Case managers can join the fight against obesity epidemic

America’s obesity epidemic is getting a tremendous amount of attention these days. You hear on the television news and read in the newspaper almost daily about how Americans need to lose weight and get fit.

According to the Centers for Disease Control and Prevention, more than one-third of adults in the United States (78.6 million) are obese and about 17% of children ages 2 to 19 (12.7 million) are obese.

The annual healthcare cost of obesity is nearly $200 billion, or nearly 21% of medical expenditures in this country, according to The Campaign to End Obesity, a Washington, D.C.-based organization.

There’s some good news on the horizon, according to Richard Hamburg, deputy director of the Trust for America’s Health. The Trust for America’s Health and the Robert Wood Johnson Foundation issue an annual report, "The State of Obesity: Better Policies for a Healthier America."

"We’ve put out this report for 11 years and seen a steady rise in obesity rates among adults and children. For a number of years, rates were going up in all 50 states. This year, we saw a significant rise in obesity rates in just six states: Alaska, Delaware, Idaho, New Jersey, Tennessee, and Wyoming," Hamburg says.

According to the report, obesity rates are highest in the South and among African-Americans, Latinos, and lower-income, less educated Americans. The report found that more than one in 10 children become obese as early as ages 2 to 5.

"Obesity is an escalating problem in the United States. Some studies suggest that it’s leveling off, but one in three children and adolescents are overweight and obese, and more than half of them are likely to be overweight as adults," says Dennis Carrillo, MPH, health promotion specialist at Health Net in Los Angeles.

Some adolescents are being diagnosed with a variety of conditions, such as diabetes and hypertension, that used to affect just adults, Carrillo says.

"The prevalence of overweight and obesity is increasing and involves both genders, all age groups, all classes, and all income and educational levels," says Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.

Obesity affects essentially every organ system in the body, and the relative risk of death and disease increases disproportionately as weight increases, she adds.

Obesity can cause a wide range of adverse health effects, including coronary heart disease, hypertension, type 2 diabetes, high cholesterol, stroke, cancer, sleep apnea, osteoarthritis, and gallstones, according to the National Institutes of Health.

But the good news is that diabetes and pre-diabetes can be rolled back by relatively small changes in physical activity and weight, Hamburg says.

"You don’t have to run 20 miles a week to make a difference," he adds.

Traditionally, the healthcare system has focused on caring for people who already are sick, but that’s starting to change, Hamburg points out.

"Now instead of focusing on what to do after someone develops a chronic condition, the healthcare system is starting to focus on what to do to stop that from happening and to mitigate the effect. We’re seeing good examples of what’s being done to get the obesity epidemic under control," he says.

Providers and health plans are working with the underserved community and teaching them to self-manage their health, he says. In the workplace, employers are offering incentives to promote weight loss, such as giving employees savings on their healthcare cost if they participate in wellness programs, he says.

For instance, Capital District Physicians’ Health Plan (CDPHP) has offered its Weigh 2 Be program to its members at locations throughout the area it serves for several years and has recently launched a website that offers weight management tools to the public at large. The Albany, NY, health plan offers employer groups the option of a similar program in the work site as well as one-on-one meetings with registered dieticians and personal trainers. (For details on the CDPHP programs, see page 136.)

Health Net has developed a telephonic coaching program, Fit Families for Life, for children and adolescents ages 6 to 20 who have a body mass index at the 95th percentile, which classifies them as obese. The Los Angeles-based managed care plan also offers a home edition of the Fit Families for Life program for members and offers weight management classes to community-based organizations.

"We try to do as much as we can to empower the whole family and instill healthy habits. Healthy eating isn’t just the responsibility of one person. It’s something that can benefit the whole family," Carrillo says. (For details on the program, see the article below.)

When case managers work with obese patients, they have many opportunities to make a huge difference in their lives, Mullahy says.

"By providing advocacy, education, and emotional support, we can create a more positive continuum of care. Case managers can be invaluable in identifying core areas of intervention that are appropriate based on the client’s readiness to change and can collaborate with the client and the healthcare team to determine a goal-directed plan of care," she says.