Healthcare

MISSION

The mission of the Healthcare Workgroup was to identify existing efforts to support healthcare providers at all levels in addressing obesity prevention, and to propose additional strategies to prevent and reduce obesity among in-patients and out-patients.  

CONTEXT

Workgroup members discussed prevention strategies that could be undertaken or reinforced in: nursing schools medical schools, and other educational settings; local public health departments; professional associations of healthcare providers; clinical settings; and healthcare advocacy groups.  Hospitals were discussed in terms of their triple role as care facilities, worksites, and community leaders. (Hospital-based worksite wellness efforts appear in the Worksite section of this plan.)  Because this setting is so broad, the Healthcare Workgroup’s vision is extremely ambitious.  Engaging additional partners in government, business and other sectors will be critical to fulfilling the vision.

In addition to proposing the vision, goals and objectives listed below, Healthcare Workgroup members expressed concern that obesity prevention efforts be designed to help without harming.  Some Workgroup members discussed the possible benefits of using terms other than “obesity,” at least in non-clinical settings, to reduce stigma and other social and emotional problems associated with weight bias. Others reported that the American Academy of Pediatrics, which used to use the terms “at risk for overweight” and “overweight” to describe children in certain BMI-for-age-and-sex percentiles, now uses the clinical terms “overweight” and “obese.”

Workgroup members recognized a strong need for interventions beyond the clinical setting and emphasized the potential role of healthcare providers as partners in efforts to integrate education about, and opportunities for, healthy nutrition and physical activity behaviors across the lifespan in numerous settings.

TEN YEAR VISION

By 2020:

  • Provider practice will routinely include healthy weight maintenance in annual physicals for all patients. To support this goal, healthcare providers at all levels will receive education that increases confidence and competence in addressing healthy weight maintenance including measuring and interpreting BMI; motivational interviewing; counseling patients on healthy eating, physical activity, decreased screen time, and adequate sleep; and referring for obesity-related prevention and support, including mental health support.  In addition, providers will be involved in prevention not only as clinicians but also as community-level and state-level advocates for policy and environmental change.
  • Patients will understand how to be active and make food choices that promote health, including healthy weight maintenance. To support this goal, healthcare providers will offer educational materials to patients (including in waiting areas) and will collaborate in crafting social marketing messages that do not promote weight bias or stigma and that do promote beneficial behaviors (including the six target behaviors and other beneficial practices such as eating breakfast, eating meals as a family, and obtaining adequate sleep).  This statewide social marketing campaign will be widely recognized and utilized and will help ensure that hospitals, clinics, WIC programs, schools and other agencies and organizations provide consistent messages to the public.
  • Health care coverage will reimburse adequately for obesity prevention activities.  To support this goal, insurers will ensure coverage for routine BMI screening, nutrition and physical activity counseling, and lactation support, and will also cover evidence-based prevention and treatment interventions, including mental health interventions.  Insurers will incentivize healthy weight management and active lifestyles.
  • Breastfeeding rates at six months will be 70%.  To support this goal, more hospitals will have Baby-Friendly certification; home visits to new mothers by a public health nurse knowledgeable about lactation will be routine; breast pumps will be available for loan through hospitals and WIC; and insurance reimbursement will be available for lactation support provided by pediatricians, family practice physicians, dietitians, midwives, nurse practitioners, advanced RNs, and physician assistants.
  • State and local public health departments will be recognized as valuable leaders in population-based primary prevention efforts.  To support this goal, surveillance capacity will be increased to more accurately assess nutrition and physical activity behaviors and BMI status for children and adults at not only the state but also the county level; city-county health departments will have access to funding needed to implement and evaluate upstream policy and environmental interventions; and public health agencies will develop a more integrated chronic disease prevention model addressing common risk factors such as poor nutrition and physical inactivity. 
  • The Montana Nutrition and Physical Activity State Plan will be used to inform and coordinate obesity prevention efforts.  To support this goal, the State Plan will be developed and maintained to link healthcare providers and patients with useful tools such as My Pyramid, More Matters, and similar resources.  Notices of updates will routinely be communicated to healthcare providers through their professional associations, and the State Plan will be incorporated into the training of nursing students and other programs educating future healthcare providers.

This vision is consistent with specific Healthy People 2020 Objectives as follows:

  • NWS HP2020–1: Increase the proportion of adults who are at a healthy weight.
  • NWS HP2020–2: Reduce the proportion of adults who are obese.
  • NWS HP2020–15: (Developmental): Prevent inappropriate weight gain in youth and adults.
  • NWS HP2020–16: Increase the proportion of primary care physicians who regularly measure the body mass index of their patients.
  • MICH HP2020–12: Increase the proportion of mothers who breastfeed their babies.
  • MICH HP2020–27: Decrease the percentage of breast-fed newborns who receive formula supplementation within the first 2 days of life.
  • MICH HP2020–28: Increase the percentage of live births that occur in facilities that provide recommended care for lactating mothers and their babies.
  • NWS HP2020–13: Increase the proportion of physician office visits that include counseling or education related to nutrition or weight.
  • PAF HP2020–8: Increase the proportion of children and adolescents that meet guidelines for television viewing and computer use.
  • PAF HP2020–14: Increase the proportion of physician office visits for chronic health diseases or conditions that include counseling or education related to exercise.
  • NWS HP2020–6: Increase the contribution of fruits to the diets of the population aged 2 years and older.
  • NWS HP2020–17: Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older.
  • NWS HP2020–7: Increase the variety and contribution of vegetables to the diets of the population aged 2 years and older.

TWO YEAR OBJECTIVES

By 12/12:

  1. Produce and disseminate a statewide social marketing campaign to reduce childhood obesity.
    Who:  Billings Clinic, Blue Cross Blue Shield
    Behavior: ↑BF ↑PA ↑FV ↓TV ↓SSB ↓ED

  2. Identify and coordinate interventions that can help prevent both obesity and cancer.
    Who:  MT DPHHS Cancer Program
    Behavior: ↑BF ↑PA

  3. Provide education to hospitals about the Ten Steps to Successful Breastfeeding for Hospitals (the Baby-Friendly USA initiative).
    Who:  Montana Hospital Association, NAPA
    Behavior: ↑BF

  4. Advocate for insurance coverage of lactation counseling during home visits.
    Who:  NAPA, Lewis and Clark City County Health Department.
    Behavior: ↑BF

  5. Explore possibilities for incorporating obesity prevention efforts (including making hospitals more Baby-Friendly) into the strategic plan of the Indian Health Service
    Who:  Indian Health Service.
    Behavior: ↑BF ↑PA ↑FV ↓TV ↓SSB ED

  6. Explore venues for educating WWAMI students about obesity prevention
    Who:  Montana Hospital Association.
    Behavior: ↑BF ↑PA ↑FV ↓TV ↓SSB ↓ED

  7. Provide mini-grants up to a total of $5,000 to support accomplishment of one or more five-year goals.
    Who:  NAPA,
    Behavior: ↑BF ↑PA ↑FV ↓TV ↓SSB ↓ED

Five Year Goals:

By 12/16:

  1. Add a Continuing Medical Education (CME) session on obesity prevention to the annual conference of the Montana chapter of the American Academy of Pediatrics.
    Who:  MT chapter of AAP
    Behavior: ↑BF ↑PA ↑FV ↓TV ↓SSB ↓ED

  2. Increase the number of professional associations of healthcare providers that offer education (such as annual conference sessions, telemedicine trainings, or CMEs) on primary prevention of obesity, and screening for and treatment of obesity.
    Who: Montana chapter of the American Academy of Pediatrics; Montana Hospital Association; Montana Dental Association; Billings Clinic; others
    Behavior: ↑FV ↓SSB ↓ED ↑PA ↓TV ↑BF

  3. Increase recognition/funding regarding the capacity of local health departments to plan, implement and evaluate upstream primary obesity prevention strategies, including strategies addressing risk factors (for example, physical inactivity) that contribute to multiple chronic diseases.  
    Who: To be determined
    Behavior: ↑FV ↓SSB ↓ED ↑PA ↓TV ↑BF

  4. Increase the number of healthcare purchaser groups that include in their benefits package incentives for healthy weight management and active lifestyles and adequate reimbursement for obesity prevention activities.
    Who: To be determined
    Behavior: ↑FV ↓SSB ↓ED ↑PA ↓TV ↑BF

  5. Ensure that one or more agencies/organizations are tasked with (and resourced for) advancing and monitoring healthcare supports for breastfeeding (such as those listed below).
    Who:  NAPA (pending funding), and/or the Montana Statewide Breastfeeding Coalition, and/or DPHHS Maternal and Child Health, and/or others
    Behavior: ↑BF


    Examples of activities include:
  • Identifying and supporting champions (CEOs, nurse managers, physicians) in hospitals/birthing centers to promote breastfeeding best practices moving toward Baby Friendly designation
  • Marketing the benefits of Baby-Friendly designation education to hospitals/birthing centers
  • Developing a media campaign that educates the public about the Baby-Friendly designation and promotes hospitals that are Baby-Friendly
  • Creating (as needed) and making available resources to assist healthcare providers in supporting breastfeeding ; and recognizing (incentivizing) providers who adopt recommended practices
  • Expanding the collection of  data on breastfeeding in Montana (initiation, 48/72 hr follow-up, 3 months, 6 months, 12 months) beyond families served through WIC
  • Increasing the number of breast pump loaner programs utilizing WIC