173459

©2018 by American Academy of Pediatrics

Obesity is a Chronic Disease

• June 2013 AMA adopted policy recognizing obesity as a chronic disease state

• complex disease condition mediated through the interplay of multiple genetic, biologic, metabolic, behavioral, social, economic and cultural determinants

• Most prevalent chronic disease of childhood • Obesity 12.7 million

• Asthma 6.2 million

Slide adapted from IHCW Building a Foundation for Healthy Active Living: Overview Module

Socioecological Model for Child Health

Slide adapted from IHCW Building a Foundation for Healthy Active Living: Overview Module

Slide adapted from IHCW Building a Foundation for Healthy Active Living: Overview Module

Complications of Obesity seen in Adults

Children and adolescents with obesity have a 70-80% chance of having overweight or obesity as adults

• Heart Disease• Cancer• Stroke• Type 2 Diabetes• Osteoarthritis• Physical Disability• High Blood Pressure• Sleep Apnea

Economic costs

12.7 million US Children and adolescents with obesity-$92,000 individual

average cost of obesity in adulthood-Lifetime societal cost $1.1 trillion

Kasman et al. 2015 Brookings Instititute.

The Message

-

5-2-1-0 MessageWhat is 5-2-1-0?

Common evidence-based message to promote healthy eating and active living utilized across the country

-Simple message

-Backed by scientific evidence

-Endorsed by multiple associations

-Ties together multiple messages in communities

• Provides vitamins and minerals

• Important for growth, development, immune function

• Lower rates of chronic diseases

• heart disease,• stroke,

• high blood pressure,

• diabetes, • Cancer

• Emerging science may help prevent weight gain

• Recreational Screen Time• Used for non-educational

purposes

• AAP recommends < 2 hours recreational screen time

• Increased prevalence of overweight and obesity

• Lower reading scores

• Attention problems

• No screen media if <2yrs

• No screen devices in the bedroom

• Essential for weight maintenance

• Prevention of chronic diseases• heart disease

• Diabetes

• colon cancer• 0steoporosis.

• Activity sharply declines during adolescence.

• Active families Active children Active adults

• Increased since the 1970s

• Associated with • overweight and obesity

• displacement of milk consumption

• dental cavities.

• 100% Juice -AAP recommends that children

• 1–6 year olds old consume <4–6 oz daily

• 7–18 year olds consume < 8–12 oz daily

• Water provides is the best healthy alternative to sugary drinks.

More than a Message:Multi-setting Approach

National Model Program: 5210 Let’s Go!

• What is the 5210 Let’s Go! Program?

• Nationally recognized childhood obesity prevention program developed in Maine

”Our multi-setting model allows us to reach child care programs, schools, out-of-school programs, and health care practices and unite them in the goal of encouraging children to adopt healthy habits that will last a lifetime.”

-Goal is to change environments to make the healthiest choice the easiest choice!

-Offers toolkits and technical assistance to change policies and procedures in six settings:

Schools Out-of-school

Early childhood Health Care

Workplace Community

National Model Program: Let’s Go!

Maine data

5-2-1-0 Healthy Choices CountUnited Way of Central Iowa

Healthiest State InitiativeIowa Department of Public Health

5-2-1-0 Healthy Choices Count

5-2-1-0 Materials

• Facebook: • 5210dsm

• Twitter: • @@5210dsm, #live5210dsm• @HealthiestIowa,#healthychoicescount

• Pinterest: • 5210dsm

5210 Social Media

http://www.iowahealthieststate.com/resources/individuals/5210/

•Limit unhealthy choices for snacks and celebrations, while providing healthy choices.

•Limit or eliminate sugary drinks – provide water.

•Prohibit the use of food as a reward.

•Provide opportunities to get physical activity every day.

•Limit recreational screen time.

5-2-1-0 Healthy Choices Count: Schools & Childcare Sectors

• Participate in local, state and national initiatives that support healthy eating and active living.

• Engage community partners to help support healthy eating and active living.

• Partner with and educate families in adopting and maintaining a lifestyle that supports healthy eating and active living.

• Implement a staff wellness program that includes healthy eating and active living.

• Collaborate with Food and Nutrition Programs to offer healthy food and beverage options.

5-2-1-0 Healthy Choices Count: Schools & Childcare Sectors

5-2-1-0 Healthy Choices Count

5-2-1-0 Healthy Choices Count

5-2-1-0 Healthy Choices Count

www.iowahealthieststate.com/resources/individuals/5210/

FY18 5-2-1-0 Program Implementation

5210 Health Care

5-2-1-0 Health Care in Iowa

• 2017- 5-2-1-0 Health Care- United Way of Central Iowa

• Modeled after 5210 Let’s Go! Health Care Program in Maine

• 14 clinic sites in Central Iowa across 5 health systems

• Expansion planned to >24 additional sites 2017-2019

• 2018- 5-2-1-0 Health Care-Iowa Medical Society • 4 IDPH Funded Communities + 8 clinics

5-2-1-0 Health Care Sites

5-2-1-0 Health Care5-2-1-0 Health Care Registered Site

1. Connect to community and 5-2-1-0 Healthy Choices Count efforts—Display 5-2-1-0 poster in waiting room and all exam rooms where pediatric patients are seen.

2. Accurately weigh and measure patients—Calculate and record BMI.

3. Have a respectful conversation around healthy eating and active living—Utilize the Healthy Habits questionnaire at well-child visit age 2-18.

• -Annual 5-2-1-0 Health Care Survey• -5-2-1-0 Health Care Site of Distinction

www.iowamedical.org/iowa/Childhood_Obesity

http://www.iowahealthieststate.com/resources/individuals/5210/

5-2-1-0 T-shirts

5-2-1-0 Health CareIMS 5-2-1-0 Health Care Webinar Series: -Free CME/CEU Enduring Credit-Live/Archived

• Accurately Weighing and Measuring Pediatric Patient-3/8/18

• Weight Stigma-3/20/18• Motivational Interviewing/Brief Action Planning-4/12/18• Implementing Stage 1 and 2 Assessment and Treatment

of Childhood Obesity in the Primary Care Clinic- 4/24/18

Weight Stigma

• Prevalent in numerous settings

• Affects health and personal, social, educational and professional achievement.

• Barrier to prevention, intervention, and treatment

• Learn from other examples: HIV/AIDs, various cancers, alcoholism, drug use

Disease Stigma

Pont SJ, Puhl R, Cook SR, et al, AAP SECTION ON OBESITY, THE

OBESITY SOCIETY. Stigma Experienced by Children and Adolescents With

Obesity. Pediatrics. 2017;140(6): e20173034

What is Weight Stigma?

• Societal devaluation of a person because he or she has overweight or obesity

• Often stereotyped as lazy, unmotivated, or lacking in willpower and discipline

• Stereotypes lead to social rejection, prejudice, discrimination

• Verbal, physical, and relational forms

• Subtle and overt expressions

Motivational Interviewing

• As defined by clinical psychologists Drs. Stephen Rollnick and William Miller, Motivational Interviewing (MI) is a collaborative, goal-oriented method of communication with particular attention to the language of change.

• It is designed to strengthen an individual’s motivation for, and movement toward, a specific goal by eliciting and exploring the person’s own arguments for change.

• MI is a style as much as a technique, skill, and spirit. That is, MI comprises both discrete technical skills as well as a general ability to experience and express empathy and support autonomy.

MI defined

• Preferred method of counseling for obesity management• Client-centered, directive method for enhancing intrinsic

motivation to change by exploring and resolving ambivalence

- Ambivalence=weighing the pros and cons of change; having both positive and negative thoughts about an issue

• The goal is to facilitate fully informed, deeply contemplated and internally motivated choices; behavior change will follow

Miller & Rollnick, 1991

Motivational interviewing (MI)

• Important to remember that the patient and family may not be ready for a change

• Listen to them

• Use motivational interviewing to help determine next steps

• If the patient and family are ready to start getting healthy use the stages of treatment to guide your management

• Use brief action planning

• If the patient and family are not ready, respect the stage and ask if you can follow up

Clinic Approach

Comparison of usual practice vs. MI

Usual Practice

• Clinician sets agenda• Tell patient what’s

important• Clinician decides when

tomove ahead w/goals

• Clinician is responsible forpatient making changes

• Clinician is instructor• Success measured by

weight loss, change inphysical measures, etc.

Motivational interviewing

• Patient sets the agenda• Patient decides what is

important, in line w/corevalues, beliefs and needs

• Patient sets pace for work

• Patient is responsible for if, what & when behavior change occurs

• Clinician is a guide• Success is measured by

patient’s own values and goals

• Studies show that allowing patients the opportunity to advocate for their own change is predictive of their future behavior change.

• Conversely, if we force or pressure peopleto make a decision about change, or if we tell them they must change, they will often argue for the status quo.

• Once a patient verbalizes an argument for change (or an argument for status quo), we can predict that their behavior will follow that argument.

• Therefore, allowing patients the opportunity to talk about why they want to change has proven benefits.

Listening for Change Talk

• Emphasize your concern for their health and focus on behavior changes rather than only on weight

• Acknowledge the difficulty in making lifestyle changes and provide support

• Recognize that small weight losses or behavior changes can result in significant health gains

• Stabilizing weight gain/Weight Loss

• Behavior Change/ Healthier Habits

• Improved labs- HDL/Triglycerides/ALT/Glucose

Outcomes

Resources

http://www.iowahealthieststate.com/resources/individuals/5210/

www.iowamedical.org/iowa/Childhood_Obesity

• Overview of the Issue

• Multi-sector Approach to Childhood Obesity-5-2-1-0 Healthy Choices Count

• Weight Stigma

• Motivational Interviewing

• Resources

Objectives

Thank You!

• Jennifer Groos, MD, FAAP

• Jennifer.groos@unitypoint.org

• 515-208-7922• Twitter: @jengroosmd

Additional Resources

1st Five Nutrition Series

https://www.youtube.com/channel/UCFWcOCpDCQDk6DVh1e1aZ9A

• Tools to support Stage 1 and Stage 2 Management and Treatment in Primary Care

• 9 Topic specific patient handouts and accompanying provider guides

• Will be posted to the IMS Childhood Obesity Resource Page

Healthy Habits Toolkit

Fruits and Vegetables Family Meals Healthy Drink Choice Screen Time Physical Activity

Sleep Healthy Eating Styles Portion Sizes Breakfast & Regular Meals

5-2-1-0 Activities

5-2-1-0 Activities